BHLMP Form 1.b.

Barangay Health System Development Six Building Block Indicators

Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
Health Aktibo at (1) May Barangay Ordinance sa pagpapatibay ng RED - 0-3/7 Based from the Best
Leadership and kumikilos na kasalukuyang Barangay Health Governance Body YELLOW - 4-6/7 Practice among the
Governance Barangay (BHGB)* o resolusyon sa pagtatatag ng Barangay Health GREEN - 7/7 Copy of the policy ZFF Cohort
Health Board (BHB) kung saan nasasaad ang mga tungkulin at Municipalities
Governance responsibilidad ng Board at ng bawat miyembro.
Body o (2) Ang Barangay Health Governance Body (BGB)* o Copy of policy - Best Practice
Barangay BHB ay binubuo ng mga sumusunod: stating the among the ZFF
Health Board a. Barangay Captain members if the Cohort
b. Barangay Secretary BHGB/BHB Municipalities;
- Adopted and
c. Barangay Treasurer
modified based
d. Midwife from R.A. 7160 Title
e. Kagawad on Health V;
f. Barangay Nutrition Scholar - Philippine Health
g. Brgy. Day Care worker (kung naangkop) Agenda 2016-2022 –
h. SK Chairman Guarantee 1
i. BHW President - WHO Primary
j. 4Ps Parent Leader Representative Health Care Core
k. IP Leader (kung naangkop) Principles
- R.A. 8425
l. School Principal (kung naangkop)
- 1987 Constitution
m. AdHoc Member as sectoral representation (kung
Sec. 13-16, 22-23
naangkop)

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 1 of 20
Name of Barangay:
Municipality / City:
Province & Region: __________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks
Barangay
Name of Barangay Captain: ____________________________________________
Name of Assigned Midwife: ____________________________________________
Name of DOH Representative: _________________________________________
Standard of Means of Basis for the
Indicators √ OR X
Performance Verification Parameters
(3) Ang BGB o BHB ay dapat may pagpupulong na hindi
Copy of Adopted and
bababa sa isang beses (o higit pa kung kailangan) sa
minutes/proceeding modified based
loob ng tatlong buwan at ang mga pagpupulong na ito
s of the BHB from R.A. 7160 Title
ay dokumentado kung saan nasasaad ang mga napag meetings V
sang ayunan na susunod na mga hakbang.
Copy of R.A. 7160 Title VI
(4) Inilalatag ni Brgy. Kapitan ang mga isyu sa minutes/proceeding Chapter 1 Article 1
pangkalusugan ng barangay sa buwanang pagtitipon ng s of the ABC Section 495-e
ABC (Association of Barangay Captains) meeting / Key
informant interview
Copy of Board of Midwifery
(5) Nagbibigay ng accomplishment report si at inilalatag minutes/proceeding Code of Ethics
s of the RHU staff Sections X and XII as
ni Midwife ang mga isyu sa pangkalusugan ng barangay
meeting and/or PIR supplementary
sa buwanang pagtitipon ng mga RHU staff at/o sa PIRs where the issues document to RA
kasama si MHO were raised / Key 7392
informant interview
(6) Sa loob ng isang taon, merong nailatag na isa o R.A. 7160 Chapter 3
mahigit pa na BHGB or BHB Resolution sa Sangguniang Section 54-c
Barangay na naging basehan upang magkaroon ng
Copy of the policy
Barangay Ordinance ukol sa pagpapatibay ng Barangay
Health System o ano mang polisiya sa kalusugan na
pinagtibay ng Sangguniang Barangay
(7) Pagtatasa o pagsusuri ng health system Copy of assessment Best practice from
performance ng barangay gamit ang BHLMP roadmap and updated the HLGP Cycle 1
at pagsumite ng nasabing roadmap sa munisipyo roadmaps
(1) Pagkakaroon ng aprobadong Barangay Development RED - 0-2/5 Copy of the - R.A. 7160 Section
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 2 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
106
approved
Plan - JMC No. 1 Series of
development plan
2007
(2) Dapat nasasaad sa Barangay Development Plan ang Copy of the R.A. 8425 Section 2,
mga prayoridad na pangangailangang pangkalusugan at approved 4 (b)
development plan
mga hakbang kung paano ito malulutas. Ang mga
and minutes/
pangangailangang pangkalusugan na nakasaad ay dapat activity reports of
ring nakuha sa mga nagawang konsultasyon sa community
komunidad (e.g. Brgy. Assemblies). consultations done
Minutes/document R.A. 7160 Section
Development (3) Nagsagawa ng Annual Brgy. Investment Planning ation of the Annual 109b
Plan (na may kasama ang Barangay Development Council YELLOW - 3-4/5 Brgy. Development IRR R.A. 7160 Article
Health GREEN - 5/5 Planning 88-b7
Component) Department of
Copy of the Budget and
(4) Naipapatupad ang Barangay Development Plan accomplishment/ac Management 2012
tivity reports Primer On Barangay
Budgeting
- Department of
Certificate of
Budget and
attendance /
(5) Pagdalo ng representative ng barangay sa Management 2012
attendance sheet
konsultasyon ng munisipyo para pagplaplano o pagbuo Primer On Barangay
and or activity
ng MIPH Budgeting
report from the
- Recommendations
mLGU
from consultations
Mga aktibidad (1) May listahan ng mga kasalukuyang mga leaders sa RED - 0-1/4 List of identified WHO Primary
na kasama ang komunidad YELLOW - 2-3/4 community leaders Health Care Core
and their Principles

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 3 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
represented
organization/group
Copy of the IRR R.A. 7160 Article
certificate of 64
(2) Tiyakin na ang mga naangkop na community leaders
training / training
ay nabigyang kapasidad sa pag-oorganisa ng
attendance sheets /
komunidad o community organizing training activity
reports
1987 Constitution
Komunidad (3) Tiyakin na ang mga miyembro ng komunidad ay may GREEN - 4/4 Copy of Sec. 13-16, 22-23
mga tungkuling itinalaga sa pagpapatupad at
implementation
pagsubaybay ng mga programang pang kalusugan sa plan
barangay
R.A. 7160 Section
(4) Pagsagawa ng hindi bababa sa dalawang barangay 397b; Section 398c
assemblies at/o public hearings para for Copy of activity IRR R.A. 7160 Article
report/feedback local health data status of health report 194a; 195c
programs, health issues, policies, etc.
Health Financing Alokasyon ng Hindi bababa sa 5% ng Brgy. Budget ang inilaan para sa Based on ZFF
RED - 0-0.9% Copy of approved experience
Bugdet para sa Health
YELLOW - 1-4% and signed Brgy.
Health ng Formula: Budget
GREEN - 5%
BLGU (Brgy. Health Budget ÷ Total Brgy. Budget) x 100%
Paggamit ng Hindi bababa sa 95% ng Brgy. Health Budget ang RED - <70% Copy of signed brgy
Bugdet para sa nagamit YELLOW - 70- financial utilization
Health ng Formula: (Brgy. Health Expenditure ÷ Brgy. Health 94% report / Copy of
BLGU Budget) x 100% GREEN - 95- DILG budget
utilization forms
100%

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 4 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
(1) Mayroong listahan ng mga maralitang pamilya sa IRR R.A. 7160 Article
PhilHealth 122a3-xi
barangay RED – 0/2 Copy of list with
Coverage para
(2) Pagsumite ng listahan ng mga maralitang pamilya sa YELLOW – 1/2 receiving signature IRR R.A. 7875 Rule
sa mga GREEN – 2/2 of the MSWDO
mahihirap munisipyo bilang pagrerekomenda para sa indigent IV Section 22-23
certification ng PhilHealth
Health Human Sapat na Brgy. Health Workers gamit ang HR to population ratio na:
Resource DOH Standards -
Sapat na Manual of
RED - 0/2 Operation on
Barangay (1) 1 BHW= 20 Households o Kabahayan List of existing
YELLOW - 1/2 Maternal, Newborn,
Health Human human resource
GREEN - 2/2 and Child Health
Resource
and Nutrition
Presidential Decree
(2) 1 BNS= 1 Barangay
No. 1569
Pagsasanay ng RED - 0-1/
mga Barangay Ang mga kailangang pag-unlad ng kawani ay natugunan: YELLOW - 2-4/5
Copy of Certificates
Human GREEN - 5/5 Training courses
of training; List of
Resource (1) Lahat (100%) ng mga BHWs ay nakakuha na ng Basic based from DOH
trained staff, date of
BHW Training training, type of BHW Training
training Manual
Presidential Decree
(2) Ang BNS ay nakakuha na ng Basic BNS Training
No. 1569
(3) Lahat ng mga naangkop at lumalabas na bagong Copy of training Republic Act 7883
pagsasanay na pangangailangan (hal. Continuing needs assessment Section 6-c
Professional Education) ng mga BHWs at BNS ay forms/report / List Presidential Decree
natutukoy of training need per No. 1569

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 5 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
staff
Copy of Republic Act 7883
(4) Lahat ng mga naangkop at lumalabas na bagong communication Section 6-c
document that Presidential Decree
pagsasanay na pangangailangan (hal. Continuing
shows the midwife No. 1569
Professional Education) ng mga BHWs at BNS ay naiulat coordinated the
sa MHO sa pamamagitan ni Midwife training needs to
MHO
(5) Ang mga sharing sessions ng mga BHWs ukol sa DOH DM No. 2009-
Copy of activity 0302
health education at preventive medicine ay
report/ attendance
naisasagawa sa kanilang mga nakatakdang kabahayan o sheet
households
Pangangalap, (1) May naipasang polisiya ukol sa BHW registration RED - 0-1/ DILG MC 2010-147
Copy of the policy
Pagrerehistro and accreditation YELLOW - 2-4/5
at (2) Paggaya at pagsunod sa sistema at pamamaraan ng GREEN - 5/5 DILG MC 2010-147
Pagpapanatili munisipyo sa pangangalap at pagpapanatili ng BHWs sa
ng mga Copy of the policy
pamamagitan ng pagpasa ng barangay administrative
Barangay issuance ukol dito
Health (3) Ang sistema at pamamaraan sa pangangalap at Key informant DILG MC 2010-147
Workers pagpapanatili ng BHWs ay naipapatupad interview
Copy of DILG MC 2010-147
accreditation and
(4) Lahat ng accredited BHWs ay aktibo activity reports/
data reports per
BHW
(5) Lahat ng BHW na napaalis o natanggal sa serbisyo ay Copy of DILG MC 2010-147
dumaan sa patas at angkop na proseso o due process proceedings/

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 6 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
document of the
dismissal case / Key
informant interview
Mga polisiya sa R.A. 7883
(1) Pagkakaroon ng Barangay Resolution sa pagapruba
angkop at ng pamamaraan at iskedyul ng pagbibigay ng BHW and Copy of the policy
tamang oras BNS honorarium RED - 0/2
na pagbibigay
YELLOW - 1/2 R.A. 7883
ng mga (2) Ang buong honoraria ng mga BHW and BNS ay GREEN - 2/2 Key informant
honorarium ng naibibigay sa tamang oras na naaayon sa naipasang
mga BHWs and interview
resolusyon ng LHB o Brgy. Council
BNS
(1) Ang pagkuha/pagbili ng supplies at essential medicines ay DOH-NCPAM's
base sa morbidity at mortality data ng barangay Training Manual on
Copy of mortality Pharmaceutical
and morbidity Supply Chain
reports Management for
Madaling Local Government
makuha na Facilities
Gamot at (2) Ang mga natukoy na essential medicines ay maaring RED - 0-1/3 DOH-NCPAM's
Access to
Supplies sa makuha sa barangay health facility tuwing operating hours YELLOW - 2/3 Training Manual on
Medicine nito. Pharmaceutical
Barangay GREEN - 3/3 Copy of inventory
Health Supply Chain
records
Facility* Management for
Local Government
Facilities
(3) Mayroong buwanang physical count ng essential medicine DOH-NCPAM's
Copy of inventory
at supplies Training Manual on
records
Pharmaceutical

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 7 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
Supply Chain
Management for
Local Government
Facilities
Copy of patient - Recommendations
(1) Pagkakaroon ng patient health records sa mga BHS from consultations
health records
- Based from the
Best Practice among
(2) Ang mga performance ng Barangay base sa Health the ZFF Cohort
Gumagana na Copy of
data at mga problemang kakabit nito ay naiiulat kada RED - 0-1/3 Municipalities
Health minutes/proceeding
buwan sa barangay health governance body o YELLOW - 2/3 - Adopted and
s of the meeting
Information barangay health board para matugunan modified based
GREEN - 3/3
System from R.A. 7160 Title
V
Health - Based from the
Information (3) Pagkakaroon ng buwanang updated barangay health Best Practice among
Site visit
System data board the ZFF Cohort
Municipalities
Ang barangay ay may sistema para sa pagtatala ng mga
pasyente/kliyente ng mga sumusunod na serbisyo:
(1) Maternal Health Services RED - 0-5/11
Sistema sa (2)  EPI YELLOW - 6-
pagrerehistro (3)  Under-five Nutrition Registry System
10/11
ng pasyente (4)  TB Control GREEN - 11/11
- Recommendations
(5)  Notifiable/Communicable/Emerging Diseases (e.g.
from consultations
Leprosy, etc. except HIV due to confidentiality)

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 8 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
(6)  Non-Com Diseases
(7) Drugs and Substance Abuse
(8)  Mental Health
(9)  Persons with Disabilities
(10) Injuries
(11) Program for Senior Citizen
Copy of health data DOH FHSIS Manual
(1) Nasa oras na pagsumite ng buwanang health data forms submitted of Operations
(e.g. M1) ng barangay sa RHU/PHN/MHO with stamp on
receiving copy
Copy of health data DOH FHSIS Manual
(2) Nasa oras na pagsumite ng barangay quarterly forms submitted of Operations
health data (e.g. Q1) sa RHU/PHN/MHO with stamp on
Paguulat at RED - 0-1/4 receiving copy
paggamit ng (3) May bagong listahan ng mga pangunahing sanhi ng YELLOW - 2-3/4 DOH FHSIS Manual
mga Data morbidity at mortality at konsultasyon sa barangay GREEN - 4/4 Copy of list of Operations
kada taon
(4) Mayroon sistema sa pagsubaybay sa mga buntis at Check for a - Based from the
pregancy tracking Best Practice among
kayang matukoy kung sino-sino ang:
system / List of the ZFF Cohort
- nasa early risk detection, action and referral
pregnant women
- kabilang sa teenage pregnancies disaggregaed by
- mayroong Philhealth membership each category
Mortality Buwanang pag-uulat ng maternal, under-5, infant and RED: walang Copy of death R.A. 10354
Report neonatal sa pamamagitan nang ginagamit na Death buwanang ulat reports
Report system c/o Midwife GREEN: may
buwanang ulat

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 9 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
Ang mga sumusunod na data ng Social Determinants of health na
galing sa munisipyo ay na-validate ng barangay kada taon:
(1) Male and female age groups
(2) Population and residential density of barangay
- DILG-BLGD RPS
(3) Current labor force and employment including 2008 p.72
Data sa Social income class RED - 0-3/7
Copy of data forms IRR R.A. 7160 Article
Determinants YELLOW - 4-5/7
(4) Population, religious affiliation and indigenous submitted 122a3-xi
of Health GREEN - 6-7/7
people
(5) Elementary and secondary school participation and
completion rates
(6) Housing facilities and utilities situation
(7) Hazard mapping
Ang mga updated profiles o listahan ng sumusunod na vulnerable - IRR R.A. 7160
populations ay nasusumite sa munisipyo sa tamang oras: Article 122a3-xi
- ZFF Learnings from
(1) Pregnant and lactating women (quarterly) Resilient Health
(2) Under-five children (annual) Systems Program
Profiling ng
(3) PWDs (annual) RED - 0-3
mga
(4) Elderly (annual) YELLOW - 4-5 Copy of list/profiles
Vulnerable
(5) Out of school youth (annual) GREEN - 6-8
Population
(6) Households in disaster-prone area (annual)
(7) Households with IPs*, if applicable (annual)
(8) Households in remote areas or GIDA*, if applicable
(annual)
Early Warning (1) May naitatag na early warning system sa barangay RED - 0/2 Site visit / Copy of R.A. 10121
Manual of

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 10 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
Operations
System para sa
(2) Ang barangay ay may mekanismo para maikalat ang YELLOW - 1/2 Site visit / Copy of R.A. 10121
Emergencies o
mga impormasyon na nanggagaling sa early warning GREEN - 2/2 Manual of
Sakuna Operations
system
Health Service - Republic Act 7883
Delivery Section 6
(1) Lahat (100%) ng mga BHWs ay nagsasagawa ng Copy of activity - DOH Guidelines on
home vistits at, kung kailangan, i-refer ang mga reports / establishing Service
pasyenteng nangangailangan ng mas mataas na antas attendance sheets / Delivery Networks
ng pangangalaga feedback forms - Field Health
Service Information
System Manual
Barangay (2) Ang Barangay nutrition scholar (BNS) ay RED - 0-1/3 Presidential Decree
health service nagsasagawa ng buwanang operation timbang at YELLOW - 2/3 No. 1569
delivery pagsubaybay sa mga batang may edad na 0-24 months GREEN - 3/3 Copy of OTP records
at mga batang malnourished na may edad 0-59 months
old
- Manual of
Operation on
(3) Hindi bababa sa isang beses isang linggo na Copy of
Maternal, Newborn,
pagbisita ng nurse or RHM para magbigay ng health communication
and Child Health
services sa barangay na may koordinasyon sa BHB document/ records
and Nutrition
Program
Patient- (1) May nakapaskil na BHS citizen's charter na nasa RED - 0-3/7 Site visit/ Presence Recommendations
centered care lokal na dayalekto YELLOW - 4-6/7 of a Citizen's from consultations
Charter

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 11 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
(2) Pagsasagawa ng konsultasyon sa komunidad sa GREEN - 7/7 Recommendations
Copy of activity from consultations
paggawa ng patnubay o protocols sa pagbibigay ng
reports
health services sa barangay
(3) Pagkakaroon ng patnubay sa BHS sa pag obserba ng Copy of protocols/ Patient’s bill of
mga karapatan ng pasyente guidelines rights

(4) Pagsasagawa ng gender-sensitivity assessment para Copy of Best practice from a

sa BHS (gamitin ang USAID tool para ma-assess ang accomplished USAID health
gender sensitivity ng isang health facility) assessment tool project
Best practice from a
(5) Pagsasagawa ng mga pamamaraan para malutas ang Copy of strategies/
USAID health
mga kakulangan sa pagiging gender-sensitivity ng BHS activity reports
project
(6) Pagsasagawa ng mga pamamaraan para mapataas ZFF Learnings from
ang pag-access sa mga serbisyong pangkalusugan ng Copy of strategies/ Resilient Health
activity reports Systems Program
mga mamamayan sa GIDA, IP communites, at iba pang
sektor ng lipunan
(7) Kung Doktor ang nasa BHS, pinagbibigy alam sa mga Key informant Patient’s bill of
pasyente ng BHS ang lahat tungkol sa kanilang interview/ Focus rights
kondisyong medical na may kasamang diagnosis/ Group discussion /
prognosis, mga treatment options, peligro at Patient records
indicating the
komplikasyon na maaaring mangyari. Sila ay binibigyan
consultations done
rin ng karapatang tumanggap o tumanggi sa ano mang
procedure/medication, investigation o treatment at
bibigyan ring kaalaman kung ano ang mga maaaring
maging resulta ng pawing desisyon.

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 12 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
(1) Ang BHS ay may satisfaction/feedback mechanism Recommendations
Feedback Copy of feedbacks from consultations
mechanism ng para sa mga pasyente at kliyente RED - 0/2
mga pasyente YELLOW - 1/2 Copy of BHB Recommendations
(2) Ang mga feedbacks na nakuha sa mga pasyente ay minutes indicating from consultations
at kliyente ng GREEN - 2/2
kasama sa BHB agenda the agenda
BHS discussed
Assessed need
(1) Ang barangay ay mayroong isang health based on ZFF Cohort
station/center o kaya naman ay sila ay kasama sa isang Site visit and MLGP
catchment area Municipalities field
experience
(2) Ang barangay health station/center ay bukas para sa - IRR R.A. 7160
mga out-patient services (8 hours, 5 times a week) at Article 25, 101-a4
tuwing may emergency, disaster, at birthing services* - DOH Sentrong
(24 hours, 7 times a week) Sigla Level 1 Quality
Standard List
 Ito ay may fully functional health equipment at supplies
Gumaganang RED - 0-1/3
Health (thermometer, BP Apparatus, weighing scale) YELLOW - 2/3 *emergency and
Facilities  May Midwife na naka assign sa health facility (na may GREEN - 3/3 birthing services
hindi bababa sa isang beses sa isang linggo na applicable only to
Site visit
pagbibigay ng serbisyo at on call kapag may mga GIDA barangays
sakuna)
 May BHW/BNS/RHMPP/NDP na naka-duty tuwing oras
ng serbisyo at on call kapag may sakuna
 May kuryente
 May supply ng tubig
*emergency and birthing services applicable only to GIDA
barangays

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 13 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
(3) Ang Barangay Health Station/ Center ay nagbibigay Assessed need
ng mga sumusunod sa serbisyo: based on ZFF Cohort
1. Pre-Natal and MLGP
Site visit / Key
2. Postnatal Municipalities field
informant Interview
experience
3. Family Planning / Focus Group
4. EPI Discussion/ Patients
5. IMCI Records
6. IYCF
7. General Consultation (as needed)
(1)  May sasakyan na nakatalaga bilang Emergency DOH Guidelines on
Site visit / Key establishing Service
transport vehicle* sa barangay na available 24/7 informant Interview Delivery Networks
/ Focus Group
*Transportation expenses e.g. fuel, driver, etc. should not be Discussion
shouldered by the indigent patients

Naitatag ang (2) Mayroong madaling mapupuntahan na waiting Assessed need

RED - 0-3/7 based on ZFF Cohort
Gatekeeping at home/ halfway house para sa mga nasasakupan ng Site visit / Key
YELLOW - 4-5/7 Municipalities field
Referral barangay (if applicable especially if GIDA barangay). informant Interview
GREEN - 6-7/7 experience
System / Focus Group
**Ang halfway house ay pwedeng wala sa sariling Discussion
barangay
(3)  Ang mga kabahayan ay napagbigyang alam kung Key informant Recommendations
nasaan ang mga referral facilities at blood facilities na Interview / Focus from DOH
pwedeng gamitin ng mga nasasakupan ng barangay Group Discussion

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 14 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
DOH Guidelines on
(4) Mayroong two-way referral system sa pagitan ng establishing Service
Copy of agreement/
barangay at RHU para masigurado ang tamang Delivery Networks
referral protocol
koordinasyon sa pagdala sa mga pasyente

(5) Palawakin ang gatekeeping at referral mechanism sa Recommendations

List of first contacts from DOH
pamamagitan ng pagaalam kung sino ang first contact
per family
of care sa bawat pamilya
(6) Bigyang kaalaman ang mga first contacts tungkol sa Copy of the Recommendations
from DOH
service delivery path at siguraduhing sila ay orientation activity
makakasama sa gatekeeping report
(7) Pagkakaroon o pagpapaskil ng facility map at service Recommendations
Site visit from DOH
delivery map sa Barangay Hall
- WHO List of
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
Essential Package of
naibibigay: Health Services
1)Maternal and Newborn Health (3) - Philippine Health
Agenda Targets
a) Birth preparedness plan and referral RED - 0-5/10 Copy of patients - WHO report on
Health
b) Nutrition promotion and assessment YELLOW - 6- records and Philippine Health
Promotion
9/10 promotional and IEC Service Delivery
Services c) Mothers class/Family development session
GREEN - 10/10 materials Profile
2) Child health (2) - IRR R.A.7160
a) Growth monitoring Article 101-a19-20
b) Promotion of infant and young child feeding
3) Family Planning (3) - WHO List of

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 15 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
a) Health education on family planning Essential Package of
b) FP counselling Health Services
- Philippine Health
c) Provision of FP commodities
Agenda Targets
4) ASRH (2) - WHO report on
a) IEC on ASRH, HIV, STI, Gender-based Violence (GBV) Philippine Health
b) Counselling on prevention of teenage pregnancy Service Delivery
5) Oral Health (2) Profile
a) IEC on oral health - IRR R.A.7160
b) Tooth brushing drill Article 101-a19-20
6) Communicable Disease (3)

a) IEC on Cough Manners

b) IEC on Hand Hygiene/ Proper Hand Washing
c) IEC on Local Wound Care for Animal Bite Victims

7) Lifestyle-related or Non-Communicable Disease (2)

a) Presence of healthy lifestyle programs
b) IEC of the healthy lifestyle programs
8) Environmental Health and Sanitation (4)
a) Promotion of water and air quality and food safety
b) Promotion of vector control and waste
management
c) Presence of road signage
d) Presence of road safety policies
9) Mental Health (1)

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 16 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
a) Promotion of awareness on mental health
10) Blood Donation (1)
a) Promotion of bloodletting activities
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
1) Maternal and Newborn Health (3-4) - WHO List of
a) Pregnancy Tracking Essential Package of
Health Services
b) Antenatal/Prenatal care
- Philippine Health
c) Post-partum Care Agenda Targets
d) Safe labor and delivery (if birthing facility) - WHO report on
2) Child health (2) Philippine Health
Disease Service Delivery
a) EPI RED - 0-4/9
Prevention and Copy of patients' Profile
b) Injury prevention YELLOW - 5-7/9
Control records - IRR R.A.7160
3) Family Planning(1) GREEN - 8-9/9
Services Article 101-a19-20
a) For permanent methods, refer to RHU
4) Communicable Disease (3)
a) Active case finding and reporting for TB
b) Active case finding and reporting of other notifiable
diseases
c) Skin Disease Screening
5) Lifestyle-related or Non-Communicable Disease (1)
a) Routine screening for risk factor identification

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 17 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
6) Environmental Health and Sanitation (3)
a) Presence of vector control and waste management
b) Coordination with the MHO/RHU on the testing of
water source (safe water)
c) Coordination with the MHO/CHO/PHO on the zero
open defecation program/ provision of toilets
7) Mental Health (1)
a) Referral of identified cases to RHU
8) Drug and Substance Abuse (2)
a) IEC on Drug Substance Abuse
b) Profiling of identified patients (if applicable) and
Referral of identified cases to RHU
9) Senior Citizens (1)
a) Immunization
Curative Ang mga sumusunod na serbisyo sa bawat programa ay dapat RED - 0-3/8 Copy of patients' - WHO List of
Service naibibigay: YELLOW - 4-6/8 records / Essential Package of
GREEN - 7-8/8 accomplished Health Services
1) Maternal and Newborn Health (2-3)
referral forms - Philippine Health
a) Referral to RHU Agenda Targets
b) BEmONC services, if applicable - WHO report on
c) Administration of lifesaving drugs for Midwives (AO Philippine Health
2010-0014) Service Delivery
2) Child health (3) Profile
a) CIMCI and IMCI - IRR R.A.7160
Article 101-a19-20
b) Provision of micronutrient supplements

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 18 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
c) Referral to RHU
3) ASRH (1)
a) Referral to RHU
4) Oral Health (1)
a) Referral to RHU
5) Communicable Disease (2)
a) Coordinate with TB-DOTS facility
b) Referral to RHU/ appropriate health facility
6) Lifestyle-related or Non-Communicable Disease (3)
a) Treatment for Hypertension
b) Treatment for Diabetes
c) Referral to RHU/ appropriate health facility
7) Mental Health (1)
a) Referral to RHU/ appropriate health facility
8) Drug and Substance Abuse (1)
a) Referral to RHU/ appropriate health facility
Ang mga sumusunod na serbisyo sa bawat programa ay dapat - WHO List of
naibibigay: Essential Package of
1)Lifestyle-related or Non-Communicable Disease (4) Health Services
Copy of patients' - Philippine Health
a) Monitor post stroke rehabilitation RED - 0-1/4
Rehabilitative b) Home visits for blood pressure monitoring, records / Agenda Targets
YELLOW - 2-3/4
Services accomplished - WHO report on
c) Home visits for blood sugar monitoring GREEN - 4/4 referral forms Philippine Health
d) Home visits for monitoring of maintenance drugs intake
2) Health for persons with physical disability (1) Service Delivery
a) Community based rehab or referral to RHU Profile

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 19 of 20
Name of Barangay: Name of Barangay Captain: ____________________________________________
Municipality / City: Name of Assigned Midwife: ____________________________________________
Province & Region: __________________________________________ Name of DOH Representative: _________________________________________
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Standard of Means of Basis for the
Major Block Sub-Blocks Indicators √ OR X
Performance Verification Parameters
3) Mental Health (1) - IRR R.A.7160
a) Monitoring of treatment process of mental health Article 101-a19-20
patients
4)Drug and Substance Abuse (1)
a) Referral to RHU

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 20 of 20