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ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 1 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
loob ng tatlong buwan at ang mga pagpupulong na ito the BHB meetings
ay dokumentado kung saan nasasaad ang mga napag
sang ayunan na susunod na mga hakbang.
Copy of
(4) Inilalatag ni Brgy. Kapitan ang mga isyu sa
minutes/proceedings of
pangkalusugan ng barangay sa buwanang pagtitipon
the ABC meeting / Key
ng ABC (Association of Barangay Captains) informant interview
Copy of
(5) Nagbibigay ng accomplishment report si at minutes/proceedings of
inilalatag ni Midwife ang mga isyu sa pangkalusugan the RHU staff meeting
ng barangay sa buwanang pagtitipon ng mga RHU staff and/or PIR where the
at/o sa PIRs kasama si MHO issues were raised / Key
informant interview
(6) Meroong naipasa na hindi bababa sa isang (1)
Barangay Ordinance sa loob ng isang taon ukol sa
pagpapatibay ng Barangay Health System o ano mang Copy of the policy
polisiya sa kalusugan na pinagtibay ng Sangguniang
Barangay
(7) Pagtatasa o pagsusuri ng health system
Copy of assessment and
performance ng barangay gamit ang BHLMP roadmap
updated roadmaps
at pagsumite ng nasabing roadmap sa munisipyo
Barangay RED - 0-2/5
(1) Pagkakaroon ng aprobadong Barangay Investment Copy of the approved
Investment Plan YELLOW - 3-4/5
Plan development plan
(na may Health GREEN - 5/5
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 2 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Component) (2) Dapat nasasaad sa Barangay Investment Plan ang
mga prayoridad na pangangailangang pangkalusugan Copy of the approved
development plan and
at mga hakbang kung paano ito malulutas. Ang mga
minutes/ activity reports
pangangailangang pangkalusugan na nakasaad ay of community
dapat ring nakuha sa mga nagawang konsultasyon sa consultations done
komunidad (e.g. Brgy. Assemblies).
Minutes/documentation
(3) Nagsagawa ng Annual Brgy. Investment Planning
of the Annual Brgy.
kasama ang Barangay Development Council Development Planning
Copy of the
(4) Naipapatupad ang Barangay Investment Plan accomplishment/activity
reports
Certificate of attendance /
(5) Pagdalo ng representative ng barangay sa
attendance sheet and or
konsultasyon ng munisipyo para pagplaplano o pagbuo
activity report from the
ng MIPH mLGU
List of identified
(1) May listahan ng mga kasalukuyang mga leaders sa community leaders and
komunidad their represented
organization/group
Mga aktibidad na RED - 0-1/4 Copy of the certificate of
(2) Tiyakin na ang mga naangkop na community
kasama ang YELLOW - 2-3/4 training / training
leaders ay nabigyang kapasidad sa pag-oorganisa ng
Komunidad GREEN - 4/4 attendance sheets /
komunidad o community organizing training activity reports
(3) Tiyakin na ang mga miyembro ng komunidad ay
Copy of implementation
may mga tungkuling itinalaga sa pagpapatupad at
plan
pagsubaybay ng mga programang pang kalusugan sa
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 3 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
barangay
(4) Pagsagawa ng hindi bababa sa dalawang barangay
assemblies at/o public hearings para for
Copy of activity report
report/feedback local health data status of health
programs, health issues, policies, etc.
Hindi bababa sa 5% ng Brgy. Budget ang inilaan para sa
Alokasyon ng RED - 0-0.9%
Health Copy of approved and
Bugdet para sa YELLOW - 1-4%
Formula: signed Brgy. Budget
Health ng BLGU GREEN - 5%
(Brgy. Health Budget ÷ Total Brgy. Budget) x 100%
Hindi bababa sa 95% ng Brgy. Health Budget ang Copy of signed brgy
Paggamit ng RED - <70%
nagamit financial utilization report
Health Bugdet para sa YELLOW - 70-94%
Formula: (Brgy. Health Expenditure ÷ Brgy. Health / Copy of DILG budget
Financing Health ng BLGU GREEN - 95-100% utilization forms
Budget) x 100%
(1) Mayroong listahan ng mga maralitang pamilya sa
PhilHealth barangay RED – 0/2
Copy of list with receiving
Coverage para sa (2) Pagsumite ng listahan ng mga maralitang pamilya YELLOW – 1/2
signature of the MSWDO
mga mahihirap GREEN – 2/2
sa munisipyo bilang pagrerekomenda para sa indigent
certification ng PhilHealth
Sapat na Barangay Sapat na Brgy. Health Workers gamit ang HR to population ratio na: RED - 0/2
List of existing human
Health Human (1) 1 BHW= 20 Households o Kabahayan YELLOW - 1/2
Health resource
Resource (2) 1 BNS= 1 Barangay GREEN - 2/2
Human
Resource Pagsasanay ng Ang mga kailangang pag-unlad ng kawani ay natugunan: RED - 0-1/ Copy of Certificates of
mga Barangay (1) Lahat (100%) ng mga BHWs ay nakakuha na ng YELLOW - 2-4/5 training; List of trained
Human Resource Basic BHW Training GREEN - 5/5 staff, date of training, type
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 4 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(2) Ang BNS ay nakakuha na ng Basic BNS Training of training
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 5 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
process case / Key informant
interview
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 6 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Ang barangay ay may sistema para sa pagtatala ng mga
pasyente/kliyente ng mga sumusunod na serbisyo:
(1) Maternal Health Services
(2) EPI
(4) TB Control
Sistema sa RED - 0-5/10
pagrerehistro ng (5) Notifiable/Communicable/Emerging Diseases (e.g. YELLOW - 6-9/10 Registry System
pasyente Leprosy, etc. except HIV due to confidentiality) GREEN - 10/10
(6) Non-Com Diseases
(10) Injuries
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 7 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(3) May bagong listahan ng mga pangunahing sanhi ng
morbidity at mortality at konsultasyon sa barangay Copy of list
kada taon
(4) Mayroon sistema sa pagsubaybay sa mga buntis at Check for a pregancy
kayang matukoy kung sino-sino ang: tracking system / List of
- nasa early risk detection, action and referral pregnant women
- kabilang sa teenage pregnancies disaggregaed by each
- mayroong Philhealth membership category
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 8 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Population oras: GREEN - 6-8
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 9 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(2) Ang Barangay nutrition scholar (BNS) ay
nagsasagawa ng buwanang operation timbang at
pagsubaybay sa mga batang may edad na 0-24 months Copy of OTP records
at mga batang malnourished na may edad 0-59
months old
(3) Hindi bababa sa isang beses isang linggo na
Copy of communication
pagbisita ng nurse or RHM para magbigay ng health
document/ records
services sa barangay na may koordinasyon sa BHB
(1) May nakapaskil na BHS citizen's charter na nasa Site visit/ Presence of a
lokal na dayalekto Citizen's Charter
(2) Pagsasagawa ng konsultasyon sa komunidad sa
paggawa ng patnubay o protocols sa pagbibigay ng Copy of activity reports
health services sa barangay
(3) Pagkakaroon ng patnubay sa BHS sa pag obserba Copy of protocols/
ng mga karapatan ng pasyente guidelines
(4) Pagsasagawa ng gender-sensitivity assessment RED - 0-3/7
Patient-centered Copy of accomplished
para sa BHS (gamitin ang USAID tool para ma-assess YELLOW - 4-6/7
care assessment tool
ang gender sensitivity ng isang health facility) GREEN - 7/7
(5) Pagsasagawa ng mga pamamaraan para malutas
Copy of strategies/ activity
ang mga kakulangan sa pagiging gender-sensitivity ng
reports
BHS
(6) Pagsasagawa ng mga pamamaraan para mapataas
ang pag-access sa mga serbisyong pangkalusugan ng Copy of strategies/ activity
mga mamamayan sa GIDA, IP communites, at iba pang reports
sektor ng lipunan
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 10 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(7) Pinagbibigy alam sa mga pasyente ng BHS ang
Key informant interview/
lahat tungkol sa kanilang sakit at ang iba't ibang
Focus Group discussion /
paraan ng paggamot (tradisyonal at western medicine)
Patient records indicating
dito. Sila ay binibigyan rin ng kakayanang mag the consultations done
desisyon kung anung paraan ang kanilang nais gamitin.
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 11 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(2) Ang barangay health station/center ay bukas para
sa mga out-patient services (8 hours, 5 times a week)
at tuwing may emergency, disaster, at birthing
services* (24 hours, 7 times a week)
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 12 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(1) May sasakyan na nakatalaga bilang Emergency
transport vehicle* sa barangay na available 24/7 Site visit / Key informant
Interview / Focus Group
*Transportation expenses e.g. fuel, driver, etc. should not be Discussion
shouldered by the indigent patients
(2) Mayroong madaling mapupuntahan na waiting
home/ halfway house para sa mga nasasakupan ng
Site visit / Key informant
barangay (if applicable especially if GIDA barangay).
Interview / Focus Group
Discussion
**Ang halfway house ay pwedeng wala sa sariling
Naitatag ang barangay RED - 0-3/7
Gatekeeping at YELLOW - 4-5/7
Referral System (3) Ang mga kabahayan ay napagbigyang alam kung GREEN - 6-7/7
Key informant Interview /
nasaan ang mga referral facilities at blood facilities na
Focus Group Discussion
pwedeng gamitin ng mga nasasakupan ng barangay
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 13 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(6) Bigyang kaalaman ang mga first contacts tungkol sa
Copy of the orientation
service delivery path at siguraduhing sila ay
activity report
makakasama sa gatekeeping
(7) Pagkakaroon o pagpapaskil ng facility map at
Site visit
service delivery map sa Barangay Hall
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
1)Maternal and Newborn Health (3)
a) Birth preparedness plan and referral
b) Nutrition promotion and assessment
c) Mothers class/Family development session
2) Child health (2)
a) Growth monitoring
b) Promotion of infant and young child feeding RED - 0-5/10 Copy of patients records
Health Promotion
3) Family Planning (3) YELLOW - 6-9/10 and promotional and IEC
Services materials
a) Health education on family planning GREEN - 10/10
b) FP counselling
c) Provision of FP commodities
4) ASRH (2)
a) IEC on ASRH, HIV, STI, Gender-based Violence (GBV)
b) Counselling on prevention of teenage pregnancy
5) Oral Health (1)
a) IEC on oral health
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 14 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
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)
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:
Disease 1) Maternal and Newborn Health (3-4) RED - 0-3/8
Prevention and a) Pregnancy Tracking YELLOW - 4-6/8 Copy of patients' records
Control Services b) Antenatal/Prenatal care GREEN - 7-8/8
c) Post-partum Care
d) Safe labor and delivery (if birthing facility)
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 15 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
2) Child health (2)
a) EPI
b) Injury prevention
3) 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
4) Lifestyle-related or Non-Communicable Disease (1)
a) Routine screening for risk factor identification
5) 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
6) Mental Health (1)
a) Referral of identified cases to RHU
7) Drug and Substance Abuse (2)
a) Profiling of identified patients
a) Referral of identified cases to RHU
8) Senior Citizens (1)
a) Immunization
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 16 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
1) Maternal and Newborn Health (2-3)
a) Referral to RHU
b) BEmONC services, if applicable
c) Administration of lifesaving drugs for Midwives (AO
2010-0014)
2) Child health (3)
a) CIMCI and IMCI
b) Provision of micronutrient supplements
c) Referral to RHU
3) ASRH (1) RED - 0-3/8 Copy of patients' records /
Curative Service a) Referral to RHU YELLOW - 4-6/8 accomplished referral
4) Oral Health (1) GREEN - 7-8/8 forms
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
ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 17 of 18
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
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
1)Lifestyle-related or Non-Communicable Disease (4)
a) Monitor post stroke rehabilitation
b) Home visits for blood pressure monitoring,
c) Home visits for blood sugar monitoring
d) Home visits for monitoring of maintenance drugs RED - 0-1/4 Copy of patients' records /
Rehabilitative intake YELLOW - 2-3/4 accomplished referral
Services forms
2) Health for persons with physical disability (1) GREEN - 4/4
a) Community based rehab or referral to RHU
3) Mental Health (1)
a) Monitoring of treatment process of mental health
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 18 of 18