DM-Amended-AFHF 07282021
DM-Amended-AFHF 07282021
DM-Amended-AFHF 07282021
Department of Health
OFFICE OF THE SECRETARY
April 2021
DEPARTMENT MEMORANDUM
No. 2021- ______________
I. RATIONALE
Investment in adolescent health brings a three-fold benefit to a teen - their present selves,
their adult selves, and the next generation of individuals that they will be raising. As adolescence
is a period of vulnerability for numerous psychosocial health concerns, the best health guidance
during this critical period translates to an unremarkable present and a future of maximized
potential. However, there are identified gaps in providing health guidance to a population that is
characterized to have poor health-seeking behavior. Adolescents regard themselves to be in their
prime physical selves as a function of their biological and their psychosocial development, at the
same time this is a period of establishing behaviors that challenge their optimum health status
and may adversely impact their health in the future.
As the country transitions to Universal Health Care, this is an opportunity to ensure that
facilities are adolescent-friendly, to overcome any form of barriers experienced by adolescents in
seeking health services. As adolescence is a period in their life where their agency to seek health
services is established, a friendly and welcoming environment can contribute to a behavior that
can be carried throughout their lifecourse, to seek health services for disease prevention and
management.
The Adolescent-Friendly Health Facility standards were crafted and approved in 2014. In
2017, implementers at the local level experienced difficulty in the operationalization of AFHF
standards. To address the issue, Department Memorandum No. 2017-0098 in accordance to the
Administrative Order 2013-0013 "National Policy and Strategic Framework on Adolescent
Health and Development," specified the elements to carry out the AFHF Standards using an
evaluation tool developed by the Adolescent Health and Development Program of the Disease
Prevention and Control Bureau.
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ● Trunk Line 651-7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 ● URL: http://www.doh.gov.ph; e-mail: officeofsoh@doh.gov.ph
In 2019, the Department Memorandum 2019-0069, “Guidelines in the Implementation of
Recognition for the Adolescent-Friendly Health Facilities and Preparation of Proposals for the
Cash Grants” was implemented to recognize health facilities for their valuable contribution to the
Adolescent Health and Development Program through the establishment of Adolescent-Friendly
Health Facilities and to encourage health facilities to achieve Level III standards for Adolescent-
Friendly Health Facility,
After the assessment and national recognition of level III facilities, the national assessors
convened to review and evaluate the strengths and challenges encountered in the past years of
implementing the certification process. The results prompted to revise the AFHF evaluation tool
to ensure that the certified facilities are truly functional to address the adolescent health needs.
III. OBJECTIVE
The updated criteria shall apply to all health facilities in the country and the
recommended criteria for school-based and community-based health services for adolescents.
V. DEFINITION OF TERMS
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2. The city/municipal health officers and AHDP coordinators shall ensure the provision
of minimum adolescent services as defined by the UHC law that are responsive to the
adolescents' present-day needs.
a. The establishment and enhancement of AFHF shall translate to service utilization
of all adolescents from prevention, management, and rehabilitation of health
concerns.
4. Health facilities shall record all services rendered and received by adolescents
disaggregated by sex and age (10-14 and 15-19 years old).
a. An identified focal person shall regularly conduct the process of reporting and
monitoring to track its implementation in the facility.
b. Reporting flow from facility to city/provincial offices, regional office and national
office shall follow the routine process.
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defined as truly adolescent-responsive measured through reach, service utilization,
referrals and follow-up. It is
The core elements are infrastructure, human resource, adolescent-responsive services, and
recording and reporting mechanisms which features measures of functionality.
Level I facility ensures to uphold the core elements. Level II upgrades to involve the
adolescents in demand generation activities for their peers and allies, teleconsultation
feature for health services, facility-based policy support, and community
involvement. Level III facilities are further enhanced with policy and budget support
beyond the facility/ department, staff members having the capacity to train and
support facilities classified as Level I and II, and the provision of a safe space for
adolescent-led activities.
Level II CHD* (AHDP focal or Responsible for all phases of the assessment,
alternate/designate) as chair including planning, fieldwork, analysis, and
reporting consolidation
a) Leads the coordination of AFHF
assessment
b) Documents the AFHF assessment
process from pre, during, and post-
assessment
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c) Schedules the pre-meeting with the
assessors to review tools
d) Assigns members of their tasks
e) Conducts after assessment review for
feedback and report collation
Atleast one representative from the - Supports the team leader during the
following: assessment proper
- conducts fieldwork and execute tasks given
● Government agencies by the team leader
(Department of Social Welfare - Shares feedback and other observation of
and Development, Region the assessment
● Department of Education, region - Endorses result assessment too to the team
or Division); CWC/NYC, leader
province; Representatives from
NGOs or CSOs
● Commission on Population and
Development
Level DOH National (AHDP focal or Responsible for all phases of the assessment,
III alternate/designate from a different including planning, fieldwork, analysis, and
region) as team leader reporting consolidation
a) Leads the coordination of AFHF
assessment
b) Documents the AFHF assessment
process from pre, during, and post-
assessment
c) Schedules the pre-meeting with the
assessors to review tools
d) Assigns members of their tasks
e) Conducts after assessment review for
feedback and report collation
CWC/NYC (based on a different - Supports the team leader during the
region that is being assessed) assessment proper
- conducts fieldwork and execute tasks given
Any two representatives from the by the team leader
following: - Shares feedback and other observation of
the assessment
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● Government agencies - Endorses result assessment too to the team
(Department of Social Welfare leader
and Development, Region
● Department of Education, region
or Division); CWC/NYC,
province; Representatives from
NGOs or CSOs
‘*The CHD shall serve as the provider of technical support and validation of apex/ regional
hospitals for level I and level II certification
4. Certification Process
a. Level I Certification Process
1) Provision of orientation and technical assistance from the CHO/PHO
AHDP coordinator documented and verified through the attendance sheet
and the issuance of a certificate of attendance of the facility head for
primary care facilities or Department heads for hospitals designated
AHDP coordinator of the facility.
2) The facility's AHDP coordinator and the facility/ department head shall
conduct a self-assessment on their compliance to the elements of a level 1
AFHF using the monitoring tool supported by the reference material
provided during the orientation.
3) For the first step, the health facility shall make a formal application for
level 1 certification for the self-assessment. Once the AFHF assessment is
compiled and completed, the health facility will submit the following
documents to Cho/PHO:
a. Letter of intent
b. Completed Self-assessment report
c. Orientation proof of attendance, documentation of the TA
provided
d. MOVs based on the reference material
4) The CHD/PHO AHDP coordinator shall validate the submitted documents
and visit the facility within 4 weeks of application. Once all the elements
for level 1 AFHF by the C/PHO, the facility shall be certified as a level 1
AFHF. It is upon the discretion of the C/PHO if the validation process can
be done through a physical visit or virtual means, provided that an actual
visit is done within the year.
*For regional and APEX hospitals the CHD is responsible for the
validation
5) The certification is valid for one year. Hence annual recertification shall
be conducted to ensure continuous compliance to the criteria and to verify
the functionality of the AFHF.
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1) To be eligible for level 2 certification, a facility must have a valid
certificate of level 1 AFHF for at least six months
2) Provision of orientation and technical assistance from the C/PHO AHDP
coordinator documented and verified through the attendance sheet and the
issuance of a certificate of attendance of the facility head for primary care
facilities or Department heads for hospitals designated AHDP coordinator
of the facility.
3) The facility's AHDP coordinator and the C/PHO AHDP Coordinator shall
conduct a readiness assessment on their compliance to the elements of a
level 2 AFHF using the monitoring tool supported by the reference
material provided during the orientation.
4) The health facility applies for level 2 certification shall be made once the
AFHF level 2 monitoring tool's elements are completed. The application
process will involve the submission of the following to the Regional
AHDP Coordinator:
a. Letter of intent
b. Completed assessment report
c. Orientation proof of attendance, documentation of C/PHO
assessment
d. MOVs based on the reference material
5) The regional level 2 assessment team shall validate the submitted
documents and visit the facility within 3 months of application. Upon
validating the elements of an AFHF upon the visit, the facility shall be
certified as a level 2 AFHF.
6) Level 2 assessment team shall conduct annual monitoring for
recertification to ensure continuous compliance to the criteria and
verifying the functionality of the AFHF. The Provincial AHDP
coordinator shall schedule this to assess all elements' continuity to ensure
the facility's functionality. It is upon the Regional Office AHDP
Certification team's discretion to conduct the visit virtually or through an
actual visit, provided that an actual visit is done at a minimum of 2 year-
interval.
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AFHF using the monitoring tool supported by the reference material
provided during the orientation. This, along with the MOVs, shall be
submitted to the Regional AHDP coordinator with the Provincial/City
Health Coordinator copy furnished.
4) The regional coordinator shall provide a follow-up TA to support and
verify the assessment and MOV's.
5) A formal application for level 3 certification shall be made once the
elements of the AFHF in the tool verified by the regional coordinator have
been complied with. The application process will involve the submission
of the following to the National office through the Regional Coordinator:
a. Letter of intent
b. Completed assessment report
c. Orientation proof of attendance, documentation of Regional
AHDP assessment
d. MOVs based on the reference material
6) The National level 3 assessment team shall validate the submitted
documents and visit the facility within 3-6 months of application. Upon
validating the elements of an AFHF upon the visit, the facility shall be
certified as a level 3 AFHF.
7) Annual monitoring for recertification shall be conducted to ensure
continuous compliance to the criteria and verifying the functionality of the
AFHF. This shall be scheduled by the regional AHDP coordinator to
assess the continuity of all elements to ensure the facility's functionality. It
is upon the discretion of the National Certification team to conduct the
visit virtually or through an actual visit, provided that an actual visit is
done at a minimum of 3 year-interval.
5.
6. AHDP Recording and Reporting Forms
Form 1: Recording Form
Form 2: Reporting Tool
Form 3 Provincial/ City Consolidation Report-
Form 4: Provincial Consolidation Report
Form 5: National Annual Consolidation report
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Other agencies:
Philhealth
POPCOM
DEPED
CSO’s/ NGO’s/ Development Partners
IX. EFFECTIVITY
Undersecretary of Health
Office for Technical Services
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AFHF Registry Form I
Region
Province
Municipality/ City
Barangay
Name of Facility
Type of Facility: ☐ Private ☐ Public ☐ Others
Classify the facililty: ☐RHU ☐ BHS ☐ LIC ☐ Infirmary ☐ Hospital ☐ Others, specify _________
☐L1 ☐L3 ☐Apex/Regional Medical Centers
For hospitals, kindly classify:
☐ District ☐ Provincial ☐ Others, specify ___
AFHF status/level ☐Level I ☐Level II ☐Level III
Year certified
Certifying/Assessment team :
MHO/ Program head year started:
AHDP Coordinator year started:
Identify TOP 3 Adolescent Health Concerns encountered in the facility:
☐ Smoking/ Tobacco Use ☐ Mental Health ☐ Teen Pregnancy/Parenthood
☐ Drug use ☐ Out-of-school ☐ Abuse
☐ Alcoholic beverage drinking ☐ Chronic illness ☐ Dysfunctional family
☐ Body Image Issuees ☐ Gender identity issues ☐OTHERS:
___________________________
List of adolescent-related activities, if any:
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PROVINCIAL/CITY HEALTH OFFICE
Office
AHDP Coordinator, year started
Region
Province
Total Number of Certified Level 1
AFHF
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0
12
9
1
0
INFRASTRUCTURE
Signage (defined) ✔ ✔ ✔ Presence of the signage that follows the
branding guidelines (TEMPLATE)
- The facility name, services,
schedule
- Size, quality of the material of
signage
- Name of personnel of the facilities
- Contact number/ FB page/ email
Privacy and confidentiality Space/s with Audio-Visual privacy
mechanisms ✔ ✔ ✔
• Space/s with Audio- ✔ ✔ ✔ Signed oath/ contract on upholding privacy
Visual privacy and confidentiality
• Signed oath/ contract on
upholding privacy and
confidentiality
Flexible time ✔ ✔ ✔ Designated schedule for a private space
HUMAN RESOURCE
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Minimum core staff training Certificates of training
- Foundational Course, ✔ ✔ ✔ Certificate of competence (based on PTE)
HYO (except for Pedia, Refresher certification (every three years)
Adolescent Medicine through supportive supervision, to include
Specialists, Pedia Gyne) ✔ ✔ ✔ Interpersonal Communication and
- AJA/ADEPT (except for Counseling
Adolescent Medicine ✔ Optional ✔
Specialists)
- FPCBT1 (except for
OBGYN)
Additional/ Optional: ✔ ✔ ✔ Space/s with Audio-Visual privacy
- HIV community-based Designated schedule for a private space
screening
(Consult with HIV program)
- Infection Prevention
Control
- Interpersonal
Communication and
Counseling
- Gender Sensitivity
training
Orientation on administrative ✔ ✔ ✔ Attendance sheet/s
roles
Orientation on AFHS (privacy, ✔ ✔ ✔ Attendance sheet/s
confidentiality, non-judgemental Signed oath/ contract on upholding privacy
approach, child protection policy) and confidentiality (every three years)
for all staff
SERVICES
Demand generation Services Documentation of the following:
IEC materials ✔ ✔ ✔ Availability and distribution
Online platform ✔ ✔ ✔ Activity log and analytics
School/ Community lectures ✔ ✔ ✔ Activity log (documentation templates)
Minimum services available
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PROVISION OF - Stock cards (Availability of
COMMODITIES ✔* ✔+ ✔+ commodities for the services)
- Immunization (HPV
vaccination, tetanus) ✔* ✔+ ✔+ - Registry/ TCL/ ITR (Service
- Deworming ✔* ✔+ ✔+ utilization)
- Nutritional ✔
supplementation * optional for ✔+ ✔
- Contraceptives specialized + supported by
clinics RHU
Basic Essential Health Package Service utilization
- Psychosocial screening ✔ ✔ ✔
(Rapid/ Comprehensive)
- Health consultation ✔ ✔ ✔
- Nutritional counseling ✔* ✔ ✔
- Dental consultation ✔* ✔ ✔
- Child protection/ VAC ✔ ✔ ✔
prevention and response
STI/HIV Package Service Utilization
STI/HIV screening ✔ ✔ ✔
counseling ✔ ✔* ✔
Contraceptives counseling
Pregnancy Package Service Utilization
Prenatal services ✔* ✔* ✔
Health education classes (1st consult (1st consult ✔
1. Female Reproductive Health, only) only)
stages & bodily changes
during Pregnancy
2. Nutrition and oral health
during Pregnancy
3. Future planning
4. Breastfeeding Practice
5. Newborn care
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6. Family Planning Decision
Postnatal services
Delivery, dedicated bed/s for teen
mothers in the ward ✔ at least one bed, separated physically to
✔ ensure privacy and confidentiality
LABORATORY* Service utilization
CBC ✔* ✔
Urinalysis ✔* ✔
STI screening ✔ ✔
HIV screening ✔ ✔
Pregnancy testing ✔ ✔
Others ✔ ✔
* optional for
specialized
clinics
REFERRAL Referral forms
With identified partner/s ✔ ✔ ✔ Referral logbook
(school/primary facility)
Link to the secondary and tertiary ✔ ✔
facility (HCPN)/ directory
Downward referral mechanisms ✔ ✔ ✔
With direct access to the social ✔ ✔ ✔
worker, PNP (Child protection and
health nutrition referral pathway)
MONITORING AND
EVALUATION
Recording Tools SBCC activity logs
- Reach of demand ✔ ✔ ✔ Adolescent Services logbook
generation activities ✔ ✔ ✔ Referral logbooks
- Service utilization (by ✔ ✔ ✔ Follow-up calendar
services) ✔ ✔ ✔ Quarterly report with proposed actions
- Successful referrals ✔ ✔ ✔
- Follow-up monitoring
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- Client satisfaction survey
Reporting and Monitoring Quarterly summarized report
Initial certification Client profile (HEEADSSSS)
- Tools utilized ✔ ✔ ✔
- Community/ Client Profile ✔ ✔ ✔
Quarterly summarized report (template)
Recertification submitted to Provincial AHDP focal
- Quarterly Program ✔ ✔ ✔ Quarterly Client satisfaction report
Accomplishment ✔ ✔ ✔ Client profile (HEEADSSS)
- Annual Program ✔ ✔ ✔
Accomplishment ✔ ✔ ✔
- Regular and timely PHO Division PHO/CHO
submission of the report Office
LEVEL 2
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All Level 1 standards plus the following:
Not less than six months from being certified as level 1:
Primary
Health Care School/ Hospital
MOV
Facility (RHU, Community (Level I-III)
BHS, Infirmary,
Specialized clinics)
INFRASTRUCTURE
Signage (defined)
Privacy and confidentiality
mechanisms
- Policy on privacy and ✔ ✔ ✔ Facility/ office order
confidentiality posted
- Separate rooms for ✔ ✔ ✔ Confidentiality poster
consultation, treatment, and Audio-Visual privacy (designated room)
counseling Designated schedule for a private space
Flexible time ✔ ✔ Beyond the school hours or designated
schedule for adolescents
Client satisfaction survey (date/time)
Safe space for adolescent-led ✔ Area inspection
activities Logbook on use of safe space
HUMAN RESOURCE
Minimum staff requirement Office order on the designation (6 months
- With a designated AHDP ✔ ✔ ✔ to 1 year before accreditation) of active
coordinator staff as AHDP coordinator
- Refresher support as needed ✔ ✔ ✔
- Teleconsultation training ✔ Optional ✔ DOH to validate the program as an
- ASHRIE ✔ ✔ ✔ acceptable training (online or regional
certification)
POLICY SUPPORT
AHDP TWG or ✔ Pedia-OB TWG, with adolescent
OB and Pedia Department engagement
Collaboration
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Protocols and guidelines for patient- ✔ ✔ Office order /Memo
provider interaction Citizen’s charter (reflecting adolescent-
HSP one-on-one)
Philhealth registration optional ✔ Philhealth accredited
Provision for special consideration ✔ ✔ ✔ The roles of the AHDP coordinator/
in emergencies and disasters facilities in the DRMMH plan are defined.
(DRMMH planning participated by The coordinator shall ensure that
AHDP coordinator/s from the adolescents' services and needs during
respective facility) emergencies are included.
SERVICES
Demand generation/ social, ✔ ✔ ✔ Activities guided by national framework/
behavioral change communication Local youth development plan that are
- annual action plan for applicable in their area (Standard template,
information dissemination guidelines, multistakeholder)
- Activities for parents and
families Activity report
Referral MOV
- Has an updated directory of ✔ ✔ ✔ - Referral forms
adolescent services - Referral logbook
- Linked with adjunct services ✔ ✔ ✔
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(TESDA, CSOs, etc.)
- Linked with Local youth ✔ ✔ - Minutes of the Meeting (at least
development office quarterly)
MONITORING
Recording Tools MOV
- Adolescent records easily ✔ ✔ Monthly accomplishment report (service
identifiable (tagging) (tagging in (tagging in utilization)
family hospital
records) records)
REPORTING AND MONITORING ✔ ✔ ✔ Quarterly summarized report
Initial certification ✔ ✔ ✔ Quarterly Client satisfaction report
Tools utilized ✔ ✔ ✔ Client profile (HEEADSSS)
Community/ Client profile ✔ ✔ ✔
Recertification ✔ ✔ ✔ Quarterly summarized report submitted to
Quarterly Program Accomplishment PHO Division PHO/CHO Provincial AHDP focal
Annual Program Accomplishment Client profile (HEEADSSS)
Regular and timely submission of
the report
Innovations (Optional) Activity Report
Documentation of good practices
Target Functionality ✔ ✔ ✔ Based on reports (EXISTING
Utilization TEMPLATE)
Referral Adolescent profile
Follow-up Increasing utilization (>5% of the general
Client satisfaction survey adolescent pop’n)
% successful referrals (~70%)(referral
logbook) (/ # referred)
% successful follow-up –
Client satisfaction rating
AHDP Coordinator’s trip report/
assessment
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LEVEL 3
Primary
Health Care School/ Hospital Primary Health Care Facility (RHU, BHS,
Facility (RHU, BHS, Community (Level I-III) Infirmary, Specialized clinics)
Infirmary, Specialized
clinics)
INFRASTRUCTURE
Signage (defined)
Privacy and confidentiality
mechanisms
Flexible schedule implemented
POLICY SUPPORT
AHDP included in the Local ✔ ✔ ✔ Existence of local development plan
Development Plan AHDP highlighting AHDP
included in the School: School improvement plan
hospital budget highlighting adolescent health concerns
Hospital: Coordination with the higher
body (provincial/ regional/ national)
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through the HCPN, include AHDP reports
and strategy in the meeting
AHDP Municipal/ City level ✔ ✔ ✔ Regular TWG meetings as seen in
TWG with an option to utilize member of the minutes
LCPC (Local Council for the municipal Health, DepEd, PopCom,
Protection of children) chaired by TWG Adolescent/youth, CSO/ private partners
the mayor +MHO+ DSWD represented in all meetings
SERVICES
demand generation/ social,
behavioral change communication
- Targeting community Advocacy and health promotion plan
- Supported by Local chief ✔ ✔ ✔ (clearly define advocacy and health
executives promotion)
✔ ✔ ✔
Activity report
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- Centralized one-stop-shop ✔ Manual
services for adolescents all services
- Delivery, a dedicated ward available at the
for teen mothers in the one-stop-shop
ward Inspection, ward logbook
- Separate ward/ section for ✔
males and females at least a room/ward, separated physically
to ensure privacy and confidentiality
✔ Inspection, ward logbook
MONITORING &
EVALUATION
Recording Tools
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% successful follow-up
Client satisfaction rating
AHDP Coordinator’s trip report/
assessment
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