Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

January 18, 2024

DEPARTMENT MEMORANDUM
No. 2024- 0035

FOR: MINISTER OF _HEALTH-BANGSAMORO AUTONOMOUS

REGION _IN MUSLIM MINDANAO (MOH-BARMM) AND ALL
CENTERS FOR HEALTH DEVELOPMENT (CHD) DIRECTORS

SUBJECT: Implementation of the 2023 Local Government Unit Health Scorecard

(LGU HSC) Performance Results

Monitoring of health system performance is necessary as it enables translation of

priorities for health reforms into organizational and individual objectives, provides focus on
results and enhances accountability. Monitoring and Evaluation (M&E) is
a critical element to
evaluate developments in health outcomes and recognize crucial areas for improvement.

The LGU Health Scorecard (LGUHSC) is

one of the M&E tools of the Department of
Health (DOH). It
is a composite scorecard of stakeholders within the province/city-wide health
system (P/CWHS). The local government, as stewards of the local health system, is
accountable for each of their health systems. The LGU HSC tracks and reports on the progress
of health reform implementation, measures the performance of LGUs for outputs and outcomes
which they are accountable for, and reports performance results in a manner that clients and
stakeholders can easily comprehend.

In support of the current administration’s directives, the National Objectives for Health
2023-2028, the 8-Point Action Agenda and the Philippine Development Plan 2023-2028, the
LGU HSC
priority
in
health
collaboration with the different health programs of the DOH identified the
indicators to be monitored for CY 2023-2028 medium term (Table 1). Further,
this policy provides the directions, timelines and tools for the implementation of the 2023 LGU
HSC Performance Results (Table 2).

Table 1. List of LGU HSC Medium Term Indicators for CY 2023-2028

Indicator |

A. HUMANSTIC LEADERSHIP AND GOOD GOVERNANCE

Indicator 1. Percentage of LGU budget allocated for health
Indicator 2. With complete Local Investment Plan for Health (LIPH) / Annual Operational
Plan (AOP)
Indicator 3. Functional Local Health Board
B. ACTION AGENDA 1:
BAWAT PILIPINO, RAMDAM ANG KALUSUGAN (Every
Filipino experiences health and well-being)
Mainstream the primary health care approach, ensuring that every Filipino experiences and
benefits from comprehensive health services without experiencing financial hardship.
Indicator 4, Number of Accredited Konsulta Provider | PhilHealth
C.ACTION AGENDA 2: LIGTAS, DEKALIDAD, AT MAPAGKALINGANG
SERBISYO (Safe, high-quality, and people-centered services)
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 focal 1113, 1108, 1135
Direct Line: 711-9502; 711-9503 Fax: 743-1829 e URL: http:/Avww.doh.gov.ph; e-mail: dohosce‘ doh.gow.pht
Ensure the provision of high quality, safe, and people-centered services, which include
access to affordable medicines, across the lifestages.
Indicator 5. Health Service Coverage Target Met
5.1. Percentage of Fully Immunized Child
5.2. Percentage of pregnant women with at least 4 prenatal check —ups
5.3. Percentage of adults 20 years old and above who were risk assessed using the
PhilPEN protocol
5.4. TB Case Notification Rate
5.5. TB Treatment Success Rate
5.6. Presence of approved Provincial/City/ Municipal Nutrition Action Plan with
Target
5.7. Presence of Nutrition Action Officer with staff complement
5.8. Proportion of Households Using Safely Managed Drinking Water Services
5.9. Proportion of Households Using Safely Managed Sanitation Services
D. ACTION AGENDA
3: TEKNOLOHIYA PARA SA MABILIS NA SERBISYO
(Technology for efficient health service delivery)
Leverage digital health and technology for efficient and accessible health service delivery.
Indicator 6. EMR utilization for digitalized service delivery at public primary care

facilities
E. ACTION AGENDA
emergencies)
4: HANDA SA KRISIS (Ready for health crises and

Ensure a responsive and resilient health system and communities that can effectively prevent,
prepare for, respond to, and recover from public health emergencies and crises.
Indicator 7. With institutionalized Disaster Risk Reduction and Management inHealth
(DRRM-H) System
F. ACTION AGENDA 5: PAG-IWAS SA SAKIT (Disease prevention and health
promotion) and ACTION AGENDA 6: GINHAWA NG ISIP AT DAMDAMIN
(Mental health and overall well-being)
Address determinants of health and improve healthy behaviors through the promotion of
health-enabling settings, implementation of healthy public policies, and enhancement of
health literacy, well-being and ensure quality mental health services. Enhance Filipinos’
well-being and ensure quality mental health services.
Indicator 8. Health promotion policies and programs implemented
8.1 Maternal and Child Nutrition
8.2 Community nutrition (Barangay/ Local Nutrition Program)
8.3 Mandatory Infant and Children Health Immunization

8.4 Tobacco and vape control

8.5 Restricted access of minors to alcoholic beverages
8.6 Hygiene and sanitation
8.7 Mental Health
8.8 Violence and injury prevention (gender-based violence, violence against women,
and violence against children)
8.9 Empowering Barangay Health Workers
G. ACTION AGENDA, NO. 7: KAPAKANAN AT KARAPATAN NG HEALTH
WORKERS (Advancement and protection of health workers’ rights and well-being)
Prioritizing health care workers’ welfare and rights, and strengthening our health institutions
against the threat of pandemics.
Indicator 9. HRH to Population Ratio
Indicator 10. Provision of FULL hazard pay, subsistence and laundry allowances to
permanent public health workers (Physician, Public Health Nurse & Midwife) in
accordance with RA 7305 (Magna Carta for Public Health Workers)
 H. ACTION AGENDA
8:
against any pandemics)
PROTEKSYON SA ANUMANG PANDEMYA (Protection
Strengthen health systems and structures to prevent, manage, and recover from disease
outbreaks and potential pandemics.
Indicator 11. Presence of a Functional Epidemiology and Surveillance Unit (ESU)

The implementation and management of the 2023 LGUHSC performance results shall
strictly follow the schedules/timelines as specified below:

Table 2. Timelines for the Implementation and Management of 2023 LGUHSC

Performance Results

|
Municipal/ Component City (CC) Level: MHO
and DOH on or before the
1.Data Validation through document Representatives last Friday of
review (ex. Target Client List) February 2024
2. Data Collection (Filling up of the
Municipal Data Capture Form)

* Submission of accomplished and DOH

Representative-validated Municipal _and CC
DCE
to
the Provincial Health Office (PHO)
Provincial Level PHO and PDOHO on or before the 1"
1.Data Validation either through: Friday of April
a. Health Facility Visit 2024
b. Data Reconciliation Meeting
2. Data Collection (Filling up of the
Provincial Data Capture Form)
3. Online Data Entry
Highly Urbanized Cities (HUC)/ CHO and DOH on or before the Ist
Independent Component Cities (ICC) Representatives Friday of April
Level: 2024
1. Data Validation through document
review (ex. Target Client List)
2. Data Collection (Filling up of the Data
Capture Form)

*Provinces, HUCs, and ICCs shall

submit a scanned copy of the signed and
validated DCFs and accomplished DQAT
to the CHDs.
—
Regional Level: LGU HSC Regional on
or before the 3
1. The LGU HSC Coordinators shall Coordinator Friday of April
coordinate with the Regional 2024
Epidemiology Surveillance Unit/FHSIS
Point Person to request for municipal and
component city disaggregated data of
FHSIS indicators, and with regional
program coordinators for indicators not
included in FHSIS which shall be
submitted to the BLHSD for validation
and migration into the LGU HSC web-
based system
2. The LGU HSC coordinators shall
monitor and ensure encoding of the
validated data (LGU general information)
in the LGU HSC Web-Based System
3. The CHDs shall forward copies of the
scanned, signed and validated DCFs and
accomplished DQAT submissions to the
BLHSD-LGU HSC Team
National Level:
1. Encoding of Data from other
BLHSD LGUHSC
Team
or
on before last
Friday of April
registries/information systems of the DOH 2024
and other NGAs
Closing of Online Data Entry followed by LGU HSC Regional 1 Monday of May
opening of LGUHS website for review of Coordinators and 2024
encoded 2023 performance results in the BLHSD LGU HSC
website specifically for the correctness of Team
external and internal benchmark ratings

(http://lguhealthscorecard.doh.gov.ph/login)

(Closing of online data entry means

encoding and/or editing of data entered in
the system will no longer be allowed. After
which, only viewing is permitted in the
website.)

Submission of corrections (color rating only) LGU HSC Regional May 19-27
on the encoded 2023 performance results by Coordinators
the Regional Coordinators

*Submission of corrections beyond the set

deadline will no longer be accommodated.
 Opening of Online Reports and Results BLHSD LGU HSC June | - onwards
Utilization Team
*By this time, the CHDs may print their
respective report cards for dissemination and
utilization.

Submission of scanned and signed DCFs

BLHSDthrough email addresses:
to LGU HSC Regional
Coordinators
May
2 - onwards

Iguhsc@doh.gov.ph
Regional LGU Health Scorecard CHD July — December
Conferences/ Health Summit

The data that will be released by the National Nutrition Council (NNC) and PhilHealth
(PHIC) - Central Office shall be used as the official result of Nutrition and PHIC related
indicators in the LGUHSC. Thus, any discrepancies with the data coming from the LGUS shall
be coordinated to the NNC and PHIC Central Office for corrections.

Attached are the following as annexes for information, reference and dissemination of
CHDs and LGUs:
1. ANNEX A—-LGU Health Scorecard Metadata
2. ANNEX B — Data Capture Form and Assessment Tool (DCFAT) — Province/
HUC/ICC
-
3. ANNEX C Data Capture Form and Assessment Tool (DCFAT)
Municipality/ CC
-
-
4. ANNEX D Excel Matrix for Governance Indicators
-
5. ANNEX E Regional Validation Tool

You may access the copy of the metadata and tools CY 2023-2028 indicators’ metadata through
https://bit.ly/20232028LGUHSC. For inquiries and clarifications, you or your staff may
contact Dr. Miriam Cecilia Sales, through (02) 651-7800 local 1307 or at email addresses
mcbsales@doh.gov.ph or lguhsc@doh.gov.ph.

For your information and guidance.

Authority of the
Ta
By Health

LILIBETH C. DAVID, MD, MPH, MPM, CESO I

Undersecretary for Health
UHC
Policy and Strategy Cluster
“é

ANNEX A

2023-2028 LGU Health Scorecard Metadata

Responsible
Indicator

A. HUMANSTIC LEADERSHIP AND GOOD GOVERNANCE

Bureau of Local Indicator 1. Percentage of
Health Systems LGU budget allocated for
Definition

Refers to the proportion of LGU

budget (Personnel Services,
Means
Formula/
of Verification

Numerator: Total LGU budget

allocated to health, nutrition &
Baseline
(Year)

Provinces:
29.86%
Muni, CC
ee
eet
For
HUC, ICC

data collection
Prov.
Official Data
Source

DOF-BLGF

Development health Maintenance & Other Operating population

{BLHSD) Expense (MOOE), and Capital HUCs/ICCs:
Outlay) earmarked to health Denominator: Total LGU budget 28.00%
including budget attributable to
health (e.g. nutrition & Multiplier: 100 Muni/CC:
population) expressed in 14.86%
percentage
(LGU HSC,
*Budget that can be attributed to 2022)
health are those used for
activities which main purpose
to improve health (e.g, feeding
is
programs)
Bureau of Local
Health Systems
Indicator 2. With complete
Local Investment Plan for
The LIPH/AOP
HUC/ICC has
of Province/
passed through
MOV:
PROVINCE/HUCACC
- 2023: 2024
AOP
2023: 2024 AOP
2024: 2025 AOP
Signed and
validated LGU
Development Health (LIPH) / Annual the appraisal process and has 1. Copy of the complete final 2025: 2026-2028 LIPH AND HSC DCF
(BLHSD) Operational Plan (AOP) been concurred by the CHD version of the Province/ 2024: 2025 2026 AOP submitted by
Director/BARMM Minister of HUC/ ICC-wide LIPH AOP 2026: 2027 AOP the Local
Health, and/or AOP, AND 2027: 2028 AOP Health Office
2. Accomplished LIPH and/or 2025: 2028: 2029-2031 LIPH AND To the CHD
For Mun/Cc: AOP appraisal checklist 2026-2028 2029 AOP
The LIPH/AOP has been concurred (signed) by CHD LIPH AND
endorsed to the PHO. Director/ MOH BARMM 2026 AOP Concurred by the CHD
Minister or designated Director/ BARMM Minister or
representative on or before 2026: 2027 designated representative on or
December 31 of the AOP before December 31 of the
reporting year reporting year
2027: 2028
AQP

/
Page 1 of 16
 Office
Responsible Indicator .
Definition
Means
Formula/
of .
Verification
.
National
Baseline
(Year) Muni, CC
2023-2028 LGU TARGET

HUC, ICC Prov.

Official Data
Source
MUNICIPALITIES/ 2028:
COMPONENT CITIES 2029-2031
1. Copy
of the complete LIPH AND
Municipal/ CC LIPH and/or 2029 AOP
AOP, AND
2. Endorsement from the Endorsed
MHO/ CC Health Officer/ by the
Mayor and evidence of M/CCHO
receipt by the PHO on or and/or
before December 31
theof Mayor to
the PHO on
reporting year
or before
December
31 of the
reporting
year
Bureau of Local Indicator 3. Functional Refers to the extent wherein the EO on LHB organization. This 44.49% of 2023-2028: 2023-2028: 2023-2028: Signed and
Health Systems Local Health Board Local Health Board (LHB) is shall contain the following, LGUs have all validated LGU
Development able to meet the minimum among others: the With 3/3 With 3/3 With 3/3 HSC DCF
(BLHSD) required members (compliant a. Members of the LHB in components of component components component submitted by
with RA 7160 and 11223) compliance with RA 7160, a functional s s the Local
including civil society RA 11223 and DILG MC LHB Health Office
organization (CSO) 2022-083; (LGU HSC, To the CHD
representative (compliant with b. Functions and operations 2022)
DILG M.C. 2022-083). The (e.g. schedule of meetings)
LHB shall be also able to c. Sources of funds
perform its mandated functions d. Committees created, as
as follows: applicable
1. Deliberate and recommend Received copy of LHB
to the Sanggunian the resolution to the Sanggunian
annual budget on health proposing the annual health
responsive to the needs of budget with evidence on the
the LGU prioritization of LGU needs
2. Recommend the Received copy of at
least 1 LHB
development/ updating of resolution per quarter
local health policy/ies with
the aim to strengthen health
recommending
Sanggunian
to the
the passing of
Page 2 of 16
 Responsible Formula/ Baseline ORs PON LGU TARGET Official Data
Indicator Definition
Means of Verification
(Year) Muni, CC HUC, ICC Prov. Source
systems management and ordinance/ resolution on matters
service delivery as aligned pertaining to health
with UHC - With proof of meetings
3. Create committees and of committees and
engage/ involve community/ consultation with
private sector community/ CSO
representatives in selected representatives outside
LHB activities the regular members of
LHBLHB resolutions
received by the
Sanggunian
Tecommending
ordinance/ resolution on
matters pertaining to
heaith
B. MAINSTREAM THE PRIMARY HEALTH CARE APPROACH, ENSURING THAT EVERY FILIPINO EXPERIENCES AND BENEFITS FROM COMPREHENSIVE
HEALTH SERVICES WITHOUT EXPERIENCING FINANCIAL HARDSHIP.
PhilHealth Indicator 4. Number of NHIP Konsulta Package — Means of Verification: - 2023: for 2023: for 2023: for PhilHealth
Accredited Konsulta
Konsultasyong Sulit at Tama Konsulta Accreditation Certificate baseline baseline baseline
Provider (Konsulta) Package Konsulta
Providers - refers to primary 2024-2028: 2024-2028: 2024-2028:
care facilities and/ or health care TBD TBD TBD
professionals accredited by
PhilHealth to provide the
Konsulta package
C. ENSURE THE PROVISION OF HIGH QUALITY, SAFE, AND PEOPLE-CENTERED SERVICES, WHICH INCLUDE ACCESS TO AFFORDABLE MEDICINES, ACROSS
THE LIFESTAGES.
Indicator 5. Health Service Coverage Target Met

Disease Indicator 5.1. Percentage of Refers to the number of

infants Numerator: No. of Fully 59.92% 2023: 95% 2023: 95% 2023: 95% FHSIS
Prevention and Fully Immunized Child and children in the population Immunized Children (FHSIS, 2022)
Control Bureau that met the definition of FIC,
(DPCB) expressed in percentage Denominator: Total Population x
multiplier (population 12
LGU

FIC
is
defined as a child who
completed their 1 dose of BCG,
months and below)

Page 3 of 16
 Office National 2023-2028 LGU TARGET
. Formula/ . Official Data
Responsible Indicator Definition
ays
Baseline
Means of . .
Verification
(Year)
.
Muni, CC HUC, ICC Prov. Source
3 doses of pentavalent vaccine Multiplier: 100
(DPT-HepB-Hib), 3 doses of
OPV, and 2 doses of MMR on
or before | year of age. 2nd
dose of MCV to

be
given at 12
months old
Disease Indicator 5.2. Percentage of Refers to the number of pregnant Numerator: 83% (NDHS) 2023: 87.1% FHSIS
Prevention and pregnant women with at least women w/ at least 4 prenatal 2024: 88.2%
Control Bureau 4 prenatal check —ups check-ups Number of pregnant women with at
least 4 prenatal check-ups aged
2025:
2026:
89.30%
90.48%
(DPCB)
(availed as follows among the 10-14 years old 2027: 91.6%
total estimated number of 15-19 years old 2028: 92.7%
pregnant women in the| 20-49
population):
Denominator:
¢ 1% tri = up to 12 weeks Total delivery during the year
and 6 days AOG (at least
1
check-up) Multiplier: 100
© 2™ tri = 13-27 weeks and
6 days AOG
check-up)
(at
least 1
e 3" tri = 28 weeks AOG
and more (at least 2
check-ups)
Disease Indicator 5.3. Percentage of Refers to the number of
adults, Numerator: Number of adults (20 10.57% TBD TBD TBD FHSIS
Prevention and adults 20 years old and 20 years old and above who years old and above) who were risk (FHSIS, 2022)
Control Bureau above who were risk were risk assessed using the assessed using PhilPEN
(DPCB) assessed using the PhilPEN Philippine Package of Essential
protocol NCD Interventions (PhilIPEN) Denominator: Total population X
protocol among the total number multiplier (adults age 20 years
LGU

of adults 20 years old and above old and above)

in the total population expressed
in percentage Multiplier: 100

Page 4 of 16
 Office National 2023-2028 LGU TARGET
. Formula/ Official Data
Responsible Indicator sas
Definition
°

Means of Verification "Weary Muni, CC HUC, ICC Prov. Source

Disease Indicator 5.4. TB Case Number of notified TB, all forms Numerator: Total number of 382 for every 10% 10% increase 10% Officially
Prevention and Notification Rate for every 100,000 population notified TB cases, all forms 100,000 increase from the increase released IT IS
Control Bureau population from the previous year from the Report by the
(DPCB) Notified TB, all forms: include Denominator: Total Population of {LGU HSC, previous previous national
new and relapse (whether the LGU 2022) year year program
bacteriologically confirmed or
clinically diagnosed) who were Multiplier: 100,000
detected, registered, and
reported to the MNTPs
Disease
Prevention and
Indicater 5.5. TB Treatment
Success Rate
Refers to the percentage of TB,
all forms that are successfully
Numerator: Number of
TB, all
forms that are cured and completely
92.17% 90% or 90% or higher 90% or LGU TB
(LGU HSC, higher higher Case Outcome
Control Bureau treated treated 2022) Report in
(DPCB) ITIS
Denominator: Total number of TB,
all forms registered during a
specified period

Multiplier: 100%
National Indicator 5.6. Presence of The Local Nutrition Action Plan Approved and funded Local N/A 2023: Data Source:
Nutrition
Council (NNC)
approved and funded (LNAP) is a three-year plan Nutrition Action Plan. 2023 Approved and funded LNAP Province/ City/
Provincial/City/ Municipal containing the objectives and Municipal/
Nutrition Action Plan with nutrition interventions that will MOV: 2024-2028: Barangay
Target be implemented to address the a. Copy of LNAP TBD Nutrition office
malnutrition problem at the b. Sangguniang Report
provincial, city, municipal and Bayan or Local Nutrition committee submitted to
barangay level. The LNAP Resolution adopting the Loca! NNC
operationalizes the Philippine Nutrition Action Plan
Plan of Action for Nutrition Frequency:
(PPAN) and Regional Nutrition Formulated
Action Plan (RNAP) at
the local and/or updated
level. The P/C/M/BNAP
prepared by the respective
is every year

nutrition committees and should

be integral part of the local
an

development plan and funded

the Annual Investment Program
in
(AIP). The plan is updated

Page 5 of 16
 Office National 2023-2028 LGU TARGET
Formula/ Official Data
Responsible Indicator Definition
Means of Verification
Baseline
. .
Muni,CCc HUC,ICC Prov. Source
(Year)
yearly to reflect the results of
OPT Plus.

NNC Indicator 5.7. Presence of A full-time or part time Province: 1355 NAO One
(1) One (1) One
(1) LGU Human
Nutrition Action Officer with designate by the local chief a. One (1) designated NAO per (NNC) designate designated designate Resource and
at least one (1) staff executive either from a separate Province and at least 1 staff d NAO NAO with at dNAO Nutrition
complement nutrition office or from among complement and per least 1 staff with at Office
the sectoral departments of the b. 80% of its municipalities/ Municipa complement least 1
(Province/City/
local government unit with at component cities has one (1) lity / CC) per HUC/ ICC staff Municipal
least one staff complement (i.e. designated NAO per LGU complem level)
technical staff/ support staff) ent per submitted to
HUC/ICC: province NNC
The Nutrition Action Officer One (1) designated NAO per HUC/
(NAO) serves as focal point for
nutrition and coordinates with
ICC with at least 1 staff complement AND

the local nutrition committee to Municipalities/ Component Cities: 80% of

facilitate the implementation of One (1) designated NAO per Mun/ its
the LNAP. cc municipal
ities and
NAO should have at least one MOV: compone
(1) staff complement (technical/
administrative staff support)
|— Appointment or designation nt cities
paper of NAO signed by have one
Govemor or Mayor {1}
— Organizational chart te designate
determine administrative line of dNAO
authority of NAO per LGU
Health Indicator 5.8. Increase in the Refers to the number of Numerator: 64,82% 2023: 69.22% FHSIS
Promotion Proportion of households households using safely Total number ofhouseholds using
(FHSIS, 2022)
2024: 73.62%
Bureau- using safely managed managed drinking-water safely managed drinking-water °
2025: 78.01%
Environmental drinking-water services services meeting the following 3 services 2026: 82.41%
Health criteria. (1) located inside the 2027: 86.81%
household or within its Denominator: 2028: 91.21%
premises; (2) available at least Projected No. of Households for the
12 hours per day and (3) the given year

Page 6 of 16
 Office National 2023-2028 LGU TARGET
Formula y Official Data
Responsible Indicator Definition
Means of Verification
. Baseline . Source
Muni,CC HUC,ICC Prov.
(Year)
water supplied should be free of
fecal contamination (optional: Multiplier: 100
priority chemical), among the
total number of
households
expressed as
a percentage.

Health Indicator 5.9. Increase on Refers to the number of HHs Numerator: 66.10% 2023: 70.34% FHSIS
Promotion the Proportion of Households using safely managed sanitation Total no. of households using safely 2024: 74.58%
(FHSIS, , 2022)
Bureau- using safely managed services among the total number managed sanitation services 2025: 78.81%
Environmental sanitation services of HHs expressed as a 2026: 83.05%
Health percentage. Denominator: 2027: 87.29%
Projected No. of Households for the 2028: 91.53%
Safely Managed Sanitation given year
Services:
(1) sanitation facility is not Multiplier: 100
shared with other HHs and
(2) the sewage/excreta should Note:
either be To be reported cumulatively from
- stored in a containment tank month 1 to month 12.
and treated (in situ) and
application of sanitation by
products for reuse/disposal OR
~ stored in a containment tank)

desludged, transported, treated

and disposed off-site and
application of sanitation by-
products for reuse/disposal OR
- stored in a containment tank or
conveyed through a
sewer/sewerage system and
treated off-site and application
of sanitation by-products for
reuse/disposal

Page 7 of 16
 Responsible Formula/ Baseline 20S 2028 LGU TARGET Official Data
Indicator Definition
Means of Verification Muni, CC HUC, ICC Prov. Source
(Year)

D. LEVERAGE DIGITAL HEALTH AND TECHNOLOGY FOR EFFICIENT AND ACCESSIBLE HEALTH SERVICE DELIVERY.
Knowledge Indicator 6. EMR utilization To pass the indicator, All Health Numerator: Number Publicof
- For baseline data collection in 2023. Signed and
Management
and Information
for digitalized service
delivery at public primary
Centers/RHU
in the
City/Municipality shall conform
Barangay health stations/Health
Centers/Rural Health Unit in the
Targets for the succeeding years will be set
upon review of the baseline performance
validated LGU
HSC DCF
Technology care facilities with ALL parameters: City/Municipality utilizing EMR to results submitted by
Service digitalize service delivery the Local
1.Presence of Electronic Health Office
Medical Record at ALL Rural Denominator: Current number of
Health Units/Health Public Barangay health
Centers/Barangay Health stations/Health Centers/Rural Health
Stations Units in the City/Municipality

2. Digitalization of Work Multiplier: 100

Process: The facility integrated
EMR usage into their daily
workflows
services.
of delivering the MOV: copy of FHSIS reports fully
generated using the EMR.

3. Statistical Report Generation:

FHSIS reports fully generated
using the EMR.
E. ENSURE A RESPONSIVE AND RESILIENT HEALTH SYSTEM AND COMMUNITIES THAT CAN EFFECTIVELY PREVENT, PREPARE FOR, RESPOND TO, AND
RECOVER FROM PUBLIC HEALTH EMERGENCIES AND CRISES.

Page 8 of 16
 Office National 2023-2028 LGU TARGET
: sas Formula/ Official Data
Responsible Indicator Definition Baseline
Means of Verification
‘ .

(Year)
.
Muni, CC HUG, ICC Prov. Source
Health Indicator 7. With Refers to the presence of the four MOVs for the DRRM-H Province: Presence of Presence of 4/4 Presence of Signed and
Emergency institutionalized Disaster (4) components of an Components 62.96% 4/4 DRRM-H 4/4 DRRM- validated LGU
Management Risk Reduction and institutionalized DRRM-H DRRM-H components H HSC DCF
Bureau Management in Health System: 1. Approved, updated, integrated, HUC/ICC: component component submitted by
(HEMB) (DRRM-H) System 1. DRRM-H Plan disseminated, and tested DRRM- 76.32% s s the Local
2. Health Emergency Response H Plan Health Office
Teams 2. Organized and trained Health Muni/CC:
3. Health Emergency Emergency Response Team on 55.58%
Commodities the minimum required trainings:
4. Health Operations Center or Basic Life Support and Standard
Emergency Operations First Aid (LGU HSC,
Center 3. Available and accessible (24 hrs 2022)
post impact of emergency or
disaster} essential health
emergency commodities e.g.
medicines such as
cotrimoxazole, amoxicillin,
mefenamic acid, paracetamol,
oresol, lagundi, vitamin A and
skin ointment
4. Health/Emergency Operations
Center with functional {1}
Command and Control, (2)
Coordination, (3) and
Communication
F. ADDRESS DETERMINANTS OF HEALTH AND IMPROVE HEALTHY BEHAVIORS THROUGH THE PROMOTION OF HEALTH-ENABLING SETTINGS,
IMPLEMENTATION OF HEALTHY PUBLIC POLICIES, AND ENHANCEMENT OF HEALTH LITERACY, WELL-BEING AND ENSURE QUALITY MENTAL HEALTH
SERVICES
Health Indicator8. Health Refers to the health promotion Signed and
Promotion promotion policies and policies and programs, as validated LGU
Bureau (HPB) programs implemented identified by the DOH through HSC DCF
A.O. No. 2021-0063 or “Health submitted by
Promotion Framework Strategy the Local
2030” that are issued and Health Office
implemented by the LGUs to

Page 9 of 16
 ffice
Responsible Indicator Definition
Formuta/
i

Baseline
Zops = aps Lou Taree .
Official Data
Means of Verification Muni, CC HUC, ICC Prov. Source
(Near)
promote health literacy and
healthy lifestyle

8.1 Maternal and Child Refers to local-level Consider only local policies 58.02% of 2023-2028: 2023-2028: 2023-2028:
Nutrition components of RA 11148 (Ordinance/ EO/ Resolution) in effect LGUs have
(Kalusugan at Nutrisyon ng as of December 31 of the reporting local policy With local With local With local
Mag-Nanay Act) and RA year {LGU HSC, policy in policy ineffect policy in
10028 (Expanded 2022) effect as of as of December effect as of
Breastfeeding Promotion Act) Policies intended to celebrate/ December 31 of the December
such as: commemorate related events or 31 ofthe reporting year 31 of the
1. Local legislative measures declare local holidays will NOT be reporting reporting
2. Integration of First 1,000 considered. year year
Days Strategy to Local
Plans (PDPFP, CDP, Means of Verification: Copy of local
LDIPs, AIPs) ordinance
3. Services relevant to the First
1,000 Days Strategy
4. Capacity building and/or
Facilities
5. Functional nutrition
committees
6. Mechanisms for ensuring
nutrition in emergencies
8.2 Community nutrition Refers to local-level 59.26% of 2023-2028: 2023-2028: 2023-2028:
(Barangay/ Local Nutrition components of the BNS LGUs have
Program) program (PD 1569, BNS Law or local policy With local With local With local
Strengthening the Barangay (LGU HSC, policy in policy in effect policy in
Nutrition Program) such as: 2022) effect as of asof December effect as of
1. Local legislative measures December 31 of the December
2. Organized local training 31 ofthe reporting year 31 of the
teams

Page 10 of 16
 Office National 2023-2028 LGU TARGET
Formula/ Official Data
Responsible Indicator Definition Baseline
Means of Verification
(Year)
.
Muni, CC HUC, ICC Prov. Source
3. Budget/resources allocated reporting Teporting
year year
8.3. Mandatory Infant and Refers to local-level components - 2023-2028: 2023-2028: 2023-2028:
Children Health of Republic Act No. 10152
Immunization (Mandatory Infants and With local With local With local
Children Health Immunization policy in policy ineffect policy in
Act) such as: effect as of as of December effect as of
1. Resources {vaccine December 31 of the December
commodities, etc.) 31 ofthe reporting year 31 of the
2. Public Awareness reporting reporting
(Communication Plan/ year year
Campaign/Advocacy)
3. Capacity building of
community health workers
8.4 Tobacco and vape control Refers to local-level components 59.26% of 2023-2028: 2023-2028: 2023-2028:
stipulated in existing legal LGUs have
frameworks (R.A. No. 9211 or local policy With local With local With local
Tobacco Regulation Act, E.O. (LGU HSC, policy in policy in effect policy in
No. 26 s. 2016 or Establishment 2022) effect as of as of December effect as of
of smoke-free environments in December 31
of
the December
public and enclosedplaces, E.O. 3lofthe reporting year 31 of the
No. 106 s. 2020 or Prohibiting reporting Teporting
the manufacture, distrib., year year
marketing, and sale of
unregistered ENDS/ ENNDS/
HTPs, and novel tobacco
products) such as:
1. Local legislative measures
2. Prohibition of smoking
and vaping in public
places
3. Prohibition of tobacco
marketing targeted to
minors
4. Restricting access of
minors

Page 11 of 16
 Office National 2023-2028 LGU TARGET
Formula/ Official Data
Responsible Indicator
: eqs
Definition Baseline
Means of Verification
. .

(Year)
.
Muni, CC HUC, ICC Prov. Source
5. Developing knowledge,
attitude, behaviors of
public
6. Cessation services in local
health facilities
7. Capacity/competence of
service providers
8.5 Restricted access of Refers to local-level components 33.33% of 2023-2028: 2023-2028: 2023-2028:
to
minors alcoholic beverages stipulated in existing legal LGUs have
frameworks (P.D. No. 1619 or local policy With local With local With local
Penalizing the Sale of Volatile (LGU HSC, policy in policy ineffect policy in
Substances to Minors, FDA 2022) effect as of as of December effect as of
Circular No. 2019-006 or December 31
of
the December
Guidelines in Commercial 31 ofthe reporting year 31 of the
Display, Selling, Promotion and reporting reporting
Advertising of Alcohol) such as: year year
1. Local legislative measures
2. Prohibition of alcohol
marketing targeted to
minors
3. Restricting access of
minors to alcohol by
banning sales in places
frequented by minors and
prohibiting the purchase
from and sales to minors
4. Developing knowledge,
attitude, behaviors of
public
8.6 Hygiene and sanitation Refers to local-level 54.32% of 2023-2028: 2023-2028: 2023-2028:
components of the sustainable LGUs have
sanitation program (P.D. No. local policy With local With local With local
856 or the Sanitation Code of (LGU HSC, policy in policyineffect policy in
the Philippines, DOH A.O. 2022) effect as of as of December effect as of
2019-0054 or Guidelines on the December 31 of the December
implementation of the 3lofthe reporting year 31 of the

Page 12 of 16
 Office National 2023-2028 LGU TARGET
Formula/ Official Data
Responsible Indicator Definition Baseline
Means of Verification
(Year) Muni, CC HUC, ICC Prov. Source
Philippine Approach to reporting reporting
Sustainable Sanitation) such as: year year
1. Local coordination body
to oversee the
attainment of ZOD/BSF
status at the provincial,
municipal/city, and/or
barangay levels
2. Conduct of sector
analysis planning to
identify practices,
resources, needs, and
gaps
3. Capacity building
4. Recognition, rewards,
and incentives system
8.7 Mental Health Refers to local-level components 38.27% of 2023-2028: 2023-2028: 2023-2028:
stipulated in R.A. No. 11036 LGUs have
(Mental Health Law) such as: local policy With local With local With local
1. Mental health services at {LGU HSC, policy in policy in effect policy in
primary care level 2022) effect as of as of December effect as of
2. Resources (facilities, December 31 of the December
medicines, etc.) 31 of the reporting year 31 of the
3. Public Awareness Teporting reporting
(Communication Plan/ year year
Campaign/Advocacy)
4. Reportorial Requirements
(quarterly report data
relevant to mental health
illnesses and disabilities}
5. Capacity building of
community health workers
6. Link to higher levels of
mental health care
8.8 Violence and injury - Refers to local-level 82.72% of 2023-2028: 2023-2028: 2023-2028:
prevention (gender-based components of existing LGUs have
violence, violence against Televant laws on violence and local policy

Page 13 of 16
 Office National 2023-2028 LGU TARGET
Formula/ Official Data
Responsible Indicator Definition
Means of Verification "Year| Muni,cc ucjicc Prov. Source
women, and violence against injury prevention (R.A. No. (LGU HSC, With local With local With local
children) 9262 or Anti VAWC Act, R.A. 2022) policy in policy in effect policy in
No. 7877 or Anti-Sexual effect as of as of December effect as of
Harassment Act, RA. No. December 31 of the December
11313 or Safe Spaces Act, R.A. 31 of the reporting year 31 of the
No. 7610 or Special Protection reporting reporting
of Children Against Abuse, year year
Exploitation and
Discrimination, DOH A.O. I-
Bs. 1997/ 2013-0011 or
Guidelines for Establishment
of WCPUs) such as:
1. Implementation of effective
advocacy and
communication campaigns
2. Functional
VAWC/VACI/GBV desks in
all LGUs/barangays
3. Functional reporting
mechanisms/active hotline,
ete.
4. Functional referral
mechanism/s from
barangays to appropriate
levels of response
5. Functional Women and
Child Protection Units in
LGU hospitals or health
facilities
8.9 Empowering Barangay Refers to implementation of 10.37% of 2023-2028: 2023-2028: 2023-2028:
Health Workers necessary support mechanism/s LGUs have
for BHWs (R.A. No. 7883 or local policy With local With local With local
BHWs’ Benefits and Incentives (LGU HSC, policy in policy in effect policy in
Act of 1995) such as: 2022) effect as of as of December effect as of
1, Providing appropriate
benefits, incentives, and
December
31 ofthe
31
of
the December
of the
reporting ycar 31
other protections

Page 14 of 16
 Office National 2023-2028 LGU TARGET
Formula/ Official Data
Responsible Indicator Definition Baseline
Source
Means of Verification (Year)
.
Muni, CC HUC, ICC Prov.
2. Recognizing the rights of reporting reporting
community health workers year year
to organize
G. PRIORITIZING HEALTH CARE WORKERS’ WELFARE AND RIGHTS, AND STRENGTHENING OUR HEALTH INSTITUTIONS AGAINST THE THREAT OF
PANDEMICS
Health Human Indicator 9. HRH to Refers to the proportion of Numerator: Number of HRH (MD, 2023: for baseline HHRDB
Resource Population Ratio Human Resource for Health RN, RM)
in an LGU including LGU- Administrative
Development (HRH) (MD, RN, RM) that hired, DOH-deployed and those in 2024: Data
Bureau have met the target HRH to private practice 3.43 MD : 10,000 population;
(HHRDB) population ratio during the 8.95 RN : 10,000 population; Note:Pending
reporting year Denominator: Projected population 2,80 RM 10,000 population
:
interoperability
of the LGU of information
sytems related
Multiplier: 10,000 2025: to HRH, data
4.04 MD : 10,000 population; shall be
9.89 RN : 10,000 population; gathered from,
2.80 RM :
10,000 population but not limited
to, the
2026: foilowing
4.94 MD: 10,000 population; systems
11.37 RN: 10,000 population; wherein health
2.80 RM: 10,000 population institutions are
reporting:
2027:
6.05 MD : 10,000 population; ~ NDHRHIS
13.29 RN : 10,000 population; - FHSIS
2.80 RM : 10,000 population - NHWSS
Database
2028: - iClinicSys
7.75 MD : 10,000 population; - OLRS
15.80 RN : 10,000 population;
2.80 RM : 10,000 population
Bureau of Local Indicator 10. Provision of The salary of the Physician, MOV: copy of Statement of 73.88% of LGU provides hazard pay, subsistence, and Signed and
Health Systems FULL hazard pay, Public Health Nurse & Midwife Allotment, Obligation and Balances LGUs laundry allowances to
its health workers validated LGU
Development subsistence and laundry complied with the Salary (SAOB) provided full (Physician, Public Health Nurse & Midwife) HSC DCF
(BLHSD) allowances to permanent Standardization Law, and Magna Carta submitted by

Page 15 of 16
 Office National 2023-2028 LGU TARGET
Formala/ Official Data
Responsible Indicator Definition Baseline
Means of Verification
.
Muni, CC.
HUC, ICC Prov. Source
(Year)
public health workers benefits are fully given to ALL benefits in accordance with RA 7305 (Magna Carta of the Local
(Physician, Public Health the permanent LGU-hired health (Hazard, Public Health Workers) Health Office
Nurse & Midwife) in workers: Laundry
accordance with RA 7305 I. Hazard Allowance Allowance,
(Magna Carta for Public 2. Laundry Allowance Subsistence)
Health Workers) 3. Subsistence Allowance (LGU HSC,
2022)
(Republic Act No. 7305 “The
Magna Carta of Public Health
Workers”)
H. STRENGTHEN HEALTH SYSTEMS AND STRUCTURES TO PREVENT, MANAGE, AND RECOVER FROM DISE. ASE OUTBREAKS AND POTENTIAL PANDEMICS
Epidemiology Indicator 11. Presence of a A Functional ESU is MOV - For baseline data collection in 2023 EB
Bureau (EB) Functional Epidemiology characterized by successfully Administrative
and Surveillance Unit (ESU) fulfilling the minimum
indicators specified for a
of
A copy the completed and
validated IMET. The IMET will be
Data, CHD
RESU
Functional ESU in the considered complete and validated
Integrated Monitoring and
Evaluation Tool (IMET),
it
when bears the signature of the
following individuals:
indicating the operational 1. Assessor from the LGU's Regional
teadiness and capacity of the Epidemiology and Surveillance Unit
ESU
to effectively carry out its
surveillance and response
(RESU);
2. Head of the Local Epidemiology
functions. and Surveillance Unit (LESU); and
3. Head of the Local Health Office

Page 16 of 16
 ANNEX B

OF Reporting Year: 2023

__

DEPARTMENT HEALTH
Bureau of Local Health Systems Development
Health Systems Monitoring and Evaluation Division
LGU Health Scorecard

PROVINCE/HUC/ICC DATA
GENERAL INFORMATION
Date Accomplished:
Region:
LGU Name:
GENERAL INFORMATION
Date Accomplished:

Region:

LGU Name:

Income Class:

Name
of LCE:
Years in Position:

Health Governance Training: Yes () No () If Yes, specify

Name of PHO/Designate:

Years in Position:

Health Governance Training: Yes () No () If Yes, specify

Signature of Local Date: Signature of Local Date:

Health Officer; Chief Executive:
Signature of Date:
Validator
Page 1 of 10
 INSTRUCTIONS
General:
1. Indicator number is
based on the numbering in the metadata
2.
3. Don't leave any item biank
to
Data validation should be conducted prior filling up this form

For Local Government Units:

1. Accomplish the portion labeled “This portion will be accomplished by LGU”
2. Fill-up the form with the required data (e.g., numerator, denominator). Round-off the final values into two
decimal points (e.g., xx.xx). In case an indicator is not applicable to the LGU, please put N.A and write a brief
explanation in the remarks portion.
Countersign any erasures on the DCF
aAbw
Write a short explanation for items answered “No” under remarks.
For all indicators with accomplishment rate the
of at least 20% higher than target, or at least 20% lower
than the baseline values, mention in the remarks portion reason/s for not being able to attain the target or
decrease in performance (This will allow the program to provide feedback to the concerned program or office
which in turn is expected to provide technical assistance and consider strategies to address issues during
planning). Include the sources of
initiative/efforts, whether from DOH or LGU,
information shail be used to aid data analysis.
or both, as applicable. The

LGU
report will be deemed official ONLY when submitted together with a signed certification page.
This is to establish accountability in the submission and review of LGU data reflected in this DCF.

For DOH CHDs/MOH-BARMM:

1. Accomplish the portion labeled “This portion will be accomplished by CHD Validator / Validation
Team”.
2. Fill-up the form with the required data (e.g., numerator, denominator). Countersign any erasures on the
DQAT.
Forall indicators with accomplishment rate of at least 20% higher than the target, or at least 20% lower
than the baseline values, ensure that the corresponding explanation were recorded on the remarks section
of the DQAT
4. Write a short explanation for items answered “No” under remarks.
5. Record any implementation issues or best practices not initially reported in the DCF.
6. Ensure that both the MHO and the Budget/Accounting Officer affixed their signature on the submitted DCF.

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Date::
or °
Signature of
.
Valida Reporting Year: 2023

Page 2 of 10
 THIS PORTION WILL BE ACCOMPLISHED BY LGU
5”
Indicator 2. With Complete Local Investment Plan for Health Data Quality Assessment for Indicator 2.
*DM 2022-0459 requires LGUs
to develop their respective health
plans based on rational and realistic planning. Criteria/ Means of Result
Verification
With 2024 AOP concurred (signed) by the CHD Director: Copy
of the complete
final version of the
DO
Yes

Province/ HUC/ ICC-

YES NO wide 2024 AOP, AND ONo

Accomplished 2024 OD
Yes
Criteria for Province/HUCHCC YES NO
1. Copy of the complete final version of the
AOP
appraisal
checklist concurred
Province/ HUC/ ICC-wide 2024 AOP, AND (signed) by CHD O No
2. Accomplished 2024 AOP appraisal checklist Director/ MOH
concurred (signed) by CHD Director/ MOH BARMM Minister or
BARMM Minister or designated designated
representative on or before December 31, representative on or
2023 before December 31,
2023
When was the AOP appraisal checklist concurred by the CHD
Director/MOH BARMM Minister?
When was theAOP
appraisal checklist
concurred by the CHD Director/MOH BARMM
Minister?
Benchmark: Scoring System (external
benchmark)
2023 National Target: Green: With 2024 AOP that has
100% of HUCs and ICC passed through the DOH-CHD
have 2024 AOP that appraisal process and concurred
passed through the DOH- (signed) by the CHD
CHD/MOH-BARMM Director/MOH-BARMM Minister Remarks (Write a short explanation for
appraisal process and has or designated representative on items answered “No”, Record any
been concurred (signed) or before December 31, 2023
implementation issues or best practices not
by the CHD Director
/MOH-BARMM Minister or
Red: Absence of 2024 AOP
with 2024 AOP but did not pass
or initially reported in the DCF):

designated representative through the DOH-CHD/MOH-

on or before December 31, BARMM
appraisal process and
2023 not been concurred (signed) by
the CHD Director/ MOH-BARMM
Minister or designated
representative on or before
December 31, 2023

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues or best practices not initially
reported in the DCF. Record any implementation issues
encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date:
Validator Reporting Year: 2023

Page 3 of 10
Indicator 3. Functional Local Health Board (LHB) Data Quality Assessment for Indicator 3.
* Refers to the extent wherein the LHB is able to meet the
minimum required members including civil society organization Criteria/ Means of Verification Result
(CSO) representative. It
is also able to perform its mandated 1. EO onLHB organization. O Yes
functions. This shall contain the
following among others:
With presence of 3/3 LHB Components: a. Members of the LHB in ONo
compliance with RA 7160,
RA 11223 and DILG MC
YES NO
2022-083
b. Functions and operations,

1.
Criteria/ Means
of Verification
EO on LHB organization. This shall contain
YES NO
ae
.
Source of funds
Committees created, as
the following among others: applicable
a. Members of the LHB in compliance with
RA 7160, RA 11223 and DILG MC 2022-
2. Received copy of LHB
resolution to the Sanggunian
O Yes

083 proposing the annual health,

b. Functions and operations (e.g. schedule including minutes of O No
of meetings, source of funds) meeting/s
c. Sources of funds
d. Committees created, as applicable
3. Received copy of
LHB
at least 1
resolution per quarter
O Yes

2. Received copy of LHB resolution to the recommending to the

Sanggunian proposing the annual health Sanggunian the passing of ONo
budget ordinance/ resolution on
3. Received copy of at
least 1 LHB resolution matters pertaining to health
With proof of meetings of
per quarter recommending to the -
Sanggunian the passing of ordinance/ committees and
resolution on matters pertaining to health consultation with
- With proof of meetings of committees community/ CSO
and consultation with community/ representatives outside
CSO representatives outside the the regular members of
regular members of LHBLHB LHBLHB resolutions
resolutions received by the received by the
Sanggunian recommending Sanggunian
ordinance/ resolution on matters recommending
pertaining to health ordinance/ resolution on
matters pertaining to
Benchmark: Scoring System (external health
benchmark)
National Target: All = Green: With presence of 3/3 LHB Remarks (Write a short explanation for
LGUs have 3/3 LHB Components items answered “No”. Record any
Components =
Red: No LHB component is present implementation issues or best practices not
or with presence of less than 3 initially reported in the DCF):
LHB components

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer; Chief Executive:
Signature
Vandator
° of Date:: Reporting Year: 2023
:

Page 4 of 10
Indicator 6. EMR utilization for digitalized service delivery at Data Quality Assessment for Indicator 6.
public primary care facilities.
What to Check Count how
For baseline data collection. LGUs will not be rated many RHU/
HC/ BHS have
the component
EMR Component Number of
Public 1. How many RHU/ HC.
PCF (RHUs/ HCs/ BHS have a functioning
BHS)
EMR
that
has the
component:
EMR system
RHU/ BHS/ BHS?
in the
1. Presence of Electronic Medical 2. How many RHU/ HC/
Record the Rural Health Units/
in BHS have the EMR
Health Centers/ Barangay Health used/ integrated on all
Stations* of the following work
2. Digitalization of Work Process: All processes:
a. Initial registration
facilities integrated EMR usage into
b. Pulling up records
their daily workflow of delivering the c, Recording of
services: consultation
a. Initial registration d. Recording of
b. Pulling up records diagnostic
c. Recording of consultation examinations*
d. Recording of diagnostic (applicable to
examinations’ (applicable to RHUs/HCs only)
3. How many RHU/ HC,
RHUs/HCs only)
3. Statistical Report Generation:
BHS
generate FHS!IS
report through EMR?
FHSIS reports fully generated using
the EMR
Remarks (Write a short explanation for
items answered “No”. Record any
*List /Name the type of EMR present in the LGU: implementation issues encountered):

A. Number of public primary

care facilities (e.g. RHU, HC,
BHS) within the LGU that
HAS MET ALL THREE
CRITERIA of EMR
Utilization X 100=
B. Total Number of public
primary care facilities (e.g.
RHU, HC, BHS) within the
LGU No
Data

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date: Reporting Year: 2023
"
"

Validator
Page 5 of 10
Indicator 7. With institutionalized Disaster Risk Reduction and Data Quality Assessment for Indicator 7.
Management in
Health (DRRM-H) System
*Institutionalized DRRM-H system means the availability of ALL
four criteria.

YES NO
Criteria Means
of Resul
Criteria Means of Verification Yes No Verification
(MOV)
t
(MOV)
41.Approved, 1.1 signed O Yes
Approved, Approved, updated, updated, DRRM-H pian ONo
updated, disseminated and tested disseminate
disseminated Plan evidenced by the dand tested 1.2 endorsement
DRRM-H Plan and its Disaster to tocal chief
1 yas
and tested ON 0
endorsement to the focal Risk executive or
Disaster Risk
. ‘

chief executive or health Reduction health council

Reduction and council. Revision log for and (Health/ DRRM
Management in updatedness. Signed Management Budget Review)
Health ( (ORRM- documentation that the nea
(DRRMH)
.
1.3 Signed
Plan P lan was disseminated O Yes
H) Plan documentation of
and t
signed activity conducted
Fag
documentation of testing
.
and circulated, OR
of the pian. other supporting
Organized and Organized and trained documents on
trained Health Health and Emergency dissemination
and Emergency Response Teams (HERTs) 1.4 The plan being
Response on minimum required annually tested by O Yes
Teams (HERTs) | training: Basic Life Support drills, table top,
on minimum (BLS) and Standard First program No
. implementation
required Aid (SFA)
7

reviews with
training: Basic corresponding
Life Support documentation:
signed
(BLS) and documentation of
.
Standard First activity conducted
Aid (SFA) 2. Organized 2.1 Any
of the O Yes
Available and Refers to available
.
and trained
Heaith
following
documents:
or alike [1 No

accessible
.
essential health Emergency -Official Personnel
ve
essential health ¢mergency commodities Response Team Order
such as Anti-infectives, on minimum -Local Ordinance
emergency
commodities Analgesics, Antipyretics required Executive Order
|
Fluids/Electrolytes, trainings: Basic
Respiratory Drugs, Dietary/ Life Support and 2.2 All HERT O Yes
Nutritional Products that is Standard First
Aid
members have
Basic Life Support
ONo
accessible within 24 hours
post impact of emergency/
First
ane Standard
disaster as evidenced by Any ofhe?
any
ofthe
following: following
or alike
logistics inventory/MOA documents:
on availability/access of -Training
commodities. Certificate
-Training
Health Ata minimum, the LGU may raabase son
Operations present a designated or BLS,
Center or converted area (may be
Emergenc s hared with DRRM) where a 3.Available and
Fi

Essential
i

eration. ORRM-H personnel and accessible commodities are

OP
equipment are available in essential health available suchas q yes
Center with
of
.
performing the functions emergency Anti-infectives,
CNo
functional the system on command commodities Anaigesics,
system onthe and control, coordination Antipyretics

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signat °f Date:*

Vatida ‘or Reporting Year: 2023

.

Page 6 of 10
 4Cs (Command and communication as Fiuids/Electrolytes
and Control, evidenced by the ,Respiratory
following: Drugs,
Communication, Dietary/Nutritional
Coordination) Products
1. Apolicy (or alike
document) establishing
an Incident Command
Any
of the alike
following or
System (ICS) documents:
2. Documentation of -Logistics
actual conduct of Inventory
meetings, -MOA on
documentation or alike availability and
document or
any formal access of
commodities
agreement or
arrangement through
MOA/MOU with Note:
DRRMC or partners in Refer to DM 2018-
or disaster
emergency
management
0430

3. Equipment or tools 4.Heaith Command and

utilized for Operations Control
communication in Center or 4.1 A policy O Yes
generating or Emergency establishing an D No
Operations Incident
disseminating data or Center with Command System
reports functional (ICS) that will be
system on the activated in an
Benchmark: Scoring System (external 4Cs (Command event of
and Control, emergency or
benchmark) Communication, disaster.
National Target: All = Green: With presence of 4 DRRM- Coordination)
LGUs have 4/4 H Components Coordination
O Yes
DRRM-H = Red: No DRRM-H component is 4.2 Any of the
following or alike O No
Components present or
with presence lessof documents:
than 4 DRRM-H components -documentation of
actual conduct of
Remarks (Write a short explanation for items answered “No”. meetings
-formal agreement
Record any implementation issues encountered): or arrangement
with DRRMC or
others partners in
emergency
disaster
or
management e.g.
MOA, MOU,
Policy

Coordination
4.3 Equipment or O Yes
tools utilized for O No
communication for
voice, print and
electronic
transmittal.

Remarks (Write a short expianation for

items answered “No”. Record any
implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer; Chief Executive:
Signature of Date::
Vatidator Reporting Year: 2023
.

Page 7 of 10
Indicator 8. Health promotion policies and programs Data Quality Assessment for Indicator 8.
implemented
*refers to health promotion policies and programs, as What to Request For?
identified by the DOH guided by AO No. 2021-0063 or “Health
Promotion Framework Strategy 2030”, that are issued and
1, Copy of local policy (Ordinance, EO,
resolution) adapting/ localizing the
implemented by the LGUs to promote health literacy and Maternal and child nutrition law/policy_in
healthy lifestyle. effect as of December 31, 2023
O Yes O No policy
Notes:
2. Copy of local policy (Ordinance, EO,
- Consider only local policies in effect as of December
31, 2023. resolution) adapting/ localizing the
- Policies intended to celebrate/commemorate related Community nutrition (Barangay/ Local
events or declare local holidays will NOT be Nutrition Program) law/policy in effect as
considered. of December 31, 2023
O Yes O No policy
3. Copy of local policy (Ordinance, EO,
tesolution) adapting/ localizing the
Mandatory Infant and Children Health
immunization law/policy in effect as of
List of identified health With local policy in effect December 31, 2023
promotion policies and as of December 31, 2023? 0 Yes O No policy
programs implemented Yes No 4. Copy of local policy on policy (Ordinance,
EO, resolution) adapting/ localizing the
1. Maternal and child nutrition Tobacco and vape use prevention and
control law/policy in effect as of December
31, 2023
2. Community nutrition
(Barangay/ Local Nutrition O Yes O01No
policy
Program) 5. Copy local
of policy (Ordinance, EO,
3. Mandatory Infant and resolution) adapting/ localizing the
Children Health Restricted access of minors to alcoholic
Immunization beverages law/policy_in effect as of
4. Tobacco and vape use December 31, 2023
prevention and control
0 Yes O No policy

5. Restricted access of minors

6. Copy
of local policy (Ordinance, EO,
resolution) adapting/ localizing the Hygiene
to alcoholic beverages and sanitation law/policy in effect as of
6. Hygiene and sanitation December 31, 2023
O Yes 0D No
policy
7. Mental health promotion 7. Copy of local policy (Ordinance, EO,
(Mental Health Law resolution) adapting/ localizing the Mental
8. Violence and injury health promotion (Mental Heaith Law)
law/policy_in effect as of December 31
prevention (Gender-based
2023
violence, violence against DO Yes
0 No policy
women, and violence
against children)
8. Copy of local policy (Ordinance, EO,
resolution) adapting/ localizing the
9. Empowerment mechanisms Violence and injury prevention (Gender-
for Barangay Health based violence, violence against women,
Workers and violence against children) law/policy in
effect as of December 31, 2023
O Yes ONo policy
9. Copy of local policy (Ordinance, EO,
resolution) adapting/ locatizing the
Empowerment mechanisms for
Barangay Health Workers law/policy in
effect as of December 31, 2023
0 Yes O1No policy

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
of Date:
pignature Reporting Year: 2023

Page 8 of 10
 Remarks (Write a short explanation for items answered “No”. Remarks (Write a short explanation for
Record any implementation issues encountered): items answered “No”. Record any
implementation issues encountered):

Indicator 10. Provision of FULL hazard pay, subsistence, and Data Quality Assessment for Indicator 10.
laundry allowances to permanent public health workers
(Physician, Public Health Nurse & Midwife) in accordance with Does the LGU provide full hazard pay,
RA 7305 (Magna Carta of Public Health Workers) subsistence, and laundry allowances its to
health workers (Physician, Nurse & Midwife)
*Does the LGU provide full hazard pay, subsistence, and laundry in accordance with RA 7305 (Magna Carta of
allowances to its
health workers (Physician, Nurse & Midwife) in Public Health Workers)?
accordance with RA 7305 (Magna Carta of Public Health
Workers)? Hazard Pay:
O Yes ONo
YES NO
Subsistence:
O Yes O No
Magna Carta Benefits YES NO
Provided to PHWs Laundry Allowance:
O Yes ONo
Hazard Pay

Subsistence
Remarks (Write a short explanation for
items answered Record any
“No”.
Laundry Allowance implementation issues encountered):

Note: An LGU must have provided all the three incentives (hazard
pay, subsistence, and laundry allowance) following the provisions
of RA 7305 (Magna Carta of Public Health Workers), computed
using the current salary to be able to answer YES. Otherwise, the
target is not met.

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date: Reporting Year: 2023
"
"

Validator
Page 9 of 10
 Certification Page
o

Part |. To be accomplished by the LGUs

LGU Name: Date Accomplished:

This is to certify that the data provided in the LGU Health Scorecard Data Capture Form are final and
correct to the best of our knowledge. We understand that the data we provided in the LGU Health Scorecard Data
Capture Form will be the basis in producing the LGU Health Report Card and performance results of Seal of Good
Local Governance — Health Compliance and Responsiveness Area.

SIGNED:

(Note: Affix your signature above printed name. Indicate your office & position opposite your name.)

LGU HSC Coordinator/Point Person

(Signature over Printed Name}

Local Health Officer/Officer-In-Charge

(Signature over Printed Name)

NOTED BY:

Local Chief Executive

(Signature over Printed Name)

Part If. To be accomplished by the DOH

This is
Capture Form,
to certify that the undersigned have reviewed the data provided in this LGU Health Scorecard Data
Remarks:

SIGNED:

(Note: Affix your signature above printed name.

Noted by:

Assigned DOH Representative

{Signature over Printed Name}

Page 10 of 10
 ANNEX C
Reporting Year: 2023
;

DEPARTMENT OF HEALTH
Bureau of Local Health Systems Development
Health Systems Monitoring and Evaluation Division
LGU
Health Scorecard
MUNICIPALITY/CC DATA CAPTURE FORM
GENERAL INFORMATION
Date Accomplished:

Region:

Province:

LGU Name:

Income Class:

Name of LCE:
Years in Position:
Health Governance Training: Yes ( ) No () If Yes, specify

Name of CHO/MHO/Designate:

Years in Position:
Health Governance Training: Yes ( ) No ()
If Yes, specify

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date:
Validator
Page 1 of 10
 INSTRUCTIONS
General:
1. Indicator number is
based on the numbering in the metadata
2. Data validation should be conducted prior to filling up this form
3. Don't leave any item blank

For Local Government Units:

1. Accomplish the portion labeled “This portion will be accomplished by LGU”
2. Fill-up the form with the required data (e.g., numerator, denominator). Round-off the final values into two
is
decimal points (e.g., xx.xx). In case an indicator not applicable to the LGU, please put N.A and write a brief
explanation in the remarks portion.
Countersign any erasures on the DCF
apo Write a short explanation for items answered “No” under remarks.
For all indicators with accomplishment rate of at least 20% higher than the target, or at least 20% lower
than the baseline values, mention in the remarks portion reason/s for not being able to attain the target or
decrease in
performance (This will allow the program to provide feedback fo the concerned program or
office
which in turn is expected to provide technical assistance and consider strategies to address issues during
planning). Include the sources of initiative/efforts, whether from DOH or LGU,
information shall be used to aid data analysis.
or both, as applicable. The

LGU report will be deemed official ONLY when submitted together with a signed certification page.
This is to establish accountability in the submission and review of LGU data reflected in this DCF.

/
For DOH CHDs/MOH-BARMM:
1. Accomplish the portion labeled “This portion will be accomplished by CHD Validator Validation
Team”.
2. Fill-up the form with the required data (e.g., numerator, denominator). Countersign any erasures on the
DQAT.
3. Forall indicators with accomplishment rate of at least 20% higher than the target, or at least 20% lower
than the baseline values, ensure that the corresponding explanation were recorded on the remarks section
of the DOAT
4. Write a short explanation for items answered “No” under remarks.
5. Record any implementation issues or best practices not initially reported in the DCF.
6. Ensure that both the MHO and the Budget/Accounting Officer affixed their signature on the submitted DCF.

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date: .

Validator Reporting Year:. 2023

Page 2 of 10
 THIS PORTION WILL BE ACCOMPLISHED BY LGU

Indicator 2. With Complete Local Investment Plan for Health Data Quality Assessment for Indicator 2.

*DM 2022-0459 requires LGUs to develop their respective health

plans based rational and realistic planning.
on Criteria/ Means of Result
Verification
With 2024 AOP endorsed to and received by the PHO: 1. Copy ofthe complete 0 Yes
Municipal/ CC 2024
AOP, AND
YES NO O No

Criteria for Province/HUC/ICC YES NO

2. 2. Endorsement from 0 Yes
the MHO/ CC Health
4. Copy
of the complete Municipal/ CC LIPH
and/or AOP, AND
Officer/ Mayor and
evidence of receipt by O No
2. Endorsement from the MHO/ CC Health the PHO on
or
before
Officer/ Mayor and evidence ofreceipt by
the PHO on or before December 31 of the
December 31, 2023

reporting year When was the AOP endorsed to and received

by the PHO?
When was the AOP endorsed to and received by the PHO?

Benchmark: Scoring System (external

benchmark)
2023 National Target: Green: With Copyof the
Municipality/Component complete Municipal/CC 2024 Remarks (Write a short explanation for
City has 2024 AOP that AOP, with endorsement from the items answered “No”. Record any
was endorsed to and MHO/ CC Health Officer/ Mayor implementation issues or best practices not
received by the PHO on or and evidence of receipt by the initially reported in the DCF):
before December 31, 2023 PHO on
2023
or before December 31,

Red: Absence of 2024 AOP

with 2024 AOP but was not
or
endorsed by the MHO/ CC Health
Officer/ Mayor and evidence of
receipt by the PHO on or before
December 31, 2023

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues or best practices not initially
reported in the DCF. Record any implementation issues
encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date:
Validator Reporting Year: 2023

Page 3 of 10
Indicator 3. Functional Local Health Board (LHB) Data Quality Assessment for Indicator 3.
* Refers to the extent wherein the LHB is able to meet the
minimum required members including civil society organization Criteria/ Means of Verification Result
(CSO) representative. It is also able to perform its mandated 1. EQ on LHB organization. O Yes
functions. This shail contain the
following among others:
With presence of 3/3 LHB Components: a. Members of the LHB in
compliance with RA 7160,
O No

RA 11223 and DILG MC

YES NO
2022-083
b. Functions and operations
Criteria/ Means of Verification YES NO c. Sources of funds
1. EO on LHB organization. This shall contain d. Committees created, as
the following among others: applicable
a. Members of the LHB in compliance with
RA 7160, RA 11223 and DILG MC 2022-
2. Received copy of LHB
resolution fo the Sanggunian
D Yes

083 proposing the annual health,

b. Functions and operations including minutes of O No
29
Sources of funds meeting/s
Committees created, as applicable 3. Received copy of at least 1 D Yes
2. Received copy of LHB resolution to the LHB
resolution per quarter
Sanggunian proposing the annual health
budget
recommending
to the
Sanggunian the passing of O No
3. Received copy of at least 1 LHB resolution ordinance/ resolution on
per quarter recommending to the matters pertaining to health
Sanggunian the passing of ordinance/ - With proof of meetings of
resolution on matters pertaining to health committees and
- With proof of meetings of committees consultation with
and consultation with community/ CSO community/ CSO
representatives outside the regular representatives outside
members of LHB resolutions received by
the Sanggunian recommending
the regular members of
LHB resolutions received

ordinance/ resolution on matters by the Sanggunian

pertaining to health recommending
ordinance/ resolution on
Benchmark: Scoring System (external matters pertaining to
health
benchmark)
National Target: All = Green: With presence of 3/3 LHB
LGUs have 3/3 LHB Components Remarks (Write a short explanation for
Components =
Red: No LHB component is present items answered “No”. Record any
or with presence
LHB
of less than 3 implementation issues or best practices not
initially reported in the DCF):
components

Remarks (Write a short explanation for

items answered “No”.
Record any implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date: .

Validator Reporting Year:. 2023

Page 4 of 10
Indicator 6. EMR utilization for digitalized service delivery at Data Quality Assessment for Indicator 6.

|
public primary care facilities.
What to Check Count how
For baseline data collection. LGUs will not be rated many RHU/
HC/ BHS have
the component
EMR Component Number of
Public 41. How many RHU/ HC.
PCF (RHUs/ HCs/
BHS) that
has the
BHS

EMR
have
system
a
functioning
in the
EMR component: RHU/ BHS/ BHS?
1. Presence of Electronic Medical 2. How many RHU/ HC/
Record in the Rural Health Units/ BHS
have the EMR
Health Centers/ Barangay Health used/ integrated on all
of the following work
Stations*
processes:
2. Digitalization of Work Process: All
a. Initial registration
9
facilities integrated EMR usage into b. Pulling up records
their daily workflow of delivering the c. Recording of
services: consultation
a. Initial registration d. Recording of
b. Pulling up records diagnostic
c. Recording of consultation examinations*
d. Recording of diagnostic (applicable to
examinations* (applicable to RHUs/HCs only)
3. How many RHU/ HC.
RHUs/HCs only) BHS generate FHSIS
3. Statistical Report Generation:
report through EMR?
FHSIS reports fully generated using
the EMR
Remarks (Write a short explanation for
items answered “No”. Record any
*List /Name the type of EMR present in the LGU: implementation issues encountered):

A. Number of public primary

care facilities (e.g. RHU, HC,
BHS) within the LGU that
HAS MET ALL THREE
CRITERIA of EMR
Utilization Xx 100 =
B. Total Number of public
primary care facilities (e.g.
RHU, HC, BHS) within the
LGU
Data

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date:
Validator Reporting Year: 2023

Page 5 of 10
Indicator 7. With institutionalized Disaster Risk Reduction and Data Quality Assessment for Indicator 7.
Management in
Health (DRRM-H) System
*Institutionalized DRRM-H system means the availability of ALL
four criteria.

YES NO
Criteria Means
of Result
Criteria Means of Verification Yes No Verification
(MOV) (MOV)
1. Approved, Approved, updated, 1.Approv 1.1 signed O Yes
updated, disseminated and tested ed, DRRN-H plan ONo
disseminated Plan evidenced by the updated,
DRRM-H Plan and its dissemin 1.2 endorsement to
O Yes
tested
and
Disaster Risk
endorsement to
the local
chief executive or health
ated and
tested
local chiefexecutive
or health council 0 No
Reduction and council, Revision log for Disaster (Health/ DRRM
Management in updatedness. Signed Risk
Reductio
Budget Review)
Health (DRRM- documentation that the
nand 1.8 Signed
;

H) Plan plan was disseminated

documentation of
_

and signed Manage O Yes

documentation of testing ment in activity conducted DNo
of the plan. Health
(DRRMH
and circulated, OR
other supporting
2. Organized and Organized and trained
) Plan
trained Health Health and Emergency spouments on
and Emergency Response Teams (HERTs)
Response on minimum required 1.4 The plan being
Teams (HERTS) training: Basic Life Support annually tested by
on minimum (BLS) and Standard First drills, table top,
0 Yes
required Aid (SFA)
program CNo
training: Basic implementation
Life Support corresponding it

(BLS) and documentation:

Standard First
.
signed
Aid (SFA) documentation of
3. Available and Refers to available activity conducted
accessible essential health 2. Organized 2.1 Any of the O Yes
essential health emergency commodities and trained following or alike ONo
such as Anti-infectives, Health documents:
emergency Emergency -Official Personnel
ye Analgesics, Antipyretics
commodities Response Order
Fluids/Electrolytes,
Respiratory Drugs, Dietary/ Team on -Local Ordinance
Nutritional Products that
accessible within 24 hours
is minimum
required
-Executive Order

post impact of emergency/ trainings: 2.2 Ail HERT DO Yes

disaster as evidenced by
any of the following:
Basic Life
Support and
members have
Basic Life Support
No
logistics inventory/MOA Standard and Standard First
on availability/access of First Aid Aid Training
commodities. Any
of the following
or alike documents:
4. Health
Operations
At a minimum, the LGU
may present a
designated
Crain
- pore
Official IDs on BLS
i
Center or converted area (may be
or
Emergency SORRMH perconnel nee 3.Available Essential
Operations
Center with
equipment are available
performing the functions of
in and
accessible
commodities are
available such as O Yes
functional the system on command essential Anti-infectives, ONo
system onthe and control, coordination health Analgesics,
4€s (Command and communication as emergency Antipyretics
evidenced by the commodities Fluids/Electrolytes,
and Control,
following: Respiratory Drugs,
Signature of Local Date: Signature of Local Date:
Health Officer: Chief Executive:
of Date:
signature Reporting Year: 2023

Page 6 of 10
 Communication, Dietary/Nutritional
Coordination) A policy {or alike Products
document)
establishing an Any
of the following
Incident Command or alike documents:
System (ICS) -Logistics Inventory
Documentation of -MOA on availability
actual conduct of and access of
meetings, commodities
documentation or alike
document or any
formal agreement or Note:
arrangement through Refer to DM 2018-
MOA/MOU with 0430
DRRMC
or partners in
emergency or disaster 4,Health Command and
management Operations Control
Equipment or tools Center or 4.1 A policy O Yes
utilized for Emergency establishing an C1 No
communication in Operations Incident Command
generating or Center with System (ICS) that
disseminating data or
reports
functional
system on
will be activated
an event of
in
the 4Cs emergency or
Benchmark: (Command disaster.
Scoring System (external and Control,
benchmark) Communicati Coordination
National Target: All ®
Green: With presence of 4 DRRM- on,
Coordination
4.2 Any
of the
following or alike O Yes
LGUs have 4/4 H Components
documents: O No
DRRM-H = Red: No DRRM-H component is )
-documentation of
Components present or
with presence of less actual conduct of
than 4 DRRM-H components meetings
-formal agreement
or arrangement with
Remarks (Write a short explanation for items answered “No”. DRRMC or others
Record any implementation issues encountered): partners in
emergency or
disaster
management e.g.
MOA, MOU, Policy
Coordination
4.3 Equipment or
tools utilized for
communication for O Yes
voice, print and ONo
electronic
transmittal.

Remarks (Write a short explanation for

items answered “No”. Record any
implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date:
Reporting Year: 2023
”
"

Validator
Page 7 of 10
of
as
Indicator 8. Health promotion policies and programs Data Quality Assessment for Indicator 8.
implemented
*tefers to health promotion policies and programs, as What to Request For?
identified by the DOH guided by AO No. 2021-0063 “Health
Promotion Framework Strategy 2030", that are issued and
or 1. Copy
of local policy (Ordinance, EO,
resolution) adapting/ localizing the
implemented by the LGUs to promote health literacy and Maternal and child nutrition law/policy in
healthy lifestyle. effect as of December 31, 2023
OC Yes
ONo policy
Notes:
of local policy (Ordinance, EO,
.
2.
=

Copy
- Consider only local policies in effect as of December
31, 2023. resolution) adapting/ localizing the
- Policies intended to celebrate/commemorate related Community nutrition (Barangay/ Local
events or declare local holidays will NOT be Nutrition Program) law/policy in
of December 31, 2023
as effect
considered.
0 Yes 0 No policy
List of identified health
. ee
With local policy
effect
in 3.
Copy of
resolution) edoeti (Ordinance, EO,
adapting/ localizing the

programmeimplemented as of December 31, Mandatory Infant and Children Health

Yes
20237
No
Immunization law/policy in
December 31, 2023
effect
O Yes 0 No policy
1. Maternal and child nutrition 4, Copy oflocal policy on policy (Ordinance,
EO, resolution) adapting/ localizing the
- — Tobacco and vape use prevention and
(Barenguy’ Local Mutation control law/policy in effect as of December
31, 2023
Program) O Yes ONo policy
3. Mandatory Infant and 5. Copy of local
policy (Ordinance, EO,
Children Health resolution) adapting/ localizing the

4.
Immunization
Tobacco and vape use
Restricted access of
minors to
alcoholic
beverages law/policy in effect as of
prevention and control December 31, 2023
5. Restricted access of O Yes O1No policy
to
minors alcoholic 6. Copy of local
policy (Ordinance, EO,
resolution) adapting/ localizing the Hygiene
beverages
6. Hygiene and sanitation and sanitation law/policy in effect as of
December 31, 2023
DOYes O No policy
7. Mental health promotion
7

(Mental Health Law

7. Copy
oflocal policy (Ordinance, EO,
resolution) adapting/ localizing the Mental
8. Violence and injury health promotion (Mental Health Law)
prevention (Gender-based law/policy in effect as of December 31
violence, violence against 2023
women, and violence O Yes ONo policy
against children) 8. Copy
oflocal policy (Ordinance, EO,
9, Empowerment resolution) adapting/ localizing the
Violence and injury prevention (Gender-
mechanisms for Barangay
based violence, violence against women,
Health Workers
and violence against children) law/policy in
effect as of December 31, 2023
0 Yes O No policy
9. Copy
oflocal policy (Ordinance, EO,
resolution) adapting/ localizing the
Empowerment mechanisms for
Barangay Health Workers faw/policy in
effect as of December 31, 2023
O Yes U1 No
policy

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
of Date:
gmature Reporting Year: 2023

Page 8 of 10
 '
Reporting Year: 2023

Remarks (Write a short explanation for items answered “No”. Remarks (Write a short explanation for
Record any implementation issues encountered): items answered “No”. Record any
implementation issues encountered):

Indicator 10. Provision of FULL hazard pay, subsistence, and Data Quality Assessment for Indicator 10.
laundry allowances to permanent public health workers
(Physician, Public Health Nurse & Midwife) in accordance with Does the LGU provide full hazard pay,
RA 7305 (Magna Carta of Public Health Workers) subsistence, and laundry allowances to its
health workers (Physician, Nurse & Midwife)
*Does the LGU provide full hazard pay, subsistence, and laundry in accordance with RA 7305 (Magna Carta of
allowances to
its health workers (Physician, Nurse & Midwife) in Public Health Workers)?
accordance with RA 7305 (Magna Carta of Public Health
Workers)? Hazard Pay:
O Yes 01 No

YES NO
Subsistence:
0 Yes O No
Magna Carta Benefits YES NO
Provided to PHWs Laundry Allowance:
O Yes O No
Hazard Pay

Subsistence
Remarks (Write a short explanation
for items answered “No”. Record any
Laundry Allowance implemeniation issues encountered):

Note: An LGU must have provided all the three incentives (hazard
pay, subsistence, and laundry allowance) following the provisions
of RA 7305 (Magna Carta of Public Health Workers), computed
using the current salary to be able to answer YES. Otherwise, the
target is not met.

Remarks (Write a short explanation for items answered “No”.

Record any implementation issues encountered):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Date:
Reporting Year:. 2023
i

Validator
Page 9 of 10
 Part |. To be accomplished by the LGUs

LGU Name: Date Accomplished:

This is to certify that the data provided in the LGU Health Scorecard Data Capture Form are final and
correct to the best of our knowledge. We understand that the data we provided in the LGU Health Scorecard Data
Capture Form will be the basis in producing the LGU Health Report Card and performance results of Seal of Good
Local Governance — Health Compliance and Responsiveness Area.

SIGNED:

(Note: Affix your signature above printed name. Indicate your office &position opposite your name.)

LGU HSC Coordinator/Point Person

(Signature over Printed Name)

Local Health Officer/Officer-In-Charge

(Signature over Printed Name)

NOTED BY:

Local Chief Executive

(Signature over Printed Name}

Part ll, To be accomplished by the DOH

This is to certify that the undersigned have reviewed the data provided in this LGU Health Scorecard Data
Capture Form.

Remarks:

VALIDATED BY:
(Note: Affix your signature above printed name}

Assigned DOH Representative

(Signature over Printed Name}

Page 10 of 10
—
aed)
100,
Annex D

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DOUEAOP concares devepthelr 2075-2025 LPH
{slened) by the CHO respective health [concurred by the CHD}
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 ANNEX E

Cee GUL
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Date:
Region Validating:

Validation Team:
Designation Signature
4 ce

|
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20|

10.
*TL- Team Leader

Region Validated:
LGU Name:

Team Validated:
Designation Signature
4 rr
1.

2.
3.
4.
5.
6.
7.
8.
9
10.
*TL- Team Leader

Page 1 of 2
 Discussion Areas
Topic Issue(s)/Observation(s) Suggestion(s)
Data Collection 1. 1.
2. 2.
3. 3.

Data Validation 1. 1
2. 2.
3. 3.

Data Analysis and 1. 1.

Interpretation 2. 2.
3. 3.

Report Utilization and 1. 1.

Dissemination 2. 2.
3. 3.

Overall Implementation 1. 1.

Process 2. 2.
3. 3.

LGU HSC Tools 1. 1.

2. 2.
3. 3.

LGU HSC Web-Based 1. 1.

System 2. 2.
3. 3.

Good Practices
<short narrative ~300 words >

<short narrative ~300 words >

<short narrative ~300 words >

Page 2 of 2