BHLMP Form 1.b.

Barangay Health System Development Six Building Block Indicators

Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Aktibo at (1) May Barangay Ordinance sa pagpapatibay ng
kumikilos na kasalukuyang Barangay Health Governance Body (BHGB)* o
Barangay resolusyon sa pagtatatag ng Barangay Health Board (BHB) Copy of the policy
Health kung saan nasasaad ang mga tungkulin at responsibilidad
Governance ng Board at ng bawat miyembro.
Body o
Barangay (2) Ang Barangay Health Governance Body (BGB)* o BHB ay
Health Board binubuo ng mga sumusunod:
a. Barangay Captain
b. Barangay Secretary
c. Barangay Treasurer
Health d. Midwife
RED - 0-3/7
Leadership e. Kagawad on Health
YELLOW - 4-6/7
and f. Barangay Nutrition Scholar Copy of policy stating the
GREEN - 7/7
Governance g. Brgy. Day Care worker (kung naangkop) members if the BHGB/BHB
h. SK Chairman
i. BHW President
j. 4Ps Parent Leader Representative
k. IP Leader (kung naangkop)
l. School Principal (kung naangkop)
m. AdHoc Member as sectoral representation (kung
naangkop)
(3) Ang BGB o BHB ay dapat may pagpupulong na hindi Copy of
bababa sa isang beses (o higit pa kung kailangan) sa loob ng minutes/proceedings of
tatlong buwan at ang mga pagpupulong na ito ay the BHB meetings

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 1 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
dokumentado kung saan nasasaad ang mga napag sang
ayunan na susunod na mga hakbang.
Copy of
(4) Inilalatag ni Brgy. Kapitan ang mga isyu sa
minutes/proceedings of
pangkalusugan ng barangay sa buwanang pagtitipon ng ABC
the ABC meeting / Key
(Association of Barangay Captains) informant interview
Copy of
(5) Nagbibigay ng accomplishment report si at inilalatag ni minutes/proceedings of
Midwife ang mga isyu sa pangkalusugan ng barangay sa the RHU staff meeting
buwanang pagtitipon ng mga RHU staff at/o sa PIRs kasama and/or PIR where the
si MHO issues were raised / Key
informant interview
(6) Sa loob ng isang taon, merong nailatag na isa o mahigit
pa na BHGB or BHB Resolution sa Sangguniang Barangay na
naging basehan upang magkaroon ng Barangay Ordinance
Copy of the policy
ukol sa pagpapatibay ng Barangay Health System o ano
mang polisiya sa kalusugan na pinagtibay ng Sangguniang
Barangay
(7) Pagtatasa o pagsusuri ng health system performance ng
Copy of assessment and
barangay gamit ang BHLMP roadmap at pagsumite ng
updated roadmaps
nasabing roadmap sa munisipyo
Barangay RED - 0-2/5
(1) Pagkakaroon ng aprobadong Barangay Development Copy of the approved
Development YELLOW - 3-4/5
Plan development plan
Plan (na may GREEN - 5/5

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 2 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Health (2) Dapat nasasaad sa Barangay Investment Plan ang mga
Component) prayoridad na pangangailangang pangkalusugan at mga Copy of the approved
development plan and
hakbang kung paano ito malulutas. Ang mga
minutes/ activity reports
pangangailangang pangkalusugan na nakasaad ay dapat of community
ring nakuha sa mga nagawang konsultasyon sa komunidad consultations done
(e.g. Brgy. Assemblies).
Minutes/documentation
(3) Nagsagawa ng Annual Brgy. Investment Planning
of the Annual Brgy.
kasama ang Barangay Development Council Development Planning
Copy of the
(4) Naipapatupad ang Barangay Development Plan accomplishment/activity
reports
Certificate of attendance /
(5) Pagdalo ng representative ng barangay sa konsultasyon attendance sheet and or
ng munisipyo para pagplaplano o pagbuo ng MIPH activity report from the
mLGU
List of identified
(1) May listahan ng mga kasalukuyang mga leaders sa community leaders and
komunidad their represented
organization/group
Mga aktibidad RED - 0-1/4 Copy of the certificate of
(2) Tiyakin na ang mga naangkop na community leaders ay
na kasama ang YELLOW - 2-3/4 training / training
nabigyang kapasidad sa pag-oorganisa ng komunidad o
Komunidad GREEN - 4/4 attendance sheets /
community organizing training activity reports
(3) Tiyakin na ang mga miyembro ng komunidad ay may
Copy of implementation
mga tungkuling itinalaga sa pagpapatupad at pagsubaybay
plan
ng mga programang pang kalusugan sa barangay

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 3 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(4) Pagsagawa ng hindi bababa sa dalawang barangay
assemblies at/o public hearings para for report/feedback
Copy of activity report
local health data status of health programs, health issues,
policies, etc.
Hindi bababa sa 5% ng Brgy. Budget ang inilaan para sa
Alokasyon ng RED - 0-0.9%
Health Copy of approved and
Bugdet para sa YELLOW - 1-4%
Formula: signed Brgy. Budget
Health ng BLGU GREEN - 5%
(Brgy. Health Budget ÷ Total Brgy. Budget) x 100%
Copy of signed brgy
Paggamit ng Hindi bababa sa 95% ng Brgy. Health Budget ang nagamit RED - <70%
financial utilization report
Health Bugdet para sa Formula: (Brgy. Health Expenditure ÷ Brgy. Health Budget) YELLOW - 70-94%
/ Copy of DILG budget
Financing Health ng BLGU x 100% GREEN - 95-100% utilization forms
(1) Mayroong listahan ng mga maralitang pamilya sa
PhilHealth
barangay RED – 0/2
Coverage para Copy of list with receiving
(2) Pagsumite ng listahan ng mga maralitang pamilya sa YELLOW – 1/2
sa mga signature of the MSWDO
GREEN – 2/2
mahihirap munisipyo bilang pagrerekomenda para sa indigent
certification ng PhilHealth
Sapat na Sapat na Brgy. Health Workers gamit ang HR to population ratio na: RED - 0/2
Barangay List of existing human
(1) 1 BHW= 20 Households o Kabahayan YELLOW - 1/2
Health Human resource
Health (2) 1 BNS= 1 Barangay GREEN - 2/2
Resource
Human
Pagsasanay ng Ang mga kailangang pag-unlad ng kawani ay natugunan: Copy of Certificates of
Resource RED - 0-1/
mga Barangay (1) Lahat (100%) ng mga BHWs ay nakakuha na ng Basic training; List of trained
YELLOW - 2-4/5
Human BHW Training staff, date of training, type
GREEN - 5/5 of training
Resource (2) Ang BNS ay nakakuha na ng Basic BNS Training

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 4 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Copy of training needs
(3) Lahat ng mga naangkop at lumalabas na bagong
assessment forms/report /
pagsasanay na pangangailangan (hal. Continuing
List of training need per
Professional Education) ng mga BHWs at BNS ay natutukoy staff
(4) Lahat ng mga naangkop at lumalabas na bagong Copy of communication
pagsasanay na pangangailangan (hal. Continuing document that shows the
Professional Education) ng mga BHWs at BNS ay naiulat sa midwife coordinated the
MHO sa pamamagitan ni Midwife training needs to MHO
(5) Ang mga sharing sessions ng mga BHWs ukol sa health
Copy of activity report/
education at preventive medicine ay naisasagawa sa
attendance sheet
kanilang mga nakatakdang kabahayan o households
(1) May naipasang polisiya ukol sa BHW registration and
Copy of the policy
accreditation
(2) Paggaya at pagsunod sa sistema at pamamaraan ng
munisipyo sa pangangalap at pagpapanatili ng BHWs sa
Copy of the policy
Pangangalap, pamamagitan ng pagpasa ng barangay administrative
Pagrerehistro at issuance ukol dito
RED - 0-1/
Pagpapanatili (3) Ang sistema at pamamaraan sa pangangalap at
YELLOW - 2-4/5 Key informant interview
ng mga pagpapanatili ng BHWs ay naipapatupad
GREEN - 5/5
Barangay Copy of accreditation and
Health Workers (4) Lahat ng accredited BHWs ay aktibo activity reports/ data
reports per BHW
Copy of proceedings/
(5) Lahat ng BHW na napaalis o natanggal sa serbisyo ay document of the dismissal
dumaan sa patas at angkop na proseso o due process case / Key informant
interview

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 5 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Mga polisiya sa (1) Pagkakaroon ng Barangay Resolution sa pagapruba ng
angkop at pamamaraan at iskedyul ng pagbibigay ng BHW and BNS Copy of the policy
tamang oras na honorarium RED - 0/2
pagbibigay ng
YELLOW - 1/2
mga (2) Ang buong honoraria ng mga BHW and BNS ay GREEN - 2/2
honorarium ng naibibigay sa tamang oras na naaayon sa naipasang Key informant interview
mga BHWs and resolusyon ng LHB o Brgy. Council
BNS
Madaling (1) Ang pagkuha/pagbili ng supplies at essential medicines ay Copy of mortality and
base sa morbidity at mortality data ng barangay morbidity reports
makuha na
(2) Ang mga natukoy na essential medicines ay maaring makuha RED - 0-1/3
Access to Gamot at
sa barangay health facility tuwing operating hours nito. YELLOW - 2/3 Copy of inventory records
Medicine Supplies sa
GREEN - 3/3
Barangay (3) Mayroong buwanang physical count ng essential medicine at
Health Facility* supplies Copy of inventory records

Copy of patient health

(1) Pagkakaroon ng patient health records sa mga BHS
records
Gumagana na (2) Ang mga performance ng Barangay base sa Health data
at mga problemang kakabit nito ay naiiulat kada buwan sa RED - 0-1/3 Copy of
Health minutes/proceedings of
barangay health governance body o barangay health board YELLOW - 2/3
Health Information the meeting
para matugunan GREEN - 3/3
Information System
System (3) Pagkakaroon ng buwanang updated barangay health
Site visit
data board
Sistema sa Ang barangay ay may sistema para sa pagtatala ng mga RED - 0-5/10
pagrerehistro pasyente/kliyente ng mga sumusunod na serbisyo: YELLOW - 6-9/10 Registry System
ng pasyente (1) Maternal Health Services GREEN - 10/10

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 6 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(2) EPI
(3) Under-five Nutrition
(4) TB Control
(5) Notifiable/Communicable/Emerging Diseases (e.g.
Leprosy, etc. except HIV due to confidentiality)
(6) Non-Com Diseases
(7) Drugs and Substance Abuse
(8) Mental Health
(9) Persons with Disabilities
(10) Injuries
Copy of health data forms
(1) Nasa oras na pagsumite ng buwanang health data (e.g.
submitted with stamp on
M1) ng barangay sa RHU/PHN/MHO receiving copy
Copy of health data forms
(2) Nasa oras na pagsumite ng barangay quarterly health
submitted with stamp on
data (e.g. Q1) sa RHU/PHN/MHO receiving copy
Paguulat at RED - 0-1/4
(3) May bagong listahan ng mga pangunahing sanhi ng
paggamit ng YELLOW - 2-3/4
morbidity at mortality at konsultasyon sa barangay kada Copy of list
mga Data GREEN - 4/4
taon
(4) Mayroon sistema sa pagsubaybay sa mga buntis at Check for a pregancy
kayang matukoy kung sino-sino ang: tracking system / List of
- nasa early risk detection, action and referral pregnant women
- kabilang sa teenage pregnancies disaggregaed by each
- mayroong Philhealth membership category

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 7 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Buwanang pag-uulat ng maternal, infant and neonatal
Mortality RED: walang buwanang ulat
deaths gamit ang Maternal and Neonatal Death Report Copy of death reports
Report GREEN: may buwanang ulat
system c/o Midwife
Ang mga sumusunod na data ng Social Determinants of health na
galing sa munisipyo ay na-validate ng barangay kada taon:
(1) Male and female age groups
(2) Population and residential density of barangay
(3) Current labor force and employment including income
Data sa Social class RED - 0-3/7
Copy of data forms
Determinants YELLOW - 4-5/7
submitted
of Health (4) Population, religious affiliation and indigenous people GREEN - 6-7/7

(5) Elementary and secondary school participation and

completion rates
(6) Housing facilities and utilities situation
(7) Hazard mapping
Ang mga updated profiles o listahan ng sumusunod na vulnerable
populations ay nasusumite sa munisipyo sa tamang oras:
(1) Pregnant and lactating women (quarterly)
Profiling ng mga (2) Under-five children (annual) RED - 0-3
Vulnerable (3) PWDs (annual) YELLOW - 4-5 Copy of list/profiles
Population (4) Elderly (annual) GREEN - 6-8
(5) Out of school youth (annual)
(6) Households in disaster-prone area (annual)
(7) Households with IPs*, if applicable (annual)

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 8 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(8) Households in remote areas or GIDA*, if applicable
(annual)
Early Warning Site visit / Copy of Manual
(1) May naitatag na early warning system sa barangay RED - 0/2
System para sa of Operations
YELLOW - 1/2
Emergencies o (2) Ang barangay ay may mekanismo para maikalat ang Site visit / Copy of Manual
GREEN - 2/2 of Operations
Sakuna mga impormasyon na nanggagaling sa early warning system
(1) Lahat (100%) ng mga BHWs ay nagsasagawa ng home Copy of activity reports /
vistits at, kung kailangan, i-refer ang mga pasyenteng attendance sheets /
nangangailangan ng mas mataas na antas ng pangangalaga feedback forms
(2) Ang Barangay nutrition scholar (BNS) ay nagsasagawa ng
RED - 0-1/3
Barangay health buwanang operation timbang at pagsubaybay sa mga
YELLOW - 2/3 Copy of OTP records
service delivery batang may edad na 0-24 months at mga batang
GREEN - 3/3
malnourished na may edad 0-59 months old
Health (3) Hindi bababa sa isang beses isang linggo na pagbisita ng
Copy of communication
Service nurse or RHM para magbigay ng health services sa
document/ records
Delivery barangay na may koordinasyon sa BHB
(1) May nakapaskil na BHS citizen's charter na nasa lokal na Site visit/ Presence of a
dayalekto Citizen's Charter
(2) Pagsasagawa ng konsultasyon sa komunidad sa paggawa RED - 0-3/7
Patient- ng patnubay o protocols sa pagbibigay ng health services sa Copy of activity reports
YELLOW - 4-6/7
centered care barangay GREEN - 7/7
(3) Pagkakaroon ng patnubay sa BHS sa pag obserba ng mga Copy of protocols/
karapatan ng pasyente guidelines

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 9 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(4) Pagsasagawa ng gender-sensitivity assessment para sa
Copy of accomplished
BHS (gamitin ang USAID tool para ma-assess ang gender
assessment tool
sensitivity ng isang health facility)
(5) Pagsasagawa ng mga pamamaraan para malutas ang Copy of strategies/ activity
mga kakulangan sa pagiging gender-sensitivity ng BHS reports
(6) Pagsasagawa ng mga pamamaraan para mapataas ang
pag-access sa mga serbisyong pangkalusugan ng mga Copy of strategies/ activity
mamamayan sa GIDA, IP communites, at iba pang sektor ng reports
lipunan
(7) Kung Doktor ang nasa BHS, pinagbibigy alam sa mga
pasyente ng BHS ang lahat tungkol sa kanilang kondisyong
medical na may kasamang diagnosis/ prognosis, mga Key informant interview/
treatment options, peligro at komplikasyon na maaaring Focus Group discussion /
mangyari. Sila ay binibigyan rin ng karapatang tumanggap o Patient records indicating
tumanggi sa ano mang procedure/medication, investigation the consultations done
o treatment at bibigyan ring kaalaman kung ano ang mga
maaaring maging resulta ng pawing desisyon.
Feedback (1) Ang BHS ay may satisfaction/feedback mechanism para
Copy of feedbacks
mechanism ng sa mga pasyente at kliyente RED - 0/2
mga pasyente YELLOW - 1/2 Copy of BHB minutes
(2) Ang mga feedbacks na nakuha sa mga pasyente ay
at kliyente ng GREEN - 2/2 indicating the agenda
kasama sa BHB agenda
BHS discussed
Gumaganang (1) Ang barangay ay mayroong isang health station/center o
Site visit
Health Facilities kaya naman ay sila ay kasama sa isang catchment area

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 10 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(2) Ang barangay health station/center ay bukas para sa
mga out-patient services (8 hours, 5 times a week) at
tuwing may emergency, disaster, at birthing services* (24
hours, 7 times a week)

 Ito ay may fully functional health equipment at supplies

(thermometer, BP Apparatus, weighing scale)
 May Midwife na naka assign sa health facility (na may hindi
Site visit
bababa sa isang beses sa isang linggo na pagbibigay ng
serbisyo at on call kapag may mga sakuna)
 May BHW/BNS/RHMPP/NDP na naka-duty tuwing oras ng
serbisyo at on call kapag may sakuna RED - 0-1/3
 May kuryente YELLOW - 2/3
 May supply ng tubig GREEN - 3/3
*emergency and birthing services applicable only to GIDA
barangays
(3) Ang Barangay Health Station/ Center ay nagbibigay ng
mga sumusunod sa serbisyo:
1. Pre-Natal
Site visit / Key informant
2. Postnatal
Interview / Focus Group
3. Family Planning
Discussion/ Patients
4. EPI Records
5. IMCI
6. IYCF
7. General Consultation (as needed)

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 11 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(1) May sasakyan na nakatalaga bilang Emergency
transport vehicle* sa barangay na available 24/7 Site visit / Key informant
Interview / Focus Group
*Transportation expenses e.g. fuel, driver, etc. should not be Discussion
shouldered by the indigent patients
(2) Mayroong madaling mapupuntahan na waiting home/
halfway house para sa mga nasasakupan ng barangay (if
Site visit / Key informant
applicable especially if GIDA barangay).
Interview / Focus Group
Discussion
**Ang halfway house ay pwedeng wala sa sariling
Naitatag ang barangay RED - 0-3/7
Gatekeeping at YELLOW - 4-5/7
Referral System (3) Ang mga kabahayan ay napagbigyang alam kung nasaan GREEN - 6-7/7
Key informant Interview /
ang mga referral facilities at blood facilities na pwedeng
Focus Group Discussion
gamitin ng mga nasasakupan ng barangay

(4) Mayroong two-way referral system sa pagitan ng

Copy of agreement/
barangay at RHU para masigurado ang tamang
referral protocol
koordinasyon sa pagdala sa mga pasyente

(5) Palawakin ang gatekeeping at referral mechanism sa

List of first contacts per
pamamagitan ng pagaalam kung sino ang first contact of
family
care sa bawat pamilya

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 12 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
(6) Bigyang kaalaman ang mga first contacts tungkol sa
Copy of the orientation
service delivery path at siguraduhing sila ay makakasama sa
activity report
gatekeeping
(7) Pagkakaroon o pagpapaskil ng facility map at service
Site visit
delivery map sa Barangay Hall
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
1)Maternal and Newborn Health (3)
a) Birth preparedness plan and referral
b) Nutrition promotion and assessment
c) Mothers class/Family development session
2) Child health (2)
a) Growth monitoring
Health b) Promotion of infant and young child feeding RED - 0-5/10 Copy of patients records
Promotion 3) Family Planning (3) YELLOW - 6-9/10 and promotional and IEC
Services a) Health education on family planning GREEN - 10/10 materials
b) FP counselling
c) Provision of FP commodities
4) ASRH (2)
a) IEC on ASRH, HIV, STI, Gender-based Violence (GBV)
b) Counselling on prevention of teenage pregnancy
5) Oral Health (1)
a) IEC on oral health

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 13 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
6) Communicable Disease (3)
a) IEC on Cough Manners
b) IEC on Hand Hygiene/ Proper Hand Washing
c) IEC on Local Wound Care for Animal Bite Victims
7) Lifestyle-related or Non-Communicable Disease (2)
a) Presence of healthy lifestyle programs
b) IEC of the healthy lifestyle programs
8) Environmental Health and Sanitation (4)
a) Promotion of water and air quality and food safety
b) Promotion of vector control and waste management
c) Presence of road signage
d) Presence of road safety policies
9) Mental Health (1)
a) Promotion of awareness on mental health
10) Blood Donation (1)
a) Promotion of bloodletting activities
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
Disease 1) Maternal and Newborn Health (3-4) RED - 0-3/8
Prevention and a) Pregnancy Tracking YELLOW - 4-6/8 Copy of patients' records
Control Services b) Antenatal/Prenatal care GREEN - 7-8/8
c) Post-partum Care
d) Safe labor and delivery (if birthing facility)

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 14 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
2) Child health (2)
a) EPI
b) Injury prevention
3) Communicable Disease (3)
a) Active case finding and reporting for TB
b) Active case finding and reporting of other notifiable
diseases
c) Skin Disease Screening
4) Lifestyle-related or Non-Communicable Disease (1)
a) Routine screening for risk factor identification
5) Environmental Health and Sanitation (3)
a) Presence of vector control and waste management
b) Coordination with the MHO/RHU on the testing of water
source (safe water)
c) Coordination with the MHO/CHO/PHO on the zero open
defecation program/ provision of toilets
6) Mental Health (1)
a) Referral of identified cases to RHU
7) Drug and Substance Abuse (2)
a) IEC on Drug Substance Abuse
b) Profiling of identified patients (if applicable) and Referral
of identified cases to RHU
8) Senior Citizens (1)
a) Immunization

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 15 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification
Ang mga sumusunod na serbisyo sa bawat programa ay dapat
naibibigay:
1) Maternal and Newborn Health (2-3)
a) Referral to RHU
b) BEmONC services, if applicable
c) Administration of lifesaving drugs for Midwives (AO
2010-0014)
2) Child health (3)
a) CIMCI and IMCI
b) Provision of micronutrient supplements
c) Referral to RHU
3) ASRH (1) RED - 0-3/8 Copy of patients' records /
Curative Service a) Referral to RHU YELLOW - 4-6/8 accomplished referral
4) Oral Health (1) GREEN - 7-8/8 forms
a) Referral to RHU
5) Communicable Disease (2)
a) Coordinate with TB-DOTS facility
b) Referral to RHU/ appropriate health facility
6) Lifestyle-related or Non-Communicable Disease (3)
a) Treatment for Hypertension
b) Treatment for Diabetes
c) Referral to RHU/ appropriate health facility
7) Mental Health (1)
a) Referral to RHU/ appropriate health facility
8) Drug and Substance Abuse (1)
a) Referral to RHU/ appropriate health facility

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 16 of 17
Name of Barangay: Name of Barangay Captain:
Municipality / City: Name of Assigned Midwife:
Province & Region: Name of DOH Representative:
Date Accomplished:
BHLMP FORM 1B: BARANGAY HEALTH SYSTEM DEVELOPMENT SIX BUILDING BLOCK INDICATORS
Major Block Sub-Blocks Indicators √ OR X Standard of Performance Means of Verification

Ang mga sumusunod na serbisyo sa bawat programa ay dapat naibibigay:

1)Lifestyle-related or Non-Communicable Disease (4)

a) Monitor post stroke rehabilitation
b) Home visits for blood pressure monitoring,
c) Home visits for blood sugar monitoring
d) Home visits for monitoring of maintenance drugs intake RED - 0-1/4 Copy of patients' records /
Rehabilitative
YELLOW - 2-3/4 accomplished referral
Services 2) Health for persons with physical disability (1)
GREEN - 4/4 forms
a) Community based rehab or referral to RHU
3) Mental Health (1)
a) Monitoring of treatment process of mental health
patients
4)Drug and Substance Abuse (1)
a) Referral to RHU

ZFF BHLMP Form 1.b. Barangay Health System Development Six Building Block Indicators |Page 17 of 17