QPMC Liph 2019

Annex F. LIPH Form 2.
COST ASSUMPTIONS BY PILLAR, PPAS, RESOURCE REQUIREME
REGION: _____________
PROVINCE/HUC/ICC: _____________
LIPH CY: 2020 to 2022
Strategic Pillar:
SERVICE DELIVERY Municipality/
Name of Health
PPA Performance Indicator District Component
Program/Project/ Facility
(2) (3) City/Barangay
(5)
Activities (PPA) (4)
(1)
A. Major PPA1 -
FACILITY DEVELEPMENT AND

ENHANCEMENT PROGRAM
Goal: To upgrade hospital service capability from Level I to Level II Category with 200 Autho
1. Inpatient Management and Treatment QPMC
a. Procurement of addtional beds to

100% Bed Occupancy Rate
complete 175-200 beds
Replace worn out ICU Beds
95% of patients are given

b. Procurement of equipment for approprite treament in the
Wards , Special Areas-OR/DR, ICU OR/DR including ICU and
NICU
Page 1 of 69
Strategic Pillar:
Name of Health
(5)
(1)
Page 2 of 69
Strategic Pillar:
Name of Health
(5)
(1)
52,870,000.00
c. Relocation of NBS&NBHSF on the

100% of newborns are
2nd Floor - New Building, Procurment
screened
of NBS Kits
>Procurement of Newborn Hearing

Euipment
2. Outpatient Management
2.1 Charity OPD (to include Mental 100% OPD Patients are
Health) catered
2.2 Pay OPD (Medical Arts Building)
2.2.1 Establish OPD Laboratory
2.3.2 Establish Pharmacy
Services: Installation of Furniture and
Fixtures for the following Consultaion
Office
OB/Gyne
ENT-HNS
Surgery/Orthopedic Surgery
Pediatrics
Medicine
Nephrology
Neurology
Cardiology
Pulmonology
Gastroenterology
Dermatology
Physical /Rehab Unit

100% provision of safe,
3. Establsishment of Blood Bank w/
accessible blood from non-
additional function
remunerated donors
Page 3 of 69
Strategic Pillar:
Name of Health
(5)
(1)
5,880,000.00
100% of patients for transport

4. Ambulance Service are managed and brought to
Health Facilities on time
5. Procurement of Laboratory 100% of special test are

Equipment needed for Special Tests examined and released on time
!00% of Radiologic Requests

6. Upgrading of Radiology Equipment received are performed and
released on time
21,000,000.00
100% of scheduled treatment

7. Procurement of Dialysis Machines are rendered to patients for
dialysis
Page 4 of 69
Strategic Pillar:
Name of Health
(5)
(1)
8. Improvement of Dental Service -

100% of patients are seen and
Procurement of Equipment and
treated of dental problems
instruments
9. Establishment of Ambulatory
Surgical Clinic - procurement of various
OR Instruments/Equipment
100% of Patients are counseled

10. Establishment of HIV Testing Center
and screened on time
11. Transport Service - Procurement of People and goods are

Trnsport vehicle transported on time
12. Training Center/Events Place and

100% Equipped Training
Dormitory
Center and Dormitory
Patient Satisfaction (QPMC

13. Provision of Housekeeping Services
Rating of Very Satisfied)
Page 5 of 69
Strategic Pillar:
Name of Health
(5)
(1)
14. Procurement of equipment for

Engineering and Maintenacne
15. Procuremnt of Vaccines for the

100% of patients are treated
Animal Bite Center
100% of patients are

16. Maintainance of TB DOTS supplies
diagnosed and treated
17. Procurement of Generator Set installed Gen Set 1500KVA
18. Hospital Information System -

installed electronic medical
Electronic Medical Record Procurement
record
of system
Sub-total Major PPA1 - Facility Development and Enhancement Program
B. Major PPA2
Human Resource Complement
Goal: To fulfill manpower complement based on DOH requirement for 200 Bed Capacity Hospital
a. Appointment of qualified employees 12 nurses are appointed for

to regular positions Wards
Ward Nurse Standard Ratio

Nurse/Patient 1:12
Nurse for Special Areas: Dialysis, 19 nurses are appointed for

OR/DR, ER Special Areas
Physician :patient ratio 1:20 10 Physicians are appointed
6 Medical Specialist including

Pathologist
Medical Technologist for Blood Bank
4 Med Techs are appointed
and Lab
Dorm Manager 1 Dorm Manager is appointed
Page 6 of 69
Strategic Pillar:
Name of Health
(5)
(1)
Human Resource Officer 1 HR
1 Med Records Officer

Medical Records Officer
appointed
Bookkeeper 1 Bookkeeper appointed
Electronic Medical Records 1 Medical Records Officers
4 Data Encoder
Sub-total Major PPA2

C. Major PPA3
HUMAN RESOURCE
DEVELOPMENT PROGRAM
Attendance of Nurses and Ancillary

Personnel to trainings required by DOH
Provision of TEV to participants for
training
100% of Nurse Responders are

1. Emergency Medical Technician
Trained
2. Standard First Aid 15 ER/ward Nurses
3. BLS Training 100% of Nurses, IW
100% of perosnnel in special
4. ACLS Training
areas are trained
5. Basic Blood Banking 9 Med Techs are Trained
6. Microbiology Training 3 Med Techs are Trained
7. Triaging/ER Training 100% of ER Staff are trained
8. Special Areas Training (Nurses)

Essential Integrated Newborn Care
Critical Care Training
Standard Operating Room
Techniques and Procedures
100% of Frontliners are
9. Customer Service
trained
10. Networking 7 IT Personnel are Trained
3 Records Personnel are
11. Medical Records Management
trained
12. Infection Control 25 Participants are Trained
Page 7 of 69
Strategic Pillar:
Name of Health
(5)
(1)
13. CSC Track I and II 6 Dept Heads ar trained
14. Family Planning Consultation and Meetings conducted semi
Networking with RHUs annual
15. Procurement Management Training
Total Service Delivery

NOTE: Please use separate sheet for each Strategic Pillar.
(1) F1 Plus Strategic Pillar: Service Delivery, Governance, Regulation, Financing
▪ Projects/Programs/Activities (PPA) - Identified priority strategies/interventions that address health needs and health inequities
- Goal – desired outcome for each major PPA
(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention (such
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered by t
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted, indicate if area covers GIDA/IP/Urban
(5) Name of Health Facility - the exact name of the facility where the PPA will be applied/conducted
(6) Target - Should correspond with PPA Performance Indicator (eg. number, %, rate) for the year indicated
(7) Resource Requirement – Inputs needed for the PPA to be achieved/conducted
§ Items Description - e.g. meals, accommodation, TEV, venue, kit, etc
§ Expense Category: PS, MOOE, CO-Infrastructure/Equipment
§ Unit Cost: Cost to produce/conduct the P/P/A
§ Quantity: Number of the P/P/A to be produced/conducted
§ Total Cost: Unit Cost multiplied by the Quantity of P/P/A to be produced/conducted
(8) Fund Source – which/what office will be able to fund the investment:
§ DOH – Central Office or Centers for Health Development;
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangay
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencie
Page 8 of 69
QUIREMENTS AND FUND SOURCE (LIPH MOTHER PLAN)
Resource Requirements (PhP)

Target (7)
(6)
Expense
Items Description Unit Cost
Category
2020 2021 2022
ith 200 Authorized Bed Capacity
ABC: 175 ABC:200 ABC:200
100.00% 100.00% 100.00% Hospital Beds w/ Bedside Table CO 45,000.00
ICU Bed CO 160,000.00
Orthopedic Bed with complete

CO 200,000.00
accessories
Defibrillator w/ Monitor (Adult,

80.00% 90.00% 95.00% CO 850,000.00
Neonate)
Anesthesia Machine with Ventilator CO 1,500,000.00
Blood Pressure Machine, with

adult,pedia cuff, stand type, digital, CO 35,000.00
non-mercurial
Choledoscope CO 1,000,000.00
Craniotomy Set CO 2,600,000.00
Page 9 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
CTG Machine CO
X-Ray, C-Arm CO 6,500,000.00
Delivery Table w/ Detachable

CO 2,000,000.00
Strirrup, Mattress and OB Chair
Electrocautery Machine CO 400,000.00
ECG Machine with Analyzer CO 120,000.00
Fetal Monitor with

CO 220,000.00
Cardiotocograph
Infant Warmer CO 380,000.00
Laparospcopic Tower CO 3,000,000.00
Mechanical Ventilator CO 1,900,000.00
Non Contact Thermometer CO 20,000.00
OR Light, Ceiling Mounted, Dual

CO 2,000,000.00
Head
OR Light, LED, Mobile CO 1,200,000.00
OR Table with Complete

CO 700,000.00
Accessories
Page 10 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
Patient Monitor CO 600,000.00
Pharmaceutical Refrigerator CO 300,000.00
Suction Machine, 5 Liters CO 100,000.00
100% 100% 100% NBS kits and supplies MOOE 550.00
100% 100% 100% NBHS Equipment CO 300,000.00
Various Office Equipment -

Computers, Furnitures and Fixtures
CO
Automatic Immunoassay Analyzer-

100% 100% 100% CO 3,500,000.00
Chemiluminescence
Page 11 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
Blood Letting Chair CO 275,000.00
Blood Weighing Scale with Mixer CO 350,000.00
Blood Bank Ref CO 880,000.00
Triple Blood bag MOOE 250.00
1 Ambulance and Various

CO
Equipment and Supplies
Dry Chemistry Analyzer CO 2,000,000.00
Incubator, Microbiology CO 300,000.00
Bacterial Identification and

CO 5,000,000.00
Susceptibility Machine
Mobile Radiology Van CO 5,000,000.00
Ultrasound, 4D CO 4,000,000.00
Mobile X-Ray CO 12,000,000.00
Dialysis Machine CO 1,500,000.00
Page 12 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
Periapical X-ray CO 250,000.00
Dental Chair CO 290,000.00
Light Curing Machine CO 25,000.00
High speed hard piece CO 12,000.00
Low speed handpiece CO 20,000.00
Dental Instrument Set CO 100,000.00
Various OR Equipment, Hernia Set,

Hemorroidal clamp, Anal Dilator,
MOOE/CO 2,000,000.00
Fistula probes, Trachoestormy Set,
Vascular Clamp, Vein Retractor
Equipment and Reagents CO/MOOE
1 Pick Up Truck & Utility Van CO
Various Furniture & Fixtures and

CO
Training Equipment
Janitorial Supervisory Service and

VS VS VS MOOE 60,000.00
supplies
Page 13 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
Various Equipemnt and supplies CO/MOOE 1,000,000.00
vaccines MOOE 1,900.00
Drugs and Meds and Medical

MOOE 200,000.00
supplies, regaents for testing
CO 15,000,000.00
Information System-Electronic
CO 4,000,000.00
medical record
6 6 Nurse 1 Salary and allowance PS 1,401,719.29
19 Nurse 1 Salary and allowance PS 576,472.07
Medical Officer III Salary and

10 PS 1,551,862.56
Allowance
6 Medical Specialist II PS
4 Medical Technologist I PS 391,177.52
1 Dorm Manager PS 391,177.52
Page 14 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
1 HR Officer PS 391,177.52
1 Med Records PS 391,177.52
1 Bookkeeper PS 209,676.00
1 Medical Records Officer PS 391,177.52
4 Data Encoder PS 152,088.00
4 4 4 MOOE 35,000.00
10 5 Registration Fee / TEV MOOE 1,500.00

100 100 100 Registration Fee / TEV MOOE 500
25 25 MOOE 1,500.00
Registration Fee / TEV
Registration Fee / TEV MOOE 5,000.00
MOOE 12,000.00
Registration Fee / TEV MOOE 20,000.00
2 sessions
1 session MOOE 25,000.00/session
conducted Meals, Speaker/Consultant Fee
Registration Fee / TEV MOOE
3 MOOE 8,000.00
25 MOOE 30,000.00
Meals, Speaker/Consultant Fee
Page 15 of 69
Target (7)
(6)
Expense
Category
2020 2021 2022
2 2 2 1000
Meals MOOE
inequities
ervention (such as projects, programs, products and other initiatives)

ts covered by the HUC/ICC where they will also be reflected in the latter’s respective plans
GIDA/IP/Urban poor and other vulnerable population
GU (Barangays)
national agencies; NGOs/CSOs; private and other sectors; and unfunded PPAs
Page 16 of 69
Date: ______________
) Fund Source (PhP)

(8)
Total Cost DOH LGU

Quantity (Unit Cost x
Quantity) CO CHD PLGU C/MLGU BLGU
50 2,250,000.00 1,125,000.00 1,125,000.00
3 480,000.00 480,000.00
3 600,000.00 600,000.00
7 5,950,000.00 4,250,000.00 1,700,000.00
2 3,000,000.00 1,500,000.00 1,500,000.00
22 770,000.00 770,000.00
1 1,000,000.00 100,000.00
1 2,600,000.00 2,600,000.00
Page 17 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

1 6,500,000.00 6,500,000.00
2 4,000,000.00 400,000.00
4 1,600,000.00 1,200,000.00 400,000.00
7 840,000.00 600,000.00 240,000.00
2 440,000.00 440,000.00
3 1,140,000.00 760,000.00 380,000.00
1 3,000,000.00 3,000,000.00 3,000,000.00
5 9,500,000.00 7,600,000.00 1,900,000.00
10 200,000.00 200,000.00
1 2,000,000.00 2,000,000.00
1 1,200,000.00 1,200,000.00
1 700,000.00 700,000.00
Page 18 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

4 2,400,000.00 2,400,000.00
1 300,000.00 300,000.00
10 1,000,000.00 100,000.00
2000 1,100,000.00 1,100,000.00
1 300,000.00 300,000.00
12,000,000.00 12,000,000.00
1 3,500,000.00 3,500,000.00
Page 19 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

2 550,000.00 275,000.00 275,000.00
2 700,000.00 350,000.00 350,000.00
1 880,000.00 880,000.00
1000 250,000.00 250,000.00
3,000,000.00
1 2,000,000.00 2,000,000.00
1 300,000.00 300,000.00
1 5,000,000.00 5,000,000.00
1 5,000,000.00 5,000,000.00
1 4,000,000.00 4,000,000.00
1 12,000,000.00 12,000,000.00
3 4,500,000.00 4,500,000.00
Page 20 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

1 250,000.00 250,000.00
1 290,000.00 290,000.00
1 25,000.00 25,000.00
1 12,000.00 12,000.00
1 20,000.00 20,000.00
1 100,000.00
1 2,000,000.00 1,200,000.00
2,000,000.00 2,000,000.00
2,000,000.00 2,000,000.00
3,000,000.00
12 720,000.00 720,000.00
Page 21 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

1 1,000,000.00 1,000,000.00
7000 13,300,000.00 1,900,000.00 3,800,000.00 7,600,000.00
3 600,000.00 600,000.00
1 15,000,000.00
1 4,000,000.00
146,867,000.00 88,980,000.00 4,050,000.00 27,037,000.00
12 16,820,631.48 16,820,431.48
19 10,952,969.33 10,952,969.33
10 15,518,625.60 15,518,625.60
15,518,625.00 15,518,625.00
4 1,564,710.07 1,564,710.07
1 391,177.52 391,177.52
Page 22 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

1 391,177.52 391,177.52
1 391,177.52 391,177.52
1 209,676.00
1 391,177.52
4 608,352.00
62,758,299.56 61,548,894.04
12 420,000.00 420,000.00
15 22,500.00 22,500.00
300 150,000.00 150,000.00
50 75,000.00 75,000.00
5 40,000.00 40,000.00
4 20,000.00 20,000.00
12 144,000.00 144,000.00
12 240,000.00 240,000.00
3 75,000.00 75,000.00
50,000.00 50,000.00
3 24,000.00 24,000.00
3 90,000.00 90,000.00
Page 23 of 69
) Fund Source (PhP)
(8)
Total Cost DOH LGU

6 180,000.00 180,000.00
6 6,000.00 6,000.00
1,536,500.00 - - 1,536,500.00
211,161,799.56 88,980,000.00 4,050,000.00 90,122,394.04 - -
Page 24 of 69
___________
Others
Page 25 of 69
Others
Page 26 of 69
Others
Page 27 of 69
Others
3,000,000.00
Page 28 of 69
Others
Page 29 of 69
Others
15,000,000.00
18,000,000.00
Page 30 of 69
Others
Page 31 of 69
Others
18,000,000.00
Page 32 of 69
Annex G. LIPH Form 2. COST ASSUMPTIONS BY PILLAR BY PPAS BY RESOURCE REQ
REGION: _____________
LIPH CY: 2020 to 2022
FINANCING
PPA Performance Name of Health
District Municipality
Indicatorb (3) (4) Facility
Program/Project/Activities (PPA)a (2) (5)
(1)
A. Major PPA1
1
a.
b.
c.
B. Major PPA2
1
a.
b.
c.
C. Major PPA3
1
a.
b.
c.
Total Financing
NOTE: Please use separate sheet per AOP Year (Year 1, Year 2, Year 3)
a
Projects/Programs/Activities - Identified priority strategies/interventions that address health needs and health inequities
b
PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular activity
c
Target - Should correspond with PPA Performance Indicator (eg. number, %, rate)
d
Items Description - e.g. meals, accommodation, TEV, venue, kit, etc
e
Expense Category: PS, MOOE, CO-Infrastructure/Equipment
f
Fund Source – which/what office will be able to fund the investment
Page 33 of 69
FINANCING
(1)
DOH - from DOH Central Office, Centers for Health Development
LGU - Government funds from the Local Government Units: PLGU (province), CLGU (city), MLGU (municipality), Othe
g
Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other nation
Page 34 of 69
RESOURCE REQUIREMENTS BY FUND SOURCE (MOTHER PLAN) FOR CY _________
Resource Requirements (In PhP)

Targetc (7)
(6)
Items Expense Total Cost
Time Frame Unit Cost Quantity
Descriptiond Categorye (Unit Cost x Quantity)
CY _____
s and health inequities
s of a particular activity (such as projects, programs, products and other initiatives)
Page 35 of 69
Targetc (7)
(6)
CY _____
GU (municipality), Others (barangay, etc)
t partners); other national agencies; NGOs/CSOs whether local or national; private and other sectors
Page 36 of 69
CY _________
Date: ______________
Fund Sourcef (in PhP)

(8)
DOH LGU
OTHERSg
CO CHD PLGU C/MLGU
Page 37 of 69
REGION: _____________
LIPH CY: 2020 to 2022
GOVERNANCE
(1)
A. Major PPA1
1
a.
b.
c.
B. Major PPA2
1
a.
b.
c.
C. Major PPA3
1
a.
b.
c.
Total Governance
a
b
c
d
e
f
Page 38 of 69
GOVERNANCE
(1)
g
Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other nation
Page 39 of 69

Targetc (7)
(6)
CY _____
Page 40 of 69
Targetc (7)
(6)
CY _____
t partners); other national agencies; NGOs/CSOs whether local or national; private and other sectors
Page 41 of 69
CY _________
Date: ______________

(8)
DOH LGU
OTHERSg
CO CHD PLGU C/MLGU
Page 42 of 69
REGION: _____________
LIPH CY: 2020 to 2022
REGULATION
(1)
A. Major PPA1
1
a.
b.
c.
B. Major PPA2
1
a.
b.
c.
C. Major PPA3
1
a.
b.
c.
Total Regulation
a
b
c
d
e
f
Page 43 of 69
REGULATION
(1)
Page 44 of 69

Targetc (7)
(6)
CY _____
Page 45 of 69
Targetc (7)
(6)
CY _____
Page 46 of 69
CY _________
Date: ______________

(8)
DOH LGU
OTHERSg
CO CHD PLGU C/MLGU
Page 47 of 69
Annex F. LIPH Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, RESOURCE REQUIRE
REGION: _____________
LIPH CY: 2020 to 2022
Strategic Pillar: Municipality/

FINANCING PPA Performance Indicator District Component
Program/Project/ (2) (3) City/Barangay
(1)
A. Major PPA1 -
Hospital Finance Sustainability

Progarm
Goal: To ensure Systemized processing and monitpring of claims reimbursement
Tracking of Claims for PHIC, PCSO

and other agencies
85% of tota/ amount
Filing of Claims within 60 days from
transmitted are collected
discharge of in patients
within 60 days
36 meeting are conducted with

Conduct consultaion / Meeting with Billing and Claims and
staff during reporting and monitoring Philhealth Verification
Personnel
Total Hospital Financing

(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted, indicate if area covers GIDA/IP/U
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Bara
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national a
ESOURCE REQUIREMENTS AND FUND SOURCE (LIPH MOTHER PLAN)
Resource Requirements (
Name of Health Target (7)
Facility (6)
(5) Items Description
2020 2021 2022
laims reimbursement
85.00% 85.00% 85.00% Office Supplies
Computer with complete accessories
Internet Fees
12 12 12 Meals
ealth needs and health inequities
a particular strategy/intervention (such as projects, programs, products and other initiatives)

es the legislative districts covered by the HUC/ICC where they will also be reflected in the latter’s respective plans
ndicate if area covers GIDA/IP/Urban poor and other vulnerable population
GU (municipality); BLGU (Barangays)
pment partners); other national agencies; NGOs/CSOs; private and other sectors; and unfunded PPAs
Resource Requirements (PhP) Fund Source (Ph
(7) (8)
Total Cost DOH
Expense
Unit Cost Quantity (Unit Cost x
Category CO CHD
Quantity)
MOOE 45,000.00 36 1,620,000.00
CO
55,000.00 6 330,000.00
MOOE 60,000.00 36 2,160,000.00
MOOE 800.00 36 28,800.00
4,138,800.00 - -
Date: ______________
Fund Source (PhP)

(8)
LGU
Others
PLGU C/MLGU BLGU
1,620,000.00
330,000.00
2,160,000.00
28,800.00
4,138,800.00
Annex F. LIPH Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, RESOURCE REQUIREMENTS AND FUND SOURCE (LIPH
REGION: _____________
LIPH CY: 2020 to 2022

REGULATION Name of Health Target
PPA Performance Indicator District Component (6)
(5)
Activities (PPA) (4) 2020 2021
(1)
A. Major PPA1 -
Upgrading of Facilities and Maintain

License to Operate of all services offered
Goal: To ensure that all service offered are licensed by the DOH
1. Laboratory LTO QPMC
Participation to National External
Quality Assessment to the following Enrolled to NEQAS to the 4
National Refernece Laboratory: RITM, NRL with Very Satisfactory 75.00% 85.00%
San Lazaro SACCL, Lung Center, Rating of 75%
NKTI
Maintain acrrediation of Tertiary 100% compliant to assessment
100.00% 100.00%
laboratory tool
2. Radiology- Procurement of Film
Badge
100% compliant to assessment

4. Phil Health Accreditation 100.00% 100.00%
tool
100% compliant to assessment 100.00% 100.00%
5. Hospital License to Operate tool
5.1. Blood Bank
5.2 Pharmacy
100% compliant to assessment
5.3 Ambulance Service Provider 100.00% 100.00%
tool
6. Environment Compliance Certificate
Total Hospital Regulation

(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention (such as projects, programs, products and other initiativ
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered by the HUC/ICC where they will also be reflected in th
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted, indicate if area covers GIDA/IP/Urban poor and other vulnerable population
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs; private and other sectors; and unf
ND FUND SOURCE (LIPH MOTHER PLAN)
Resource Requirements (PhP) Fun

Target (7)
(6) Total Cost DOH
Expense
Items Description Unit Cost Quantity (Unit Cost x
2022 Category CO
Quantity)
95.00% Application Fee -
NKTI MOOE 5,500.00 3 16,500.00
Lung Center MOOE 7,500.00 3 22,500.00
RITM MOOE 5,500.00 3 16,500.00
San Lazaro SACCL MOOE 6,000.00 3 18,000.00

100.00% Renewal Fee MOOE 2,500.00 3 7,500.00
Accreditation Fee MOOE 10,000.00 3 30,000.00
Renewal Fee MOOE 2,500.00 3 7,500.00
100.00% Accreditation Fee MOOE 5,500.00 3 16,500.00
100.00%
1,100.00 3 3,300.00
100.00% Renewal Fee MOOE 6,500.00 6 39,000.00
135,000.00 -
, programs, products and other initiatives)

C where they will also be reflected in the latter’s respective plans
her vulnerable population
SOs; private and other sectors; and unfunded PPAs
Date: ______________
Fund Source (PhP)

(8)
DOH LGU
Others
CHD PLGU C/MLGU BLGU
16,500.00
22,500.00
16,500.00
18,000.00
7,500.00
30,000.00
7,500.00
16,500.00
39,000.00
- 135,000.00
Annex F. LIPH Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, RESOURCE REQUIREME
REGION: _____________
LIPH CY: 2020 to 2022

GOVERNANCE Name of Health
(5)
(1)
A. Major PPA1 -
Leadership and Management
Goal: To develop a health system approach of thingking, decision-making and collaborative ac
1. Creation of Hospital Committees: QPMC
Office Order, 4 Meetings
Credentialing and Privileging
conducted/year
Blood Transfusion semiannual meeting
Healthcare Waste Management
Patient Safety
Infection COntrol
Antimicrobial Stewardship
Pharmacy and Therapeutics
Emergency and Disaster Preparedness
CQI
Grievance
Information and Communiation
Technology
2. Implemenation of Anti-Smoking in
decreased % of Smokers
the Workplace Policy
Conduct IEC
3. Implemenation of Newborn Screening 100% of newborn are screened

and Newborn Hearing Policy before discharge
4. Family Planning Program in
complaince to RA 10354 List of FP aceptor
5. Health Emergency Managemnet fire drill/earthquake drill
Program conducte 2x a year
6. Implementaion of Anti-Hospital
deposit Law
7. Implemetation of Anti-Detention
Policy
Total Governance
(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention (such
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered by t
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted, indicate if area covers GIDA/IP/Urban
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangay
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencie
QUIREMENTS AND FUND SOURCE (LIPH MOTHER PLAN)

Target (7)
(6)
Expense
Items Description
2020 2021 2022 Category
llaborative action among depatment heads
4 4 4 Meals / Snacks MOOE
2 2 2
4 4 4
2 2 2
4 4 4
2.00% 2.00% 2.00%
12 12 12
2 2 2
12.00% 12.00% 12.00%
4 4 4
Meals / Snacks MOOE
2.00% 2.00% 2.00%

Meals / Snacks MOOE
inequities
ervention (such as projects, programs, products and other initiatives)

ts covered by the HUC/ICC where they will also be reflected in the latter’s respective plans
GIDA/IP/Urban poor and other vulnerable population
GU (Barangays)
national agencies; NGOs/CSOs; private and other sectors; and unfunded PPAs
equirements (PhP) Fund Source (PhP)
(7) (8)
Total Cost DOH LGU
Unit Cost Quantity (Unit Cost x
Quantity) CO CHD PLGU
2,000.00 16 32,000.00 32,000.00
1,200.00 6 7,200.00 7,200.00

1,200.00 16 19,200.00 19,200.00
1,200.00 6 7,200.00 7,200.00
1,200.00 16 19,200.00 19,200.00
1,200.00 6 7,200.00 7,200.00
1,200.00 12 14,400.00 14,400.00
1,200.00 6 7,200.00 7,200.00
1,200.00 36 43,200.00 43,200.00

-
3,500.00 6 21,000.00 21,000.00

177,800.00 - - 177,800.00
Date: ______________
urce (PhP)
(8)
LGU
Others
C/MLGU BLGU

QPMC Liph 2019

Uploaded by

Copyright:

Available Formats

QPMC Liph 2019

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

QPMC Liph 2019

Uploaded by

Copyright:

Available Formats

Annex F. LIPH Form 2.

COST ASSUMPTIONS BY PILLAR, PPAS, RESOURCE REQUIREME

FACILITY DEVELEPMENT AND

1. Inpatient Management and Treatment QPMC

a. Procurement of addtional beds to

Replace worn out ICU Beds

95% of patients are given

c. Relocation of NBS&NBHSF on the

>Procurement of Newborn Hearing

Physical /Rehab Unit

100% of patients for transport

5. Procurement of Laboratory 100% of special test are

!00% of Radiologic Requests

100% of scheduled treatment

8. Improvement of Dental Service -

100% of Patients are counseled

11. Transport Service - Procurement of People and goods are

12. Training Center/Events Place and

Patient Satisfaction (QPMC

14. Procurement of equipment for

15. Procuremnt of Vaccines for the

100% of patients are

17. Procurement of Generator Set installed Gen Set 1500KVA

18. Hospital Information System -

Sub-total Major PPA1 - Facility Development and Enhancement Program

a. Appointment of qualified employees 12 nurses are appointed for

Ward Nurse Standard Ratio

Nurse for Special Areas: Dialysis, 19 nurses are appointed for

Physician :patient ratio 1:20 10 Physicians are appointed

6 Medical Specialist including

Dorm Manager 1 Dorm Manager is appointed

Human Resource Officer 1 HR

1 Med Records Officer

Bookkeeper 1 Bookkeeper appointed

Electronic Medical Records 1 Medical Records Officers

Sub-total Major PPA2

Attendance of Nurses and Ancillary

100% of Nurse Responders are

7. Triaging/ER Training 100% of ER Staff are trained

8. Special Areas Training (Nurses)

Sub-total Major PPA3

Total Service Delivery

Resource Requirements (PhP)

ith 200 Authorized Bed Capacity

ABC: 175 ABC:200 ABC:200

100.00% 100.00% 100.00% Hospital Beds w/ Bedside Table CO 45,000.00

ICU Bed CO 160,000.00

Orthopedic Bed with complete

Defibrillator w/ Monitor (Adult,

Anesthesia Machine with Ventilator CO 1,500,000.00

Blood Pressure Machine, with

Craniotomy Set CO 2,600,000.00

X-Ray, C-Arm CO 6,500,000.00

Delivery Table w/ Detachable

Electrocautery Machine CO 400,000.00

ECG Machine with Analyzer CO 120,000.00

Fetal Monitor with

Infant Warmer CO 380,000.00

Laparospcopic Tower CO 3,000,000.00