Integrated Family Health Unit Program

Monitoring Tool

Respondents:

Name Designation Contact Details

 Form 1: LGU Profile

1.1 Demographic Data

Province:

City/Municipality:

Name of Health Facility:

Total Number of Barangays:

Total Population:
Total Number of Health Facilities under
supervision of this health facility Health Centers: BHS:

Is the facility PhilHealth Accredited? Yes No ______

MCH

Konsulta Package______
Identify PhilHealth Accreditation
FP services

Others, pls specify:_____________________

Health Facility with DOH BEmONC
accreditation/certification
MBFHI__________

AFHF (specify level I or II)

1.2 Human Resources: Adequacy, Training and Competence

Number of RHU Staff

MHO PHN PHM BHW NDP RHMPP Others:

specify

1
 Specific Program Training/s Received
Managed
1. Data Management Training
1. Family Planning 2. Comprehensive NIP Training
Name of Staff Position 2. Safe Motherhood 3. FP CBT Level 1-Family Planning Competency
3. ADHP Based Training Level 1
4. Oral Health 4. PPIUD Postpartum Intrauterine Device
5. IMCI Training
6. Nutrition 5. Interval IUD - Interval Intrauterine Device
7. NIP 6. PSI - Progestin Subdermal Implant Training
8. WCPP 7. BTL - Bilateral Tubal Ligation
9. NBS 8. NVS - No Scalpe Vasectomy Training
10. HWP PWD 9. IMCI - Integrated Management of Childhood
11. HWP SC Illness Program
10. BEmONC - Basic Emergency Maternal
Obstetrics and Newborn Care
11. ENBS - Expanded Newborn Screening
12. NHS - Newborn Hearing Screening
13. EINC - Essential Intrapartum Newborn Care
14. PIMAM - Philippine Integrated Management
of Acute Malnutrition
15. LMT - Lactation Management Training
16. IYCF - Infant Young Child Feeding
17. ASET 2.0 - AJA 2.0 Skills Enhancement
Training
18. Adolescent Foundational Course
19. Others, specify.
1.
2.
3.
4.
5.
6.

7.
8.
9.
10.

Form 2: Records Review and Analysis

2
 2A.1: Availability of National Policies
PROGRAM YES NO REMARKS

Maternal Newborn Child Health & Nutrition

● RA 10354 The Responsible Parenthood and Reproductive Health

Law

Family Planning Program

● Executive Order No. 12, S. 2017: "Zero Unmet

Need for Modern Family Planning" Through The
Strict Implementation Of The Responsible
Parenthood And Reproductive Health Act
● Administrative Order 2017-0005: Guidelines in Achieving Desired
Family Size through Accelerated and Sustained Reduction in Unmet
Need for Modern Family Planning Methods

Newborn Screening Program

● RA 9288 Newborn Screening Act of 2024

● RA 9709 Universal Newborn Hearing Screening Program for the

prevention, early diagnosis and intervention of Hearing Loss
Women and Children Protection Program

● RA 9262: Anti-violence Violence Against Women Against

Women and Their Children And Their Children Act Of 2004
● Administrative Order 1-B s. 1997: DOH Policy on the
establishment of Women & Children’s Protection Units
(WCPU)
● Administrative Order 2013-0011: Revised guidelines on
the establishment of WCPUs in all hospitals
National Immunization Program

● Republic Act No. 10152 – An act providing for mandatory

basic immunization services for infants and children, repealing
for the purpose Presidential Decree 996, as amended.
● Republic Act No. 7846 – An act requiring compulsory
immunization against hepatitis B for infants and children
below eight (8) years old, amending for the purpose
Presidential Decree No. 996 and appropriating funds
therefore.
Adolescent Health & Development Program

3
 PROGRAM YES NO REMARKS

● AO 2013-0013 National Policy and Strategic Framework on

Adolescent Health & Development
● DM 2017-0098 Adolescent Friendly Health Facility Standard
Evaluation Tool
Oral Health Program

● AO 2007-0007 Guidelines in the Implementation of Oral

Health Program for Public Health Services
● 2018 -0369-A Use of Revised Oral Health Forms 1 (Individual
Patient Treatment Record) and 2 (Consolidated Oral Health
Status, Services and Medical History Report)
● 2020-0020 Guidelines on the Phase – Out of Mercury Use in
Dental Restorative Procedures
● 2020 – 0027 Guidelines on the Allocation and Utilization of
Mobile Dental Vehicle (MDV)
Nutrition Program

● Republic Act 10028 Expanded Breastfeeding Promotion Act of

2009
● Republic Act 11148 Kalusugan ng Magnanay Act

● AO 2005- 0014 National Policies on Infant and Young Child

Feeding
● EO 51 National Code of Marketing Breastmilk Substitutes,
Breastmilk Supplements and Other Related Products
● AO 2015-005 National Guidelines on the management of Acute
Malnutrition for Children under 5 years old
Integrated Management of Childhood Illness Program

IP-GIDA (Indigenous People - Geographically Isolated and

Disadvantaged Areas) Program
● Joint Memorandum Circular No. 2013-01 (Guidelines on the
Delivery of Basic Health for indigenous Cultural Communities
Indigenous People
● AO No. 2020-0023 Guideline on Identifying GIDA and
Strengthening their health system

4
 2A.2 Availability Local Ordinances
PROGRAM YES NO TITLE/S

Safe Motherhood Program

Family Planning Program

Newborn Screening Program

Women and Children Protection Program

National Immunization Program

Adolescent Health & Development Program

Oral Health Program

Nutrition Program

Integrated Management of Childhood Illness Program

IP GIDA Program

2A.3 Availability of Manual of Procedures

PROGRAM YES NO REMARKS

Safe Motherhood Program

Family Planning Program

Newborn Screening Program

Women and Children Protection Program

National Immunization Program

Adolescent Health & Development Program

Oral Health Program

Nutrition Program

Integrated Management of Childhood Illness Program

IP GIDA Program

5
 2B. Availability of Annual Work and Financial Plan
PROGRAM With Targeted Budget and Source of Funds
Plan/ WFP?

YES NO

Safe Motherhood Program

Family Planning Program

Newborn Screening Program

Women and Children Protection Program

National Immunization Program

Adolescent Health & Development Program

Oral Health Program

Nutrition Program

Integrated Management of Childhood Illness

Program
IP GIDA Program

2C.A Inventory of Logistics

6
 Programs Availability Stock on Hand Is it Source Remarks
Sufficien
(Quantity) 1. DOH
t within
Procured
3
2. LGU
months?
Procured
3. Others
( Specify)

Yes No Ye N
s o

Safe Motherhood Program

◻ Oxytocin

◻ Calcium Carbonate

◻ Dexamethasone/Betamethasone

Family Planning Program

◻ PSI

◻ Condom

◻ COC Pills

◻ POP Pills

◻ IUD

◻ DMPA

◻ PPIUD Instruments

◻ IUD Instruments

Newborn Screening

◻ Expanded NBS Kits

WCPP

◻ Dignity Kits

National Immunization Program

7
 Programs Availability Stock on Hand Is it Source Remarks
Sufficien
(Quantity) 1. DOH
t within
Procured
3
2. LGU
months?
Procured
3. Others
( Specify)

◻ Ice Pack

◻ Vaccine Carrier

◻ Vaccine Ref

◻ Thermometer

◻ BCG

◻ Hepa B

◻ Penta

◻ OPV

◻ IPV

◻ PCV

◻ MMR

◻ MR

◻ Td

◻ PPV

◻ Influenza vaccine

◻ AEFI kit (Epinephrine, Cetirizine,

.
Paracetamol)
.

8
 Programs Availability Stock on Hand Is it Source Remarks
Sufficien
(Quantity) 1. DOH
t within
Procured
3
2. LGU
months?
Procured
3. Others
( Specify)

◻ Syringes ( 0.05, 0.5, 2ml,3ml)

Adolescent Health & Development

Program

◻ Adolescent Gang Chair

◻ Paracetamol

◻ Adolescent Steel Cabinet

◻ Adolesccent Sintraboard

◻ Trolly

Oral Health Program

◻ Fluoride Varnish

◻ Light Cure units

◻ Pits and Fissure Sealant

◻ Autoclave

◻ Portable Ultrasonic Scaler with mini

water tank and accessories

◻ High Speed handpieces bundled with

spurs

◻ Glass Ionomer

◻ Dental Instruments

◻ Pediatric Toothbrushing Model

9
 Programs Availability Stock on Hand Is it Source Remarks
Sufficien
(Quantity) 1. DOH
t within
Procured
3
2. LGU
months?
Procured
3. Others
( Specify)

Nutrition Program

◻ RUTF

◻ RUSF

◻ Calcium Carbonate

◻ Vitamin A

◻ Ferrous sulfate

◻ Micronutrient Powder

◻ F75

◻ F100

Integrated Management of Childhood

Illness

◻ Paracetamol

◻ Zinc drops/ syrup

◻ Salbutamol nebules

◻ Amoxicillin drops/ syrup

◻ Oresol

IP GIDA

◻ Losartan

◻ Amlodipine

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 Programs Availability Stock on Hand Is it Source Remarks
Sufficien
(Quantity) 1. DOH
t within
Procured
3
2. LGU
months?
Procured
3. Others
( Specify)

◻ Vitamin B Complex

◻ Vitamin C

◻ Paracetamol

◻ Multivitamins

◻ Salbutamol Nebule

◻ Simvastatin

◻ Atorvastatin

2C.B Record / Forms / IEC Materials

PROGRAMS Availability Stock on Is it Source Remarks
Hand Sufficient
1. DOH Procured
within 3
(Quantity) 2. LGU Procured
months?
3. Others ( Specify)

Yes No Yes No

Safe Motherhood Program

◻ Mother & Baby Booklet

◻ CBS Loogbook

◻ Flipchart

Family Planning Program

◻ Flipchart

◻ Gather

11
 PROGRAMS Availability Stock on Is it Source Remarks
Hand Sufficient
1. DOH Procured
within 3
(Quantity) 2. LGU Procured
months?
3. Others ( Specify)

◻ MEC Wheel

◻ Fliptarp

◻ Flyers/Brochure

◻ Wallchart

◻ FP Form I

◻ FP Client Card

◻ FP TCL
Newborn Screening

◻ Poster

◻ NBS Logbook

◻ Flyers/Brochure
Women and Children
Protection Program

◻ Flyers/Brochure

◻ WCPP Logbook

National Immunization
Program

◻ Flyers/Brochure

◻ NIP TCL

Adolescent Health &

Development Program

◻ Flyers/Brochure

12
 PROGRAMS Availability Stock on Is it Source Remarks
Hand Sufficient
1. DOH Procured
within 3
(Quantity) 2. LGU Procured
months?
3. Others ( Specify)

◻ Adolescent logbook

◻ Adolescent TCL

◻ Fliptarp

◻ Flipchart

Oral Health Program

◻ Flipchart

◻ Oral Health TCL

◻ Oral Health Forms

Nutrition Program

◻ Flipchart

◻ Posters

Integrated Management of
Childhood Illness Program

◻ Flipchart/Chart Booklet

◻ IMCI Logbook

◻ IMCI Forms
IP GIDA Program

◻ Flyers/Brochure

13
 2D: Service Coverage and Utilization
Program Indicator Target Actual Target Met? Remarks
Accomplishment
YES NO
Family Planning Program
● Demand Satisfied for mFP
● mCPR
Safe Motherhood Program
● No. of Deliveries
● No. of Livebirths
● 4ANC
● SBA
● FBD
● 2PPV
● No. of Maternal Deaths
● No. of Pregnant Women 10 – 14 years old

● No. of Pregnant Women 15 – 19 years old

● No. of Pregnant Women 20 – 49 years old

Newborn Screening Program

● Total Numbers of Newborns Screened

● Number of Neonatal Deaths

Integrated Management of Childhood Illness
● No. of Under Five Deaths
● No. of Infant Deaths
Nutrition Program
● No. of newborns who were initiated on
breastfeeding within 1 hour after birth
● No. of SAM
● No. of MAM
National Immunization Program
● FIC

14
 Program Indicator Target Actual Target Met? Remarks
Accomplishment
YES NO
● CIC
Adolescent Health & Development Program
● No. Teenage Pregnancies
● Adolescent Birth Rate
Oral Health Program
● Orally Fit Children (12-59 months old)

15