Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
17 February 2022

DEPARTMENT MEMORANDUM
No. 2022 - NR _[ 4d

TO: ALL _UNDERSECRE I ECRETARIES:

SERVICES AND CENTERS FOR HEALTH DEVELOPMENT. (CHD);

SUBJECT:
Promotion Programs

Department Memorandum No. 2021-0068 dated February 4, 2021 entitled “Submission of Self-Appraisal
Checklist for P/CWHS Population-wide Health Promotion Programs” provides a self-appraisal checklist
used to assess existing health promotion interventions in the seven identified priority areas of the Health
Promotion Framework Strategy and five action areas of the Ottawa Charter for Health Promotion. The
subsequent Department Memorandum No. 2021-0277 entitled “FY 2021 Local Health Systems Maturity
Levels (LHS ML) Annual Monitoring and Updated LHS ML Monitoring Tool” designated the
accomplished DM 2021-0068 as the means of verification (MOV) for SD3 Characteristic: Health
Promotion Programs or Campaigns KRAs 1.4, 2.3 and 3.2.

To respond to feedback from LHS ML monitoring by implementers, the DOH provides herewith a revised
P/CWHS Self-Appraisal Checklist to streamline guidelines on assessing health promotion initiatives,
validating the Self-Appraisal Checklist, and progressing across the Local Health Systems Maturity Levels
(LHS ML). In
addition to this revised checklist, Department Circular No. 2021-0409 entitled “Reiteration
of Must-Know Health Promotion Policy Issuances” shall continue to be the primary guidance on bases the
for LHS ML validation.

The CHDs and

BARMM-MOH shall validate the completeness and accuracy of the
P/CWHS-accomplished self-appraisal checklists and documents attached as means of verification (Annex
B). Validated submissions and documentary support shall be used for annual LHS ML validation.

For strict compliance.

By
Authority of the Secretary of Health:

MARIA ROSARIO SINGH-VERGEIRE, MD, MPH, CESO II

Undersecretary of Heafth
Public Health Service¢ Team

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1108, 1111, 1112, 1113
Direct Line: 711-9502; 711-9503 Fax: 743-1829 « URL: http://www.doh.gov.ph; e-mail: fduque@doh.gov.ph
Annex A. Self-Appraisal Checklist For P/CWHS Population-Wide Health Promotion
Programs (May be
downloaded through this link: https://tinyurl.com/HPB-SAC2)

Instructions:
1. Use only one (1) checklist for one (1) health promotion intervention.
2. Submit the accomplished and signed Self-Appraisal Checklist (SAC) to your Center for Health
Development (CHD).
3. Submission should include copies of documents that will serve as means of verification (MOV)
to check accuracy of answers in the checklist.
4. A list of these documents which can be considered as MOVs are summarized in Annex A.

City/ Province Region

Income Class O Ist O2nd O3rd O4th O5Sth O 6th

Name/Title of the Health Promotion Intervention

(Please put only one program/project/policy in this checklist.)

1. Briefly describe the health promotion intervention and the problems it is trying to address.

2. Who are the target beneficiaries/ population of

this health promotion intervention?

3. Which priority area (PA) does O PAI: Diet and Exercise © PAS: Mental Health
your intervention address? (Enabling improved nutrition Qncreasing psychosocial and mental
and increased physical activity) well-being)

Youmay check more than one
(1) PA, BUT LIMIT ONLY
those related to your health
promotion intervention.
© PA2: Environmental Health © PA6: Sexual and
to (lackling environmental, sanitation, and
climate change impacts on health)
Reproductive Health
(Promoting positive sexual and
© PA3: Immunization
reproductive behavior)

(Promoting vaccine use) © PAT: Violence and

NOTE
that PAs selected should Injury Prevention
be supported by data. O PA4: Substance Use
{Protecting communities from
(Preventing tobacco use, illicit drug use,
violence and injury)
and harmful alcohol use)

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4. When did implementation of this health promotion intervention/activity start?

5. Was there data showing the presence of the problem (described in question #1) that OQ Yes O No
led you to implement the intervention/activity?

a, If yes, what is the source of Data Source Parameter/ Data Before Most Recent
this data/evidence? Category Intervention Data

Example: Local oj
Percent 25% 10%
Provide at least one ()
data pouty
:

Morbidity and Year: 2008

with Year: 2010
source per priority area Mortality Data on hypertension
identified in question #3. Cardiovascular
Diseases
You may attach additional sheets
of paper if
more space is needed.

Examples of data sources are

FHSIS, LGU Scorecard,
SGLG Health Indicators,
Morbidity & Mortality Data,
Year:

_ _ Year:

Year: Year:
Hospitalization Data, —_ —___
KAP Survey, etc.

Year: Year:

Health Promotion Action Areas

1. Please ensure that all means of verifications cited are relevant to the health promotion
intervention and the
questions below.
2. Cite the specific provision or part of the MOVs submitted that answers the questions below.
» Please ensure that the documents submitted as means of verification are dated (as applicable).
4. Note that one (1) document may be used as MOV for multiple questions as long as properly
cited.

Build Healthy Public Policy Means of Verification

Is there a local policy (ie., © Yes O No
ordinance/ resolution/EO) that
supports the implementation of
the health promotion
intervention/activity?

Is the local policy still

in effect O Yes © No
(i.e., not repealed by other
policies, re-issued by current
chief executive)?

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Is the local policy aligned with a O Yes ONo
national law?
Specify Provision/Page in the Policy:

Does the policy have a O Yes ONo

background that explains the
problem/s and the reason/s why
it should be addressed? Specify Provision/Page in the Policy:

Does the policy contain the O Yes O No

objectives and specific outcomes
that implementers aim to
achieve? Specify Provision/Page in the Policy:
Does the policy state where the O Yes ONo
funds/resources for the
intervention/activities will be
coming from? Specify Provision/Page in the Policy:

Does the policy identify © Yes O No

individuals or offices who will
be implementing the
intervention/activities and what Specify Provision/Page in the Policy:
their specific roles are?

Create Supportive Environments Means of Verification

Is there a physical space/ O Yes ONo
environment (e.g., room,
building, street, walkway,
open/green space, designated
space/area, etc.) that supports
the implementation and
enforcement of the intervention?

Are these identified O Yes ONo

spaces/environments safe,
secure, and free from
interference and obstructions
when conducting an
intervention/activity?

Is the intervention free from O Yes O No

procedures/processes that could
prevent persons with disabilities

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or persons of
different
socioeconomic class/cultural
background/educational level
from participating in the
intervention?

Reorient Health Services Means of Verification

Are the human and/or financial © Yes O No
resources needed for
the
implementation ofthe
intervention made available in
the LGU?

Are the resources needed for the O Yes O No

implementation of the
intervention included in the
LGU’s approved financial Specify Section/Page in the Document:
plans?

Is the implementation of the © Yes O No

intervention linked or
coordinated with the LGU’s
primary care services (i.e., BHS,
RHU, CHO, and other primary
local health facilities)?

Develop Personal Skills Means of Verification

Are training/orientations/ © Yes © No
seminars/courses provided to
implementers to achieve the
goals of the intervention?

Are information/education/ © Yes O No

advocacy activities conducted to
improve people’s knowledge,
attitudes, and practices towards
resolving the identified health
problem/s of the intervention?

Does the health promotion © Yes O No

intervention have its own set of
Information/Education/
Communication (IEC)
materials?

Are the IEC materials, capacity © Yes O No

building modules, FAQs, etc.
understandable and accessible

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 all? (e.g., translated to local
for

languages/dialects, sign
language interpreter for video
materials, captioning, etc.)

Strengthen Community Action Means of Verification

Are individuals/groups from the O Yes O No
marginalized sectors (e.g.,
PWDs, IPs, LGBTQIA+,
indigent population, women
sector, etc.) involved in the
planning of the programs?

Does the intervention have a © Yes © No

feedback mechanism to
elicit
insights, comments, suggestions
from target beneficiaries and
people who participate in the
intervention/activities?

Is there involvement and © Yes O No

participation of the target
beneficiaries/intended audience
in the intervention?

- end of checklist

Accomplished by
(Provincial/City HEPO
representative from
or
province/city/municipality)
oiher
Approved by:
(Provincial/City Health Officer)
FOR OFFICIAL USE
Validated by:
(CHD HPU)
ONLY
-
Signature: Signature: Signature:

Name: Name: Name:

Designation/ Designation/ Designation/

Position: Position: Position:

Date: Date: Date:

kk

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Annex B. Documents Considered as Means
SELF APPRAISAL CHECKLIST
QUESTION
Building Healthy Public Policy
All Questions
Please cite specific provisions/sections in
MOVs provided which answer each
question in this area
Create Supportive Environments
Is there a physical space/ environment
(e.g., room, building, street, walkway,
open/green space, designated
space/area, etc.) that supports the
implementation and enforcement of
the intervention?
Are these identified
spaces/environments safe, secure, and
free from interference and
obstructions when conducting an
intervention/activity?
of Verification (MOVs)
MEANS OF VERIFICATION
(May be any, but not limited to the following)
© Copy of Ordinance
@
Copy of Resolution
@
Copy of Executive Order
@ Photos
or videos of buildings, streets, walkways, open/green
spaces, facilities, infrastructure, venues, and other physical
environments, such as but not limited to:
© Jogging paths, open spaces for exercise/physical activity
©Protected bicycle lanes, racks
©Facilities and venues for dietary supplementation programs
(e.g., karinderya)
© Handwashing facilities, toilets
© Facilities and venues for administration of vaccines
© Designated smoking/vaping areas
© Places where signages (e.g., no smoking/selling of tobacco
products, school zones, bicycle/share the road, etc.) are
posted
© Facilities and venues for conduct of
peer support group
meetings
° Adolescent-friendly health facilities
© VAWC desks
© Other forms of documentation of places where intervention is held
or which support its implementation and enforcement
@ Photos or
videos of built/physical environments showing
provisions for privacy, security, and safety, such as but not limited
to:
Adequate lighting/street lamps
Railings, safety barriers
Fire alarms, exits, extinguishing systems
oooaoo8o
Evacuation plans
Proper ventilation systems
Visible warnings and signages
© Video and CCTV surveillance
© Photos or videos showing efforts to make built
environments/places/venue of intervention free from physical
barriers, such as but not limited to:
© Accessible entrances
00
Wheelchair ramp/lift
Elevators
Power-assisted doors
ooo Toilets for PWDs
Adequate space for assistive devices or personal assistance
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is the intervention free from
procedures/processes that could
prevent persons with disabilities or
persons of different socioeconomic
class/cultural background/educational
level from participating in the
intervention?
Are the human and/or financial
for
resources needed the
implementation of the intervention
made available in the LGU?
Are the resources needed for the
implementation of the intervention
included in the LGU’s approved
financial plans?
Is the implementation of the
intervention linked or coordinated
with the LGU’s primary care services
(i.e., BHS, RHU, CHO, and other
primary local health facilities)?
Are training/orientations/
seminars/courses provided to
implementers to achieve the goals of
the intervention?
Are information/education/ advocacy
activities conducted to improve
people’s knowledge, attitudes, and
practices towards resolving the
identified health problem/s of the
intervention?
Does the health promotion
intervention have its own set of
Information/Education/
Communication (IEC) materials?
Copy
ofStandard Operating Procedures/ Manual of
Procedures
Non-discrimination statement or
policy
Other documentation showing non-discriminatory policies and
procedures related to the intervention and/or providing for
non-discriminatory alternatives to these, if applicable
Summary of responses to/actions taken to address
complaints/comments related to difficulties in accessing the
intervention
Reorient Health Services
@ Work and Financial Plan
@
Project Procurement Management Plan
© Fund Utilization Reports
e Annual Investment Program/Annual Procurement Plan
© Loca! Development Investment Program
® Documentation/photos of purchases
e Narrative reports
© Local Investment Plan for Health
© Proof of filled-up positions (i.e., Department Personnel Orders,
plantilla)
© Other financial/budget reports
@ Referral protocols
e IEC materials showing instructions on how to access primary care
services
@ Provisions in
policies showing linkage to primary care services
e Activity reports, proceedings, or other documentation showing
linkage to primary care services
Develop Personal Skills
© Capacity building reports (including proof of
coverage of all target
participants, if available)
© Documentation/photos of trainings/ orientations
© Attendance sheets of trainings/ orientations
® Narrative reports of trainings/orientations
¢ Post-training assessments/test results
® Capacity building evaluation forms/results
© Training certificates of implementers who completed capacity
building activities
¢ Approved communication plan or strategy complementary to the
intervention/activity
© Narrative reports of information/ education/advocacy activities
conducted
© Documentation/photos of information/ education/advocacy
activities conducted
e Communication materials (e.g., posters, flyers, public service
announcements, scripts, pamphlets, social media cards, etc.)
© Approved communication plan or strategy complementary to the
intervention/activity
® Documentation/photos of
dissemination and actual use of
communication materials (i.e., posters, tarpaulins posted in
target
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 areas, etc.)

Are the LEC materials, capacity
building modules, FAQs, etc.
understandable and accessible for all?
(e.g., translated to local
languages/dialects, sign language
interpreter for video materials,
captioning, etc.)
® Photos/videos, or other documents that show initiatives to make
public activities and communications materials accessible to
all
(regardless of disability, educational background, etc.), such as, but
not limited to:
© Documents and communication materials translated to local
languages/dialects
©
of
Videos or screenshot videos with sign language
interpreters, captioning, text-to-speech options
© Communication materials placed in strategic areas with clear
line of sight to standing or seated users

Strengthen Community Action

Are individuals/groups from the © Documents/policies identifying representative/s of marginalized

marginalized sectors (e.g., PWDs, IPs,
LGBTQIA+, indigent population,
women sector, etc.) involved in the
planning of the programs?
groups in
technical working groups or other consultative bodies
© Attendance sheet of meetings/activities indicating participation of
marginalized sectors or representative of marginalized groups
© Minutes/proceedings/photos of consultative meetings and activities
indicating participation of marginalized sectors or representative of
marginalized groups
Minutes/proceedings of
planning meetings indicating that concerns
of marginalized sectors were discussed and addressed
® Memorandum of agreement/understanding detailing partnerships
with marginalized groups

Does the intervention have a feedback © Post-event feedback survey

mechanism to elicit insights, © Client satisfaction survey/reports/rating
comments, suggestions from target © Photos/documentation of hotlines/contact numbers, email
beneficiaries and people who addresses, or other communication channels accepting
participate in the feedback/reports
intervention/activities? @ Screenshots of participant comments on posts uploaded in social
media
e@
Summary report of feedback using the established feedback
mechanisms
e Summary report of actions taken to address the feedback gathered
through established feedback mechanisms

Is there involvement and participation e Attendance sheet to events/activities related to the intervention
of the target beneficiaries/intended © Pledge of commitment from target beneficiaries/population
audience in the intervention? ® Photo or video documentation showing that target
beneficiaries/population were involved in events/activities related
to the intervention
© Other forms of documentation showing that target
beneficiaries/population contributed and participated in the
intervention (¢.g., youth/adolescent groups staging plays or
producing content on adolescent sexual and reproductive health,
community members volunteering to paint and decorate
handwashing facilities)

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