ANNEX B

THIS PORTION WILL BE ACCOMPLISHED BY LGU/IPHO FOR THIS PORTION WILL BE ACCOMPLISHED BY
BARMM ASSIGNED DOH REPRESENTATIVE/MOH-BARMM
Indicator 4. Functional Local AIDS Council (LAC) Data Quality Assessment for Indicator 4.

Refers to the degree to which LGUs have active local AIDS councils
(LACs) which are able to meet the level of functionality as stipulated in Criteria/ Means of Result
Section 19 of IRR of RA 11166 either in the form of advocacy or HIV Verification
referral activities. 1. For creation of Council  Yes
- Local Policy
(Executive
Complied with 3/3 components:
Order/Ordinance) issued  No
by LGU on creation of
YES NO LACs
harmonized with RA
11166
Criteria for Province/HUC/ICC YES NO 2. For Budget- Local  Yes
1. Multi-sectoral composition of LAC members Investment Plan for
2. With allocated HIV related budgets either from Health (LIPH)/ Annual
GAD or other sources, and Investment Plan (AIP),  No
and
3. Annual plans of HIV-related programs/ activities  Yes
3. For HIV-related
and projects programs/ activities and
projects implementation
- LGU Annual/ Activity  No
Report through DILG
Benchmark: Scoring System (external submitted to PNAC
benchmark) Secretariat (pursuant to
2023 National Target: Green: Complied with 3/3 Section 5.1 of IRR
of RA 11166)
100% of Provinces/HUCs/ components
ICCs/Municipalities/CCs Red: Was not able to comply
have Functional Local with the 3 components by Remarks (Write a short explanation for items
AIDS Councils by December 31, 2023 answered “No”. Record any implementation
December 31, 2023 issues or best practices not initially reported in
the DCF):
Remarks (Write a short explanation for items answered “No”. Record
any implementation issues or best practices not initially reported in the
DCF.):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date: Reporting Year: 2023
DOHRep/MOH-BARMM
 ANNEX B
Indicator 5. Percentage of LGUs with localized MH Program Data Quality Assessment for Indicator 5.

The LGU is mandated by RA 11036 also known as “Mental Health Act”, Criteria/ Means of Result
specifically stated in Section 2. “There is a need to promote the well- Verification
being of people by ensuring that; mental health is valued, promoted and 1. Presence of a Local
protected; mental health conditions are treated and prevented; timely, Ordinance/ Executive
affordable, high quality, and culturally- appropriate mental health case is Order – Copy of LGU
Ordinance or
made available to the public; mental health service are free from coercion Executive Order
and accountable to the service users; and persons affected by mental containing the
health conditions can exercise the full range of human rights, and following: A
participate fully in society and at work free from stigmatization and coordinating body (e.g.
discrimination." local health boards or
regional council or
mental health working
Complied with 9/9 components:
group, as applicable)
i. Complementary
YES NO personnel (At  Yes
least one MHO  No
and one nurse or
allied health
Criteria for Province/HUC/ICC YES NO professional
1. Presence of a Local Ordinance/ Executive preferably a
Order or similar regulation plantilla position)
2. A coordinating body (e.g. through Local Health ii. Complementary
Boards or Regional Council or a personnel
Mental Health Working Group as applicable) serving as MH  Yes
service providers  No
3. Complementary personnel – duly filled-up MH
focal person verified against the appointment trained on
paper (if plantilla) or contract of service for JO mhGap (for
with an order designating doctors and
him/her as MH focal nurses), MHPSS,
4. Complementary personnel serving as MH service SBIRT, CBDR
providers trained on mhGap (for doctors and (for doctors,
nurses), MHPSS, SBIRT, CBDR (for Doctors, nurses and
nurses and other allied medical professionals) other allied
among other DOH- medical
prescribed MH training professional)
among other
5. Promotion and awareness campaign plans using
DOH-
HPB playbooks on Mental Health
prescribed MH
6. All RHUs providing MNS services such as training
but not limited to iii. Promotion and
i. Assessment/screening awareness
ii. Psychological counseling campaign plans
iii. Medication (if applicable) using HPB
iv. Referral playbooks on  Yes
7. All Primary health care facilities accredited by MH  No
PhilHealth providing MNS services such as but iv. RHUs providing
not limited to MNS services
i. Assessment/screening (assessment/
ii. Psychological counseling screening,
iii. Medication (if applicable) psychosocial  Yes
iv. Referral counseling,  No
8. Appropriate allocation of Mental, Neurologic and medication if
Substance-Use related commodities
9. Budget Allocation for the implementation of MH
Program

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date: Reporting Year: 2023
DOHRep/MOH-BARMM
 ANNEX B
Remarks (Write a short explanation for items answered “No”. Record applicable and
any implementation issues or best practices not initially reported in the referral)  Yes
DCF.): v. Primary health  No
care facilities
accredited by
PhilHealth
providing MNS
services
(assessment/
screening,
psychosocial
counseling,
medication if
applicable and
referral)  Yes
vi. Appropriate  No
allocation of
mental,
neurologic and
substance-use
related
commodities  Yes
vii. Budget  No
allocation for
implementation
of MH program
2. Coordinating body –  Yes
Copy of LGU
Ordinance or Executive
Order reflecting the  No
composition of the
coordinating body;
MOM with resolution

3. Complementary personnel  Yes

– duly filled- up MH focal
person verified against the
appointment paper (if  No
plantilla) or contract of
service for JO with an
order designating him/her
as MH focal

4. Complementary personnel  Yes

serving as MH service
providers trained on
mhGap (for doctors and  No
nurses), MHPSS, SBIRT,
CBDR (for doctors,
nurses and other allied
medical professional)
among other DOH-
prescribed MH training –
Report from CHs on the
number of trained MH
Staff, Certificate of
Completion Verified
with MHD Directory,

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date: Reporting Year: 2023
DOHRep/MOH-BARMM
 ANNEX B
Trainings are conducted
by CHDs
5. Promotion and awareness  Yes
campaign plans using
HPB playbooks on MH
– Report from CHDs on  No
the number of
promotional and
awareness campaigns
related to MH (if
possible submit a
documentation e.g. soft
copy of IECs,
record of webinar,
etc.)

6. RHU providing MNS  Yes

Services- Report form
facilities containing
individual treatment  No
records, type of service
provided including
quantity and name of
medication
dispensed
7. PHC facilities accredited  Yes
by PhilHealth providing
MNS services –
Accreditation  No
Certificate, a report
from facilities
containing individual
treatment record, type of
service provided
including quantity and
name of medication
dispensed

8. Appropriate allocation of  Yes

mental, neurologic and
substance-use related
commodities –  No
LIPH
9. Budget allocation for the  Yes
implementation of MH
program – LIPH
 No

Remarks (Write a short explanation for items

answered “No”. Record any implementation
issues or best practices not initially reported in
the DCF):

Signature of Local Date: Signature of Local Date:

Health Officer: Chief Executive:
Signature of Assigned Date: Reporting Year: 2023
DOHRep/MOH-BARMM