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Health Policy Development Program

The iCHT The Marikina City Experience and Quick Guide to the iCHT System

2013


B. iCHT Concept and Software Development

C. iCHT Pilot Implementation in Marikina City D. Quick Guide to iCHT Implementation

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iCHT System

A. Introduction

The

Content Guide


Introduction

The Department of Health (DOH) Department Order 2011 – 0188 entitled ‘Kalusugan Pangkalahatan (KP) Implementation and Execution Plan’ provides a clear path in the achievement of Universal Health care through its three strategic thrusts: (1) Financial Risk Protection; (2) Access to Quality Health Services; and (3) Attainment of Health-related Millennium Development Goals (MDGs).

In particular, the attainment of health related MDGs strategy applies additional effort and resources in localities with high concentration of families who are unable to receive critical health services by using the approach of Community Health Teams (CHT). This approach was supported by the results of the Family Health Book (FHB) Operations Research done in Compostela Valley wherein the increase in use of FP/MNCHN services such as Antenatal Care (ANC), Facility Based Delivery (FBD), Immunization and Modern Family Planning (MFP) among families was influenced by the health navigators. They visited low-income, poorly educated families and provided them health messages through the FHB and assisted them in health use planning and adherence.

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Based on the DO 2011-0188 issuance, for the Scaleup Phase (CY 2012 to 2013), the mobilization of at least 100,000 CHTs should be organized and trained in identifying clients with health needs on FP/MNCHN by profiling and health risk assessment, guiding clients in the formulation of health plans, linking clients to health providers and facilities and providing information to families on their entitlements as PhilHealth members. By this time, they should already be partnered to the 5.2 million poorest families listed in the National Household Targeting System-Poverty Reduction (NHTS-PR) and eventually to 10.8 million families by 2016. However, with the implementation of CHT nationwide, there are certain bottlenecks that have been identified. These include: (1) high cost of printing for the various paper forms and materials, (2) high transaction cost for the validation of profiles of household members, (3) time consumed in the consolidation of data (barangay to regional level), (4) error-prone manual reporting system, (5) time consumed in updating the central database of NHTS and PhilHealth membership list, and (6) inability to relay real time information to health facilities to help them estimate resources for health needs of clients. These identified bottlenecks in the implementation of CHT activities may be addressed by the use of iCHT, a computer based application which is an automated version of the CHT tools specifically designed for the profiling of families, provision of critical health information and development of Health Use Plans (HUP). This development was led by Health Policy Development Program (HPDP), a USAID-funded project, in cooperation with the DOH-NCR and City Government of Marikina as the main pilot site of implementation.


iCHT Concept and Software Development Concept The general concept (Figure 1) of the iCHT system is to deploy CHT partners using a tablet-based application which serves as a substitute of the CHT forms. In this case, the paper-based forms are translated into an automated version wherein it can perform profiling of families, formulation of specific health plans with standardized multimedia health messages, referral to facility, monitoring of utilization and follow-up.

Figure 1: General Concept of iCHT

On the other hand, the CHT deployment shall also be monitored by the CHT supervisors, health center staff and health managers. With the current consolidation and reporting scheme of the pen and paper CHT approach (Figure 2) which is time consuming and error-prone, the iCHT system, through a web-based application, will be used to generate reports using its cloud computing capability. This shall sort the CHT reports to their required classification.

Figure 2: Pen and Paper CHT Reporting Flow

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From the data collected during the home visits and follow-ups of CHT partners, when synced via wireless internet to the admin server, this will already be accessible to the health providers, LGU health staff and DOH (Figure 3).

Figure 3: iCHT Reporting Flow

The iCHT Tablet Application The features of the tablet application are the following: a. Each CHT partner will be provided by a tablet installed with an iCHT android application wherein a username and password is provided to access the application.

Figure 4: iCHT Log-in Page

b. The assigned head of households for the CHT partner will be accessed upon the login. Initial details such as NHTS number, birth date, sex and address of the head of household are uploaded in the system. Home


Figure 5: Household Search Page

This shall be validated and updated by the CHT partner during the home visit. During the profiling, the PhilHealth membership and NHTS category are also asked in the application.

Figure 6: Profiling Page

Adding household members are also facilitated by the application wherein the birth date, sex, relationship with the head of household and PhilHealth membership are also determined.

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Figure 7: Adding Household Members

c. Automatic identification of health risks from the profiling will initiate the HUP development. The criteria used for HUP eligibility are seen in Table 1. For HUP A/B, C, and F, these will be automatically developed when the household member meets the conditions of age and/or sex. While for HUP D, E and G, screening questions shall be asked by the system to proceed in the profiling. For example in HUP D, the system will ask if the female member aged >15 years old is pregnant (Figure 8). Table 1: Criteria for HUP Eligibility

Criteria for HUP Eligibility Male or Female Age < 1 years old Male or Female Age 1 to <5 years old Female, >15 years old, Pregnant Female, >15 years old , < 6 weeks post-partum Female, aged 15-49 years old Male or Female, Aged 10 onwards, with cough for > 2 weeks.

Figure 8: HUP Eligibility Qualifier

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Health Use Plans HUP A/B HUP C HUP D HUP E HUP F HUP G


d. HUP development for newborn, infant, child aged 1 to 5 years old, pregnant, postpartum, family planning and cough of more than two weeks. When a member has already been profiled and screened for health risks, the CHT partner may now start assisting the client in health use planning. A set of questions patterned from the paper-based form were translated to easily navigate the CHT partner in determining referrals. Most of the HUPs except for HUP G and F have two components in planning: (1) Identification of Danger Signs which is usually located on the first part and (2) Assessment of needed health services. For example in HUP D, the pregnant is screened first with Danger Signs (Figure 9). If there are items that are selected in the list of signs and symptoms, the system will automatically refer the client to a hospital. While, if there are no danger signs, the planning will proceed to the maternal profile, identification of prenatal check-ups and screening for high risk pregnancies (Figure 10).

Figure 9: Pregnancy Danger Signs

Figure 10: Risk Assessment

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e. Every HUP has a standardized pop-out and video health messages to provide health education and awareness among the families. For example in HUP D, when the question for prenatal check-up is asked and answered by Oo or Hindi, a pop-out message will appear for every answer (Figure 11 & 12). While there are video health messages such as Newborn Screening and Exclusive Breastfeeding campaign embedded in the HUP that should be played and shown to the client (Figure 13).

Figure 11: Pop-up message for Oo

Figure 12: Pop-up message for Hindi

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Figure 13: Video screenshot on messages for newborn screening and exclusive breast feeding

For the full list of pop-out and video health messages, see Annex H. f.

Referral of clients to health facilities is also integrated in the HUP development. This feature customizes the type of health facility based on the health service needed by the client (Table 2). Table 2: Service Delivery Network by type of Referral

HUP

Health Center

Lying-in

Government Hospital

Private Hospital

✔ ✔ ✔ ✔

✔ ✔ ✔ ✔

✔ ✔

✔ ✔

HUP AB Danger signs Others

HUP C Danger signs Others

HUP D Danger signs Antenatal care Facility for NSD Facility for CS

✔ ✔

✔ ✔

HUP E Danger signs Postnatal care

FP consultation

Cough consultation

HUP F HUP G

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For example in HUP D, dangers signs are referred only to government and private hospitals since that this needing immediate intervention. The lists of hospitals are not only those in the situated in the municipality or city but also those who are adjacent or near the location of the client. Moreover, for the antenatal care, the pregnant may be referred to the health center, private lying-ins and hospitals since that these facilities can accommodate the health services needed by the client. g. Generation of notifications which prompts the follow-up of households through syncing and updating with the web server. For this feature, the data inputted by the CHT partner during the field visit shall be transferred to the web server/admin panel through wireless internet connection. The admin panel will generate the notifications and update the android application. For example in HUP D, if a pregnant women has no antenatal check-up and she has been referred by the CHT partner to the health center, the admin panel will generate notification in the tablet application to follow-up if the client went to the facility for health services (Figure 14).

Figure 14: Notifications Page

The iCHT Administrator Application Features of the Admin Panel Application: a. Accessibility level of users (see Annex I) b. Adding CHT members c. Generation of essential reports d. Prompting the generation of notifications for android application e. Health Risk Assessments f. HUP Development

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iCHT Pilot Implementation in Marikina City Marikina City was chosen as the pilot site for iCHT implementation due to the presence of Pantawid Pamilyang Pilipino Program or (4Ps), number of trained CHT partners, and existing IT infrastructure (availability of internet connections and servers). HPDP expressed its interest to Marikina City as a pilot site last May 22, 2012 through a meeting with Marikina City Health Office (CHO) and representatives from the Marikina Information System (MIS) office. The iCHT concept, proposed times and counterparts expected from the LGU was presented. The CHO agreed that the implementation of CHT strategy in their city experiences difficulty due to the (1) downloading of forms, (2) data consolidation since their midwives are flooded with various tasks, and (3) delay in the transfer of TEVs of the CHT volunteers which ensure commitment. They also agreed that the use of an Information and Communication Technology (ICT) will greatly affect the CHT implementation. However, they raised some concerns in the security of tablets as this may post risks. The CHO suggested that the Barangay Hall may be involved with the barangay tanods in the field work of the CHTs. Moreover, the suggested procurement of tablet PCs as part

of their counterpart of the LGU may not be provided since that the annual budget allocation for health has already been programmed for this year. It was also agreed that the tablets will be under the ownership of the Marikina CHO after the turnover of the iCHT system.

To formalize the iCHT project development and pilot testing in Marikina City, the CHO requested formalization of roles between the stakeholders of the project by drafting a Memorandum of Understanding (MOU) signed by the City Mayor and Chief of Party of HPDP. The MOU indicates the roles and functions of each party in the rollout of the iCHT system (see Annex A).

Development of the iCHT software for Marikina City The iCHT system was developed over a period of five (5) months, from August to December 2012. The software development was contracted out to AppLabs Digital Studios., an IT application developer. Last August 1, 2012, a formal meeting was conducted between AppLabs, Marikina CHO and HPDP. This was a venue for the CHO to provide an orientation of the current CHT implementation of the city as well as the possible sites for the pilot. While on the part of AppLabs, they presented their iCHT concept presentation which includes digitizing and creation of a paperless CHT tool and the ability to sync reports collected via wireless connection towards the server. Marikina CHO was also expected to prepare data sets of NHTS and health facilities which shall be uploaded in the system. During the development of the applications, the following activities were done: a. Procurement of Tablet PCs based on the number of CHTs. b. Review and streamlining of the paper-based CHT forms (both Form 1 and 2A-G), referral and monitoring tools which were translated into algorithms (see Annex B). Additional questions based on the reviewed forms were also accommodated to simplify the health planning.

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c. Health messages integrated in the CHT forms were executed as pop-out messages while existing DOH health videos was also included to provide standardized presentation of messages for FP/MNCHN and TB. This was also presented with Marikina CHO. d. Formulation of systematic referral of FP/MNCHN and TB services to health facilities. e. Debugging and Beta Testing of both android and admin panel applications

Preparing the IT Infrastructure of Marikina City In preparing the IT infrastructure of the iCHT System in Marikina, the developers assessed the existing server of the city in coordination with MIS. After this, the developers installed the web-based software in Marikina system based on its configuration, available memory space and compatibility issues. Since that Barangay Tumana was the target pilot site, the health center was provided with a desktop computer and internet connection through the cityâ&#x20AC;&#x2122;s local area network and wireless router. This served as the access point for the tablets to communicate with the iCHT admin panel wherein designated data for a specific CHT will be fetched from the system.

Training HPDP conducted a three-day orientation-training on the use of the iCHT application for the navigational duties of the CHTs (see Annex C). The CHO organized the CHTs that will be trained. There was a turnout of 78 CHT members from the selected site. The first day of training was devoted to the familiarization of the CHTs to their roles and functions in the delivery of health services in the barangay. The orientation was conducted by the CHD KP nurse assigned to Marikina City. It was a venue to familiarize them with the iCHT application, wherein a hands-on manipulation of the application using the PC tablet was experienced. Alongside the CHT sessions, a separate orientation for the health providers in Barangay Tumana and Marikina City Health Officers was conducted on the use of the iCHT Administration Panel. The third day was divided into three (3) parts, in the morning the CHTs were provided with a refresher on the discussions made on the first two (2) days of the training, the afternoon was devoted to a practicum for the use of the iCHT application to an actual household and finally, to evaluate the effectiveness of the training. A plenary discussion was held regarding the benefits, issues and challenges experienced with the actual use of the iCHT application.

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Deployment & Roll-out in Marikina Sixty CHT members, who were assigned a total of 2,515 households or around 40 families for each, were provided with tablets installed with the iCHT application and deployed. Prior to deployment, each CHT member was provided a commodatum as a way to secure the tablets (see Annex D). CHT members who were having difficulties in using the iCHT application were paired with those advance users. In order to not overcrowd the health center, the CHT members were grouped and assigned a specific schedule when they will get the tablets from the health center and do their home visits.

HPDP team preparing the tablets prior to deployment (left) and members of the CHT check their household assignments (right)

Monitoring & Troubleshooting During the initial deployment, a number of setbacks were documented. Some of the iCHT application crashes while being used. This was resolved by customizing the android operating system of the tablet. The customization removed unnecessary preinstalled applications in the tablet and made the iCHT application more stable. Problems in fetching and syncing of data, development of health use plans were common since the application was still in its infancy. Versions after versions of the application were developed, resolving every new glitch that was found during testing. Some of the problems were with the server and the connection from the health center. Some members of the Community Health Team in Marikina City pose with their electronic tablet containing the androidbased iCHT application during the turnover ceremony of the iCHT system in Marikina City on December 10, 2012.

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iCHT Timeline August and September 2012 • Finalization of the iCHT concept and requirements • Presentation to key stakeholders, the Department of Health and the Marikina City Government (local health board) and Marikina City Health Office • Procurement of the PC tablets • Start of software development October 2012 • End of software development and debugging • Installation of the iCHT system in the Tumana Health Center • Training of 57 CHTs of Barangay Tumana November 2012 • Random selection of 18 CHTs involved in a time and motion study • Presentation of the cost benefit analysis of the iCHT system to the Department of Health • Completion of monitoring of iCHT implementation in Tumana December 2012 • Turn over ceremony

Feedback and Results The potential of the iCHT system in improving CHT tasks was determined by randomly selecting eighteen (18) CHT members who assessed the ease of using iCHT and were subjected to a time and motion analysis to determine the length of time needed to profile families and develop HUPs. In addition, the relative cost of the iCHT system versus the use of paper-based forms and materials for a five-year period and the amount of savings that may be derived for each CHT member in a year were also estimated. Feedback from the CHT members who have used the iCHT system reveals the following: 1. The CHTs validated the user-friendliness of the application and the portability and convenience of bringing a tablet instead of a set of forms and booklets; 2. The delivery of health messages did not miss out on health messages to be delivered. The multimedia format was found to be more interesting by the families; and 3. The data gathered by the CHTs seamlessly synced to the iCHT administration panel that is accessible to the health center midwife, thus providing instant report consolidation.

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The key findings in using the iCHT system versus the paper-based approach are the following: 1. There is no difference in the training cost between the two methods; 2. The cost of materials for the iCHT is lower than that of the paper-based approach; 3. The cost of household visits is lower when using the iCHT because of the shorter time spent in profiling, developing health use plans, and delivering health messages; 4. Data processing and reporting is significantly quicker and less expensive when using the iCHT; and 5. Considering all the costs involved in the two methods, using the iCHT system is less expensive and can generate savings by around PhP 9,000 per CHT annually.

â&#x20AC;&#x153;Using the tablets with the iCHT makes our work easier and faster. We just need to press buttons and show the families the health messages.â&#x20AC;? -Luchi Lamac, CHT member trained on iCHT The iCHT system was shown to be more advantageous than the traditional paper-based approach because of the lower cost of materials and the lesser time spent in performing CHT functions. Using the iCHT system is nearly half as expensive over a five-year period. The difference in cost between the two methods translates to a savings of PhP 9,314 for each CHT member per year when using the iCHT system.

Luchi Lamac, Marikina CHT member, assisting a family in developing health use plans using the tablet-based iCHT application.

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Quick Guide to iCHT Implementation

As a reference for the roll-out of the iCHT technology to the other regions, a guide was developed to assist the CHDs and LGUs in the implementation. This was based from the preparatory and implementation activities done in Marikina City pilot experience.

â&#x2020;&#x2019;Download the video at: https://dl.dropbox.com/u/32411870/Quick%20Guide%20To%20iCHT.mp4

A. Preparatory Phase In the preparatory phase, assessment of areas for implementation, resources, software development and pre-deployment activities are expected to be accomplished. In this section, the agreements made by both CHD and LGUs are expected to support the implementation.

1) Targeting Areas for Implementation With the benefits of iCHT in the reduction of cost in the CHT deployment, ease in reporting, among others, it is ideal to implement such technology in all areas. However, with several constraints in the implementation, it is essential to note basic considerations in selecting sites. This may determine if the area selected will meet the basic requirement of the system. These are as follows: a. Are there existing IT resources in the area such as internet connection or Local Area Networks? b. What is the current NHTS household target for iCHT implementation (Q1, Q2 or CCT Households)? c. With regards to the geographical orientation of the areas, is there an internet or 3G connection provider?

2) Determining the Resource Requirement and Costs After a site has already been selected, the resources needed for the implementation should be identified basing on the scale of implementation. This may vary depending on the targeted areas

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if province-wide or selected municipalities/cities only. To determine the required resources, the CHD should have already identified which LGUs to be covered and number of NHTS households to be targeted. Android Application The android application will be primarily be used by the CHT partners in the field. This requires the following: a. Determine the number of Tablet PCs to be procured by the identifying the number of CHT partners needed in the deployment. The recommended ratio in determining the number of CHT partners is 1 CHT Partner: 20 Households based from the DO 2011-0188. b. Customize the software application based on the needs of the LGU. This is optional for the implementing CHDs and LGUs. c. Conduct of trainings for CHT partners and health staff. d. Preparation of logistics for deployment Admin Panel Application The requirements in setting-up the admin panel/ web server application are the following: a. Provision of server where the application shall be installed. b. Establish an internet connection or Wireless Local Area Connection (WLAN) if internet is not available c. Computers to be installed at the health centers. d. Preparation of required data sets that will be uploaded in the admin panel. e. Training of Health Staffs in using the both the tablet application and admin panel.

→Preparing the iCHT Database Prepare the following for integration in the iCHT database in excel format: • NHTS or CCT Database with the following details NHTS ID number Name of head of household Age/Birthdate Sex Complete address Name of dependents and their age, sex, and relation to head of household • List of CHT members and their assigned households • List of all health facilities with the following information Name of the facility Contact Details Address PhilHealth Accreditation Services Available • List of users for the admin panel with their corresponding access authorization level

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3) Engaging with LGUs A video material was developed especially design for local chief executives (LCE) to secure their support. It was designed to give an idea on what the iCHT system is and how it can potentially improve the performance of CHT functions. It is available in two languages: English and Filipino. Filipino Version

http://youtu.be/UCjOoPHM2o4

Download the videos at: Filipino version: https://dl.dropbox.com/u/32411870/iCHT%20LCE%20Filipino.mp4 English version: https://dl.dropbox.com/u/32411870/iCHT%20LCE%20English.mp4 Agreements between the CHD and LGUs are important in the execution and sustainability of the iCHT. With the identified areas for implementation, the CHD should secure commitment of the LCEs and its staff through a Memorandum of Understanding (MOU). This shall contain the agreements of each party on their functions, duties, and responsibility in the implementation of iCHT.

4) Setting-up the IT Infrastructure When the agreements have been made between the CHD and LGU and the resources are already available (i.e. tablets, servers, routers, etc.), it is now ready to set up the IT infrastructure suited for the iCHT system. Note that the setup for both android and admin panel application can be simultaneously done to maximize the time spent for the preparation. For the android application, tablet PCs should already be procured and customized before the installation of the software application. Customization of the tablet PCs entails that this should only be used for the iCHT application and not for other purposes. Customization of the android application depends on the discretion of the CHD and LGU if they want to. This includes modification of language, health messages, and other components that is more suitable in the area of roll-out. With the experience in Marikina City, the health messages, language, and other parts of the android application were presented to the City Health Office to

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at least provide feedback from them if the features of the application compliment their current health programs. Customization may be outsourced with IT Company specializing application development, however, it important to consider the time of development. This may lengthen the process of development based on the degree of changes in the software which may delay the training and deployment of the CHT partners. When the customization of iCHT application has already been completed, this should be installed to the tablet PCs for beta testing. To proceed on the beta testing, the admin panel should be ready by this time. To setup the admin panel application, the server, internet connection/WLAN and computers should be already in place. The server, where the application will be accessed to by the users, will be managed by a primary administrator. In this case, the CHD and LGU should identify who will manage the server. This includes tasks on uploading of data sets of the targeted areas which contains the list of households and service delivery network; identification of access level among the users of the application; and maintains the web server. Internet connection or WLAN should be established to sync and update the data from the web server to the tablet. Make sure that the routers and computers are already functional in the area. It is recommended to install the equipment at the health centers. The data sets that will be used for the deployment should be submitted by the LGU staff for uploading in the system. These include, the list of names of NHTS households matched with the CHT partners and the Service Delivery Network. The list of NHTS households may be obtained from the regional or local DSWD. This list should be matched with the number of CHT partners that will be trained. The recommended ratio for CHT partner to its assigned household is 1:20. However, this may vary depending on the availability of the CHT volunteers in the area. In the case of Marikina City, 2515 households of Barangay Tumana were accommodated by 60 CHT partners. In assigning households to the CHT partner, it should take into consideration if the volunteer is a Parent Leader (PL). In this case, the covered CCT households may already be assigned to the PL. Another factor would be designation of households should be at least accessible with the CHT partner. It is also important to arrange the grouping of households according to their address and proximity. While in determining the Service Delivery Network that will be used for the referral of patients, the LGUs should prepare a list of health facilities (health centers, private lying-ins, private hospitals and government hospitals). Information such as the name of the facility, address,

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contact person, contact number, and PhilHealth Accreditation should be also contained in the list.

5) Conduct iCHT Training The planner should ensure that the tablets are ready for use before training the CHTs. This means that the customized application has already been developed and functional especially in the syncing and updating capability with the admin server application through beta testing. In addition, training materials should be prepared by the trainers. This includes the training design, modules and forms used in the deployment. An instructional manual (see Annex F) and an instructional video (see disk 2) on the use of the iCHT application were developed to assist in the conduct of training. The conduct of iCHT training for CHT partners may take three days of training. With the experience in Marikina, the first day of training was dedicated in the orientation of roles, process and tools of the CHT volunteer. While the remaining two days, this shall be focused on the discussions of the iCHT actual demonstration of profiling, HUP development, notifications, field practicum and arrangements for the deployment.

6) Preparing for the deployment and monitoring of CHT partners Before the deployment of the trained CHT partners, the commodatum or the agreement between the LGU and CHT in using the iCHT Tablet should be signed. Moreover, the logistics should be prepared. First, the CHT partners should be provided with the list of assigned NHTS households at hand. This will serve as an opportunity for them to locate the households before the home visit. Second, the referral forms should be readily given to family members who are referred to the health facilities. Third, the schedule of services in the health center as well as the point persons should be oriented to the CHT partners since they should also providing them the a list of referred clients by using a summary call sheet or customized form. Maintaining the integrity of the tablet PC should be oriented among the CHT partners not only in the iCHT training but also during the deployment. The health staff should identify storage cabinets where the tablet PCs will be stored when not in use. Policies in charging the equipment as well as the monitoring of ins and outs of the tablet should also be formulated. At least one staff of the health center should be familiar in troubleshooting the tablet PCs and web server application. Another important aspect that should be look into would be the anticipation that demands for health services for FP/MNCHN and TB will increase. Like what happened in Tumana Health Center, the midwife verbalized that during the deployment of CHTs in the area, patients for immunization and FP services increased. In this case, the Municipal/City Health Officer should at least prepare the health facilities for supplies and other resources to accommodate its clients.

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Annexes

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Annex A. HPDP and Marikina City Memorandum of Understanding MEMORANDUM OF UNDERSTANDING ON THE SETUP, PROMOTION, AND MAINTENANCE OF THE INTELLIGENT COMMUNITY HEALTH TOOL (iCHT) IN MARIKINA CITY The City Government of Marikina and the UPecon Foundation Inc.-Health Policy Development Program (HPDP), hereafter referred to as the Parties, COGNIZANT of the fact that Marikina City is responsible for the timely delivery of basic health services to the people; RECOGNIZING the provision of the Local Government Code that mandates Marikina City to ensure and promote the health and safety of its constituents; AWARE of the value of information regarding affordable and accessible quality health care services and products, together with their costs; REALIZING the value of the latest mobile communication technology to promote, disseminate, and share relevant information to end users; DESIROUS of the promotion of informed choice that leads to better health seeking behavior of Marikina City families, especially those with limited financing sources for health care needs; REAFFIRMING the Partiesâ&#x20AC;&#x2122; resolve to develop and further enhance a functional referral system that considers the respective capacities of health care providers in Marikina City; COMMITTED to the realization of potential benefits through multilateral policy formulation and decision-making among stakeholders; Accordingly, the Parties, operating under this MOU agree as follows: ARTICLE 1 The Parties hereby employ the Intelligent Community Health Tool (iCHT), which will automate the process and tools employed by Community Health Teams in helping poor families access critical health services through development of and adherence to health use plans. The iCHT shall be an Android-based application that will facilitate a more efficient way of collecting and updating relevant database, create and track adherence to health use plans by target families, and deliver standardized health messages. ARTICLE 2 The Parties agree to undertake the following functions, duties, and responsibilities for this MOU, with each Party providing its own resources in implementing its activities: A. Marikina City shall: 1.) Provide HPDP with the roster, including all pertinent data, of Marikina City households that are identified as poor by the National Household Targeting System for Poverty Reduction (NHTS-PR) or are beneficiaries of the Pantawid Pamilyang Pilipino Program (4P), with an assurance that all information

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shall be used solely in the development of iCHT and accessed only by authorized Community Health Teams and by designated staff from the City Health Office; 2.) Provide HPDP with a list of names of Community Health Teams and their corresponding assigned households that are beneficiaries of the Pantawid Pamilyang Pilipino Program (4P); 3.) Provide HPDP with a list of names, addresses, contact details, services provided, and corresponding fees (if available) of all PhilHealth-accredited health care facilities in the city, from both public and private sectors, from all its available databases, such as those from the Business Permit and Licensing Office; 4.) Mobilize instrumentalities, officers, and staff for the implementation of an Executive Order that will support the setup, promotion, and maintenance of iCHT; 5.) Organize designated representatives from the City Health Office and the systems administrator of the Marikina City website to execute tasks related to the operations of iCHT, including but not limited to approving new registrants in the network, reviewing all information reflected in the CHT reports and in the health provider profiles and ensuring their correctness, and monitoring the network for potential user abuse; 6.) Issue the necessary executive fiat and recommend to its Local Health Board the enactment of appropriate local legislative acts related to the iCHT activities, such as but not limited to establishing an inter-agency committee that will promote and maintain iCHT and defining annual budgetary allocations for its promotion and maintenance; 7.) Provide logistics and administrative support to activities, strategies, and materials related to the setup, promotion, and maintenance of iCHT application and website to ensure sustainability from launching onwards; 8.) Allow HPDP to access to Marikinaâ&#x20AC;&#x2122;s existing systems for the setup and hosting of the iCHT website; 9.) Ensure the protection of the tablets by defining a clear protocol on its handling, storage and maintenance, which may include employing the services of Barangay Service Point Officers (BSPOs) or other individuals who may be able to escort the CHTs during their family visits and physically secure the units; and 10.) Cooperate with HPDP in validating the functionality of the application and the website and the accuracy of all reports produced by the package. B.

HPDP shall provide technical assistance to Marikina City in the: 1.) Conduct of consultative meeting with the Office of the City Mayor, the City Health Office, and the Marikina City Local Health Board for the development of iCHT; 2.) Formulation, development, and setup of the Android-based and user-friendly iCHT application that will introduce efficiency into the processes and tools of the Community Health Teams, potentially generating demand for health services in the city; 3.) Setup of the iCHT website, which shall contain information on NHTS-PR poor and 4Ps households, health status of families, and health care providers in the city and shall generate CHT reports and statistics, such as the number of health use plans developed and complied; 4.) Provision of tablets that shall contain the iCHT application and shall solely be used for pertinent activities by the Community Health Teams; and 5.) Conduct of technical assistance and capacity-building activities for Marikina City and other partners in relation to their functions and responsibilities in implementing all the tasks contained therein, especially in training for the use of and maintaining the iCHT application and website. ARTICLE 3

Unless otherwise agreed, each Party will be accountable for the cost resulting from its own participation in the activities contained in this MOU. ARTICLE 4

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A Working Committee shall be created for the implementation of the provisions in this MOU. The Working Committee shall organize meetings, consultations, and workshops and shall meet at least once a month or whenever deemed appropriate. It will be responsible for developing the agendas, presentations, and minutes of each activity. Action items will be clearly identified and tracked in the minutes. Moreover, the working committee will monitor and evaluate the outputs, progress, and accomplishments of the iCHT initiative in relation to its objectives. ARTICLE 5 This MOU may be amended upon mutual agreement of the Parties. ARTICLE 6 This MOU shall remain in force for three months effective on the date of the final signature and may be extended for a similar period unless one Party officially notifies the other of its desire to suspend or terminate this MOU one month prior to its intended date of expiration. Either Party may terminate this MOU at any time, to take effect one month from receipt of the notice by the other Party. Signed in Marikina City, Metropolitan Manila this __th day of September 2012. For the City Government of Marikina:

For the Health Policy Development Program:

________________________________ Hon. DEL R. DE GUZMAN Mayor, Marikina City

________________________________ ORVILLE JOSE C. SOLON, PhD Chief of Party, UPecon Foundation, Inc. â&#x20AC;&#x201C; Health Policy Development Program

Annex B. Algorithms See file Alogorithms.rar

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Annex C. Marikina Training Design

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TRAINING DESIGN ACTIVITY: “Orientation/Training of Community Health Teams in Marikina City in the use of iCHT”

DATES: October 4-5 & 8, 2012 VENUE:

Marikina City Health Office Building, Marikina City

FUNDING AGENCY : Marikina City Health Office RATIONALE: The organization and mobilization of Community Health Teams (CHT) is the main strategy to generate demand for health services among the targeted poor. This is espoused in the MNCHN Manual of Operations (DM 2011-0177) and the Kalusugan Pangkalahatan Execution Plan and Implementation Arrangement (DO 2011-0188.), being formally implemented in the year 2011. Although a number of issuances have been disseminated, operational issues have been raised from its nationwide implementation. Among others the implementation of CHT is faced with the following concerns and bottlenecks, (1) expenses of monthly printing of various paper forms, (2) high transaction cost in validating of information from individual CCT/ NHTS PR HHs, (3) difficulty in updating critical databases (e.g. CCT/NHTS list, PHIC membership list), (4) time consuming manual consolidation of reports, (5) error-prone manual reporting system, and (6) providing real time info to health facilities to help them estimate resources for clients referred to them. These bottlenecks in the implementation of CHTs with its very nature need an efficient, compact tool which is easily upgradable and modifiable for the dynamic needs of its implementation. In this age of robust development in the field of Information Communication Technology (ICT), it will be advantageous to integrate such to eliminate the issues bought by the current pen and paper approach of the CHT implementation, thus the development of an Internet Community Health Team or iCHT. The iCHT is an automated version of the CHT tools specifically the profiling form and the six (6) Health Use Plans (HUPs), packaged into a user-friendly application embedded in a PC tablet, which when synchronized via internet to a server and then received by an Administration Panel, can generate reports on vital indicators monitored by the CHTs inherent in its navigational functions. Marikina City has 11,997 NHTS PR poor household, Barangay Tumana in particular, is a known “melting pot” Barangay, with 3,940 NHTS poor households (33% of Marikina), among which 1,956 are CCT beneficiaries was chosen as the pilot testing site of the iCHT due to its diverse profile of poor families.

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TRAINING OBJECTIVES: The training will provide a venue for the Community Health Teams, CHT Supervisors, Marikina City Health Officers and partner private health providers in familiarizing themselves with the iCHT application and to discuss changes in the CHT forms bought by the automation of the CHT tools in paper format. At the end of the training, the participants will be able to do the following: a. Understand the navigational function of the Community Health Team b. Understand the various concepts in delivering the CHT tasks through the use of the iCHT application c. Maneuver through the Profiling and Health Use Plans in the iCHT application d. Learn the basic handling and maintenance of the PC tablet as platform for the iCHT application

DESCRIPTION: This will be a three-day orientation/training on the use of the iCHT application for the navigational duties of the CHTs of Marikina City particularly in Barangay Tumana. The first two (2) days of the training will be devoted to the familiarization of the CHTs to their roles and functions in the delivery of health services in the Barangay. It will also be a venue to familiarize them with the iCHT application, where in a hands-on manipulation of the application using the PC tablet will be experienced. Alongside the CHT sessions, a separate orientation for the health providers in Barangay Tumana and Marikina City Health Officers will be conducted for the use of the iCHT Administration Panel. The third day will be divided into three (3) parts, in the morning the CHT will be provided with a refresher on the discussions made on the first two (2) days of the training, the afternoon, will be devoted to a practicum for the use of the iCHT application to an actual household and finally, to evaluate the effectiveness of the training a plenary discussion will be held regarding the benefits, issues and challenges experienced with the actual use of the iCHT application.

TRAINING GOALS: At the end of the three day activity, it is expected that:  The Community Health Teams are oriented on their roles and functions such as:

    

Profiling of Assigned households Health Risk Assessment Relaying Health Messages Development of Health Use Plans with assigned household

Follow-up on Health Use Plan adherence  The Community Health Teams are familiar in the use of the iCHT application  City Health Officers and Health Managers/Providers are familiar in the use of the iCHT Administration Panel  Community Health Teams, Barangay Officials, Health Providers are aware of the proper handling and maintenance of the PC tablet.  Agreements on monitoring the pilot implementation of the iCHT in Barangay Tumana have been identified

PREPARATION FOR THE TRAINING The following are preparation work for the iCHT orientation/training for CHTs of Barangay Tumana;  

Consultative meeting with Marikina CHO for the training design of the iCHT training Venue: Marikina City Health Office c/o Dr. Cristy Sy – Technical Chief 2


   

o Use of projector(s) and sound system o Meals and snacks of participants o Transportation arrangements Invitation of Participants c/o Mr. Brian Mascarina – DOH KP Nurse & Dr. Cristy Sy – Technical Chief Transportation of participants c/o Mr. Ziffred Anchetta – Barangay Captain of Tumana Mass reproduction of iCHT Administration Panel & Application module c/o HPDP Team & AppLabs Team Presentations c/o HPDP Team, Marikina CHO & AppLabs

THE TRAINING DAY 1: OVERVIEW OF COMMUNITY HEALTH TEAMS ROLES, FUNCTIONS AND TOOLS Expected Participants:    

60 CHT members in Barangay Tumana, Marikina City 3 representatives from Brgy. Tumana Health Center 2 representatives from Brgy. Tumana Hall Marikina CHO o Dr. Cristy Sy o Engr. Melody Bibat DOH CHD NCR o Mr. Brian Mascarina

Trainers/Facilitators:  

8 representatives from HPDP UPecon 4 representatives from AppLabs Digital Studios = 80 Participants

The morning session of the first day of training begin with the opening/welcome remarks from the City Health Officer Dr. Alberto Herrera and the Barangay Captain of Tumana, Mr. Ziffred Anchetta, followed by setting up expectations between participants and trainers and presentation of the training program. A short introduction on iCHT will be presented by the HPDP team as a prelude to day 2 of the training. After which is the discussion of the two modules namely:

 

Local Implementation of KP through CHTs The Processes and tools of the CHT

This will be facilitated by the Marikina CHO and a DOH partner, included in the module is the overview of the CHT functions as a “navigator”, the CHT tools such as the profiling form and the health use plans. A group activity is included in module 2, where in the CHTs can practice on the CHT tools in paper form. The activity will be ended by the closing remarks from the Marikina CHO, which would also mention activities for day 2 of the training. The expected outputs are as follows:

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  

Clear understanding of the roles and functions of the Community Health Teams Understanding the benefits of an automated CHT tool Understanding and mastery of the CHT tools in paper format

DAY 1 ACTIVITY OUTLINE: Dates

Time 8:00 – 8:15 am

8:15 – 8:25 am

Activity Opening Ceremonies

Activity Description 

Welcome/Opening remarks from Marikina CHO 

8:25 – 8:35 am

leveling of expectations, presentation of participants

8:35 – 9:00 am 

Day 1 October 4, 2012 Thursday

Local implementation of KP through CHTs– Module 1

11:30 – 12:00 pm

1:00 – 4:30 pm

4:30 – 5:00 pm

Dr. Alberto Herrera, City Health Officer, Marikina City

Barangay Tumana Captain Mr. Ziffred Anchetta

Dr. Cristy Sy, Technical Division Chief, Marikina CHO

Marikina CHO & DOH partner

HPDP Team

Marikina CHO & DOH partner

Marikina CHO & DOH partner

Presentation of program activities for the three day orientation/training

9:00 – 11:30 am

Overview of iCHT

Processes and tools of the CHT – Module 2

Closing remarks and introduction to day 2

Overview on the roles and functions of the Community Health Team, navigational roles, reporting process, etc. Bottlenecks & Issues from current CHT, Rationale & benefits of iCHT as compared to the current pen & paper approach Discussion on the processes of the CHT, such as Phase 1: Preparation, Phase 2: Household visits, Phase 3: Follow-up & Reporting. A group activity as a practice, will follow

Facilitator Dr. Cristy Sy, Technical Division Chief, Marikina CHO

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activities

DAY 2: FAMILIARIZATION TO THE ICHT APPLICATION Expected Participants:    

60 CHT members in Barangay Tumana, Marikina City 3 representatives from Brgy. Tumana Health Center 2 representatives from Brgy. Tumana Hall Marikina CHO o Dr. Cristy Sy o Engr. Melody Bibat DOH CHD NCR o Mr. Brian Mascarina

Trainers/Facilitators:  

8 representatives from HPDP UPecon 4 representatives from AppLabs Digital Studios = 80 Participants

The second day of activities will be devoted to the familiarization of CHTs to the iCHT application. The HPDP team alongside developers from AppLabs will discuss each health use plans, the questions and sequences within the forms and the proper handling and maintenance of the PC tablet. Before discussions the plenary will be divided into 8 groups with 7-8 members each and will be co-facilitated by a member from the HPDP team listed below: 1. Dr. Yosef Laudencia 2. Dr. Faith Obach 3. Mr. Karlo Paredes 4. Ms. Kristine Romorosa 5. Mr. Chamuel Santiago 6. Ms. Crisna Surmienda 7. Ms. Bonna Villagen 8. Mr. Lindsley Jeremiah Villarante The seating arrangement will be based on the grouping identified. The first topic will be regarding the proper use of the PC tablet, a member from AppLabs will discuss the basic operations of the PC tablet such as turning on and off, locking and unlocking the screen, proper holding, cleaning etc. This topic is discussed prior to the manipulation of the tablet to ensure that the CHTs gain confidence on the handling of the PC tablet. To demonstrate effectively group facilitators will show his/her group the actual operations of the PC tablet with an actual unit. This will be followed by the distribution of the PC tablets to CHTs, and the reading of the Commedatum by Dr. Yosef Laudencia. Upon signing the Commedatum, it will thus be collected and kept by the Marikina CHO. Next will be the actual discussions on the iCHT application, each co-facilitator will guide his/her group in learning the HUPs while being discussed by a lead facilitator depending on the health plan, which are as follows: 1. Form 1 & HUP 2A & 2B – Mr. Karlo Paredes & Dr. Faith Obach 2. HUP 2C -2D – Mr. Kristine Romorosa 3. HUP 2E – Mr. Chamuel Santiago 4. HUP 2F – Mr. Lindsley Jeremiah Villarante 5. HUP 2G – Dr. Yosef Laudencia 5


Each lead facilitator will be accompanied by a developer from AppLabs namely: 1. Mr. Darwin Toledo – Developer for the iCHT application 2. Mr. Brian Urfano – Developer for the Administration Panel Each HUPs will be discussed given a time allotment of 30 minutes each, after each HUP is discussed a simulation exercise will follow. The simulation exercises are two to three (2-3) sample cases that will be read by the lead facilitator for the CHTs to simulate on using the PC tablet. The groups will be given 5 minutes to practice using the tablet and another 5 minutes for the lead facilitator to demonstrate the answers. After the discussions and simulation exercises from the plenary, the PC tablets will be collected back for safe keeping of the Marikina CHO. The practicum will be discussed and the day two activity for the CHTs will thus end by the closing remarks of Dr. Cristy Sy of Marikina CHO. Given that there is still time at least an hour, the Marikina CHO, Barangay Tumana health providers and Barangay officials, will convene to discuss about the iCHT administrative panel, which includes the web base counterpart of the iCHT application, features such as adding administrators in the group, database updates from the field work of the CHTs, monitored health indicators of the software and the reports that can be generated by the iCHT administration panel. This will be facilitated by the HPDP team with their respective HUPs and assisted by the developer of the Administrative panel from AppLabs. The expected outputs are as follows:  Familiarized in maneuvering through the iCHT version of the profiling form and forms 2a-2g  Familiarized with the content, sequence of questioning and health messages in the iCHT application  CHT supervisors, CHO representative and health providers familiarized with the iCHT Administration Panel  Learned about the responsibility and accountability of the CHT and health providers regarding the handling and safe keeping of the PC tablet  Learned the basic maintenance of the PC tablet

DAY 2 ACTIVITY OUTLINE: Dates

Day 2 October 5, 2012 Friday

Time 8:00 – 8:15 am

Activity Opening of the activity and announcement of groupings

8:15 – 9:30 am

Discussion on the proper handling and maintenance of the PC tablets

Discussion on manual operations of the tablet such as power on & off, screen lock and unlock, proper handling, cleaning, battery reading and charging etc.

Mr. Darwin Toledo, AppLabs

9:30 – 10:00 am

Reading of the iCHT

The commedatum, a

Dr. Yosef Laudencia, HPDP

Activity Description nd Presentation of the 2 day activities

Facilitator Dr. Cristy Sy, Technical Division Chief, Marikina CHO

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Commedatum

10:00 – 10:15 am

Distribution of the PC tablet

10:15 – 10:45 am

Discussion of the iCHT version of the profiling form and HUP 2a &2b  2 Case Studies each for the profiling form and HUPs 2a & 2b

Discussion of the iCHT version of HUP 2c &2d  2 Case Studies each for the profiling form and HUPs 2c & 2d

Discussion of the iCHT version of HUP 2e  2 Case Study for the profiling form and HUPs 2e

Discussion of the iCHT version of HUP 2f  2 Case Study for the profiling form and HUPs 2f

Discussion of the iCHT version of HUP 2g  2 Case Study for the profiling form and HUPs 2f

1 random case study per each HUPs

Closing remarks and

10:45 – 11:05 am

11:05 – 11:35 am 11:35 – 11:55 am

1:00 – 1:30 pm 1:30 – 1:50 pm

1:50 – 2:20 pm 2:20 – 2:40pm

2:40 – 3:10 pm 3:10 – 3:30 pm

3:30 – 4:00 pm

contract ensuring the responsibility of the CHT to the PC tablet will be discussed, signed by the CHT and collected for safe keeping of the Marikina CHO 

Dr. Cristy Sy, Marikina CHO

Mr. Karlo Paredes, HPDP & Mr. Darwin Toledo, AppLabs

Ms. Kristine Romorosa, HPDP & Mr. Darwin Toledo, AppLabs

Mr. Chamuel Santiago, HPDP & Mr. Darwin Toledo, AppLabs

Mr. Lindsley Jeremiah Villarante, HPDP & Mr. Darwin Toledo, AppLabs

Dr. Yosef Laudencia, HPDP & Mr. Darwin Toledo, AppLabs

Dr. Yosef Laudencia, HPDP

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4:00 – 4:30 pm

4:30 – 5:30 pm

introduction to day 3 activities

Dr. Cristy Sy, Marikina CHO

Introduction to the iCHT Administration Panel  Super Admin functions  Profiling form  HUPs 2a-2g  Report synching and consolidation  HUP adherence & non adherence  Monitored health indicators

HPDP team and Mr. Brian Urfano - AppLabs

DAY 3: REFRESHER DISCUSSION ON ICHT, FIELD PRACTICUM, PLENARY DISCUSSION ON THE ACTUAL USE OF THE ICHT APPLICATION IN THE FIELD Expected Participants:    

60 CHT members in Barangay Tumana, Marikina City 3 representatives from Brgy. Tumana Health Center 2 representatives from Brgy. Tumana Hall Marikina CHO o Dr. Cristy Sy o Engr. Melody Bibat DOH CHD NCR o Mr. Brian Mascarina

Trainers/Facilitators:  

8 representatives from HPDP UPecon 4 representatives from AppLabs Digital Studios

= 80 Participants The expected outputs are as follows:  Hands-on experience in using the iCHT application, with feedback on the benefits and challenges with the automated tool  120 profiled households in Barangay Tumana with 120 or more developed HUPs  Awareness of the deliverables of the pilot testing and schedule of checkpoints from the HPDP team The third and final day of training will be divided into three parts;

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1.

The morning will be devoted to a refresher discussion on the iCHT specifically on the profiling form and HUPs 2a-2g and would be held in the Barangay Tumana Health Center, there will be simulated exercises similar to the day two activities. This will be followed by the actual field practicum of the CHTs

2.

Following the groupings in the day 2 activities, the 8 groups with 7-8 CHT members and one (1) HPDP facilitator will then proceed with the field practicum. The remaining time in the morning will be devoted to profiling at least one (1) assigned household, and another one (1) in the afternoon.

3.

Finally they will be summoned back to the training site in the Marikina City Health Office, for plenary discussion, in the plenary discussion; one (1) CHT per group will be tasked to report on the experiences rd from the practicum, following the outline of report from the 3 module of the CHT facilitators guide or Practicum to an Actual Household.

The closing will be led by Dr. Cristy Sy – Technical Division Chief, she will explain the duration of the pilot testing that will be held from October 9-22, 2012, as well as the schedule of visit of the team to check on the progress of the implementation.

DAY 3 ACTIVITY OUTLINE: Dates

Time 8:00 – 9:15 am

Activity Opening of the activity

9:15 – 10:00 am

Practicum to an actual household – Module 3

Refresher discussion on the  iCHT application

Field Practicum

Continuation of the Field Practicum

Day 3 October 8, 2012 Monday

10:00 – 12:00 pm

1:00 – 2:30 pm

Activity Description rd Presentation of the 3 day activities

Facilitator Dr. Cristy Sy, Technical Division Chief, Marikina CHO

Discussion of the guidelines for the practicum

Marikina CHO

The profiling form and HUPs 2a-2g will be discussed briefly to remind the CHTs of the important points to effectively and efficiently maneuver through the application, simulated exercises at least two (2) per HUP will also be included

HPDP Team

60 CHT members will be divided into 8 groups, with 7-8 CHT members each

Groups to be led by HPDP members (Dr. Yosef Laudencia, Karlo Paredes, Chamuel Santiago, Kristine Romorosa, Dr. Faith Obach, Lindsley Villarante, Bonna Villagen, Crisna Surmienda)

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Travel back to Marikina City Health Office Buidling

Plenary discussion

Discussion on the pilot testing and formal closing of the training program

2:30 – 3:00 pm

3:00 – 4:30 pm

4:30 – 5:00 pm

1Per group there will be at least one (1) CHT member that will report on the perceived benefits and challenges with the use of the iCHT application 

Dr. Cristy Sy, Technical Division Chief, Marikina CHO

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Annex D. Commodatum KASUNDUAN SA PAGGAMIT NG iCHT TABLET Ako, si ____________________________, ___ taong gulang at nakatira sa ___________ ____ _______ ____ ___ ___________________________, ay pinagkakatiwalaan ng City Health Office para pahiramin ng isang yunit ng SAMSUNG GALAXY TAB 2-7.0 [P3110] na tablet at may Serial Number na ___________________, kasama ang wall charger, USB cable, earphones, at User Manuals nito. Sa paggamit nito, alinsunod sa aking tungkulin bilang miyembro ng CHT, ako ay pumapayag at tutupad sa mga sumusunod na alituntunin: 1.

Pananatilihin ko ang maganda at maayos na kalagayan ng mga kagamitang ipinagkatiwala sa akin. Iingatan ko ang mga ito, mula sa pagkuha ko nito sa umaga hanggang sa pagbalik ko nito sa pagtatapos ng araw sa Tumana Health Center, ang lugar na itinalaga ng City Health Office;

2.

Pangangalagaan ko ang mga kagamitang ito sa pamamamagitan ng hindi pagbago, pagsira ng anyo, o pagtakip ng anumang numero, pagkakasulat, o iba pang mga tanda ng kagamitang ito;

3.

Sisiguraduhin ko na ang paggamit ng mga ito ay para lamang sa iCHT, tulad ng itinakda ng City Health Office. Hindi ko dapat ito gagamitin para sa mga gawaing labag sa batas, para sa mga pansariling layunin, o para sa iba pang mga dahilan;

4.

Pananagutan ko ang pagkawala o pagkasira ng mga kagamitang ito kapag ito ay naganap sa labas ng pangkaraniwang gawain, lugar, o oras ng aking mga tungkulin bilang miyembro ng CHT, o kapag ang sanhi ng pagkawala o pagkasira ng mga kagamitang ito ay mapatutunayan na dulot ng aking kapabayaan. Sa loob ng 24 oras pagkawala nito, ako ay tutungo sa pinakamalapit na himpilan ng pulisya upang magpa-blotter at magbigay ng ulat. Magbabayad ako ng makatwirang halaga para sa pagkawala o pagkasira ng mga kagamitang ito, batay sa halaga nito sa petsa ng pagkawala;

5.

Kung ang kabuuan o anumang bahagi ng mga kagamitang ito ay nasira at hindi na maaaring magamit dulot ng sunog, baha, kidlat, lindol, bagyo, kaguluhan, giyera, o iba pang mga kadahilanang hindi inaasahan, ang kasunduang ito ay magwawakas nang walang kabayaran sa City Health Office o sa miyembro ng CHT sa pamamagitan ng pagsulat ng abiso sa isaâ&#x20AC;&#x2122;t-isa;

6.

Papahintulutan ko at hindi ko kailanman tatanggihan ang City Health Office o ang sinumang inatasan nito na magsagawa ng inspeksyon sa mga kagamitang ito anumang oras; at

7.

Hindi ko ibibigay o ipahihiram ang anumang bahagi ng mga kagamitang ito o ang mga datos na nilalaman nito sa mga taong hindi inatasan ng City Health Office.

Ang kasunduang ito ay katuparan ng ugnayan sa pagitan ko, bilang miyembro ng CHT, at ng City Health Office. Hindi ito maaaring baguhin o wakasan, maliban sa mga dahilang nakapaloob sa kasunduang ito o sa iba pang kasunduan na kaugnay nito. Nilalagdaan ko ang kasunduang ito ngayong ika-____ ng ________________, taong 2012 sa City Health Office, Lungsod ng Marikina. Pangalan: _________________________________ Lagda: _________________________________ Tirahan: _________________________________ Telepono: _________________________________ Para sa City Health Office, Lungsod na Marikina: Pangalan: _________________________________ Lagda: _________________________________

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Annex E. Cost Benefit Analysis Paper and Presentation ECONOMIC EVALUATION OF USING THE iCHT SYSTEM VERSUS PAPER-BASED FORMS BY COMMUNITY HEALTH TEAMS: THE MARIKINA EXPERIENCE Laudencia Y, Paredes K, Romorosa K, Santiago C, Villarante L, Obach F, Ilagan J and Solon O Health Policy Development Program

Introduction Community Health Teams (CHTs) play a very important role in providing information to families on their health risks and needs. CHTs are also key to reaching poor households identified by the National Household Targeting System for Poverty Reduction (NHTS-PR) in providing them information on their benefits and responsibilities as PhilHealth members. In line with this, the Department of Health (DOH) mandated the deployment of 100,000 CHTs nationwide as a key strategy for universal health care. However, resource constraints have largely delayed the implementation of the CHT strategy at scale. Among these is the unavailability of forms used by CHT members in profiling and developing Health Use Plans (HUPs). In addition, processing, consolidating, and transmitting all the information in these forms from the health centers up to the provincial level requires considerable time and resources from the LGU. An electronic system called the iCHT was developed to address these challenges to CHT deployment. Essentially, the health information materials and forms used by CHTs were translated into an electronic format. The iCHT expedites the development of individual household profiles, the accomplishment of HUPs based on identified health risks, the delivery of health messages, the facilitation of referral to providers, the monitoring of adherence to HUPs, and the generation of reports from all collected information.

Objective This paper aims to determine the following: 1) The potential of the iCHT system to improve the performance of CHT tasksâ&#x20AC;&#x201D;profiling family members, developing HUPs, delivering health messages, and monitoring their adherence to HUPs; and 2) The relative cost of the iCHT system versus the use of paper-based forms and materials for a five-year period, and the amount of savings that may be derived for each CHT member in a year.

Methodology Developing the application Developing the iCHT system first involved the review and streamlining of existing CHT information, processes, and forms. These were then integrated into the iCHT system, which is composed of two main parts: first is an Android-based application, which is installed in tablets and intended mainly for use by

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the CHTs as a substitute for the forms. In addition to electronically translating these forms, standardized health messages were included through pop-up messages and videos. Automatically facilitating the referral of families who need FP/MNCHN and TB services to health care facilities may also be accomplished, together with transmitting all collected information, by syncing the tablets to Marikina Cityâ&#x20AC;&#x2122;s servers. The other part is a web-based application installed in Marikina Cityâ&#x20AC;&#x2122;s servers and intended mainly for use by health managers. This consolidates and processes all the information gathered by the CHT members using the tablets.

Pilot testing the iCHT The pilot testing of the iCHT system was conducted in Barangay Tumana, Marikina City. Sixty CHT members, who were assigned a total of 2,515 households or around 40 families for each, were provided with tablets installed with the iCHT application.

Estimating costs The five year costs of using the iCHT system and paper-based forms were estimated based on the following parameters: 1) Training The estimated cost of training for using the iCHT system and the paper-based approach, which includes meals and training materials, was determined based on the expenses incurred in training CHT members in Marikina City. The cost of training is the same for both the use of the iCHT system and paper-based forms. 2) Materials The estimated cost of using the iCHT system includes the one-time cost of the tablet and the reproduction of referral forms that will be issued to 40 families per CHT member per year. We did not include the cost of developing the system, which will be negligible since this may be installed and reinstalled to an unlimited number of tablets. On the other hand, the estimated cost of using paper-based forms was based on the actual cost of reproducing the profiling forms, the HUPs, the Family Call Sheet, the Summary Call Sheet, the Family Health Guide, the PhilHealth Guide, referral forms, and a list of health care providers for 40 families per CHT member. 3) Household visits To determine the cost of household visits, 18 CHT members were randomly selected and subjected to a time and motion analysis (TMA). The TMA was done to document the length of time needed for a family of five to be profiled and assisted in the development of various HUPs. The selected CHT members were observed in engaging three families each. The cost in terms of the length of time engaging a family was valued in terms of its proportion to the current daily minimum wage of non-agricultural workers in the National Capital Region.

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The length of time for the paper-based approach was based on an estimate by an experienced panel on CHT deployment. A similar approach to estimating the cost of time spent by CHTs was used. 4) Data processing and reporting Processing the data gathered by the iCHT system to generate reports is done in real-time by syncing the tablets with the Marikina City server. This is done through a local connection that is already set up in Tumana Health Center. It is assumed that the CHT members, midwives, and the City Health Office member spend five hours for syncing per month. The cost of time spent for data processing and reporting was calculated by estimating its proportion to the current daily minimum wage of non-agricultural workers in the National Capital Region. In using paper-based forms, processing the voluminous documents used in profiling and developing HUPs can take a total of 75 hours per month. The cost of time spent for data processing and reporting was calculated by estimating its proportion to the current daily minimum wage of non-agricultural workers in the National Capital Region. Using the above parameters, the total costs of using both methods, expressed as cost for each CHT member and projected over a five-year period, were calculated and compared. The relative cost was then determined by dividing the cost of using the paper-based approach by the cost of using the iCHT system. Finally, the savings for each CHT per year was determined by calculating the difference between the estimated costs for both methods in a year.

Limitations of the Study This study is based on a small pilot involving 18 out of 60 CHTs engaging at least three families each. A larger sample size will increase the accuracy of time and motion analysis. The study site, which is Barangay Tumana in Marikina City, is a highly-urbanized barangay with IT infrastructure already in place. This condition may not be present in other barangays in the country.

Results and Discussion The key findings in using the iCHT system versus the paper-based approach are the following: 1) There is no difference in the training cost between the two methods. The training cost for each CHT member is estimated at PhP 1,050, based on a three-day training program that includes training materials and meals. The cost is the same for the iCHT and the paper-based approach. 2) The cost of materials for the iCHT is lower than that of the paper-based approach. The cost of materials of using the iCHT for each CHT member over a five-year period is estimated at PhP 17,300. This represents a one-time cost for the purchase of the tablets (PhP

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12,500) and a recurrent cost totaling PhP 4,800 for the reproduction of referral forms that will be left with the families. On the other hand, the cost of using paper-based forms for each CHT member over a five-year period is estimated at PhP 48,480 per year. This represents a one-time cost of PhP 5,280 for reproducing the Family Call Sheet, the Summary Call Sheet, the Family Health Guide, the PhilHealth Guide, referral forms, and a list of health care providers, and a recurrent cost of PhP 43,200 for the reproduction of forms used in profiling and HUPs. 3) The cost of household visits is lower when using the iCHT because of the shorter time spent in profiling, developing health use plans, and delivering health messages. Based on the average time spent in performing CHT tasks as determined in the time and motion analysis, using the iCHT will take 30 hours per month to cover the 40 families assigned to each CHT member. Assuming that every hour spent in engaging households costs PhP 57 and that the CHT members engage each family four times in a year, the cost of using the iCHT for each CHT member over a five-year period is estimated at PhP 34,200. On the other hand, using paper-based forms will take 40 hours per month to cover the 40 families assigned to each CHT member. Using the same assumptions as in using the iCHT, the cost of using paper-based forms for each CHT member over a five-year period is estimated at PhP 45,600. We did not include the cost of TEVs as this would be the same across the two groups. 4) Data processing and reporting is significantly quicker and less expensive when using the iCHT. Since the iCHT system can instantaneously generate reports once the information collected by the tablets are uploaded to the server through syncing, we assumed that five hours is spent for data processing and reporting. Using the same cost assumption as in engaging families, the cost of time for data processing and reporting using the iCHT for each year is estimated at PhP 3,420, or PhP 57 per CHT member. This translates to PhP 285 per CHT member over a five-year period. For the paper-based forms, we assumed that the CHT member, midwife, and the CHO spend a total of 75 hours per month for data processing and reporting. Using the same cost assumption as in engaging families, the cost of time for data processing and reporting using paper-based forms for each year is estimated at PhP 51,300 or PhP 355 per CHT member. This translates to PhP 4,275 per CHT member over a five-year period. 5) Considering all the costs involved in the two methods, using the iCHT system is less expensive and can generate savings by around PhP 9,000 per CHT annually. Based on the estimated costs as stated in the above findings, using the iCHT comes out much cheaper at PhP 52,835 per CHT member for five years. The cost of using the paper-based approach, on the other hand, is at PhP 99,405 per CHT member for five years.

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A summary of the costs involved in using the two methods is summarized below: Comparison of the costs of using the iCHT system and the paper-based approach for each CHT member over five years. (in Philippine Peso)

Cost Parameters

iCHT system

Paper-based approach

Training

1,050

1,050

Materials

17,300

48,480

Household visits

34,200

45,600

285

4,275

52,835

99,405

Data processing and reporting Estimated cost for five years

By dividing the cost of using the paper-based approach by the cost of using the iCHT system, a relative cost ratio of roughly 1: 2 is obtained. This implies that using the iCHT system is nearly half as expensive as using the paper-based approach over a five year period. The difference in cost between the two methods is PhP 46,570 per CHT over a five year period or PhP 9,314 for each CHT per year when using the iCHT system.

Conclusion and Recommendations Using the iCHT system is beneficial, in terms of lower cost of materials and lesser time spent in performing CHT-related tasks, relative to using paper-based forms. Given the rapid pace of technological advancements, it is recommended that the local government units (LGUs) consider investing in the iCHT system to assist in CHT deployment. Additional materials containing health messages and forms should also be developed for the iCHT depending on the needs of the area. While other areas may not have the capacity to provide a server with a local connection, securing a third-party hosting for the database and providing internet connection in select areas, is not expected to impact significantly on costs. The DOH should support the conduct of implementation research on the use of other electronic solutions that may be used in Kalusugan Pangkalahatan (KP) implementation. This may include the use of electronic medical records and telemedicine using PCs and tablet PCs as platform.

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ECONOMIC EVALUATION OF USING THE iCHT SYSTEM VERSUS PAPER-BASED FORMS BY COMMUNITY HEALTH TEAMS: The Marikina Experience Health Policy Development Program


• CHTs play an important role in informing families of their health risks and needs, PhilHealth benefits and responsibilities • Deployment has been delayed due to lack of resources to reproduce forms and other materials, time-consuming generation of reports • HPDP developed the iCHT system to address this operational bottleneck

INTRODUCTION


Will the iCHT be more beneficial than using paper-based forms and materials in performing CHT functions?

RESEARCH QUESTION


â&#x20AC;˘ Determine the potential of the iCHT system to improve the performance of CHT tasks â&#x20AC;˘ Estimate the relative cost of the iCHT system versus the use of paper-based forms and materials for a five-year period, and the amount of savings that may be derived for each CHT member in a year

OBJECTIVES


• iCHT system developed, pilot testing conducted in Barangay Tumana, Marikina City • 60 CHT members (assigned a total of 2,515 families or around 40 each) trained in using iCHT • 18 CHT members randomly selected, subjected to time and motion analysis

METHODOLOGY


• Costs estimated in terms of: – Training – Materials – Household visits – Data processing and reporting

• Total costs of using both methods calculated and compared, expressed as cost for each CHT member and projected over a five-year period

METHODOLOGY


â&#x20AC;˘ Relative cost determined by dividing the cost of using the paper-based approach by the cost of using the iCHT system â&#x20AC;˘ Savings for each CHT member per year determined by calculating the difference between the estimated costs for both methods in a year

METHODOLOGY


• Training cost equal at PhP 1,050/CHT member • Cost of materials for iCHT at PhP 17,300/CHT member (vs. PhP 48,480) • Cost of household visits for iCHT at PhP 34,200/CHT member (vs. PhP 45,600) • Data processing and reporting quicker and less expensive for iCHT at PhP 285/CHT member (vs. PhP 4,275)

RESULTS


Cost Parameters

iCHT system

Paperbased approach

Training

1,050

1,050

Materials

17,300

48,480

34,200

45,600

285

4,275

52,835

99,405

Household visits Data processing and reporting Estimated cost per CHT for five years

â&#x20AC;˘ Using the iCHT system nearly half as expensive over a five year period (cost ratio=1:2) â&#x20AC;˘ iCHT can save around PhP 9,000/CHT member annually

RESULTS


The iCHT system is beneficial, in terms of lower costs and the lesser time spent in performing CHTrelated tasks

CONCLUSION


• LGUs to invest in installing the iCHT system as part of CHT deployment • DOH to help develop additional materials that can be included in the iCHT • Conduct implementation research on the use of other tablet PC based applications for use in KP/UHC (e.g., electronic medical records, telemedicine)

RECOMMENDATIONS


Annex F. iCHT Application Manual

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2013 Gabay sa Paggamit ng iCHT Para sa mga miyembro ng Community Health Team (CHT)

Department of Health March 2013


Contents Panimula ....................................................................................................................................................... 2 Mga Pangunahing Hakbang sa Paggamit ng iCHT ......................................................................................... 3 Paggawa ng Profile sa mga Miyembro ng Sambahayan ............................................................................... 8 Mga Planong Pangkalusugan ...................................................................................................................... 17 Planong Pangkalusugan Para Sa Bagong Silang (Edad 0-28 Araw) At Sanggol (Edad 1-11 Buwan) ..... 18 Planong Pangkalusugan Para Sa Bata (Edad 1-5 Taon) ........................................................................ 26 Planong Pangkalusugan Para Sa Pagbubuntis ...................................................................................... 32 Planong Pangkalusugan Para Sa Bagong Panganak ............................................................................. 44 Planong Pangkalusugan Para Sa Pagpaplano Ng Pamilya .................................................................... 52 Planong Pangkalusugan Para Sa Paglunas Ng Matagalang Ubo........................................................... 60

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PANIMULA Ang pagbubuo at ang pagpapalaganap ng Community Health Teams (CHT) ay ang pangunahing pamamaraan ng Kagawaran ng Kalusugan o Department of Health (DOH) sa pagtugon sa mga pangangailangang pangkalusugan ng ating mga mahihirap na kababayan. Bagama’t ito ay ipinatutupad na sa iba’t-ibang mga bayan at lungsod sa ating bansa, marami itong hinaharap na suliranin. Ang ilan sa mga ito ay ang mga sumusunod: 1) Malaki ang nagagastos buwan-buwan sa pagpi-print ng mga dokumentong ginagamit ng mga CHTs; 2) Mahirap matiyak na tama ang impormasyon na nakukuha mula sa mga sambahayan at sa mga miyembro ng pamilya; 3) Mahirap ang pagdadagdag o pagtatanggal ng mga pamilya sa mga nakalista na mga household beneficiaries na saklaw ng mga programa ng gobyerno (e.g. NHTS-PR list); 4) Maraming oras ang nagugugol sa pagbubuo ng mga data para sa paggawa ng mga report at iba pang impormasyon, na maaari sanang gamitin para sa mga gawaing pambahay atpampamilya; 5) Madalas ang mga maaring maging pagkakamali sa pagkuha, pagtatala, at pagbuo ng mga nakuhang impormasyon; at 6) Mahirap ang regular at madalas na pagbigay ng mga bagong ulat at iba pang impormasyon sa mga health facilities na makatutulong sa mga pangangailangan ng mga miyembro ng pamilyang kumokonsulta sa kanila. Dahil sa mga nabanggit na problema, nagkaroon ng pangangailangan para sa isang paraan na hindi lamang madaling magagamit ng miyembro ng CHT sa pagtupad ng kanilang mga tungkulin, kundi maaari ring makipagsabayan sa mga makabagong teknolohiya sa panahon natin ngayon. Ang iCHT ay ginawa ng DOH para sa layuning ito. Sa paggamit nito ay natutulungan ang mga miyembro ng CHT na mapadali ang pagtupad ng kanilang mga tungkulin, nababawasan ang mga pagkakamali sa pagkuha, pagtatala, at pagbuo ng mga datos na maaaring mas mapadali kung ikukumpara sa paggamit ng karaniwang papel at panulat, at nabibigyan sila ng mas maraming panahon para sa mga gawaing pantahanan at pansarili. Ang iCHT ay isang “tablet application”na ginawa para gawing automatic ang pagkuha ng profile sa mga miyembro ng sambahayan, pati ang paggawa ng anim na Planong Pangkalusugan o Health Use Plans (HUPs) sa pamamagitan ng isang computer tablet. Ang mga data,a ulat pangkalusugan, at iba pang impormasyon na nakakalap ng mga miyembro ng CHT gamit ito ay madali ring naipapadala at nabubuo sa City Health Office sa pamamagitan ng internet. Layunin ng Gabay na ito na mabigyan ng kaalaman ang mga miyembro ng CHT tungkol sa pagsasanay sa paggamit ng iCHT tablet na ipapahiram ng City Health Office. Ang mga sumusunod na nilalaman ng Gabay na ito ay tumutukoy sa mga hakbang sa paggamit ng iCHT para sa pag-profile at paggawa ng mga Planong Pangkalusugan.

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MGA PANGUNAHING HAKBANG SA PAGGAMIT NG iCHT Ang iCHT ay isang tablet application na makatutulong sa mga miyembro ng CHT na gumagamit ng computer tablet na ipagkakatiwala ng City Health Office. Bago simulan ang pagbabahay-bahay sa mga pamilyang naka-assign sa bawat miyembro ng CHT, kailangang pumunta sa lugar na itatalaga ng City Health Office upang kunin at mag-log sa paggamit ng tablet at ibalik rin ito at mag sync sa pagtatapos ng araw. Ang mga sumusunod na hakbang ay naglalarawan sa mga mahahalagang hakbang sa paggamit ng iCHT sa tablet. I.

Pagbubukas ng iCHT sa tablet Mula sa tablet ay pindutin ang icon ng iCHT, tulad ng nakalarawan. Sa pagpindot nito ay masisimulan ang programa ng iCHT.

II. Pag-sign in Kapag nabuksan na ang iCHT, makikita ang pahina na nakalarawan sa ibaba:

Ang bawat miyembro ng CHT ay bibigyan ng City Health Office ng username at password. Mahalaga na pag-ingatan ang mga ito at siguraduhing hindi ito ibibigay ito sa mga taong hindi pinahihintulutan ng City Health Office. Ang mga data na nilalaman at makakalap sa paggamit ng tablet application na ito ay maselan at maaaring magamit sa mga hindi tamang paraan. Isulat lamang ang mga ito sa kani-kaniyang kahon at pindutin ang MAG-SIGN IN upang makapasok sa programa ng iCHT at magamit ito sa pagkuha ng profile at paggawa ng mga Planong Pangkalusugan. 3


III. Pangunahing Pahina Kapag tama ang inilagay na username at password, makikita ang pahina na nakalarawan sa ibaba:

Sa pahinang ito, maaaring pindutin ang mga sumusunod: HANAPIN. Dito maaaring hanapin at piliin ang mga nakalistang mga Puno ng Sambahayan (Head of Household o HOH) para maumpisahan ang pagkuha ngprofile at paggawa ng mga Planong Pangkalusugan.

NOTIFICATIONS. Dito maaaring makita ang mga miyembro ng sambahayan na nakatakdang kumonsulta sa mga health facilities (health center o ospital), pati ang mga dapat balikan (follow-up visits) upang maituloy ang paggawa ng mga Planong Pangkalusugan. FILE. Dito ay maaaring makita ang mga data at mga impormasyon na mabubuo mula sa mga impormasyong makakalap ng miyembro ng CHT.

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I-SYNC. Mahalaga ang pag-sync upang masigurado na bago ang mga datos na nilalaman ng iCHT. Dapat itong gawin ng miyembro ng CHT pagkakuha ng tablet sa umaga bago magsimulang magbahay-bahay, at sa hapon bago ibalik ang tablet sa lugar na itinalaga ng City Health Office. Kapag pinindot ito, lalabas ang mensaheng tulad ng nakalarawan sa ibaba:

Pindutin lamang ang I-sync sa Server upang masimulan ang pag-update ng mga impormasyon na nilalaman ng iCHT. SETTINGS. Dito maaaring itakda ang ilang mga panuntunan sa paggamit ng iCHT.

IV. Mahahalagang Hakbang Ang mga pangunahing mahahalagang hakbang na ito ay ang mga hakbang na paulit-ulit na pagdadaanan sa paggamit ng iCHT. Pagtakda ng Araw Sa pagtakda ng araw ng kapanganakan, araw ng skedyul ng pagpapakonsulta, araw ng aktwal na pagbigay at pagtangap ng serbisyo o pagpakonsulta, PHIC Expiration Date at iba pa. Maaring i-set ang petsa sa pamamagitan ng dalawang paraan. Unang pamamaraan sa pag-adjust ng buwan, araw at taon ay sa pamamagitan ng pagpindut ng + o â&#x2C6;&#x2019; hangang tumugma sa nais na petsa.

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Pangalawang pamamaraan, (1) pindutin ng matagal ang kahon ng buwan hangang maging luntian ang buwan at lumabas ang pagpipilian ng buwan. (2) Pumili at pindutin ang nais na buwan.

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Sa pag-set naman ng araw at taon na bahagi ng petsa, pindutin din ng matagal hangang maging luntian ang mga numero at maari ng i-type at nais na araw at taon.

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Pagpili ng Pasilidad Ang iCHT ay naglalaman ng listahan ng mga pasilidad pangkalusugan (health center, rural health units, lying-in clinics, pribado at pampublikong ospital) at ang mga mahahalagang impormasyon tungkol sa pasalidad tulad ng contact person, contact number, address at ang PhilHealth Accreditation nito. Sa pagpili na pasilidad na parereferan ng kliente, maaring mahanap ng mabilisan ang pangalan ng pasilidad sa (1) pagpindot at pag-type ng pangalan nito sa kahon na may HANAPIN ANG FACILITY at (2) pindutin ang tumutugmang pangalan mula sa listahan sa ibaba.

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TANDAAN!_ Ang health center o ospital na pipiliin ay dapat na pinakamalapit, madaling puntahan, at alam ng pamilya.

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PAGGAWA NG PROFILE SA MGA MIYEMBRO NG SAMBAHAYAN Kinakailangang gawan ng profile ang bawat miyembro ng sambahayan bago makagawa ng Planong Pangkalusugan. Kailangan ang ilang mga impormasyon tulad ng edad, kasarian, at iba pa upang awtomatikong matukoy ng iCHT kung anong Planong Pangkalusugan ang nararapat para sa mga miyembro ng sambahayan. Sinisimulan ito sa pagpindot ng HANAPIN sa pangunahing pahina, tulad ng nabanggit at nailarawan sa naunang bahagi ng Gabay na ito.

I. Hanapin ang Head of Household (HoH) Pagkapindot ng HANAPIN ay makikita ang pahina para hanapin ang Head of Household, tulad ng nakalarawan sa ibaba:

A. Ang mga kahon na nakapaloob sa ilalim ng Impormasyon ng NHTS Household ay ginagamit para sa paghahanap ng Head of Household. Maaaring punan ang mga ito ng apleyido, unang pangalan, gitnang pangalan, petsa ng kapanganakan, o NHTS ID number ng Head of Household, at awtomatikong hahanapin ng iCHT kung ito ay nasa lisatahan ng City Health Office na nakapaloob na sa tablet. Gawin ang mga sumusunod: 1. I-type dito ang alinman sa apleyido, unang pangalan at gitnang pangalan ng Head of Household. Pindutin ang HANAPIN upang awtomatikong hanapin ng iCHT ang pangalan ng Head of Household mula sa listahan ng City Health Office na nakapaloob sa tablet. Lalabas ang listahan ng mga Head of Household na tumutugma sa inilagay na detalye sa mga kahon. 2. Piliin ang pangalan ng Head of Household ng pamilyang iniinterbyu.

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3. Para mapunan ang NHTS ID number, pindutin ang kahon para dito. Lalabas ang isang talaan para maisulat ito, tulad ng nakalarawan sa ibaba:

4. I-type lamang ang tamang NHTS ID number sa pamamagitan ng keyboard at pindutin ang I-ACCEPT. 5. Kapag napunan na ang alinman sa mga kahong ito, pindutin ang HANAPIN. Lalabas ang mga pangalan ng Head of Household na may kaparehong impormasyon sa Listahan ng Household.

6. Kung hindi lumalabas ang pangalan ng Head of Household sa listahan, ngunit siya ay benepisyaryo ng Pantawid Pamilyang Pilipino Program, pindutin ang

+

sa tabi ng

hanapinpara maidagdag ang kanyang Household sa listahan. Ang idinagdag na Head of Household ay susuriin bago mapahintulutan ng City Health Office na maidagdag sa opisyal na listahan ng mga benepisyaryo. Pagkapindot ng +, lalabas ang isang talaan na tulad ng nakalarawan sa ibaba:

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Ang mga hakbang para sa pagdadagdag ng Household ay tatalakayin sa ibang bahagi ng Gabay na ito (Tingnan ang Bahagi III: Magdagdag ng Household). Kapag ang impormasyon ng Head of Household na ibinigay sa alinman sa mga inilagay sa kahong Hanapin ang Talaan ng Household ay may katugma sa listahang nakapaloob na sa tablet, makikita ang kanyang pangalan sa Listahan ng Talaan ng Household. Kapag pinindot ang pangalan ng Head of Household, lalabas ang isang listahang tulad ng nakalarawan sa ibaba:

Piliin sa sumusunod ang tugon ng Head of Household kung Pumapayag magpa-interbyu, Tumangging magpa-interbyu, Wala sa bahay, Lumipat ng Tirahan, Hindi matagpuan, o Namatay na. Pindutin ang OK pagnakapili na ng sagot mula sa pagpipilian. Kapag pumapayag magpa-interbyu ang Head of Household ay magpapatuloy ang iCHT sa bahagi ng pag-profile ng Head of Household, na tatalakayin sa ibang bahagi ng Gabay na ito. 10


II. Pagkuha ng -Profile ng Head of Household Maaaring simulan ang pag-profile ng Head of Household kapag siya ay pumayag na magpa-interbyu. Kapag ito ang pinili sa talaan na nabanggit sa itaas, lalabas ang pahina na tulad ng nakalarawan sa ibaba.

A. Impormasyon ng Head of Household 1. Sa pahina ng Profile ng Household makikita ang buong pangalan ng Head of Household at ibang impormasyon na kailangan makuha tulad ng kaarawan, kasarian, address, kategorya sa NHTS at iba pa. Para masimulan ang pag-edit at pagkuha ng mga impormasyon, pindutin ang lapis

â&#x2013;Ą na nasa

kaliwang bahagi at pindutin ang mga kahon para sa mga impormasyon. 2. Pindutin ang kahon para sa Tirahan para mailagay dito ang address ng Household. Lalabas ang isang talaan tulad ng makikita sa ibaba. Punan ng angkop na impormasyon mula sa pagpipilian sa bawat kategorya (Region, Province, City/Municipality at Barangay) at pag-type ng pangalan ng kalye at numero ng lote o bahay.

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B. NHTS Category 1. Pindutin ang kahon para sa NHTS Category para punan ito ng impormasyon tungkol sa kategoryang itinalaga ng gobyerno sa benepisyaryong pamilya. Lalabas ang pagpipilian tulad ng nasa ibaba. Pindutin ang angkop na kategorya ng pamilya kung sila ay NHTS non-poor, NHTS poor, Pantawid Pamilyang Pilipino Program o 4Ps, o LGU Poor.

2. Ang NHTS ID number ng bahay ay nakapaloob na impormasyon sa tablet. Kung nais palitan o iwasto ang NHTS ID number ng bahay, pindutin ang kahong naglalaman ng ID number at itype ang wastong numero, sa pamamagitan ng keyboard. Pindutin ang I-ACCEPT.

3. Itanong sa iniinterbyu kung sila ay na-enroll sa Philhealth at pumili kung OO o HINDI. Kung OO ang napiling sagot, maari nang punan kung anong uri ng Philhealth Identification at Membership Category nabibilang ang iniiterbyu.

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Piliin at pindutin ang Philhealth Identification na meron at maipapakita ang kapanayam at ang kanyang kategorya sa Philhealth.

4. Kung tapos nang sagutan ang lahat ng kahon sa pahinang ito, pindutin ang kontrol na ISAVE, na matatagpuan sa bandang bahagi ng screen. Ang iba pang kontrol sa bandang ibabang bahagi ng screen ay tatalakayin sa mga susunod na bahagi ng gabay na ito: 1. Magdagdag ng Miyembro 2. I-Edit ang mga Miyembro 3. Health Use Plan

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â?¸ 13


III.

Magdagdag ng Miyembro ng Pamilya Pindutin ang kontrol na MAGDAGDAG NG MIYEMBRO upang makapagdagdag ng iba pang miyembro ng pamilya. Kapag ito ay pinindot lalabas ang pahinang tulad ng makikita sa ibaba.

Punan ng mga kinakailangang impormasyon at pindutin ang I-SAVE. (1) Para sa mga edad 10 pataas, babae man o lalaki, may mga karagdagang katanungan bago maidagdag ang miyembro. Para masala mula sa mga miyembro ng pamilya kung sinu sakanila ang maaring may TB at kailangan gawan ng Plano PangKalusugan sa Paglunas ng Matagalang Ubo, itatanong kung inuubo ba ang miyembro sa nakalipas na dalawang linggo o higit pa at pumili ng sagot kung OO o HINDI.

â?ś â?ˇ

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(2) Para naman sa mga kababaihan na edad 15 hanggang 49, may dalawang katanungan na kailangan mapunan para malaman ang planong pangkalusugan ang kanilang kinakailangan. Kung ito ba ay plano para sa buntis o plano para sa bagong panganak.

IV.

I-edit o Palitan ang mga Miyembro Kung nais palitan ang mga impormasyon sa mga idinagdag na miyembro ng pamilya, pindutin lamang ang I-EDIT ANG MGA MIYEMBRO. Lalabas ang pahinang katulad ng nasa ibaba.

Piliin lamang ang pangalan ng miyembro ng pamilya na nais i-edit, sa pamamagitan ng pagpindot sa pangalan nito. Kung nais naman burahin ang miyembro ng pamilya, piliin lamang ang ekis â&#x2013;Ą. Kapag nais namang i-edit ang impormasyon ng miyembro ng pamilya lalabas ang pahinang tulad ng nasa ibaba. Pindutin ang kahong naglalaman ng impormasyon na nais iwasto. Pindutin ang I-SAVE AT BUMALIK SA PROFILE para mai-save ang mga pagbabagong ginawa.

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V. Bumuo ng Health Use Plan o Planong Pangkalusugan Pagkatapos i-save ang lahat ng profile ng mga miyembro ng kabahayan, pindutin ang HEALTH USE PLAN upang makita ang mga pangalan ng mga miyembro ng kabahayan na nais gawan ng planong pankalusugan. Pindutin ang pangalan ng miyembro ng kabahayan na gagawan ng planong pangkalusugan.

Piliin at pindutin ang bilog sa tabi ng planong pangkalusugan na nais gawin, at pagkatapos pindutin naman ang I-PROCESS. Ang mga susunod na pahina pagkatapos pindutin ang IPROCESS ay talakayin sa susunod na bahagi ng gabay na ito.

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Mga Planong Pangkalusugan

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PLANONG PANGKALUSUGAN PARA SA BAGONG SILANG (EDAD 0-28 ARAW) AT SANGGOL (EDAD 1-11 BUWAN) Ang pahinang ito ay para sa Planong Pangkalusugan para sa Bagong Silang at Sanggol. Makakarating sa planong ito kung ang na-profile na miyembro ng pamilya ay 0-28 araw at 1-11 buwan. Sa pahina ng HEALTH USE PLAN, piliin ang sanggol na gagawan ng planong pangkalusugan.

Pindutin ang bilog sa tabi ng PLANONG PANGKALUSUGAN PARA SA BAGONG SILANG AT SANGGOL upang simulan ang pagbuo ng Health Use Plan (HUP) o planong pangkalusugan ito. Pindutin ang IPROCESS.

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Ang planong pagkalusugang ito ay may apat na bahagi: A) Impormasyon tungkol sa Sanggol; B) Danger signs sa Sanggol; C) Iba Pang Sakit ng Sanggol; D) Newborn Screening; at E) Mga Bakuna. A. IMPORMASYON TUNGKOL SA SANGGOL 1. Dito makikita ang mga impormasyon tungkol sa sanggol na kailangan makuha para sa paggawa ng planong pangkalusugan. Siguraduhing tama ang mga impormasyong ito bago pindutin ang SUSUNOD at lumipat sa bagong pahina. Kung hindi, kailangang bumalik sa pahina ng PROFILING.

2. Pindutin ang kahong SUSUNOD kung tapos nang sagutan ang mga tanong at nais nang lumipat sa susunod na bahagi ng mga tanong. B. DANGER SIGNS SA SANGGOL Ang bahaging ito ay binubuo ng mga katanungan ukol sa danger signs (palatandaan ng panganib) para sa sanggol. 1. Tanungin ang nanay na iniinterbyu kung ang sanggol ay may nararanasan sa mga nakalistang sintomas.

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Kung may danger sign na nakikita sa sanggol: i. Pindutin ang alinman sa maaaring pagpilian kung ang sanggol ay nagpapakita ng isa o higit pa sa mga sintomas sa listahan ng Danger signs. ii. Sa oras na may danger sign na nakita sa sanggol, isang mensahe ang lalabas upang maitala ninyo ang pasilidad na pagpapakonsultahan ng sanggol. Basahin ang pop-up message kung may nakitang panganib sa kalusugan ang sanggol o bagong silang. iii. Pindutin ang I-REFER upang maitala ninyo ang pasilidad kung saan magpapakonsulta ang sanggol.

iv. Matapos pindutin ang I-REFER, makikita ang listahan ng ng mga angkop na health facilities kung saan pwedeng dalhin ang sanggol. Piliin ang health facility/pagamutan na malapit sa lokasyon ng pamilya. Matapos pumili ng angkop na health facility, lalabas ang detalye tungkol sa health facility tulad ng lokasyon at taong maaring ma-contact ng pamilya para sa agarang pag-konsulta. 20


v. Matapos makapili ng health facility, pindutin ang I-SAVE upang ma-record ang planong ito ng pamilya. Ang pagpaplano ay agad na natatapos kung may nakitang Danger signs sa sanggol.

vi. Isulat ang mga detalye tungkol sa health facility sa papel na referral form para sa nanay. Ihatid ang nanay at sanggol sa napiling health facility para sa agarang konsultasyon. Kung walang danger sign na nakikita sa sanggol i. Iwanang blangko ang mga kahon. ii. Pindutin ang SUSUNOD. Magpapatuloy ang planong pagkalusugan sa pagsusuri kung may iba pang sintomas ng sakit ang sanggol.

E. IBA PANG SINTOMAS NG SAKIT SA SANGGOL Ang pagkakaroon ng sintomas ng sakit ng sanggol ay senyales na kailangan mai-refer sa isang health facility upang maagapan ang karamdaman. i. Pindutin ang alinman sa mga kahon kung ang sanggol ay may nararamdaman sa mga sintomas na nakalista. ii. Pindutin ang SUSUNODâ&#x20AC;&#x2122;

iii. Piliin ang pangalan ng health facility na napili para sa konsultasyon.

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F. NEWBORN SCREENING AT EXCLUSIVE BREASTFEEDING Ang susunod na pahina ay mga tanong na tungkol sa Newborn Screening o ang pagpapasuri sa dugo ng bagong silang sa loob ng 24 hanggang 72 oras pagkapanganak, at Exclusive Breastfeeding o ang pagpapasuso ng gatas ng ina lamang sa loob ng unang anim na buwan. 1. Sagutin ng OO o HINDI ang mga tanong ang mga tanong tungkol sa newborn screening at ekslusibong pagpapasuso. a. Kung ang sanggol ay may edad na mas mababa sa 6 buwan: Ang lalabas na tanong para sa ekslusibong pagpapasuso ay Gatas ng ina lamang ba (walang tubig o iba pang pagkain o inumin) ang ibinibigay sa sanggol?

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b. Kung ang sanggol ay edad 6 na buwan o higit pa: Ang lalabas na tanong para sa ekslusibong pagpapasuso ay Gatas ng ina lamang ba (walang tubig o iba pang pagkain o inumin) ang ibinigay sa sanggol sa unang anim na buwan? 2. Pagkatapos sagutan ang mga tanong, pindutin ang kahong PANUORIN ANG VIDEO para maipalabas ang mensahe tungkol sa newborn screening at exclusive breastfeeding.

3. Pindutin ang SUSUNOD pagkatapos mapanood ang video. 4. Lalabas ang isang mensahe kapag HINDI ang isinagot sa tanong kung ang bata ba ay binbibigyan ng purong gatas ng ina lamang. Basahin ang mensahe sa nanay na iniinterbyu upang maipaliwanag sa nanay ang kahalagahan at benepisyo ng ekslusibong pagpapasuso sa unang anim na buwan.

Pagkatapos ito basahin, pumindot kahit saan sa screen ng inyong tablet upang makapagpatuloy sa iba pang bahagi ng Planong Pangkalusugan.

5. Papiliin ang iniinterbyu kung saang health center o ospital kukuha ng mga serbisyong pangkalusugan.

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G. MGA BAKUNA Ang susunod at huling bahagi ng pagpaplano ng kalusugan ng sanggol ay magbibigay impormasyon sa mga bakunang naibigay na o hindi pa naibibigay sa sanggol. Upang makatulong sa pagpaplano at tamang pag-iskedyul ng bakuna, sumangguni sa Rekomendasyon sa petsa ng pagbakuna. Dito nakalagay ang mga petsa kung kailan maari nang ibigay ang bawat bakuna ayon sa edad ng sanggol. 1. Sa mga kahon sa ilalim ng Aktwal na petsa ng pagbigay, ilagay ang petsa kung kalian ibinigay ang bakuna sa sanggol.

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Ilagay ang petsa ng aktwal na pagbigay ng bakuna sa kalendaryo na lalabas sa pahina. Tandaan na maaring makuha ang impormasyon tungkol sa wastong buwan ng pagbibigay ng bakuna sa sanggol sa Booklet ni Mommy at ni Baby (Mother & Baby Book) o sa talaan (record) ng bakunang natanggap na ng sanggol na ibinibigay sa health center. 2. Pindutin ang I-SAVE kapag tapos na ang pagpaplanong pangkalusugan ng bagong silang at sanggol. Ang pag-pindot ng I-SAVE ay magtatapos sa planong pangkalusugan na ito. 3. Basahin ang lilitaw na mensahe tungkol sa mga detalye ng iskedyul ng konsultasyon para sa sanggol. 4.

Isulat sa papel na referral form ang mga detalyeng ito. Iwan ang papel na referral form sa nanay upang maging gabay ng nanay sa pagpapakonsulta sa health facility.

5. Pindutin ang kahit anong bahagi ng screen upang makabalik sa pahina ng HEALTH USE PLAN.

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PLANONG PANGKALUSUGAN PARA SA BATA (EDAD 1-5 TAON) Ang pahinang ito ay para sa Planong Pangkalusugan para sa Bata. Makakarating sa planong ito kung ang na-profile na miyembro ng pamilya ay isa hanggang limangtaong gulang.

Mula sa listahan ng mga miyembro ng pamilya, piliin ang pangalan ng batang gagawan ng planong pangkalusugan. Sa pahina ng HEALTH USE PLAN, pindutin ang bilog katabi ng Planong Pangkalusugan para sa Bata at sunod pindutin ang I-PROCESS.

Ang planong pangkalusugang ito ay may tatlong bahagi: (A) Impormasyon Tungkol sa Bata (B) Danger signs, (C) Bitamina A at Pampurga sa Bulate, at (D) Iba pang sintomas ng sakit.

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A. IMPORMASYON TUNGKOL SA BATA Dito makikita ang pangalan, kaarawan, at edad ng bata. Siguraduhing tama ang impormasyong ito bago magpatuloy sa susunod na pahina. Kung hindi, kailangang bumalik sa pahina ng PROFILING.

B. DANGER SIGNS SA BATA 1. Itanong sa nanay o tagapag-alaga kung ang bata ay may nararanasang danger sign o palatandaan ng panganib na nakalista sa tablet. a. Kung may nararansang danger signs ang bata: i. Pindutin ang kahon para sa sintomas na nararanasan ng bata. Pindutin ang SUSUNOD.

Basahin ang lilitaw na mensahe para i-refer ang bata sa pinakamalapit na pagamutan. 27


Pindutin ang I-REFER para pumili ng ospital na kung saan dadalhin ang bata. ii. Kasunod nito ay may lalabas na mensahe tungkol sa impormasyon ng ospital na pupuntahan. Pindutin ang I-SAVE pagkatapos bigyan ng mensahe ang tagapag-alaga ng bata.

iii. Awtomatikong titigil ang iCHT sa pagkumpleto iba pang bahagi ng planong pangkalusugan kung may danger sign ang bata. Ito ay dahil maituturing na emergency ang kanyang kalagayan at kinakailangan na siyang dalhin agad sa pagamutan. b. Kung walang danger sign na nararanasan ang bata: i. Iwanang blangko ang mga kahon para sa mga danger sign ii. Pindutin ang SUSUNOD at ang iCHT ay tutuloy sa iba pang bahagi ng planong pangkalusugan. C. BITAMINA A AT PAMPURGA SA BULATE 1. Tanungin ang nanay o tagpangalaga ng bata kung nabigyan ng Vitamin A at pampurga sa bulate ang bata sa nakaraang anim na buwan.

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a. Kung ang bata ay nabigyan ng Vitamin A o pampurga sa Bulate i. Pindutin ang bilog sa tabi ng OO sa tapat ng tanong para sa Vitamin A o Pampurga sa Bulate. Ilagay ang petsa kung kalian ito naibigay sa kahon na Petsa ng Pagbigay, gamit ang kalendaryong lalabas sa screen. ii. Tandaan na ang tatanggapin lamang ng iCHT ay ang petsa sa nakalipas na anim na buwan. b. Kung ang bata ay hindi pa nabigyan ng Vitamin A o pampurga sa Bulate: i. Pindutin ang bilog sa tabi ng HINDI sa tapat ng tanong. ii. Ilagay ang Petsa ng Pagkonsulta. Tandaan na ang ilalagay na petsa ay kung kailan dadalhin ng nanay ang bata sa health center. 2. Basahin ang lalabas na mensahe para sa importansya ng pagbibigay ng Vitamin A at Pampurga sa Bulate sa bata:

3. Pagkatapos basahin ang mga mensaheng ito, pindutin ang SUSUNOD para sa susunod na pahina.

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D. IBA PANG SINTOMAS NG SAKIT SA BATA 1. Sagutin ang mga mga katanungan tungkol sa iba pang sintomas ng sakit para sa bata. a. Kung may nararamdamang sintomas ng sakit ang bata: Pindutin ang kahon ng sintomas na mayroon ang bata. Maaaring pumili ng isa o higit pang sintomas mula sa listahan. b. Kung walang nararamdamang sintomas ng sakit ang bata: Iwanang blangko ang mga kahon kung walang nararanasan sa mga nakalistang sintomas ang bata.

2. Bago pindutin ang I-SAVE, pindutin ang kahon para sa MENSAHE PARA SA BATA para maipalabas ang video para dito.

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Kapag pinindot ang I-SAVE nang hindi napanood ang video, lalabas ang isang paalala para panoorin muna ito. 3. Kung may nararamdamang sintomas ang bata, lalabas ang isang mensahe na nagsasabing kailangang dalhin ang bata sa pagamutan. Pindutin ang I-REFER.

4. Pumili ng health center kung saan dadalhin ang bata para sa pagbibigay ng Vitamin A, pampurga sa bulate o pagkonsulta sa sintomas ng sakit. 5. Basahin sa nanay ang lalabas na mensahe tungkol sa mga detalye tungkol sa health center. 6. Isulat sa papel na referral form ang iskedyul ng konsultasyon. Iwan ang papel na referral form sa nanay upang maging gabay sa pagpapakonsulta sa health facility.

7. Pindutin ang kahit anong bahagi ng screen para makabalik sa pahina ng HEALTH USE PLAN.

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PLANONG PANGKALUSUGAN PARA SA PAGBUBUNTIS Ang pahinang ito ay para sa Planong Pangkalusugan para sa Pagbubuntis. Makakarating sa planong ito kung ang na-profile na miyembro ng pamilya ay babae, at sumagot na OO sa tanong kung siya ay ba buntis o naghihinalang buntis.

Sa pahina ng HEALTH USE PLAN, piliin ang miyembro na gagawan ng ng planong pangkalusugan.

Ang pagpaplanong pangkalusugan para sa buntis ay may limang bahagi: A) Impormasyon tungkol sa Nanay na Nagbubuntis, B) Danger Signs, C) Impormasyon sa Pagbubuntis, D) Prenatal Check-up, E) Panganib sa Kasalukuyang Pagbubuntis, F) Panganib sa Nakaraang Pagbubuntis at G) Plano sa Panganganak at Emergency. A. IMPORMASYON TUNGKOL SA BUNTIS Makikita sa unang pahina ng pagpapaplano para sa pagbubuntis ang impormasyon tungkol sa nanay na buntis. Nakasaad dito ang Pangalan ng Puno ng Pamilya (HoH), Pangalan ng Buntis, kaarawan at ang kanyang edad. Siguraduhing tama ang mga impormasyong ito bago pindutin ang SUSUNOD at lumipat sa bagong pahina. Kung hindi, kailangang bumalik sa pahina ng PROFILING upang iwasto ito. 32


B. DANGER SIGNS SA BUNTIS 1. Tanungin ang buntis kung siya ay may nararamdamang mga danger signs o sintomas na mapanganib. a. Kung may nararanasang danger signs sa buntis i. Kung ang buntis ay nakakaranas ng isa o higit pa sa mga nakalistang danger signs, pindutin ang kahon para dito. ii. Pindutin ang MENSAHE PARA SA DANGER SIGN para maipalabas ang video na nagpapakita at nagpapaliwanag ng mga danger signs na dapat tandaaan at bantayan ng buntis. iii. Pagkatapos mapanood ang video, pindutin ang SUSUNOD.

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iv. Basahin ang lalabas na mensahe at pindutin ang I-REFER.

v. Matapos pindutin ang I-REFER, pumili ng angkop na health facility na maaring puntahan ng buntis.

vi. Pagkatapos makapili ng angkop na pagamutan, lalabas ang mensahe ng buod ng detalye ng pagrefer sa pasilidad. Pindutin ang I-SAVE.

b.

Kung WALANG nararasang danger sign ang buntis i.

Kung walang danger sign na nararanasan ang iniintinterbyung buntis, iwan lamang na blangko ang mga kahon.

ii. Pindutin ang MENSAHE PARA SA DANGER SIGN upang ipalabas ang video tungkol dito.

iii. Pagkatapos mapanood ang video, pindutin and SUSUNOD. Pag napindot ang SUSUNOD nang hindi pa naipapalabas ang mga video, lalabas ang isang paalala para panoorin ito.

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C. IMPORMASYON TUNGKOL SA PAGBUBUNTIS 1. Pindutin ang kahon para sa Unang Araw ng Huling Regla (LMP) para mailagay ang hinihinging petsa.

Ang buwan ng pagbubuntis at inaasahan petsa ng kapanganakan o EDC ay kusang lumalabas batay sa inilagay na petsa ng unang araw ng huling regla. 2. Pindutin ang PANUORIN ANG VIDEO upang maipalabas ang video tungkol sa pangangalaga sa pagbubuntis.

3. Pagkatapos panoorin ang video, pindutin ang SUSUNOD. Kung napindot ang SUSUNOD nang hindi pa napapanood ang video, magkakaroon ng paalala para panoorin muna ito.

D. TALAAN NG PRENATAL CHECK-UP Ito ang susunod na pahina pagkatapos mailagay ang petsa ng LMP. Nakalagay sa pahinang ito ang mga katangungan tungkol sa mga petsa ng prenatal check-up ng buntis. Ang mga kahon sa ilalim ng Buwan ng Pagbubuntis (AOG) ay naglalaman ng mga petsang napapaloob sa una, pangalawa, at pangatlong trimester ng pagbubuntis.

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1. Sagutin ng Oo o Hindi ang tanong na Nakapag-prenatal check-up ka na ba? a. Kung nakapag-prenatal check-up na ang buntis. i. Pindutin ang bilog sa tabi ng OO kung Oo ang sagot. ii. Basahin ang lilitaw na mensaheng tulad ng nakalarawan sa ibaba:

iii. Pindutin ang kahon upang mailagay ang petsa kung kalian nagpa-prenatal check-up ang buntis. Gamitin ang kalendaryong tulad ng nasa itaas, upang i-set ang petsang ito. Ang nailagay na petsa ay kusa nang mailalagay sa kinabibilangan nitong trimester. Kung hindi nasasakop ng alinmang trimester ang nilagay na petsa sa kahon, lalabas ang isang mensaheng nagsasabing hind maaring tanggapin ng tablet ang naturang petsa. Pindutin lamang ang mensahe upang ito ay mawala, at ilagay ang tamang petsa.

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b. Kung hindi pa nakapag-prenatal check-up ang buntis i. Pindutin ang bilog sa tabi ng HINDI kung Hindi ang sagot. ii. Basahin ang lilitaw na ang mensaheng tulad ng nakalarawan sa ibaba.

iii. Pagkatapos basahin ang mensahe sa buntis, pindutin ang kahit anong bahagi ng screen ng tablet upang tumuloy sa susunod na bahagi ng planong pangkalusugan.

2. Matapos mailagay ang mga petsa ng prenatal check-up ayon sa first, second o third trimester, pupunta ang pahina sa listahan ng mga health faciltiies kung saan maaaring kumonsulta ang buntis. E. REFERRAL FACILITY PARA SA PRENATAL CHECK-UP 1. Pindutin ang kahon sa tapat ng tanong na PILIIN ANG PANGALAN NG PAGAMUTAN upang lumitaw ang listahan ng mga health facilities at makapili. 2. Matapos makapili ay agad lilitaw at mapupunan ang iba pang mga kahon tulad ng address, taong maaring ma-contact at numero ng telepono ng health facility.

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F. PANGANIB SA KASALUKUYANG PAGBUBUNTIS Ang susunod na pahina ay naglalaman ng iba pang katanungan tungkol sa mga medikal na kondisyon ng buntis. 1. Kung ang buntis ay may alinman sa mga ito, pindutin lamang ang kahon sa tabi ng nakalistang kondisyon. 2. Kung wala naman ang sagot sa pagpipilian, pindutin ang kahong: Iba pang komplikasyon (ano ito), at isulat ang sagot ng iniinterbyu.

Ang mga sumusunod na pahina ay para sa mga iba pang katanungan tungkol sa kalasukuyang pagbubuntis. 3.

Pindutin ang mga kahon na naglalaman ng sagot ng iniinterbyu. Kung wala naman sa mga pagpipilian ay maaring ilagay sa kahon na Iba pang komplikasyon (ano ito).

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G. PANGANIB SA NAKARAANG PAGBUBUNTIS Makikita sa susunod na pahina ang tanong na Ikaw ba ay nagbuntis na dati? 1. Pindutin ang bilog ng napiling sagot ng iniinterbyu kung Oo o Hindi.

a. Kung ang babae ay nagbuntis na dati: i.

Pindutin ang OO sa tanong na Ikaw ba ay nagbuntis na dati?

ii. Lalabas ang isa pang tanong tungkol sa edad kung kalian ang babae ay huling pagbubuntis. I-type lamang ang sagot sa loob ng kahon.

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iii. Ang susunod na pahina ay lalabas. Tanungin ang buntis kung siya ay nagkaroon ng alinman sa mga kondisyong ito sa kanyang huling pagbubuntis.

iv. Pindutin ang kahon ng piniling sagot, o ilagay sa kahon na Iba pang komplikasyon (ano ito) ang sagot kung wala ito sa listahan.

b. Kung ang babae ay hindi pa nagbuntis dati i.

Pindutin ang sagot na HINDI sa tanong na Ikaw ba ay nagbuntis na dati?

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ii. Magpapatuloy ang planong pangkalusugan sa susunod na pahina. H. PLANO SA PANGANGANAK AT EMERGENCY Ang susunod na pahina ay tungkol sa plano ng buntis kung saang health facility o ospital siya manganganak para sa normal delivery (NSD) o posibleng panganganak sa pamamagitan ng Cesarean section.

1. Pindutin ang kahon sa ilalim ng Facility for NSD upang makapili ng health facility na nagbibigay ng serbisyong ito. Ang listahan ng health facility na pagpipilian ay listahan na angkop lamang sa NSD. Matapos makapili ay lilitaw at mapupunan ang iba pang impormasyon tungkol sa health facility. Kung ang nanay ay nasabihan na ng doktor na hindi na siya pwede maganak ng normal, maaring iwanang blanko ang bahaging ito.

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2. Pindutin rin ang kahon sa ilalim ng Facility for Cesarean para lumabas ang listahan ng mga ospital na nagbibigay ng serbisyong ito.

Lilitaw at mapupunan ang iba pang kahon na

naglalaman ng iba pang detalye ng health facility na ito.

3. Pindutin ang kahong PANUORIN ANG VIDEO para maipalabas ang iba pang video para sa planong pangkalusugang ito.

Ito ay upang maipalawanag sa buntis ang kahalagahan ng

Newborn Screening at Ekslusibong Pagpapasuso pagkapanganak.

4. Pagkatapos mapanood ang video, pindutin ang I-SAVE. Kapag pinindot ang I-SAVE nang hindi pa napapanood ang mga video, magkakaroon ng paalala para ipanuod muna ito.

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5. Pagkatapos pindutin ang I-SAVE, lalabas ang isang mensaheng nagtatanong kung nais bang ituloy ang pag-save. Pindutin ang OO kung wala nang nais baguhin sa inilagay na impormasyon. Kung may nais na balikan at iwasto sa mga impormasyon sa nakaraang mga pahina, pindutin ang HINDI AT BUMALIK.

6. Pag tuluyan nang nai-save ang mga impormasyon, lalabas ang isang mensahe tungkol sa mga detalye ng iskedyul ng konsultasyon ng buntis. Basahin ito sa iniinterbyu.

7. Isulat sa papel na referral form ang mga detalye ng naka-iskedyul na konsultasyon. Iwan ito sa buntis para maging gabay niya sa pagpapakonsulta. 8. Pindutin ang kahit anong bahagi ng screen para makabalik sa pahina ng HEALTH USE PLAN.

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PLANONG PANGKALUSUGAN PARA SA BAGONG PANGANAK Ang pahinang ito ay para sa Pagplaplano ng mga nanay na bagong panganak. Makakarating sa planong ito kung ang na-profile na miyembro ng pamilya ay babae, at sumagot ng OO sa tanong kung siya ba ay bagong panganak sa nakalipas na anim na linggo 42 araw.

Sa pahina ng HEALTH USE PLAN, piliin ang Planong Pangkalusugan para sa Bagong Panganak. Pindutin ang SUSUNOD.

Ang planong pangkalusugan na ito ay may limang bahagi: A) Impormasyon tungkol sa Nanay na Bagong Panganak; B) Impormasyon tungkol sa Panganganak; C) Danger signs sa Bagong Panganak; D) Talaan ng Postnatal Check-up; at E) Referral Facility para sa Postnatal Check-up

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A. IMPORMASYON TUNGKOL SA NANAY NA BAGONG PANGANAK Dito makikita ang pangalan ng puno ng pamilya at pangalan, kaarawan, at edad ng miyembro na pagplaplanuhan. Siguraduhing tama ang pangalan ng nanay na ginagawan ng HUP na ito. Kung hindi, kailangang bumalik sa pahina ng PROFILING at iwasto ito.

B. IMPORMASYON TUNGKOL SA PANGANGANAK 1. Pindutin ang kahon sa tapat ng tanong na Petsa ng Panganganak. I-set ang petsa kung kalian nanganak ang babae sa kalendaryong tulad ng nakalarawan sa ibaba.

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2. Para sa ikalawa at ikatlong tanong, pindutin ang PUMILI para lumabas ang mga pagpipiliang sagot. Piliin ang sagot sa mga tanong na Saan ka nanganak? at Sino ang nagpaanak sa iyo? mula sa lalabas na listahan.

3. Kapag ang napili ay Iba pa sa parehong tanong, magkakaron ng kahon na kailangan pagpilian at pindutin upang mailagay ang kinakailangan na sagot. 4. Isunod na sagutan ang tanong tungkol sa paraan ng panganganak (Normal o Cesarean) at kung buhay ba ang sanggol (Oo o Hindi) na isinilang. 5. Kapag nakumpleto na ang mga impormasyon na hinihingi, pindutin ang SUSUNOD.

C. DANGER SIGNS SA BAGONG PANGANAK Dito ay makikita ang susunod na mga katanungan tungkol sa Danger signs o mga Tanda ng Panganib sa bagong panganak. 1. Tanungin ang nanay kung siya ay may nararamdaman sa mga mga danger sign na nakalista. a. Kung may nararanasang danger signs ang bagong panganak i. Pindutin ang kahon upang malagyan ng tsek ang mga sagot ng iniinterbyu. Maaring pumili ng higit sa isang sagot.

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ii. Pagkatapos pumili at pindutin ang kahon para sa Danger signs, pindutin ang I-REFER. iii. Lilitaw ang isang mensaheng nagsasabing dapat dalhin ang pasyente sa pagamutan. Basahin ito sa nanay. iv. Pindutin ulit ang I-REFER para makapili ng health facility o ospital na pupuntahan ng kliente. Pagkatapos nito ay lalabas ang impormasyon ukol sa napiling health facility/ospital.

v. Kung nais palitan ang health facility/ospital, pindutin lamang ang kahon para sa ng â&#x20AC;&#x2DC;Pangalan ng Pagamutanâ&#x20AC;&#x2122; upang makapili muli sa listahan. 47


vi. Pindutin ang I-SAVE Lalabas ang mensahe at impormasyon ukol sa health facilities/ospital na dapat puntahan, at sa numero ng doktor na maaring tawagan para sa sa agarang konsultasyon ng nanay na bagong panganak. b. Kung walang nararanasang danger signs ang bagong panganak i. Kung ang iniinterbyu ay walang nararamdaman o nararansan sa mga nakalistang sintomas, iwanang blangko o walang tsek ang mga kahon sa listahan. ii. Pindutin ang control ng MENSAHE PARA SA DANGER SIGNS upang maipalabas at mapanood ang video na naglalarawan sa mga sintomas na dapat tandaan at bantayan ng nanay na bagong panganak. iii. Pag napanood na ang video, maaari nang pindutin ang SUSUNOD. Kung sakaling napindot ang SUSUNOD nang hindi naipapalabas ang video, magkakaroon ng paalala para panoorin muna ito. iv. Pagkapindot ng SUSUNOD, lalabas ang isang mensahe na dapat basahin sa nanay. Ito ay upang mapaalala sa iniinterbyu kung ano ang dapat gawin sakaling magkaroon ng danger sign ang nanay. v. Pagkatapos basahin ang mensahe, pindutin lamang ang kahit anong bahagi ng screen para tumuloy sa susunod na bahagi.

D. TALAAN NG POSTNATAL CHECK-UP Ang susunod na mga katanungan ay tungkol sa petsa ng check-up pagkatapos manganak ang ina. 1. Tanungin ang ina kung siya ay nakapagpa-check-up sa loob ng 24 oras at sa loob ng 7 araw pagkatapos manganak. 2.

Sagutan ng Oo o Hindi.

3. Kung wala pang 24 oras ang nakalipas pagkatapos manganak ang ina, hindi kailangan sagutan ang tanong na Sa loob ng 7 araw?

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a. Kung ang nanay ay nagpa-check-up na sa loob ng 24 oras o sa loob ng 7 araw: i. Pindutin ang bilog sa tabi ng OO para sa mga tanong na Sa loob ng 24 oras o Sa loob ng 7 araw. ii.

Pindutin ang kahon sa tapat ng OO upang i-set sa kalendaryo ang petsa kung kalian naisagawa ang postnatal check-up.

b. Kung ang nanay ay hindi pa nagpa-check-up sa loob ng 24 oras o sa loob ng 7 araw: i. Pindutin ang bilog sa tabi ng HINDI sa tapat ng tanong na Sa loob ng 24 oras at Sa loob ng 7 araw.

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ii. Pindutin ang kahon sa tapat ng HINDI upang mailagay ang petsa kung kailan agarang makakapagpakonsulta ang nanay sa health center o ospital. iii. Pindutin ang I-REFER upang pumili kung saang health facility irerefer ang nanay na ininterbyu.

iv. Lalabas ang listahan ng mga health center ayon sa pangalan at address. I-type ang pangalan o address ng health center sa kahon at pindutin ang pangalan ng napiling health facility mula sa listahan. Ipapakita na ng tablet ang iba pang detalye tungkol sa health facility tulad ng address, numero at pangalan ng taong pwedeng tawagan dito. 4. Bago pindutin ang I-SAVE, pindutin muna ang mga control para sa Mensahe para sa Babaeng bagong Panganak, Mensahe para sa Pagpaplano ng Pamilya, Mensahe para sa Newborn Screening, at Mensahe para sa Ekslusibong Pagpapasuso upang maipalabas ang mga video na naglalaman ng mga paalalang pangkalusugan para sa nanay na iniinterbyu. Bilang marka o palatandaan na ang video ay napanood na, ang kulay ng kahon para sa bawat video ay magiging kulay luntian.

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5. Pag napanood na ang lahat ng video, maaari nang pindutin ang I-SAVE. Sakaling napindot ang I-SAVE nang hindi pa naipapalabas ang mga video, magkakaroon ng paalala para panoorin muna ito. Pagkatapos mai-save ang planong pangkalusugan, lalabas ang mensahe tungkol sa impormasyon at numero ng health center na pupuntahan ng nanay para sa postnatal check-up.

6. Ilista ang mga detalye ng naka-iskedyul na konsultasyon sa referral form na iiwan para sa nanay. Ito ay magsisilbing gabay para sa kanyang pagpapakonsulta sa health facility. 7. Pindutin ang kahit anong bahagi ng screen upang makabalik sa pahina ng HEALTH USE PLAN.

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PLANONG PANGKALUSUGAN PARA SA PAGPAPLANO NG PAMILYA Ang Planong Pangkalusugan na ito ay para sa Pagplano ng Pamilya. Makakarating sa Planong Pangkalusugan na ito kung ang miyembro ng pamilyang na-profile ay babae na may edad 10-49 taong gulang.

Mula sa pahina ng HEALTH USE PLAN, piliin ang pangalan ng miyembro ng pamilya na gagawan ng planong pangkalusugan. Piliin ang Pagpaplano ng Pamilya.

A. IMPORMASYON TUNGKOL SA MIYEMBRO NG PAMILYA Dito makikita ang pangalan, kaarawan at edad ng babaeng gagawan ng Pagplano ng Pamilya, pati na rin ang pangalan ng Puno ng Pamilya ng kinabibilangang household. Siguraduhing tama ang impormasyong nakalagay dito at pindutin ang SUSUNOD. Kung hindi, kailangang bumalik sa pahina ng PROFILING. 52


B. MGA KATANUNGAN PARA MATUKOY ANG BABAENG KAILANGAN NG MODERN FP 1. Pindutin ang bilog na sagot ng iniinterbyu, kung Oo o Hindi sa tanong na Dinadatnan ka pa ba ng regla (menstruation)?

a. Kung dinadatnan pa ng regal o menstruation ang iniinterbyu: 1. Pindutin ang bilog sa tabi ng OO. 2. Lalabas ang susunod na tanong tulad ng makikita sa ibaba.

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3. Piliin ang sagot sa tanong na Ikaw ba ay nagpatali na(ligated) o ang iyong asawa o partner ba ay nagpa-vasectomy na? Pindutin ang SUSUNOD. a. Kung ang napiling sagot ay ang Nagpatali (ligated) o Ang asawa o partner ay nagpavasectomy, dito na magtatapos ang planong pangkalusugan dahil base sa napiling sagot, ang miyembro ay may ginagamit nang permanenteng paraan ng FP. b. Kung ang napiling sagot ay HINDI, magpapatuloy pa ang iCHT sa susunod na bahagi ang planong pangkalusugan na ito. b. Kung hindi na dinadatnan ng regla o menstruation ang babae 1. Pindutin ang HINDI DAHIL sa tanong na Dinadatnan ka pa ba ng regla (menstruation)? 2. Pindutin ang kahong PUMILI at piliin ang rason kung bakit hindi dinadatnan ng regla ang iniinterbyu.

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3. Kung ang mga sagot ay isa sa mga sumusunod: (1) Hindi na dinadatnan ng regla/menopause; (2) Nagpatanggal ng bahay bata (hysterectomy); (3) Nagpatanggal ng dalawang obaryo (oophorectomy); at (4) Hindi pa dinadatnan ng regla, ang susunod na pahina pagkapindot ng SUSUNOD ay ang pahina ng health use plan dahil ang kinakapanayam ay hindi nangangailangan ng pamamaraan na family planning. 4. Kung ang mga sagot naman ay: (1) Bagong Panganak at (2) Buntis o kaya dinadatnan pa ng regla; at hindi pa nagpapatali (ligate) ang babae o hindi pa nagpa-vasectomy ang kanyang partner, tanungin kung nais niyang magbuntis.

5. Papillin ang iniinterbyu sa limang sagot na maaring pagpilian. 6. Pagkatapos pindutin ang napiling sagot, pindutin ang SUSUNOD. 7. Kung ang piniling sagot ay Oo sa loob ng dalawang taon o Hindi, kasi hindi ako nakikipagtalik, hindi na tutuloy ang iCHT sa iba pang bahagi ng plano, at babalik na sa pahina ng Health Use Plan. 8. Kung ang napiling sagot ay alinman sa Oo, pagkatapos ng dalawang taon, Hindi ko pa alam o hindi ko pa napag-iisipan, Hindi ko na gustong magkaanak, at Hindi, kasi hindi ako nakikipagtalik, ang iCHT ay tutuloy pa sa susunod na bahagi ng planong pangkalusugang ito.

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C.

MGA TANONG TUNGKOL SA PAGGAMIT NG MODERN FAMILY PLANNING 1. Tanungin sa babae kung siya ba ay gumagamit ng modernong paraan ng family planning.

a. Kung kasalukuyang gumagamit ng modern family planning: i. Pindutin ang bilog sa tabi ng OO sa tanong na Gumagamit ka ba ngayon ng modern family planning. ii. Lalabas ang susunod ang tanong na Ano ang kasalukuyan mong ginagamit? Pindutin ang PUMILI at piliin sa listahan ang ginagamit na Family Planning method ng iniinterbyu.

iii. Pagkatapos pindutin ang sagot sa paraan ng Family Planning na kasalukuyang ginagamit, lalabas naman ang pahabol na tanong na:

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iv. Kung hindi na nais palitan ng iniinterbyu ang kasalukuyang gingagamit na Family Planning method, pindutin ang HINDI. Dito na magtatapos ang pagsagot sa planong pangkalusugan. v. Pindutin ang OO kung nais palitan ang ginagamit na FP method. Lalabas ang pahinang ito:

vi. Pindutin ang kahong MENSAHE PARA SA MGA PARAAN NG MODERN FAMILY PLANNING upang mapanood ang video na naglalarawan sa ibaâ&#x20AC;&#x2122;t ibang modern paraan ng pagpaplanon g pamilya. b. Kung hindi kasalukuyang gumagamit ng modern family planning i. Pindutin ang sagot na HINDI sa katanungang Gumagamit ka ba ngayon ng modern family planning? ii. Awtomatik na lalabas ang mensaheng na tulad ng makikita sa ibaba. Basahin ito sa iniinterbyu. iii. Pindutin ang kahit anong bahagi ng screen para magpatuloy sa susunod na tanong. iv. Tangungin sa iniinterbyu ang tanong na: Gusto mo bang mag-modern family planning? v. Pumili ng sagot kung OO o HINDI. a. Kung OO, magpapatuloy ang pagbuo ng planong pangkalusugan. Basahin ang lalabas na mensahe.

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b. Kung HINDI naman ang isinagot, basahin ang lalabas na mensahe at pindutin ang IREFER upang makapili ng health facility para sa konsultasyon.

vi. Pagkatapos pumili ng health facility, punan naman ang kahon para sa Petsa ng Pagbisita gamit ang kalendaryong tulad ng nakalarawan sa ibaba.

vii. Pindutin ang control na MENSAHE PARA SA PAGPAPLANO NG PAMILYA para mapanood ang video. Pindutin ang I-SAVE. Lalabas ang isang mensahe tungkol sa 58


iskedyul ng konsultasyon na pinili ng iniinterbyu. Pagkatapos basahin, pindutin ang kahit anong bahagi ng screen para bumalik sa pahina ng HEALTH USE PLAN.

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PLANONG PANGKALUSUGAN PARA SA PAGLUNAS NG MATAGALANG UBO Ang pahinang ito ay para sa Planong Pangkalusugan para sa Paglunas ng Matagalang Ubo. Makakarating sa planong ito kung ang na-profile na miyembro ng pamilya ay higit sa 10 taong gulang, at sumagot na OO sa tanong kung siya ay inuubo sa nakaraang dalawang linggo o higit pa.

Mula sa pahinan ng HEALTH USE PLAN, piliin ang pangalan ng miyembro na gagawan ng planong pangkalusugan.

Ang planong pangkalusugan sa Paglunas sa Matagalang Ubo ay nahahati sa (A) Impormasyon ng Miyembro ng Household; (B) Talaan ng Konsultasyon para sa Ubo; at (C) Resulta ng pagsusuri sa Ubo. A. IMPORMASYON TUNGKOL SA SA MIYEMBRO NG HOUSEHOLD Dito makikita ang pangalan, kaarawan, kasarian, at edad ng miyembrong ginagawa ng planong pangkalusugan. Siguraduhing tama ang impormasyong ito. Kung hindi, kailangang bumalik sa pahina ng PROFILING para palitan ito.

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B. TALAAN NG KONSULTASYON PARA SA UBO 1. Itanong sa iniinterbyu kung siya ay kumonsulta na sa clinic para sa kanyang ubo. 2. Piliin at pindutin ang sagot ayon sa sagot ng iniinterbyu. a. Kung nagpakonsulta na sa clinic kagunay ng ubo, pindutin ang OO. i. Sagutan ang pangalawang tanong Kung oo, ano ang resulta ng iyong pagsusuri? at piliin kung TB at kung Iba pa. ii. Kung TB, lalabas ang mensahe na makikita sa ibaba. Basahin ang mensahe sa kinakapanayam at matapos pindutin ang labas ng mensahe.

iii. Kung Iba pa, lalabas ang mensahe na tulad sa ibaba punan ang kahon ng sagot kung anu ang naging resulta na pagpapakonsulta.

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iv. Pindutin at ipanuod sa kinakapanayam ang Mensahe para sa Ubong higit sa 2 linggo at pagkatapos pindutin ang I-SAVE. b. Kung HINDI pa nagpapakonsulta sa clinic kaugnay ng ubo i. Pindutin ang HINDI sa tanong na Kumonsulta ka nab a sa clinic kaugnay ng iyong ubo? ii. Lilitaw ang mensaheng tulad ng nakalarawan sa ibaba. Basahin ito at ipaliwanag sa iniinterbyu.

iii. Pindutin kahit saan sa screen ng tablet para mawala ang mensahe at tumuloy sa sumunod na pahina. iv. Pindutin ang kahon ng sa Petsa ng Pagbisita para mailagay araw kung kalian magpupunta ang paseynte para magpacheck â&#x20AC;&#x201C;up.

v. Pagkatapos i-set ang petsa ng pagpapakonsulta. Pindutin ang I-REFER para pumili ng health facility kung saan magpapakonsulta.

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vi. Pindutin ang control na MENSAHE PARA SA UBONG HIGIT SA 2 LINGGO para maipalabas ang video.

vii. Pagkatapos maipalabas ang video sa iniinterbyu, pindutin ang I-SAVE. viii. Pagkapindot ng I-SAVE, lalabas ang isang mensahe tungkol sa impormasyon at numero ng health center na pupuntahan ng iniinterbyu para sa check-up. Basahin ito sa pasyente.

ix. Ilista ang mga detalye ng iskedyul ng konsultasyon sa papel na referral form na iiwan sa pasyente. Ito ay magsisilbing gabay para sa kanyang pagpapacheck-up sa health center o klinik. x. Pindutin ang kahit anong bahagi ng screen upang makabalik sa pahina ng HEALTH USE PLAN.

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Annex G. iCHT Videos Pretest Results Pretest 1

Location: Santa Rosa City Health Office I Time and Date: 3:30 – 4:00 pm, December 28, 2012 Attended by: Dr. Darleen Delos Reyes Medical Officer III, Technical Division Dr. Soledad Rosanna C. Cunanan City Health Officer III LCE Communication Video • The video presented the Community Health Team (CHT) strategy as well-known; the video may be improved by presenting a short backgrounder of the CHT strategy, this will ensure that the LCEs are reminded of the status of their area in terms of CHT training and mobilization. • There are areas in the Philippines that do not have internet connection. A short entry on ways to acquire internet connection for GIDA and far flung areas may be needed, such as satellite internet. • The video may be more interesting to LCEs if the costing is previewed; this is to highlight the savings from adopting the technology. This is very important since the product appears to be of hi-technology and thus expensive. • The narration is not well understood, the way the words were spoken may be heavy on the accent, a neutral accent or a tagalong version of the video may be more effective. Program Managers Video • The feel of the video is high technology and expensive • The narration combined with animation and bullets is very effective in teaching managers the steps in setting up the iCHT technology. • There may be LGUs/Program managers who may like to see a Filipino version, since most of the videos they have seen from the Department of Health are in Filipino language • The video explains the iCHT system chronologically, and provides venue for learning.

Pretest 2

Location: Barangay Hall, Barangay 177, Zone 15, Camarin, Caloocan City Time and Date: 2:00 – 5:00 pm, January 15, 2013 Attended by: Barangay Captain Donata Jarito Barangay Kagawad Norma Allada Barangay Kagawad Jun Acosta Executive Assistant Edgar Zabarte 10 barangay health workers

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LCE Communication Video Procedure: The video was simply presented and then the questions of the participants were answered before asking for the comments FINDINGS: • The Barangay Captain displayed her interest by asking a lot of questions about how to acquire the system. (Most of her questions were answerable by the Program Managers video which we also showed to her after the LCE Video) • The Barangay Captain liked the animation because it was interesting and it was easy to get the message. • She also said that the video was very informative and that she did not expect that there is already a technology like this in the country. • She said she thinks that the technology will make the work of their BHWs easier and that it would also boost their morale to have something that’s so hi-tech. • She was very interested to acquire the tablets and inquired about the costs as they have wi fi already. • When asked if she would be interested to adapt to the iCHT technology or if she would be inclined to request it from the mayor, she said that the barangay has autonomy and they would be interested in it because it will make work faster and easier. • She said she understood the message of the video Instructional Video Procedure: The facilitators introduced themselves and explained the purpose of the activity. Each participant was then lent an iCHT tablet to manipulate while watching the instructional video. They were instructed to try to use the tablet by following the instructions on the video. After each Chapter, the participants were asked questions and their answers were fairly consistent. After the first five Chapters, there was a break and snack before resuming the next chapters. From the start of the Follow ups, the participants were given time to explore the tablet then the chapter would be replayed. FINDINGS: PACE • One participant said that the video was a bit fast • The others said the pace was just right because they were able to follow along with the iCHT tablet already although they still make some mistakes CLARITY • The voice, tone and timbre of delivery were just right. • The instructions were easily understandable and were explained adequately • The step-by-step instructions were easy to follow EFFECTIVITY OF VISUALS • The visuals enhanced their learning because it shows what to press and how • They said seeing it makes it easier to follow. THE TALENTS • Their voice is clear and they speak with energy. • They have happy faces (‘Masaya ang mukha’) and good energy • They are engaging and pleasant SUGESSTIONS ON TRAINING SESSION: • The general consensus was that one whole day be allotted for training of the iCHT tablet. Most of the participants were already able to follow the first parts of the iCHT though it was their first

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• • • •

time to use the tablet. One participant said she still needs a trainer to guide her, and also suggested that 3 days a week for one month training is needed. The participants also suggested that they should have a training manual that they can bring home to study and review. They also suggested that they should have regular use of the tablet to be able to learn it fully. They said that they understood the video, but they needed more time to get used to the tablet, to pressing the right buttons properly and memorizing it.

OBSERVATIONS: o The participants had different learning curves. Most can easily catch up while watching the video while a few had difficulty catching up. o From the first chapter, one elder participant expressed hesitation and felt she would have a hard time because they she didn’t even have a cellphone. After watching the other chapters and exploring the tablet, it was observed that she was now teaching the younger seatmate how to press the buttons. o One elder participant was confident to use the tablet because she has a touchscreen phone. o While some were a bit intimidated, all were excited to explore the tablet. o During the snack break all of them continued to explore the tablet on their own. o There was a general feeling of excitement and anticipation to be trained and to use the tablet in actuality on the field.

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Annex H. Pop-up and Video Messages Question

May mga palatandaan ba na may panganib sa kalusugan?

Response

If oo/hindi

HUP AB

Pop-up message

Ipakonsulta kaagad ang iyong anak kapag napansin na siya ay may sintomas ng panganib sa kalusugan. Pasusuhin at huwag hayaang malamigan ang sanggol habang dinadala sa doktor. Dalhin ang alinman sa PhilHealth ID, 4Ps ID, Member Data Record (MDR) at birth certificate (kung mayroon) upang magamit ang benepisyo ng PhilHealth.

Napa-Newborn Screening na ba ang Sanggol?

If oo/hindi

Ipa-newborn screening kaagad ang iyong bagong silang na sanggol. Walang bayad ang newborn screening sa mga PhilHealth-accredited na pagamutan ng gobyerno. Mahalaga ang newborn screening dahil makatutulong ito sa maagang pagtuklas sa mga sakit na maaaring maging sanhi ng mental retardation. Dalhin ang PhilHealth ID, Member Data Record, o 4Ps ID upang magamit ang benepisyo ng PhilHealth.

Gatas lamang ba ng ina ang ibinigay noong unang 6 buwan?

If oo/hindi

Sapat ang gatas ng ina sa pangangailangan ng iyong sanggol sa unang anim na buwan. Magbibigay ito ng proteksiyon laban sa sakit. Hindi na dapat magbigay ng tinitimplang gatas, tubig, am, o iba pang inumin o pagkain. Pagkatapos ng anim na buwan ay maaari nang pakainin ang sanggol kasabay ng pagpapapasuso. Mainam ang pagpapasuso sa loob ng dalawang taon.

Nabakunahan ba ang sanggol ng ____?

If oo/hindi

Sundin ang petsa ng pagpapabakuna para masiguro na kumpleto ang mga bakuna bago siya mag-isang taong gulang. Dalhin ang â&#x20AC;&#x153;Immunization Cardâ&#x20AC;? o Mother and Baby Book o Booklet ni Mommy at Baby sa tuwing magpapabakuna. Mahalagang magpabakuna dahil ito ay makapagbibigay ng proteksyon laban sa mga nakahahawang sakit na maaaring magdulot ng kapansanan o kamatayan.

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Ang iyo bang anak ay mayroong mga sumusunod na palatandaan ng panganib sa kalusugan?

Oo/hindi

Ang iyo bang anak ay alinman sa sintomas na ito? (pag-uubo, pagtatae, etc.)

If oo

Nabigyan ba ang bata ng mga sumusunod sa nakaraang 6 na buwan? Vitamin A

Oo/hindi

HUP C

Ipakonsulta kaagad ang iyong anak kapag napansin na siya ay may palatandaan ng panganib sa kalusugan. Dalhin ang PhilHealth ID, 4Ps ID, o Member Data Record (MDR) upang magamit ang benepisyo ng PhilHealth. Ipakonsulta ang iyong anak para matingnan at magamot ang iyong anak. Dalhin ang PhilHealth ID, 4Ps ID, o Member Data Record (MDR) upang magamit ang benepisyo ng PhilHealth. Binibigay ang Vitamin A nang libre sa health center para sa mga batang mula 6 na buwan hanggang 5 taong gulang. Pinalalakas ng Vitamin A ang resistensiya ng bata laban sa mga nakahahawang sakit at nakatutulong upang maiwasan ang pagkabulag.

Nabigyan ba ang bata ng mga sumusunod sa nakaraang 6 na buwan (pagpurga)

Oo/hindi

Meron ka bang alinman sa mga palatandaan ng panganib sa pagbubuntis?

If oo/hindi

Nakapagpa prenatal check-up ka na ba?

oo

Ipakonsulta ang iyong anak para mabigyan ng pampurga ang bata. Ang pagpupurga ay binibigay sa batang isang taong gulang pataas at inuulit kada 6 na buwan.

HUP D

Kung ikaw ay may alinman sa mga ito, maaaring nasa panganib ang iyong pagbubuntis. Magpakonsulta kaagad at dalhin ang PhilHealth ID, Member Data Record (MDR), 4Ps ID, o marriage certificate upang magamit ang benepisyo ng PhilHealth.

Ipagpatuloy ang regular na pagkonsulta. Sundin ang payong ibinigay sa check-up at bumalik sa itinakdang petsa ng follow-up. Kumonsulta kaagad upang masiguro ang kalusugan ninyo ng inyong sanggol. Magpa-prenatal check-up nang 4 na beses o higit pa simula sa unang 3 buwan, sa ika-4 hanggang ika-6 na buwan, at 2 beses o higit pa sa ika-7 hanggang ika-9 na buwan).

hindi

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(At the end of questions on assessment 4, 5 and 6)

Napakahalagang magpakonsulta nang regular para maging ligtas ang iyong pagbubuntis. Maghanda para sa panganganak sa pagamutan lamang para agad malunasan ang mga posibleng komplikasyon sa panganganak. Siguraduhing kumonsulta agad sa ospital kung may komplikasyon o emergency ang pagbubuntis o panganganak.

(Additional message for patients in their 3rd trimester)

Pagkatapos manganak, magpakonsulta sa health center sa loob ng 3-7 araw para malaman kung may komplikasyon na dapat masuri at malunasan.

(Additional message for patients in their 3rd trimester)

Sa unang 30 minuto pagkapanganak ng iyong anak, pasusuhin siya at panatilihing tuyo at di nalalamigan habang nakadikit sa iyong dibdib. Dapat siyang mapa-newborn screening sa loob ng 24 â&#x20AC;&#x201C;72 oras, at mabakunahan ng BCG at Hepatitis B.

(Additional message for patients in their 3rd trimester)

Pagkatapos manganak, mainam na magkaroon ng agwat na 3-5 taon bago magbuntis muli upang makabawi ang iyong katawan, at upang masigurado ang kalusugan ng sanggol . Magtanong sa health center tungkol sa angkop na paraan ng Family Planning pagkatapos manganak.

Ikaw ba ay nakakaranas ng alinman sa mga palatandaan ng panganib?

If oo/hindi

HUP E

Kumonsulta kaagad sa ospital kung ikaw ay may palatandaan ng panganib pagkatapos manganak. Dalhin ang PhilHealth ID, 4Ps ID, Member Data Record (MDR), o marriage certificate upang magamit ang benepisyo ng PhilHealth.

Nasuri ka ba ng doktor, nars, o midwife pagkatapos mong manganak:

If oo/hindi

Maaari kang magkakomplikasyon matapos manganak. Kumonsulta sa midwife, nars, o doktor pagkalipas ng 1 hanggang 3 araw pagkapanganak. Kung hindi ka pa nasusuri sa loob ng isang linggo, kumonsulta na kaagad sa iyong midwife, nars, o doktor. Nagbibigay ng libreng gamot sa health center para sa bagong panganak. Nagbibigay din sa health center ng mga payo tungkol sa pagpapapasuso sa sanggol, pag-aalaga ng anak, at pagpaplano ng pamilya.

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HUP F

Filtered clients for age group 10-19

Gusto mo bang gumamit ng FP?

Ang iyong katawan ay dumadaan sa mga pagbabagong sanhi ng pagdadalaga, katulad ng kakayahan mong magbuntis. Sa iyong pagdadalaga kailangan mo ng wastong impormasyon upang pangalagaan ang iyong kalusugan. Kumonsulta sa inyong health center tungkol dito. Magplano ng pamilya para sa tamang agwat ng pagbubuntis.

If Oo/hindi

Maghintay na maging 3 hanggang 5 taong gulang ang iyong bunso bago siya sundan. Ang tamang agwat ng pagbubuntis ay mahalaga upang maiwasan ang mga komplikasyon at masigurado ang kalusugan ng sanggol. Iwasang mabuntis kung ikaw ay wala pang 18 taong gulang o higit sa 35 taong gulang.

Anong gusto mong paraan ng FP?

Mas madalas ang mga komplikasyon sa pagbubuntis at panganganak kung ikaw ay wala pang 18 taong gulang o higit sa 35 taong gulang. Ang modern family planning ay simple, ligtas, at epektibo kung gagamitin ng tama at ayon sa rekomendasyon ng midwife, nars, o doktor.

If Oo/hindi

Kumonsulta sa health center para sa karagdagang payo, check-up, at sa karagdagang supply ng mga produkto sa family planning tulad ng natural family planning, pills, kondom, injectable, IUD at iba pang pamamaraan.

Kumonsulta ka na ba sa clinic kaugnay ng iyong ubo?

If hindi

Kung oo, ano ang resulta ng inyong pagsusuri?

If TB

HUP G

Kumonsulta agad sa pagamutan na may serbisyong TB-DOTS para masuri kung TB ang sanhi ng iyong ubo. Kailangang inumin ang gamot na kontra-TB nang hindi bababa sa 6 na buwan at binabantayan ng treatment partner. Kapag hindi wasto ang paggamot sa TB, maaari itong lumala at maging sanhi ng pagkamatay. Bumalik sa TB-DOTS center para sa check-up at pagsusuri ng plema.

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If iba pa

Sundin ang payo ng iyong doktor. Inumin ang iniresetang gamot ng doktor at bumalik sa itinakdang petsa ng follow-up.

Video Messages (see folder iCHT_HM_Videos) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14)

Breastfeeding Danger Signs Pagkatapos Manganak Danger Signs sa Pagbubuntis Danger Signs sa Sanggol Exclusive Breastfeeding Mensahe para sa Buntis Mensahe para sa Newborn Screening Mensahe para sa Pagpapalano ng Pamilya Mensahe para sa Ubong Higit sa 2 Linggo Mensahe sa Babaeng Bagong Panganak Mensahe sa Nanay na Bagong Panganak Mga Modernong Paraan ng Family Planning Pagpapabakuna Pangangalaga sa Kalusugan ng Bata

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Annex I. Access Level for iCHT Administrators Panel Users Feature function

Administrator (Super Admin)

Updating and adding of Households (HOH) in database Adding of Household Members and HUP Development of HOH & Member Admin Users Management (a) Adding users; (b) determining access level of other users

City/Municipal Health Office-MIS

CHT Supervisor Health Center Personnel

CHT Member

Yes

Yes (specific to its Municipality/City)

No

No

Yes

Yes (specific to its Municipality/City)

Yes

Yes

Yes

No

No

No

Yes

Yes (specific to its Municipality/City)

Yes (specific to its barangay or covered barangays)

Yes (specific to its covered households)

Check reports

Yes

Yes (specific to its Municipality/City)

Yes (specific to its barangay or covered barangays)

Yes (specific to its covered households)

Managing CHT Users of iCHT Application

Yes

Yes (specific to its Municipality/City)

No

No

Viewing notifications

Yes

Yes (specific to its Municipality/City)

Yes (specific to its barangay or covered barangays)

Yes (specific to its covered households)

Review records

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UPecon Foundation Inc. HEALTH POLICY DEVELOPMENT PROGRAM E-mail address: upecon.hpdp@gmail.com

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iCHT  

updated version of iCHT Report

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