Liph Handbook

Local Investment Planning for Health
Handbook on Principles, Guidelines,

Procedures, and Processes
Service Delivery
Health
Information
Governance
for Health
Health
Financing
Regulation
Human
Resource
for
Health
Local
I nvestment
Planning for
Health
Handbook on Principles, Guidelines, Procedures,
and Processes
Local Investment Planning for Health

Handbook on Principles, Guidelines, Procedures, and Processes
February 2015
Published by the Bureau of Local Health Systems Development (BLHSD)
Department of Health, San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila
1003 Philippines, with the assistance of the United Nations Childrens Fund
(UNICEF)
An electronic copy of this publication can be downloaded at: www.doh.gov.ph
Articles may be reproduced in full or in part for non-profit purposes without prior
permission provided credit is given to the Department of Health.
Foreword
The Local Investment Planning for Health Handbook is aimed to provide
direction and guidance to devolved health managers in the Local Government
Units (Provinces, Cities and Municipalities). The publication of this handbook is in
line with the thrust of the Department of Health to develop the local health systems
throughout the country in support of Kalusugan Pangkalahatan, thus the enhanced
health investment plans will redound to goals of better health outcomes, financial
risk protection and responsive health systems.
Further, this Handbook was created to guide Local Chief Executives and
health managers on how to establish and maintain a process of inclusive and
participatory planning, and to integrate responsibly resources and investments in
their local plans and activities based on principles of good public management and
governance. Addressed mainly to local decision-makers and technical experts in
Local Government Units, it is hoped that the local officials, who are involved in the
process of investment planning for health make use of this Handbook.
It is with trust and optimism that this Handbook would be the primary guide for
regional health staff, donor agencies and other key stakeholders in enhancing
technical assistance and to improve local health systems and service delivery to
the populace, particularly to the poor and disadvantaged groups.
LIPH Handbook | iii
Acknowledgement
The following have shared their talents and skills, and have committed their
time toward the development of the Local Investment Planning for Health
Handbook:
The DOH-BLHSD group under the supervision and guidance of Dir. Nestor
F. Santiago, Jr. and Dir. Ferchito L. Avelino and the Project Management
Team composed of Engr. Raul Alamis, Ms. Teresita Guzman, Dr. Dax Edward
Nofuente, Ms. Marifel Santiago and Ms. Cristina Flor Marifosque for extending
technical and administrative advices and assistance in the project;
The UNICEF particularly Dr. Raoul Bermejo and Dr. Pura Angela Wee, as well
as Ms. Sonja Firth from the University of Queensland for providing technical
assistance and support;
The project participants who provided valuable insights and responses during
the key informant interviews, focused group discussions, and consultative
workshops:
from DOH Central Offices: Disease Prevention and Control
Bureau, Health Emergency Management Bureau, Health Facility
Development Bureau, Health Policy Development and Planning
Bureau and Bureau of International Health Cooperation;
from DOH Regional Offices and DOH-ARMM; and
from Local Government Units of: Abra, Benguet, Mountain Province,
Baguio City, La Union, Pangasinan, Ilocos Norte, Dagupan City,
Cagayan Valley, Isabela, Batanes, Quirino, Laguna, Rizal, Oriental
Mindoro, Occidental Mindoro, Marinduque, Puerto Princesa City,
Sorsogon, Albay, Catanduanes, Cebu, Siquijor, Bohol, Cebu City,
Eastern Samar, Leyte, Northern Samar, Ormoc City, Compostela
Valley, Davao del Norte, Davao del Sur, Davao City, Surigao del
Norte, Dinagat Islands, Butuan City, City of Manila, Muntinlupa City,
San Juan City, and Valenzuela City;
The FPLA Project Management Team and Subject Matter Experts composed
of Dr. Carmelita Canila, Dr. Glenn Roy Paraso, Professor Ma. Luisa Moguel,
Dr. Imelda Mateo, Mr. Ariel Vidanes, Ms. Jowena Maalac, Ms. Antonette
Dumo, Ms. Maan Barretto, Ms. Jay Ann Suarez, Mr. Roxell Vincent Remorento,
Ms. Gladys Antonio, Mr. Diowayne Dacayan, and Mr. John Paul Paragile.
iv |LIPH Handbook
Table of Contents
Foreword iii
Acknowledgement iv
List of Tables vii
List of Figures vii
List of Acronyms viii
Definition of Terms xi
INTRODUCTION 1
PART 1: PRINCIPLES AND GUIDELINES
1.1 Planning Framework 4

1.2 Planning Team 17
1.3 Monitoring the Process 19
1.4 Roles and Responsibilities 20
PART 2: PROCEDURES AND PROCESSES
23
2.1 Essentials in Planning 24

2.2 Key Steps in Formulating LIPH and AOP
27
LIPH Handbook | v
PART 3: ANNEXES 44
Annex A
LIPH Content and Forms
45
Form 1. Summary of Investment Cost by

Instruments by Source of Financing
55
Form 2. Cost Assumptions by Instrument by

PPAs by Resource Requirements
56
Form 3. Cost Assumptions by Instrument by

PPAs by Source of Financing
57
Annex B
LIPH Appraisal Checklist 58
Annex C
AOP Content and Forms
67
Form 1. Summary of Investment Cost by

Instrument by Source of Financing
71
Form 2. Cost Assumptions by Instrument

by PPAs by Source of Financing
72
Form 3. Annual Training Plan
Form 4. Annual Procurement Management Plan

(Optional)
73
74
Annex D
AOP Appraisal Checklist
75
Annex E
Competencies of Planning Teams
84
Annex F
Development of Vision, Mission and
Goal Statement 92
Annex G
vi |LIPH Handbook
Tools for the Data Analysis
96
List of Tables
Table 1
LIPH Planning Management Structure
18
Table 2
Monitoring Checklist of the Planning Process
19
Table 3
Types of Data and Possible Sources
32
Table 4
Summary Workflow in Formulating LIPH/AOP
42
Table 5
Sample Matrix on Health Strategy and Interventions 50
List of Figures
Figure1
Planning Framework 5
Figure 2
Workflow on Participatory Process in

Formulating LIPH
24
Figure 3
Workflow Diagram in Formulating LIPH/AOP
29
Figure 4
Communication Diagram for Appraisal and

Approval
40
Figure 5
SWOT Framework 96
Figure 6
Simple SWOT Analysis
100
Figure 7
Bottleneck Framework 101
Figure 8
Indicators for Expanded Program on

Immunization
103
Simple Bottlenecks Analysis

(Facility-Based Delivery)
105
Figure 10
Problem Tree Framework
106
Figure 11
Simple Problem Tree Analysis (Low ANC 4+)
108
Figure 12 Simple Objectives Tree
109
Figure 9
LIPH Handbook | vii
List of Acronyms
ABC
Association of Barangay Captains
AOP
Annual Operational Plan
BHW
Barangay Health Worker
BIHC
Bureau of International Health Cooperation
BLHSD
Bureau of Local Health Systems Development
CHO
City Health Office/r
CO
Capital Outlay
CQI
Continuing Quality Improvement
CSO
Civil Society Organization
DBM
Department of Budget and Management
DILG
Department of Interior and Local Government
DMO
Development Management Officer
DOF
Department of Finance
DOH
Department of Health
DOH RO
Department of Health Regional Office
DP
Development Partner
DSWD
Department of Social Welfare and Development
FHSIS
Field Health Services Information System
GIDA
Geographically Isolated and Disadvantaged Areas
HFEP
Health Facilities Enhancement Program
HPDPB
Health Policy Development and Planning Bureau
HRH
Human Resource for Health
HUC
Highly Urbanized City
ICC
Independent Component City
viii |LIPH Handbook
ICC/IPs
Indigenous Cultural Communities/Indigenous Peoples
IEC
Information, Education and Communication
ILHZ
Inter-Local Health Zone
IMR
Infant Mortality Rate
KP
Kalusugan Pangkalahatan
LCE
Local Chief Executive
LGU
Local Government Unit
LHB
Local Health Board
LHS
Local Health System
LIPH
Local Investment Plan for Health
MDG
Millennium Development Goals
M & E
Monitoring & Evaluation
ME3
Monitoring and Evaluation for Efficiency and Effectiveness
MHO
Municipal Health Office/r
MMR
Maternal Mortality Ratio
NGAs
National Government Agencies
N/RAC
National/Regional Appraisal Committee
NOH
National Objectives for Health
NEDA
National Economic Development Authority
NHIP
National Health Insurance Program
NHTS
National Household Targeting System
NNC
National Nutrition Council
PDP
Philippine Development Plan
PHIC
Philippine Health Insurance Corporation
LIPH Handbook | ix
PHO
Provincial Health Office/r
POs
Peoples Organizations
POPCOM
Commission on Population
PPA
Programs/Projects/Activities
P/C/MPDO Provincial/City/Municipal Planning & Development Office/r

PPP
Public-Private Partnership
P/CWHS
Province/City-wide Health System
RDC
Regional Development Council
R/LICT
Regional/Local Implementation and Coordination Team
RUP
Reaching the Urban Poor
SDAH
Sectoral Development Approach for Health
SLA
Service Level Agreement
TA
Technical Assistance
TCL
Target Client List
TOP
Terms of Partnership
UHC
Universal Health Care
UNICEF
United Nations Childrens Fund
VMG
Vision, Mission, Goal
WHO
World Health Organization
x |LIPH Handbook
Definition of Terms
1. Agreement a binding instrument between the Department of Health and the LGU
that defines the outputs and performance milestones to be attained, the amount of
funds to be provided by the national agencies, institutions, and development partners,
and the conditions and requirements pertaining to the release of funds (e.g. Service
Level Agreement, Terms of Partnership)
2. Bottleneck Analysis an analytical approach developed by UNICEF and World
Bank that assesses costs of removing health system constraints or bottleneck to
scaling up coverage through proven interventions of high impact (www.devinfolive.info/
mbb/mbbsupport)
3. Bottom-up Budgeting (BuB) an approach in the preparation of the budget

proposal of government agencies that takes into consideration the development
needs of cities/municipalities as identified in their respective local poverty reduction
action plans, and formulated with strong participation from basic sector organizations
and civil society organizations
4. Continuous Quality Improvement (CQI) an approach to quality management
that builds upon traditional quality assurance methods by emphasizing the organization
and its systems (www.fpm.iastate.edu/worldclass/cqi.asp)
5. Environmental Scanning a methodical activity that enables planners and
decision-makers to understand the external environment and the interconnections of
its various sectors (www.horizon.unc.edu/courses/papers/enviroscan/)
6. Evidence-based Strategy a concept or strategy that is derived from or informed
by objective evidence or set of verifiable measures consisting largely or entirely of
data (www.edglossary.org)
7. Geographically Isolated and Disadvantaged Area (GIDA) hard-to-reach
areas, such as island municipalities, upland communities/mountainous areas,
Indigenous Cultural Communities/Indigenous Peoples, conflict-affected areas,
with marginalized population, physically and socio-economically separated from the
mainstream society
8. Interventions applied strategies, programs, projects, activities, and tasks that
are programmed into plans expected to lead toward the attainment of set goals and
objectives
LIPH Handbook | xi
9. Inter-Local Health Zone (ILHZ) an organized arrangement among contiguous

LGUs for coordinating the operations of an array and hierarchy of health providers
and facilities, including primary health providers, core referral hospital and end-referral
hospital, jointly serving a common population within a local geographic area under the
jurisdiction of more than one local government unit
10. Investment Planning for Health the process of identifying required resources,
beyond current resource levels, to implement effective and priority interventions that
lead to the attainment of national and local health goals and objectives
11. LGU Scorecard a tool for LGUs to track the progress of their health reform
implementation, and to measure performance of local health systems
12. Local Health Systems (LHS) all organizations, institutions and resources devoted
to undertaking local health actions; including provinces and their component LGUs,
cities, private and public health care providers, local partners and families
13. Millennium Development Goals (MDG) are eight (8) international development
goals established at the Millennium Summit of the United Nations in 2000 which
are as follows: (1) eradicate extreme poverty and hunger; (2) achieve universal
primary education; (3) promote gender equality and empower women; (4) reduce
child mortality; (5) improve maternal health; (6) combat HIV/AIDS, malaria, and other
diseases; (7) ensure environmental sustainability; and (8) develop a global partnership
for development
14. Monitoring and Evaluation for Efficiency and Effectiveness (ME3) the
monitoring and evaluation framework used by the health sector to assess the
implementation of health reforms in the country
15. Province-wide Health System (PWHS) a devolved health system composed of
the province, component cities and municipalities working together as one
16. Sectoral Development Approach for Health (SDAH) a way of planning,
organizing, coordinating and evaluating national and international support and
assistance under a common sector policy and investments program led by the DOH
17. Social Determinants of Health the conditions in which people are born, grow,
live, work and age; those circumstances are shaped by the distribution of money, power
and resources at global, national and local levels (WHO); critical characteristics of
societies and communities that have an impact on their health (e.g., level of education,
water and sanitation, housing, employment, food production, among others)
xii |LIPH Handbook
18. Stakeholders include person/s, group, and organization with interest or concern
in an organization and which affects or get affected by any or all actions, objectives,
programs, and policies of an organization
19. Strategy a careful plan or method for achieving a particular goal usually over a long
period of time
20. Urban Health Equity Assessment and Response Tool (Urban HEART) an
essential tool for situational assessment, planning, monitoring and identification of
health equity concerns, and priority sites for equity intervention in cities or urban areas
(Department Memorandum No. 2010-0207 dated 20 August 2010)
LIPH Handbook | xiii
xiv |LIPH Handbook
Introduction
The Province-wide Investment Planning for Health (PIPH) was introduced in
2006 to strengthen local health planning with significant consideration for
building capacities of devolved health managers in the local government
units, and localizing the Health Sector Reform Agenda (HSRA). PIPH was
implemented in 16 pilot convergence provinces1 in 2006. The Department of
Health (DOH) through the Bureau of Local Health Systems Development (then
called the Bureau of Local Health Development) provided the guidelines on the
PIPH. The implementation of PIPH was rolled out to 44 provinces and cities,
known as F44, in 2009 with the PIPH Operations Manual (POM) as the guide.
DOH issued Department Memorandum 2011-0202 dated 01 July 2011,
Revised Guidelines for Investment Plans for Health in Provinces and Cities to
assure alignment of the local investment planning activities of the LGUs with the
Kalusugan Pangkalahatan (KP) thrusts and strategies. However, the revision of
the guidelines did not include the review of DOH and LGU experiences on the
PIPH/CIPH approach since its implementation in 2006.
In 2014, on a collaborative project between the DOH-Bureau of Local Health
System Development and the United Nations Childrens Fund, a formal review
and revision of the PIPH/CIPH guidelines and procedures was undertaken. The
project significantly considered the DOH Regional Offices (DOH ROs) and
LGU experiences, challenges, and innovations in local health planning. The
consultation activities through interviews and focus group discussions identified
the need for simplification of procedures, planning templates and terminologies,
and synchronization of the planning phases and timelines. The LGUs also
sought for a continuing provision of technical assistance from DOH Regional
Offices, and the need to capacitate local planners in the planning process, and
in analyzing and managing data.
This edition of the Province/City-wide Investment Planning for Health (P/CIPH)
shall be called Local Investment Planning for Health (LIPH). This handbook
constitutes two major parts (1) Principles and Guidelines, and (2) Procedures
and Processes.
1
F16 provinces include Ilocos Norte, Pangasinan, Nueva Vizcaya, Ifugao, Mt. Province, Oriental Mindoro, Romblon, Capiz,
Negros Oriental, Eastern Samar, Biliran, Southern Leyte, Misamis Occidental, Agusan del Sur, South Cotabato, North
Cotabato
LIPH Handbook | 1
The LIPH shall be institutionalized and utilized as:

1. Localization tool of national health programs;
2. Basis for resource mobilization and investment planning towards
attaining local and national health goals; and
3. Official means for the DOH and development partners to engage LGUs.
The health planners at the different levels are introduced to a comprehensive and
updated yet simplified process of securing evidence. The LIPH also provides a
rationale for health investment requirements that are useful in advocating for
health resources from national agencies and funding organizations.
2 |LIPH Handbook
PART 1
Principles and Guidelines
LIPH Handbook | 3
1.1 Planning Framework

The Local Investment Planning for Health (LIPH) is a comprehensive planning
exercise following the Planning Framework (Figure 1). LIPH is a three-year
planning cycle that is applied at all levels in the locality barangay, municipal/
city, district, and province. Annual Operational Plans (AOPs) are prepared for
every year of the planning cycle.
The planning exercise aspires to attain the goals set in each of the elements
that make up a responsive health system as indicated in the planning framework
- service delivery, regulation, health financing, health information system, and
human resource for health. An exemplary leadership and governance steers the
health system that shall result to desired health outcomes.
The principles and guidelines detailed in the succeeding pages will help the
LGUs and health planners come up with a more workable and directed plan.
4 |LIPH Handbook
IMPROVED HEALTH OUTCOMES

RESPONSIVE HEALTH SYSTEM
Health
Information
Service
Delivery
Governance
for
Health
Regulation
Health
Financing
CQI
CQI
Equity, Effectiveness,
Efficiency
Human
Resource
for
Health

Year 3
Year 2
Year 1
LOCAL INVESTMENT PLAN FOR HEALTH

Barangay
Municipal/Comp. City
PROVINCE-WIDE
ILHZ
Barangay
District
CITY-WIDE
LOCAL OBJECTIVES FOR HEALTH

NATIONAL OBJECTIVES FOR HEALTH
Figure 1. Planning Framework
LIPH Handbook | 5
A. The LIPH and AOP are founded on national and local objectives for
health, guided by the vision and mission of the LGUs.
Ensuring that all Filipinos are
healthy and have access to
equitable, effective, efficient
and quality health care is
the compelling motivation in
crafting the Local Investment
Plan for Health (LIPH). The
LIPH prioritizes interventions
that will address health needs
and health inequities among the
underprivileged, Geographically
Isolated and Disadvantaged
Areas (GIDAs), Indigenous
Cultural
Communities/
Indigenous Peoples (ICCs/IPs),
Urban Poor, Senior Citizens,
Persons
with
Disabilities
(PWDs), women and children.
Local Objectives for Health

National Objectives for Health
1. The LIPH shall be guided by the National Objectives for Health (NOH),
DOH implementation framework, LGUs Development Plans and Health
Goals;
2. The LIPHs directional plan shall be detailed in the Annual Operational
Plans (AOP). Both the LIPH and AOP specify the localitys desired
health goals;
3. The LIPH and AOPs are the local expression of the DOH national
implementation framework that in turn supports the Philippine
Development Plan (PDP) towards achieving sustainable development
goals;
4. LGUs, as autonomous units of government, can aspire more than the
DOH benchmark, depending on their needs and resources. These
aspirations shall be embodied in the LIPH and AOP; and
5. Both national and local objectives for health are interlinked, complementary
and contributory to each others accomplishments.
6 |LIPH Handbook
B. The LIPH and AOP shall be evidence-based.

The LIPH and AOP shall utilize
best available and verifiable
data. All the documented
information
are
analyzed
to enable stakeholders to
understand their relevance as
basis of decisions.
1. The situational analyses
on peoples health needs
and the burden of diseases
are critical in identifying
appropriate intervention
2. The LIPH is resultsoriented
such
that
outputs, processes and
outcomes are measurable
both quantitatively and
qualitatively;

Barangay
PROVINCE-WIDE
ILHZ
Barangay
District
CITY-WIDE
3. It shall integrate all aspects of healthcare from preventive, curative to

rehabilitative health care services, including the promotional aspects
of health care services, that are undertaken in both public and private
sectors;
4. The interventions in response to peoples health needs shall be evidencebased, and are proven to be effective and efficient;
5. The LIPH and AOP are comprehensive plans with identified sources of
technical, logistics and financial requirements;
6. The Monitoring and Evaluation (M&E) system of the LIPH provides
verifiable information on baselines and end-lines, incremental (or
downward) changes as accomplishments and lessons learned from the
AOP and the LIPH; and
7. The evidences of accomplishments shall be the basis for identifying best
practices for replication and valuable lessons in scaling up or down the
interventions.
LIPH Handbook | 7
C. The LIPH shall be guided by the logical framework of integration,

coordination, and complementation.
1. Provinces, Highly Urbanized
Cities (HUCs)
and
Independent Component
Cities
(ICCs)
shall
undertake their respective
investment planning for
health;
2. HUCs and ICCs shall craft
their own LIPH as a separate
plan from the provincewide plan, but the planning
process of the HUC, ICC,
and the province shall be
done in close coordination Barangay Municipal/Comp. City ILHZ Barangay District
with each other, where one
PROVINCE-WIDE
CITY-WIDE
informs the other. Therefore,
the LIPH of HUCs and
ICCs is complementary,
supportive, and adds value to the LIPH of the contiguous province(s)
and vice versa;
3. Health needs of barangays and districts of HUCs and ICCs shall be
integrated into the LIPH. Therefore, the planning process of HUCs and
ICCs is done at three levels of health service delivery, i.e., barangay,
district (where it is present) and city. Henceforth, the plan becomes citywide in scope;
4. Health needs of barangays, municipalities and component cities of a
province shall be integrated into the LIPH. Therefore, the planning process
of provinces is done at four levels of health service delivery, i.e., barangay,
municipality/city, Inter-Local Health Zone (ILHZ) or district (where it is
present) and provincial. Henceforth, the plan becomes province-wide in
scope;
5. All LGUs, in crafting their respective investment plans for health, are
encouraged to work through partnership and collaboration with nonhealth sectors whose concerns impact on health development and
health inequities. They are likewise advised to include actions on social
8 |LIPH Handbook
determinants of health and health inequities, and interventions for the

poor and disadvantaged communities. Such strategies may include
inter-sectoral action, community participation, social cohesion and
empowerment;
6. The LIPH involves two levels of planning three-year strategic and
annual (operational) health planning. The integration of the barangaylevel strategic plans starts at the municipal or at the city levels;
7. In areas where ILHZs are present, these shall serve as the avenue for
integrating the investment plans for health involving Rural and City Health
Units and hospitals of contiguous LGUs, private health care institutions,
private sector organizations, and civil society organizations;
8. In areas where ILHZs are non-existent, the investment plans of
municipalities and component cities will be integrated at the provincial
level;
9. In cities where districts are organized, the districts of HUCs and ICCs
shall be the first avenue for integration of barangay-level investment
plans. The City Health Office (CHO) shall then integrate all district-level
investment plans;
10. After the strategic planning activities at the ILHZ/district, provincial and
city levels have been concluded and the LIPH has been drafted and
approved, planning for the AOP shall follow using the same process; and
11. The local Planning Team shall seek for the appropriate appraisals and
approvals.
LIPH Handbook | 9
D. The LIPH/AOP development shall focus on institutionalization

for sustainability.
1. The planning process for
LIPH and AOP engages the
active participation of Local
Chief Executives (LCEs),
various offices under the
LGU, and the local health
managers of both public and
private sectors. It becomes
an enabling instrument to
unify efforts and maximize
resources in achieving local
and national desired health
goals toward sustainable
development goals;

Barangay
ILHZ
Barangay
District
2. The planning process shall

CITY-WIDE
PROVINCE-WIDE
be institutionalized as a
standard for participatory
engagement
between
and among LGUs (from barangays, municipalities, cities, provinces),
private sector, communities, national/regional government agencies,
development partners and donors toward achieving local and national
health goals;
3. Key stakeholders in the local health system, from both public and
private sectors and from relevant administrative levels (barangays,
municipalities, ILHZs, component cities, HUCs, ICCs), Peoples
Organizations, communities and clients are represented in the LIPH
and AOP development;
4. The LIPH and AOP shall become the localization tool for national
agencies, such as Philippine Health Insurance Corporation
(PHIC), Regional Development Council (RDC), National Economic
Development Agency (NEDA), Department of Budget and
Management (DBM), Department of Finance (DOF) and other
relevant national government agencies;
10 |LIPH Handbook
5. The LIPH and AOP shall be harmonized with the planning activities,
budget preparation cycle, budget allocation, targets and timelines of
national and regional agencies, such as the DOH and development
partners;
6. The LIPH and AOP shall be utilized to leverage better performance of the
local health system;
7. Performance of local health systems shall be regularly monitored and
evaluated. It is therefore essential that the LIPH and AOP shall define key
interventions that are critical to improving province or city-wide health
system. Costs for these critical interventions shall be appropriately
determined and sources of funds are identified;
8. Identified indicators in the LIPH shall be the basis for assessing
performance of local health systems. Results of the regular performance
assessment shall become the basis for further technical and logistics
assistance;
9. LIPH and AOP planning and review processes, monitoring and
supervision, shall be simplified and streamlined to reduce administrative
and transaction costs, and inefficient practices; and
10. The Planning Team of the DOH Regional Offices shall supervise the
planning process. The Provincial/City Planning Team shall likewise be
cognizant to supervise the timing, quality of planning process and the
output.
LIPH Handbook | 11
E. The LIPH financial plan is based on identified strategies and critical

interventions in order to optimize the use of local and national
sources of funds.
1. The LIPH financial plan shall
be developed utilizing the
principle of participatory
planning/budgeting at all
levels;
2. The financial
section
of
the LIPH is based
on
appropriate
costs
of identified evidencebased, critical interventions
to
optimize
the
use
of
resources.
These
interventions include, but
Barangay District
not limited to the allocation Barangay Municipal/Comp. City ILHZ
CITY-WIDE
PROVINCE-WIDE
for human resources for
health, essential medicines,
logistics and technologies,
infrastructure, equipment, premium payment for social health insurance.
It defines various financial options available to the LGU, from internal
and external sources, that can finance the LIPH and AOP. Local funding
sources are leveraged with resources from national government,
development partners and private sector support;
3. Specifically, it shall contain sources of funds from national and local
public monies, development partners, foreign and local donors, private
sector, or from entrepreneurial cost-recovery schemes of government
institutions and ILHZs. It shall also indicate the funding schedule;
4. To ensure transparency and accountability, it shall adhere to government
accounting and auditing procedures, as well as monitoring and reporting
system for fund utilization. There shall be a feedback mechanism to allow
planners and implementers to decide the reallocation of resources, the
timing of fund utilization, mobilization of more funds, etc.; and
5. The plan management section of the LIPH shall clearly establish fund
management.
12 |LIPH Handbook
F. The LIPH shall express shared vision, common interests of

stakeholders, critical interventions and the required investments.
1. The LIPH represents the
accountabilities of the national
government
represented
by DOH and its attached
agencies (PHIC, PopCom,
NNC,
PNAC,
PITAHC),
LGUs and its partners, other
stakeholders with interests
in improving public health
outcomes;
2. It shall contain the basic parts:
I. Cover letter
II. Narrative Section
A. Executive Summary Barangay Municipal/Comp. City ILHZ Barangay District
CITY-WIDE
PROVINCE-WIDE
B. Introduction
C. Province/City Profile
D. Health Situationer
E. Overall Health Strategy and Proposed Specific Intervention
F. Plan Management
G. Monitoring and Evaluation
III. Planning and Costing Matrices
Refer to Annex A LIPH Content and Forms.
3. The LIPH/AOP becomes a basis for monitoring and evaluating local
health system performance.
G. The LIPH and AOP are aligned with the LGU and DOH budget
timelines.
1. The LIPH and AOP shall ensure that local investments for health are
aligned with the LGU and DOH budget timelines; and
2. The LIPH and AOP shall be developed in a timely manner in terms of
(a) review and approval by DOH and (b) forging of Agreements between
DOH and LGUs.
LIPH Handbook | 13
H. Annual Operational Plan (AOP) is a detailed translation of the

LIPH.
1. The AOP is a local policy
instrument
that
allows
the LGUs to state local
investment preferences and
priority interventions for a
particular year based on the
three-year strategic proposals
enumerated in the LIPH;
2. The
AOP
contains
interventions and investments,
including fund sources - LGU,
DOH, development partners
and
other
stakeholders
represented in the agreement;

Year 3
Year 2
Year 1
3. The AOP is expected to

result in incremental changes
leading to local health
systems improvement as
demonstrated by available essential health products and appropriate
technologies, improved regulation, responsive health workforce and
service delivery networks, equitable and sustained health financing,
powered by transformational leadership and governance structures, all
captured by a robust local and national health information system; and
4. The AOP shall contain the basic parts:
I. Cover letter
II. General Description
1. The Health Situation in the Provincial/City at the end of (Year)
2. Local Priorities in Health: Adjusting LIPH to the Current
Situation
3. Major Thrusts of the AOP
4. Adjustments in Proposed Interventions and Investments
5. Performance Indicators
Refer to Annex C for the AOP Content and Forms.
14 |LIPH Handbook
1. A
Continuous
Quality
Improvement (CQI) process
shall ensure that incremental
developmental
changes
happen
annually.
These
annual incremental changes
in public health outputs will
enable LGUs to achieve their
desired health outcomes,
thus decreasing disparities
in performance among LGUs,
among
government
and
private health care institutions,
as well as decreasing
inequities among populations;
CQI
CQI
CQI
Equity, Effectiveness,
Efficiency
I. The LIPH shall be bound by continuous quality improvement

focusing on equity, effectiveness, and efficiency.
2. There are available M&E tools

to enable DOH, its regional offices, LGUs, and other stakeholders to
assess, measure, record, and report these incremental changes. Such
tools include but not necessarily limited to the LGU Scorecard, DOH
RO Scorecard, tools used in Field Health Services Information System
(FHSIS), Hospital Statistical Reports;
3. A comprehensive localized M&E system shall be integrated into the LIPH to
ensure that these incremental developmental changes are systematically
recorded, analyzed, reported, and utilized in future planning processes;
4. The performance measurements on efficiency shall define the degree/
scale to which resources and related costs are maximized to accomplish
the intended health outcome;
5. Performance measurements on effectiveness shall determine the degree/
scale to which the expected results and outcomes are achieved; and
6. The performance measurements for equity shall focus on the degree/
scale of health investments allotted to and generating results for the poor,
disadvantaged, including but not necessarily limited to GIDA, Indigenous
Cultural Communities/Indigenous Peoples, Senior Citizen, women and
children covered by barangays, municipalities, districts or ILHZ (where
applicable), component cities, HUCs and ICCs.
LIPH Handbook | 15
J. The LIPH is an integrative tool, maximizing local and national

resources toward the development of a responsive and equitable
local health system.
IMPROVED HEALTH OUTCOMES
1. The LIPH shall be province/
city-wide (for HUCs and
RESPONSIVE HEALTH SYSTEM
ICCs) in scope, ensuring
that the investments shall
Health
Service
Information
equitably benefit all sectors
Delivery
System
of society, most especially
Governance
those who are vulnerable
for
and at risk such as those
Health
Health
Regulation
Financing
in
GIDA,
Indigenous
Human
Cultural
Communities/
Resource
for
Indigenous Peoples (ICCs/
Health
IPs), Urban Poor, Senior
Citizens,
Persons
with
Disabilities(PWDs), women
and children;
2. The LIPH shall have a threeyear
strategic
direction,
specifying investments for
priority programs, projects and activities toward the development
or strengthening of a responsive and equitable local health system1
throughout the province or city;
3. It shall enhance the availability and accessibility of human resources
for health who are competent in meeting peoples health needs at the
appropriate level of care;
4. It shall transform service delivery structure to address variations in health
needs, service utilization and outcomes across geographical locations
and socio-economic strata;
5. It shall enhance development and implementation of policies, standards
and regulation to ensure equitable access to health services, essential
medicines and technologies of assured quality, availability and safety;
Administrative No. 2010 0036, The Aquino Health Agenda: Achieving Universal Health Care for All
Filipinos describes the building blocks of a responsive health system - service delivery regulation, health
workforce, health financing, health information, and governance for health.
16 |LIPH Handbook
6. It shall have an enabling information system that shall (a) provide evidence
for policy and program development, and (b) support for immediate and
efficient provision of health care and management of province/city-wide
health systems;
7. It shall ensure a functioning, equitable financing mechanism, increasing
resources for health that will be effectively allocated and utilized to
improve the financial protection of the poor and the vulnerable sectors;
8. It shall maximize resources present (whether pooled or shared) among
inter-LGU (e.g. ILHZ Common Health Trust Fund or human resource
sharing) and inter-sectoral cooperation (ex. Public-Private Partnerships
for health);
9. It shall reflect investments to be poured into the first year of operation
(AOP Year 1) that can maximize the outputs, in turn, create high impact
on the second and third year of operations (AOP Year 2 and AOP Year
3);
10. It shall make use of resources from the national government and
Development Partners with counterpart local resources; and
11. It shall improve capacities of leaders who can transform governance for
health to establish mechanisms for efficiency, effectiveness, transparency
and accountability.
1.2 Planning Team

It is important to know the key players shall ensure that the three-year plan
and the yearly plan on local investments for health are relevant and responsive.
The following principles shall serve as a guide for the DOH ROs and LGUs in
constituting a Planning Team.
There shall be an organized Planning Team at the barangays, municipalities
or cities, ILHZs, provinces, and DOH ROs. Table 1. shows the proposed
composition of the planning management unit in the DOH-ROs and LGUs.
LIPH Handbook | 17
Table 1. LIPH Planning Management Structure

Level/Unit
Proposed Composition
Barangay
Barangay Captain, Barangay Councilor for Health, Community

Health Team, Rural Health Midwife, Barangay Health Worker
Municipal/City
Health Officer, Budget Officer, Accountant, Treasurer,

Planning Officer and Municipal/City DOH Officer, Councilor
for Health, Chief of LGU Hospital, Representative/s from
Indigenous Peoples, Peoples Organizations, Private Sector
ILHZ/District
ILHZ Technical Head, Health Officers, Chief of Hospital of

the core referral hospital, Municipal or Provincial DOH Officer
Provincial
Health Officer, Budget Officer, Accountant, Treasurer,

Planning Officer, Provincial DOH Officer, Councilor for
Health, ILHZ Technical Head, and Chief of Provincial Hospital
Regional Office
Assistant Regional Director, Planning Officer, LIPH

Coordinator, Program Managers and Provincial DOH Officer
1. The Planning Team shall have the appropriate competencies. The DOH
RO shall look into the competencies of the Planning Teams based on a
competency checklist. The DOH RO shall identify competency gaps and
plan training program to address these gaps. For details of the Planning
Teams competencies, please refer to Annex E Competencies of Planning
Teams;
2. The appointment of the LGU Planning Team shall be supported by an
appropriate policy such as an Executive Order or a Sangguniang Resolution.
The policy defines the roles and responsibilities, the funding allotment, and
other logistical resources to ensure the functionality of the team;
3. The Planning Team shall ensure participation of civil society organizations
and private health sector stakeholders in both the planning process and
implementation of the LIPH and AOP, and encourage the engagement of
other concerned government agencies;
4. The Planning Team shall be accountable for the results-based planning;
18 |LIPH Handbook
5. The Planning Team shall have in its disposal sets of technical, financial,
technological resources to enable it to plan accordingly and to complete the
LIPH and AOP on time; and
6. The Planning Team shall be equipped with planning and appraisal tools,
including but not necessarily limited to the checklist for the situational
analysis, planning matrices and costing tools for LIPH and AOP, appraisal
tools to be used by the PHOs, CHOs and ROs.
1.3 Monitoring the Planning Process

Monitoring the planning process in crafting the LIPH and AOP shall be observed
at the outset. It is important to instill the discipline of monitoring to ensure
efficiency in accomplishing the planning exercise and the quality of the output or
LIPH and the corresponding AOPs.
The Planning Team of the DOH ROs and the Provincial/City Health Offices shall
monitor the planning process using the checklist in Table 2. Each indicator
is described in detail to provide clarity on what shall have to be observed or
intentionally probed.
Table 2. Monitoring Checklist of the Planning Process
Indicators
Focal Points
Timeliness
1. DOH RO start-up communication to LGUs on LIPH and AOP

2. Actual start up period of the planning process of LIPH and AOP
3. Synchronicity of DOH and LGU planning cycle
4. Adherence to planning steps and schedules
(Refer to Figure 3. Workflow Diagram in Formulating LIPH AOP and Figure
4. Communication Diagram for Appraisal and Approval)
Methodology
1. Process is consultative and participatory

2. Use of verifiable data that clearly address health needs
(Refer to Figure 2. Workflow on Participatory Process in Formulating LIPH)
Content
1. Technical consistency and logical matching of strategies, goals,objectives of

the LIPH and AOP with the LGUs vision, mission, and NOH
2. Agreed critical interventions, performance targets, and resource requirements
by the Local Planning Team as mandated by national agencies
3. Monitoring and evaluation system
4. Continuing Quality Improvement processes
5. Linkage of national and local initiatives
6. Linkage of policy development to capacity development based on local
needs
(Refer to Annex B LIPH Appraisal Checklist and Annex D AOP Appraisal
Checklist)
Appraisal
1. Readiness of the LIPH and AOP within the agreed period

2. Feedback to LGUs on the LIPH and AOP revision and/or finalization
3. Approval of the LIPH and AOP for implementation
LIPH Handbook | 19
1.4 Roles and Responsibilites

The roles and responsibilities of the key players/stakeholders shall served as a
guide in executing the planning process and implementation of the LIPH and
AOP.
A. Local Government Units (LGUs)
1. Plan and implement the programs and projects in the LIPH/AOP and
provide counterpart funding or source-out funding for activities not
funded by DOH or Development Partners;
2. Set up the Local Planning Team, Monitoring and Evaluation Team for the
planning process and implementation of the LIPH and AOP;
3. Monitor the implementation of the LIPH/AOP and fund utilization;
4. Submit Fund Utilization Reports to DOH ROs, the frequency of which is
determined and agreed by both LGUs and DOH;
5. Ensure participation of Civil Society Organizations (CSOs), private health
sector stakeholders in both the planning process and implementation of
the LIPH and AOP;
6. Set up Local Implementation and Coordination Team (LICT), composed
of the Local Chief Executives (LCEs), their Local Health Boards (LHB),
the Local Technical Staff, Local Planning Team, CSOs, and other
private stakeholders. The LICT shall be responsible for the over-all
implementation of LIPH and AOP activities in their respective LGUs; and
7. Convene regular meeting of the LICT.
B. DOH Regional Offices
1. Responsible for the advocacy and technical assistance on the new
guidelines and shall lead in working with provinces, cities, stakeholders
on LIPH/AOP development;
2. Provide necessary, updated data to LGU Planning Teams;
3. Participate in planning workshops;
4. Appraise the plans and ensure the timely transfer of sub-allotted funds
to LGUs;
20 |LIPH Handbook
5. Develop support mechanisms for LGU implementation of the plans,

according to available resources in order to achieve desired outcomes;
6. Monitor and report the implementation of the LIPH as well as status of
utilization of funds;
7. Set up the Regional Implementation and Coordination Team (RICT),
composed of representatives from the DOH, PhilHealth, Population
Commission, Provincial/City Health Offices of the LGUs, CSO, and
other related agencies/organizations at the regional level. The RICT is
responsible for the technical supervision and coordination of LIPH/AOP
implementation across the region; and
8. Convene the regular meeting of the RICT.
C. DOH Central Office and Attached Agencies
1. Bureaus, Services, Program Managers
a. Define interventions and their standard costs to achieve annual
program targets of the LGU based on National Objectives for Health
(NOH) and DOH Implementation Framework (e.g. Universal Health
Care/Kalusugan Pangkalahatan);
b. Determine current, medium-term and long-term budgetary allocations
needed to implement LIPH and AOPs, and equitably allocate
resources from various sources;
c. Ensure prompt and efficient flow of
component LGUs, and cities; and
funds to provinces, their
d. Strengthen regional level field implementation of all DOH program

activities.
2. Bureau of Local Health Systems Development
a. Institutionalize the LIPH and AOP as the primary process in engaging
and guiding coordinated local health system reforms;
b. Disseminate pertinent guidelines on the development of the local
investment plan and other related documents;
c. Build capacity of DOH ROs as providers of technical assistance (TA)
on local investment plan to provimces/cities in coordination with the
other concerned DOH Central Office/Bureaus;
LIPH Handbook | 21
d. Ensure availability of funds for the fixed and variable tranches of the
LGUs through the DOH ROs, and DOH-ARMM; and
e. Conduct monitoring of DOH ROs, LGUs and DOH-ARMM on LIPH
implementation.
D. Development Partner/s
a. Identify technical assistance needs based on LIPH/AOP;
b. Develop technical assistance packages based on the identified
needs in the LIPH/AOP; and
c. Provide technical assistance to the development and implementation
of LIPH/AOP, as appropriate.
22 |LIPH Handbook
PART 2
Procedures and Processes
LIPH Handbook | 23
2.1 Essentials in Planning

There are important pre-requisites in crafting the three-year and annual
investment plan for health. These are: a) knowing the direction and workflow
of planning, b) timing of planning, and c) formulating or updating of the LGUs
vision, mission and goals.
A. Planning Workflow
The Planning Teams and the Local Chief Executives must have a clear grasp of
the direction of the planning process. Figure 2 illustrates the rigorous, sequential,
participatory and evidence-based approach in planning for health to ensure
community ownership and accountability.
LIPH Process for ICCs and HUCs
Integration and enhancement

of Investment Plan at City
level (LIPH)
Integrating investment plans

at District level (if applicable)
LIPH Process for Provinces
After planning
Consultation
with
concerned
barangays,
M/
CHOs, ILHZ by
PHO & CHOs,
and
other
key
stakeholders
Planning of barangays with

health
needs
requiring
investment
Before planning
Analysis of disaggregated vital
data by HUC, ICC, Provincial
& Regional Teams to determine
places & communities at risk
Integration and enhancement

of Investment Plan at
Provincial-level (LIPH)

at ILHZ level (if applicable)

at Municipal and Component
City level
Planning of barangays with

health
needs
requiring
investment
Figure 2. Workflow on Participatory Process in Formulating LIPH
24 |LIPH Handbook
Critical steps before planning:

1. Regional Planning Team analyzes disaggregated data sets and
qualitative information to determine LGUs at risk and needing
immediate attention; and
2. Regional Planning Team immediately informs LGUs of the results.
Note: Communicating pre-planning activities to barangays (through
ABCs) municipalities, districts, and cities is vital in ensuring
community ownership of the planning process and implementation.
Critical steps after planning:

1. Once the LIPH is finished, the Planning Teams of Provincial, HUCs
and ICCs, LGUs consult the concerned barangays, MHOs, and
CHO through a final review of the LIPH before submisison to the
DOH ROs or the Central Office for appraisal and approval.
Note: Communication of results of the appraisal from the DOH-RO
and Central Offices is vital in ensuring significant participation
of barangays, municipalities, districts, and cities in the LIPH
implementation.
LIPH Handbook | 25
B. Timing of the Planning Process

The Planning Team shall keep in mind that the LIPH must be ready in time for the
planning/formulation of the provincial, city LGU development/investment plan.
In the same manner, that the AOP shall be ready in time for the annual LGU
planning cycle for the coming year.
The DOH planning cycle, especially at the regional level, shall be synchronized
with the LGU planning cycle for the LIPH and AOP to ensure primarily the
efficient downloading and utilization of resources.
C. Formulating/Updating the Vision, Mission, and Goals (VMG)

Before the actual planning workshop begins, it is wise to revisit the localitys
vision, mission, and goals.
As a reference guide, a vision statement is a brief description of the desired future
state of health of the local community. It is linked with the national objectives for
health and the local stakeholders needs and values. It sets forth the beliefs
and governing principles by which leaders, managers and constituents commit
to practice.
The following questions may be used to evaluate the crafted vision statement.
Whether the answer is a yes or a no, it is best to probe its meaning by asking
why.
1.
2.
3.
4.
5.
Is the desired future to be attained clear?

Is it concise and inspirational?
Is it aspirational?
Is it noble?
Can it be done?
The mission statement is a brief description of the reason and purpose of the
health sector in relation to fulfilling the desired future state of peoples health in
the locality and the national objectives for health.
The following parameters help in evaluating the soundness and meaningfulness
of a mission statement:
1. Clear stakeholders
2. Focused on concern for inclusive growth
3. Contributes to nation building or national objectives
26 |LIPH Handbook
A goal is the general aim sought to be accomplished over a specific time period.
For LIPH purposes, a goal is achievable in three years time.
The localitys vision, mission, and goals provide the inspiration and basis for
the LIPH and AOP. If the vision, mission, goals need to be updated, revised, or
are non-existent, the local health planners shall draft the VMG, and ensure that
these VMGs are shared by the stakeholders.
Refer to Annex F Development of Vision, Mission, and Goal Statement.
2.2 Key Steps in Formulating the LIPH and AOP

This section guides local Planning Teams in coming up with an implementable
LIPH and AOP that highlight the vision, mission and goals of the Local
Government Units (LGUs). Likewise, this section guides the Planning Team
of the DOH Regional Offices and the LGUs in conducting and managing the
evidence-based planning process, in a step-wise manner. There is a built-in
communication for each key planning step.
In the same manner, the DOH Central Office is guided on providing technical
assistance to its Regional Offices such as timely data and information, use of
analytical or problem solving tools, and identification of appropriate strategies.
Workflow in formulating LIPH and AOP is described in Figure 3, while the
sources and types of data for evidence-based Situational Analysis is shown in
Table 3.
LIPH Handbook | 27
A planning workshop shall be convened, preferably with the following

stakeholders, such as but not limited to:
a. Provincial, City and Municipal Health Officers;
b. Provincial/City/Municipal Health Board Members;
c. Provincial/City/Municipal Planning and Development Officer;
d. Chief of Hospitals of the provincial, city, district, community and DOHretained hospitals;
e. Administrative Officers of the provincial, city, district or community
hospitals;
f. LGU policy-making bodies such as the Sangguniang Panlalawigan/
Panglunsod/Bayan;
g. DOH ROs Planning Officer and Local Health System Coordinator;
h. DOH ROs Development Management Officers (DMOs);
i. Representatives of private sector including peoples organizations, nonprofit organizations, hospitals, birthing homes, etc.;
j. Other concerned government agencies; and
k. Development partners and donors.
28 |LIPH Handbook
Communicate the start of the LIPH

Formulation
Gather/Update Accurate, Complete,

Verifiable Data
Do a Situational Analysis, Identify Gaps,

Determine & Analyze Health Needs &
their Causes, Prioritize Needs
Design Strategies, Directions

Identify Evidence-based
Interventions
Determine Cost of Critical
Interventions
Do Costing schedule,
Identify fund sources
Consolidate, Integrate,
Write LIPH, AOP
Implement LIPH, AOP
Communication for
appraisal from LCE
to DOH
Communication
from DOH to LGU
on Approval of LIPH,
AOP
Monitor and Evaluate
Enhanced LIPH/AOP
Figure 3. Workflow Diagram in Formulating LIPH/AOP

LIPH Handbook | 29
A. Communicating pre-planning activities

1. The DOH RO, through its
Director
or
his/her
duly
assigned representative, shall
communicate with local chief
executives and policy-makers:
Communicate the start of

LIPH formulation
a. to initiate LIPH and AOP

planning activities with public
and private stakeholders;
b. to inform them on current
DOH reforms and thrusts,
priorities, highlighting the role
of local officials as stewards
of the local health sector and
resources required for planning purposes;
c. to help them appreciate the relevance of health sector reforms and the
need for their support to continue these; and
d. to update them on specific health challenges affecting their localities.
2. The DOH RO shall emphasize that the LIPH is a medium term, three-year
plan to be undertaken by the PHO/CHO/MHO in coordination with other
health partners and stakeholders.
Planning Teams of LGUs may initiate preparation for and conduct of
planning for the LIPH/AOP even before receipt of DOHs communication.
30 |LIPH Handbook
B. Gathering/updating accurate, verifiable data

1. The Planning Team of DOH ROs and
provincial/city/municipal LGUs shall build
verifiable data (if these are not yet available)
or update their data bank;

Gather/update accurate,
complete, verifiable data
Refer to Table 3. Types of Data and Possible

Sources
2. Provincial/city/municipal Planning Teams

shall inform relevant stakeholders to
contribute in building and updating verifiable
and accurate data; and
3. LGU Planning Team of provinces/cities/
municipalities shall consolidate all relevant
and current data for their localities, including
LGU profiles, vital indices, etc.
LIPH Handbook | 31
32 |LIPH Handbook
Epidemiological data-significant diseases and
conditions; causes of illnesses and death; preventable
factors, risk identification etc; disability-adjusted life
years
Morbidity, mortality data (top 10 leading causes of
morbidity, mortality, rates and causes of illnesses,
MMR, IMR, etc)
Unmet needs for family health derived from health use
plans, TCLs, FHSIS, other client identification tools
Annual statistical reports from hospitals
MDG-related data
Indicators in the LGU scorecard
Service Delivery Networks, partnerships, clinical
support
iii. Health
Indices
Current or projected population

Literacy rates across different populations
Gender and youth-related data
Indigenous population
Population living in GIDA
Socio-economic data (e.g. poverty incidence)
Description of catchment area(s)

Geo-hazard map
Location accessibility considering remoteness,
travel time and transport, road condition, security,
proneness to erosion, flooding
Brief description regarding economic activity, tourism
and other factors affecting health status and services
GIDA and how far is this to main health care facilities
and center of socio-economic activities
Specific Data
ii. Demographic
i. Environment
Type of Data
Identify vulnerable communities &

populations within a locality and
their particular needs that have to
be addressed in the health plan
Identify gender & youth issues that
need to be addressed urgently and
long term
Identify places at risk or vulnerable

communities
Input to rationalization of health care
services & facilities
Input to program of works
Input to decision-making processes
related to disaster risk mitigation
Identify critical health needs that

have to be prioritized in the strategic
investment and annual operational
plan
Identify health needs of vulnerable
populations, their geographical
location
Identify availability of health
care providers, nearest to these
populations
Relevance and Use of the

Specific Data
Table 3. Types of Data and Possible Sources
Provincial or city or
municipal planning office
Philippine Statistical
Authority
DILG, DSWD, NEDA
Special government
offices for Indigenous
Peoples
Environmental
Management Bureau of
DENR, City or Provincial
Disaster Risk Reduction
and Management Offices
Provincial, city, municipal

health, planning &
development offices
DILG
Consolidated health
reports from the
Community Health Teams
Community-based
Management Information
Systems where available
Other special studies
from development
partners
Possible Sources
LIPH Handbook | 33

vi. Service Delivery
Private & public health care facilities, their location,

service capacities & cost of services, status of DOH
licensing & PhilHealth accreditation
Distribution of activity volumes between private and
public, other services
Patient flows
Rates of service utilization ( ex. Utilization by poor vs.
non-poor)
Mode of service delivery arrangements
Number and geographic distribution of human

resources for health (HRH) in both public and private
sectors
Technical skills or competencies of HRH & where are
they deployed (rural or urban areas)
Training Needs Assessment results
Trainings & post-training evaluation results
Tools utilized to assess the status of HRH
Resources for capacity development
v. Human Resource
for Health
Possible funding resources (internal & external)

Health Financing modalities at the communities,
district or provincial or municipal level (ex. Peso for
Health)
Grant utilization by LGUs of DOH MNCHN
grant, & other grant facilities
Local health accounts where available
Status of PhilHealth enrolment or percent coverage
most especially of vulnerable population
Data on LGU income from PhilHealth capitation
funds, claims & reimbursements per facility
iv. Health Financing
Specific Data
Type of Data
Identify local, national funding
resources for each critical
investment for health
Determine PhilHealth coverage of
vulnerable populations & utilization
of their PhilHealth benefits
Determine income from PhilHealth
if utilized to improve healthcare
services
Identify current gaps in health care

provision vis--vis health status,
unmet needs of communities
Capacities of members of service
delivery network
Referral arrangements
Match the current HRH to the health

needs
Identify HRH gaps
Identify possible HRH management
and development strategies
Identify financing needs and
resources for these HRH strategies

Specific Data
Table 3. Types of Data and Possible Sources (Cont.)
LGU Finance committee,

DOH RO through the
Provincial DOH 0ffice
Development partners
Cooperatives
NGOs
PhilHealth Provincial &
Regional offices
PHO, MHO, CHO or

DOH ROs
Human Resource
Management Office
(HRMO) of the LGU or
health care facility
PHO or MHO or CHO
HR training unit of DOH
ROs
Possible Sources
34 |LIPH Handbook
Presence or absence of health information system
that binds the entire local health system
If there is, status of this health information system
(electronic or paper based)
Indicators tracked by the Health Information System
viii. Health
Information
System (HIS)
Political divisions
ILHZ structure
Policies implemented
Partnerships/agreements
Specific Data
vii. Governance
Structure
Type of Data
Identify policies that are
developed, implemented,
monitored, evaluated
Identify strategies to enhance
government structure and
stewardship
Identify gaps & deficiencies of

this health information system
Identify capacity of people
managing HIS, depth and
breadth of this system, its
usability for planning purposes

Specific Data
Table 3. Types of Data and Possible Sources (Cont.)
PHO, LGU planning

and development office,
Sangguniang Bayan &
Panglunsod
PHO, MHO, CHO or DOH

RegionalOffices
Surveillance units of these
health offices
Possible Sources
C. Doing a situational analysis

1. Based on consolidated data,
Planning Teams at all levels
identify health needs, burden of
diseases and causes of health
problems and compare local
data with regional and national
data and other performance
benchmarks;
Do a situational analysis (identify

gaps, determine & analyze health
needs & their causes, and prioritize
needs)
Refer to Annex G Tools for Data

Analysis in identifying and prioritizing
interventions.
2. The Regional Planning Team

analyzes disaggregated data sets
and qualitative information to determine provinces, cities at risk and needing
immediate attention. It immediately informs LCEs and Health Officers of
provinces, HUCs and ICCs the results of these analyses; and
3. Health Officers may prioritize health needs based on:
a. health needs assessment: magnitude, urgency, sensitivity of the
situation or risk
b. identified target groups/beneficiaries/areas like GIDAs, Indigenous
Peoples, Urban Poor, population at risks, vulnerable groups, etc.
Situational Analysis shall be done in a participatory manner.
LIPH Handbook | 35
D. Identifying Appropriate and Evidence-based Strategies

1. The Planning Team of provincial/
city/municipal/barangay
LGUs
shall facilitate the development of
strategies, assemble evidencebased critical interventions and
costing exercises appropriate for
their respective localities;
Design strategies, directions

Identify evidence-based
interventions
2. The Planning Team of the DOH

Regional Office shall provide
technical assistance to the LGUs
in the development of appropriate
strategies
and
the
costing
exercises; and
3. The Planning Team may adopt the following process for strategy formulation:
a. Develop local roadmaps aligned with national objectives and thrusts
(e.g. NOH and KP Road Map)
b. Based on the result of the Situational Analysis, define objectives,
determine Key Result Areas, targets and critical interventions
c. Prioritize critical interventions based on:
i. results of health needs assessment: magnitude, urgency,
consistency, feasibility, sensitivity of the situation , risk
ii. identified target groups or beneficiaries
iii. current and future resources
iv. government directions
v. current and future resources
vi. local strategies proven to be effective and efficient
d. Discuss and agree with NGAs, development partners, private sector
and other stakeholders for potential health investment (type of
intervention and financial requirements)
4. Build the strategies for the LIPH and AOP using the matrix below:
Long Term Goal: ______________________________
SMART
Objectives
Key
Result
Areas
Evidence-based PPAs
Targets
36 |LIPH Handbook
Means of
verification
Programs
Projects
Activities
Timeline
Responsible
person
Required
resources
5. Planning Teams of HUCs/ICCs and contiguous provinces shall ensure their

plans are coordinated, complimentary, and interlinked.
Guide questions for strategy formulation:
1. What is our vision for the future? Our aspirations?
2. What are our critical issues?
3. What strategies are appropriate in response to the identified health
needs?
4. What tools do we need to formulate the strategies?
5. Do we have evidence-based strategies, proven to be effective, safe,
and efficient?
6. Are the plans coordinated, complementary and interlinked with
contiguous LGUs?
7. How much can we invest into each strategic intervention?
8. Do we need technical assistance in formulating our strategies? From
where/whom do we get this technical assistance?
9. When do we foresee the achievement of our goals?
10. Are the objectives and strategies in the LIPH/AOP aligned with that
of the national, regional, and local objectives?
E. Costing of Strategies
1. Based
on
the
identified
strategies, Planning Teams shall
weigh evidences and invest on
priority interventions that will
have an impact and sustained
effect when implemented;
2. Determine
the
required
investment costs and sources of
funds (from both local, national
and international) for each year
for the next three years;
Determine cost of strategies

Do costing schedule,
identify fund sources
3. Use the recommended costing

tables showing realistic costing;
and
LIPH Handbook | 37
4. The DOH Regional Office shall provide advisory on the cost of goods and
services necessary for the strategies to be implemented.
Realistic costing provides cost to interventions that respond best to
identified priority needs. The cost is context-specific to geographic
characteristics. It also follows existing guidelines set by the National
Government on cost of goods and services, and adheres to government
accounting, auditing and procurement principles.
F. Consolidating and Writing the LIPH and AOP

1. The Provincial Planning Team
shall integrate and consolidate
the different LIPHs and AOPs
of barangays, municipalities,
component cities and write the
province-wide LIPH and AOP;
2. In the same manner, the Planning
Team of HUCs/ICCs shall
integrate, consolidate the LIPH or
AOPs of barangays and districts,
(where applicable) into one citywide LIPH or AOP;
Consolidate, integrate,
write liph, aop
3. Agreements during planning

workshops shall be integrated in
the plan;
4. Follow the prescribed format of the LIPH and AOP as indicated in Annex A
LIPH Content and Forms, and Annex C AOP Content and Forms; and
5. The Planning Team may provide copies of the draft LIPH and AOP to
concerned stakeholders for review.
38 |LIPH Handbook
G. Feedback written LIPH/AOP to Key Stakeholders

1. The Local Planning Team shall feedback the final draft of the LIPH/AOP to
key stakeholders to ensure ownership;
2. The Local Health Officer (provincial and city) shall present the LIPH/AOP to
the Local Chief Executive (Governor and HUC/ICC Mayor) for approval and
allocation of resources; and
3. LCEs of municipalities and component cities are given copies of the final
LIPH/AOP approved by the Governor and HUC/ICC Mayor.
H. Appraisal and Approval Process for the LIPH and AOP

1. The provincial and HUC/ICC
health offices shall endorse
the final LIPH/AOP to the
DOH Regional Office for
appraisal;
2. The DOH Regional Office
shall undertake the initial
appraisal of the LIPH using the
appraisal checklist in Annex
B. It shall be accountable
for ensuring the readiness
of the investment plan for
submission to DOH Central
Office for final appraisal;
Consolidate, integrate, write

liph, aop
Implement LIPH, AOP
Communication
for appraisal
from LCE to
DOH
Communication
from DOH to
LGUs on approval
of LIPH,AOP
3. If there are major changes in the

LIPH, the DOH RO shall return it to the concerned LGU for enhancement.
However, if there are no major changes, the DOH RO shall endorse the
final LIPH with the signed appraisal checklist to the DOH Central Office for
approval/concurrence;
4. The DOH RO shall undertake the initial and final appraisal and approval of
the AOP using the appraisal checklist in Annex D;
LIPH Handbook | 39
Final LIPH/AOP
LGU endorsement of final/revised LIPH/AOP

to DOH RO
DOH RO conducts
appraisal of AOP
DOH RO conducts
appraisal of LIPH
LGU revision/enhancement
of LIPH/AOP
No
with
major comments and
recommendations
DOH RO endorses LIPH

with appraisal checklist to
DOH Central Office
DOH RO informs LGU

Yes
Yes
DOH CO informs DOH

RO
with
major comments and
recommendations
No
Yes
DOH RO approves AOP
DOH Central Office
reviews the final LIPH
with
major comments and
recommendations
No
DOH Central Office
approves/concurs LIPH
and informs DOH RO
DOH RO and LGU

execute agreement
Implementation of
approved
LIPH/AOP
Figure 4. Communication Diagram for Appraisal and Approval

40 |LIPH Handbook
5. The appraisal must be done within the agreed timeline;

6. The DOH RO shall execute the agreement that will formalize the engagement
of the LGUs in implementing the LIPH/AOP. The DOH RO shall likewise
provide the DOH CO copies of signed agreement, final approved LIPH and
AOP;
7. The DOH RO shall ensure that resources, e.g. technical assistance, budget
augmentation, logistics support etc., must be focused and available upon
execution of the agreement on the LIPH/AOP;
8. The local health offices shall orient LCEs and other stakeholders on the final
and approved LIPH/AOP to sustain their support in the implementation of
LIPH and AOP; and
9. The local health offices shall communicate to the stakeholders and decisionmakers at the LGUs on the results of the appraisal, amendments and approval
of the LIPH and AOP.
LIPH Handbook | 41
42 |LIPH Handbook
Identify evidence-based
ppas
Design strategies, directions
Do a situational analysis,
identify gaps, determine &
analyze health needs & their
causes, prioritize needs
Gather/update
accurate, complete,
verifiable data
Communicate the start

of liph formulation
Workflow
Identify and design appropriate

strategies, priority health
investments/interventions
for the provinces/cities/
municipalities/barangays
Enable support services
Define functions of workforce and

accountability pathways
a. Accomplish/update health and

health-related data for different
levels (PHO, MHO, CHO)
b. Give/share/validate available
data (DOH-RO, Development
Partners, NGAs)
Ensure multi-stakeholder
participation (e.g. development
partners, private sectors, etc.)
Use Evidence-based Situational

Analysis
Communicate to Local Chief

Executives (LCEs), LGU
Planning Teams
Processes
3 weeks
1 week
Timeline
Critical
Interventions
and
Investments
Planning Team and

local finance team to
do the costing
Planning team and

key stakeholders
(development
partners, private
sector, NGAs, POs,
Civil Societies
Organization)
Planning and
development office of
LGU and DOH RO
Validated
standardized
DOH
approved
health and
health-related
data.
Situational
Analysis
DOH Regional
Planning Unit
Responsible
Offices
Concurrence
from LCEs
& Planning
Teams
Expected
Output
Table 4. Summary Workflow in Formulating LIPH/AOP
Refer to Guide
questions
for strategy
formulation
Refer to Annex B
LIPH Appraisal
Checklist and
Annex D AOP
Appraisal
Checklist
Refer to Table
3 Types of Data
and Possible
Sources
Letters to LGUs
Tools
LIPH Handbook | 43
Enhanced liph/aop
Monitor and evaluate
Implement LIPH, AOP
Consolidate and write final

liph, aop
do Costing Schedule,
Identify fund sources
Determine cost of critical

interventions
LIPH, AOP
implementation
Capture all
agreements into
the plan
a. Implement M&E
b. Feedback M&E results to
stakeholders
c. Utilize M&E results for
planning to adjust health
investments for the next AOP
and subsquent LIPH
Communication
from DOH to
LGU on Approval
of LIPH, AOP
Communication
for appraisal
from LCE to DOH
a. Develop directions, target

recipients, and criteria for
success
b. Establish options; consider
opportunities for innovations
c. Discuss and agree with
development partners,
private sector for potential
health investment (type of
intervention and financial
requirements) and analyze
feasibility
d. Design cost framework and
final resource implication.
As input to
next years
AOP
3 years(LIPH)
1 year(AOP)
2 weeks
4 weeks
Satisfactorily
monitored and
evaluated plan
Accomplished
targets in the
LIPH/AOPs
LIPH/AOPs
Planning Team
Consider LGU
scorecard and
other M&E tools
Refer to Annex A
for LIPH Content
and Forms
PART 3
annexes
44 |LIPH Handbook
Annex A
LIPH Content and Forms
I. Cover Letter (1 page)
The Local Chief Executive (Mayor for HUC/ICC and Governor) shall sign this
letter endorsing the LIPH to the DOH Regional Office through the Development
Management Officer Representative assigned in the locality, signaling the start
of initial review or appraisal of the LIPH.
II. Narrative Section
A. Executive Summary (1 page)
This one-page summary provides an overview of the whole LIPH.
It highlights different sections and puts emphasis on the evidence-based
situation analysis, important gaps and deficiencies, critical interventions with
clear strategies and activities, cost of investments, financing of investments,
sources of funding, and timing of investments, expected output and outcomes
from these interventions.
B. Introduction (1-2 pages)
This chapter describes the processes, participatory approaches and
methodologies employed by the Planning Team in developing, drafting, finalizing
the LIPH and the AOP. This may include the following, but not necessarily limited
to:
1. Orientation of local decision-makers and stakeholders on health situation
and need to invest in health;
2. Composition of Planning Team and relevant policy which mandated the
creation of the team;
3. Field data gathering and analysis using LGU Scorecard and hospital
statistical reports, FHSIS, Philippine Integrated Disease Surveillance
(PIDSR), PhilHealth, monitoring activities of LGUs, Program
Implementation Reviews conducted in all municipalities, component
cities and highly urbanized cities; and
4. Various workshops conducted (either individually by local health offices,
hospitals, public and private sectors, or as a group through ILHZs or
districts) and relevant stakeholders who participated.
LIPH Handbook | 45
C. Province or City Profile (2-5 pages)

This chapter includes the provinces or citys demographic and socio-economic
profile, physical environment, political milieu that affect peoples health. In each
of the items below, briefly indicate implications for health risks, health seeking
behavior and constraints or opportunities for the local health system to prosper.
This section has to be evidence-based.
1. Physical environment:
1.1 Topography
1.2 Geo-hazard mapping (i.e., areas prone to erosions and flooding,
presence of fault lines and volcanoes)
1.3 Location of communities and health facilities vis--vis this map
1.4 Risk or hazards (i.e., occurrence of typhoons, landslides, storm surge)
2. Demographic profile:
2.1 Population
2.2 Population density
2.3 Growth and fertility rate
2.4 Death rate
3. Vulnerable populations needing more health care such as youth,
Indigenous Peoples, women and children in difficult situations, those
living in GIDAs, Urban Poor, Persons with Disability (PWD), and Senior
Citizens in specific geographical locations;
4. Environmental sanitation, sources and status of potable water;
5. Economic situation:
5.1 Major economic activities
5.2 Peoples sources of income
5.3 Poverty incidence and areas of concentration
6. Social situation:
6.1 Education
6.2 Peace and order
7. Source(s) of food such as agricultural or fishing industry;
8. Support facilities such as transportation, communication, access to
information;
9. Ethnicity and religion; and
10. Political subdivision, administrative jurisdiction, income class.
46 |LIPH Handbook
D. Health Situationer (5-10 pages)

The content of this chapter shall be culled from the analytical exercises in
determining health needs requiring investment. It describes the following:
1. General Health Status. This section discusses current vital health
indices based on local civil registry, FHSIS, health surveillance reports,
environmental & sanitation, surveys, burden of diseases (e.g. TB),
nutritional status, 3-5 year reports on leading causes of morbidities and
mortalities from RHUs, CHOs, public and private hospitals, and the LGU
Scorecard for Health.
2. Health Needs. It discusses the gaps between local peoples health status
when benchmarked with international, national targets, i.e. development
goals, National Objectives for Health or NOH, etc. Burden of diseases
can be elaborated more, such as tobacco use, rate of tobacco-related
diseases, poverty and malnutrition, etc. This section also identifies and
analyzes at-risk sub-populations and their health needs such as youth,
Indigenous Peoples, women and children in difficult situations, those
living in GIDAs, Urban Poor, Persons with Disability (PWD), and Senior
Citizens.
a. Gaps in the Health Service Delivery. This section discusses
the number, distribution and status of DOH-licensed and PhilHealth
accredited public and private health care facilities; service utilization;
health human resources; equipment; drug management system,
quality of infrastructure; surveillance units attached to these facilities;
capacity of the health service delivery network for disaster risk
reduction and management. Gaps in access, availability, utilization of
services can be elaborated more.
b. Gaps in Health Financing. This section elaborates more on
problems related to access and utilization of health services, products
emanating from gaps in health financing. It includes information on
local health accounts, health budgets (regular and project-based)
and actual expenditures for the last three years as well as sources
of financing for health. It discusses status of PhilHealth enrollment
for all programs, particularly the number and percentage coverage of
vulnerable populations under PhilHealths Sponsored Program. The
section on PhilHealths Sponsored Program covers premium subsidies
and sharing schemes among LGUs. Strengths of the localitys health
financing can include revenues from PhilHealth reimbursements and
LIPH Handbook | 47
capitation funds and income from health services. It needs to mention

how these revenues are utilized by the government to improve its
health care or other social services.
c. Gaps in Health Regulation. This section discusses status of
enforcement and compliance to national and local health laws, local

policies implemented and those that are in the pipelines, access
to low cost quality drugs/commodities, compliance of health care
facilities to DOH licensing and PhilHealth accreditation requirements
etc.
d. Gaps in Health Governance. This section discusses structures
and systems that govern the local health system within the province
(i.e., ILHZ, financial and procurement systems, local health referral
system, public-private partnerships, monitoring and evaluation
system, plans for emergency preparedness and response, Disaster
Risk Reduction & Management).
e. Gaps in Human Resources for Health. This section discusses
access to competent professional health care providers capable
of meeting health needs at appropriate levels of care and their
distribution across the public and private health sectors. It also
analyzes capacity building gaps and factors that hinder development
of the human resources for health.
f. Gaps in Health Information. This section discusses the health
information environment, its current infrastructure status, and the
kind of data it generates. It further elaborates on the capacity of the
health information system to provide timely information to decisionmakers, policy-makers, development partners for evidence-based
policy support, for program development, for immediate and efficient
provision of health care and for management of local health system.
48 |LIPH Handbook
E. Overall Health Strategy and Proposed Specific Interventions (5-10

pages)

This chapter contains the results of the strategy formulation activities, priority
strategies that will address the gaps identified under the previous section.
1. As an introductory portion, the chapter can start with a broader perspective
such as describing the:
a. Provincial/City Vision, Mission, Goals
b. Provincial/City Vision, Mission and Goals for Health
2. Critical Targets, Activities and Outcomes. This portion can contain the
following:
a. Matrix logically showing priority targets, activities, timeline, and means
of verification for each strategy and intervention area;
b. Technically feasible and evidence-based interventions that can be
implemented and shall generate incremental result within the specified
timeframe. The criteria for prioritization should also be made explicit;
and
c. Means of verification includes document(s) that can provide proof or
evidences that targets have been achieved.
A sample matrix that shows the interventions, targets, activities and timeline as
prioritized by Province X.
LIPH Handbook | 49
Table 5. Sample Matrix on Health Strategy and Interventions

Strategy
Interventions
PHIC coverage
of the near
poor not
covered by the
NHTS
PHIC
accreditation of
health facilities
and health
providers
Health
Financing
Expand NHIP
enrollment
and increase
utilization of
PhilHealth
benefits
Health
promotion on
PHIC benefits
and processes
Targets
# of near poor
enrolled in the
PHIC
# of health
facilities &
providers
accredited by
PHIC annually
50 |LIPH Handbook
Identification
and validation of
near poor using
the NHTS by the
DSWD
Improvement of
infrastructure,
equipment
Annually
# of trained
CHT
Training of
community
volunteers or
BHWs as CHT
members
Conduct of
community
dissemination
forum/ advocacy
Campaign on
utilization of
NHIP benefits
Tracking of
PhilHealth
income
Means of
Verification
DSWDs Master
list of households
in near poor
bracket
NHIPs Master
list of enrolled
households in
near poor bracket
Annually
Training of health
providers
Writing of IEC
Lay-outing
Editing
Printing
# of
PhilHealth
claims
Timeline
Enrolment of the
near poor not
covered by the
NHTS
# of IEC
materials
produced
# of health
promotion
activities
conducted
annually
Systematization
of financial
systems in
hospitals and
primary health
care facilities to
reflect income
from PhilHealth
Activities
Annually
Certificate of
accreditation
issued by
PhilHealth
# and type of
IEC materials
produced
Quarterly
Attendance
sheets and/or
Certificate of
participation
Monthly
or every
two
months
Attendance
sheets during
promotion
activities
PhilHealth claim
forms submitted
to PhilHealth;
Monthly
Vouchers of
PhilHealth
reimbursements
3. Critical Interventions include discussions on
a. Evidence-based interventions (1) in response to identified gaps and

deficiencies, (2) their link or possible attributions to attain SMART
objectives, (3) indicators and means of measurement, and (4)
indicative costing per activity in each of the interventions;
b. Doable interventions as supported by existing organizational or
management structures and policy;
c. Logical sequencing and phasing of intervention;
d. Measurability of interventions - interventions are quantifiable;
e. Investment cost for the vulnerable population, as applicable; and
f. Realistic costing of each intervention.
4. Costing of Critical Interventions
The financial plan contains:
a. Cost to finance the implementation of the three-year investment and
annual operational plan;
b. Annual breakdown of priority investments for each strategy;
c. Breakdown of the sources of funding such as (1) LGU income from
PhilHealth reimbursements, revenues, local taxation; (2) External
sources, including DOH resources, grants;
d. Costs are within the allowable cost for goods and services, as
mandated by government auditing and accounting procedures; and
e. The general principle of efficiency (value for money).
5. Time table which shows the timing or phasing of interventions by year
and the timing of expenditures are in consonance with the expected
attainment of targets.
LIPH Handbook | 51
F. Plan Management (1-3 pages)

This chapter should clearly express the management structure, processes and
procedures that the LGU shall setup to ensure implementation of the LIPH. This
chapter includes the following, but not necessarily limited to:
1. Management structure for both the LGU Planning Teams and Local
Implementation Teams. This portion identifies persons or units tasked to
manage service delivery networks, finances, procurement, logistics, civil
works, resource mobilization, human resources, coordination with DOH
Regional and Central Offices and other stakeholders, monitoring and
evaluation, etc.;
2. Public finance management (where and how to get the local resources
for the LIPH/AOP implementation), which includes budget, resource
mobilization, procurement management, logistic management, fund
management, internal accounting and auditing;
3. Summary of technical assistance (TA) and indicative cost needed for
LGUs to properly implement the LIPH and possible sources of these TAs
(ex. development partners, private sector, regional or national government
agencies, etc.);
4. Details of the communication strategies for the LIPH that involve
communicating or endorsing the plan to the LCEs, LGU policy-making
bodies, barangay stakeholders, public and private health service
providers; and
5. Details that will be entered into contractual arrangements (e.g. LGU
counterpart, Human Resources, fund management) with the DOH or/
and other national government agencies, and private organizations.
52 |LIPH Handbook
G. Monitoring and Evaluation (1-2 pages)

This chapter contains the LGUs systematic monitoring and evaluation system
that has been or about to be established.
The M & E section shall basically contain, but not necessarily limited to the
following:
1. LIPH M & E plan that contains monitoring and evaluating both technical
and fund utilization;
2. Composition of the M & E Team;
3. Targets;
4. Definition of indicators;
5. Means of verification;
6. Process of monitoring and evaluation such as frequency of monitoring for
both technical & fund utilization;
7. Tools to be used; and
8. Feedback mechanism to ensure that the M & E results are utilized for
future planning processes, program shifts, policy development, and
resource allocation/mobilization.
Based on the LIPH and AOP, and guided by the DOH M & E system, the
local Planning Team shall localize recording, reporting, feedback mechanism,
capturing reports from both public and private health sectors as service delivery
network partners.
The reports will include progress reports, accomplishment reports of outcomes,
performance and budget utilization reports, and other reports required in the
Agreement.
The LIPH shall be monitored and evaluated on three aspects:
1. Performance outputs, tracking progress of implementing interventions;
2. Performance distribution, tracking progress of implementation across
different geographical locations, across different tiers of the health
system, across public and private health care sectors, across different
LGUs; and
3. Public health outcomes, measuring progress of desired improvements
resulting from the interventions.
Being evidenced-based, the M & E system provides verifiable information on
baselines, incremental (or downward) changes, and end-lines of the annual
operational plan and the three-year LIPH.
LIPH Handbook | 53
The LGU shall collaborate with the DOH RO in monitoring and evaluating the
LGU performance vis-a-vis the agreed performance targets based on the agreed
M&E system developed. This M&E system will include a feedback mechanism
that will provide relevant information on what has happened or happening, where
it happened and why it is happening.
The feedback will basically tell the implementers, stewards, managers and
leaders how far they are from the desired objectives. It shall allow the planners to
do small-scale planning (i.e., catch-up plan, supplemental plan, reprogramming,
etc.) for priority or urgent projects in the middle of the year.
1. Description

The interventions in the LIPH shall be appropriately timed and interlinked

to ensure that the expected outputs are achieved. Costing and scheduling
of budgetary allocation shall be based on the yearly sequencing of
interventions. There should be value for money and efficiency in quantifying
the costs. The local resources shall be used to ensure institutionalization.
2. Forms
Form1: Summary of Investment Cost by Instrument by Source of
Financing
Form 2: Cost Assumptions by Instrument by PPAs by Resource
Requirements
Form 3: Cost Assumptions by Instrument by PPAs by Source of
Financing
54 |LIPH Handbook
LIPH Handbook | 55
LGU
Others
Regular
Others
DOH
NATIONAL
COUNTERPART
SOURCEOFFINANCING(PhP)
OTHERSOURCES
Date:
GRANDTOTAL
(PhP)
ANNEXA
%ofInstrumentsto
GrandTotal
AsaPercentageofGrandTotal
a
InstrumentsrefertoHealthServiceDelivery,Financing,Regulation,Governance,HumanResourcesforHealth,andHealthInformation
Note:
b
OtherSourcesrefertofundingfromothersectorseitherlocalorforeigne.g.UNAgencies,otherdevelopmentpartners,othernationalagencies,NGOs
GrandTotal
INSTRUMENTSa
C/MLGU
PLGU
LIPHCY:
PROVINCE/CITY:
REGION:
Form1.SummaryofInvestmentCostbyInstrumentbySourceofFinancing
56 |LIPH Handbook
Performance
Indicatorc
Yr.1 Yr.2 Yr.3
Total
Target
Items
Description
Expense
Category
Unit
Cost
Yr.1 Yr.2 Yr.3
CostperYear
ResourceRequirements(InPhP)
Date:
TotalCost
As%oftheGrand
Total
ANNEXA
a
b
Projects/Programs/Activitiesareidentifiedpriorityinterventionsthataddresshealthneedsandhealthinequitiesamongtheunderprivileged,GIDAs,ICCs/IPs,UrbanPoor,
PersonswithDisabilities(PWDs),SeniorCitizens,women,andchildren
c
PerformanceIndicatorreferstoprescribedhealthstandardsthatareeitherquantitativelyand/orqualitativelymeasurable
Note:
Program/Project/Activitiesb
INSTRUMENTS
Target&Time
Frame
LIPHCY:
PROVINCE/CITY:
REGION:
Form2.CostAssumptionsbyInstrumentbyPPAsbyResourceRequirements
LIPH Handbook | 57
Performance
Indicatorc
Note:
Yr.1 Yr.2 Yr.3
Total
Target
UnitCost TotalCost
PLGU
C/M
LGU
LGU
Date:
DOH
SOURCEOFFINANCINGd
Others Regular Others
ANNEXA
OtherSourcese
b
Projects/Programs/Activitiesareidentifiedpriorityinterventionsthataddresshealthneedsandhealthinequitiesamongtheunderprivileged,GIDAs,ICCs/IPs,UrbanPoor,
PersonswithDisabilities(PWDs),SeniorCitizens,women,andchildren
c
d
SourcesofFinancingreferstofundingfromothersectorseitherlocalorforeigne.g.UNAgencies,otherdevelopmentpartners
e
Program/Project/
Activitiesb
INSTRUMENTSa
Target&Time
Frame
PROVINCE/CITY:
LIPHCY:
REGION:
Form3.CostAssumptionsbyInstrumentbyPPAsbySourceofFinancing
58 |LIPH Handbook
I.
II.
III.
IV.
LIPH
Population:
Province/City:
DESCRIPTION/ANALYSIS
(year
Chairperson
DOHRegionalOfficeReviewCommittee
EXECUTIVESUMMARY
INTRODUCTION
PROVINCEORCITYPROFILE
HEALTHSITUATIONER
A. HealthNeeds
B. HealthServiceDelivery
C. HealthFinancing
D. Regulation
E. Governance
F. HumanResourcesforHealth
G. HealthInformation
V. OVERALLHEALTHSTRATEGYANDSPECIFICINTERVENTIONS
A. Vision,Mission,Goals,andStrategies,CriticalInterventions,withSMARTobjectives
B. Criticaltargets,activities,outputsandoutcomes
C. Criticalinvestments
VI. COSTINGOFCRITICALINTERVENTION
A. FinancialPlan(Costingtables)
B. Timetable
VII. PLANMANAGEMENT
VIII. MONITORINGANDEVALUATION
TotalPerfectPoints
MinimumPassingLevel=75%ofoverallTotalpoints(133.5points)
Reviewof(Year)
Region:
SummaryScoreSheet:LIPHAPPRAISALCHECKLIST
8
4
6
10
14
4
14
14
14
14
14
14
SubtotalScore
Annex B
LIPH Appraisal Checklist
7%
3%
6%
100%
30
12
5
10
178
Date
17%
Page1of9
4%
3%
11%
49%
PERCENTAGE
7
6
20
88
HighestRowScore
NumberofBarangays:
LIPH Handbook | 59
LIPH
Population:
(year
No.ofBarangays:
IncomeClass:
TheprocessundergonebytheplanningteaminLIPHpreparationincludes:
1. Orientationoflocaldecisionmakersandstakeholdersonhealthsituationandneeds
resultinginamandatetoplan/designateaplanningteam
2. Dataarevalidated&verifiablefromexistinggovernmentrecognizedinformation
gatheringtools&systems
3. Datausedintheplanningprovidearealisticandcompletehealthstatusoftheentire
province
4. Datausedinplanningprovidearealisticbasisforprojectingincrementalchangesinterms
ofperformanceoutput,oroutcome
II. INTRODUCTION(Totalpoints6)
Highlightson:
1. EvidencebasedLocalHealthSituation
2. Gapsinhealthservicedelivery,financing,regulations,humanresources,information,
governance&supportservices
3. Criticalinterventionswithclearstrategiesandactivitiesinresponsetotheidentifiedgaps
andotherchallenges
4. TotalcostofinvestmentsforeachPPA
5. Highlightsofinvestmentsperyear(timingofcriticalinterventionsandcostingperyear)
6. Sourcesoffunding
7. Expectedoutputandoutcomesfromtheseinterventions
I. EXECUTIVESUMMARY(Totalpoints7)
Note:MinimumPassingLevel=133.5pointsor75%ofoveralltotal178points
YES|NO
YES|NO
ANALYZED
STATED
TOTAL
ROW
SCORE
InstructionsonscoringtheLIPH
1. Ifrequireddata/informationisstatedonly,put1asscore;ifrequireddata/informationisstatedandanalyzed,put2asscore.
2. DonotputascoreinshadedareasunderthecolumnAnalyzed.
3. Putascoreonlyonthenumbereditems.
4. IndicatetherevisionsneededintheRemarkscolumn.
5. InformtheLGUsonanyrecommendedrevisions.
6. Determinethetotalscoreandpercentageattheendoftheappraisalchecklist.
Province/City:
Reviewof(Year)
DOHRegionalOffice:
LIPHAppraisalChecklist
Page2of9
REMARKS
ANNEXB
60 |LIPH Handbook
III. PROVINCEORCITYPROFILE(Totalpoints20)
5. Planningworkshopsarestreamlinedandfollowtherecommendedlogicalprocessesand
procedures
6. Participationofkeystakeholdersinbothpublic&privatehealthsectorsfromconcerned
barangays,municipal,city,provincialLGUs,CSOsinLIPHpreparationandplanning
YES|NO
YES|NO
ANALYZED
STATED
TOTAL
ROW
SCORE
REMARKS
ANNEXB
1. Mostcurrentvitalhealthindicesbasedonlocalcivilregistry,FHSIS,healthsurveillance
reports,environmental&sanitation,surveys,burdenofdiseases(e.g.tobaccouse),
nutritionstatus,reportonleadingcausesofmorbiditiesandmortalitiesfromRHUs,
CHOs,publicandprivatehospitals,LGUscorecard.
2. Identificationofatrisksubpopulationsandtheirhealthneedssuchasvulnerablewomen
&children,IPs,teenagers,poor,SeniorCitizens,thoselivinginGIDAs,UrbanPoor
Note:Lookfortheanalysis/relationshipofpresenteddatatoMDGgoals,NOH,ROH,PPAs,localtargets
B. HealthServiceDelivery(Totalpoints14)
Quantificationandqualificationofthecomponentsofthehealthdeliverysystemsintermsof
(deliverysystemalsoincludereporting,recording,registry):
A. HealthNeeds(Totalpoints4)
Adequatedescriptionofhealththreatsthroughanalysisof:
IV. HEALTHSITUATIONER:(SituationalAnalysisincludingGapsandDeficiencies)(Totalpoints88)
Page3of9
1. Physicalenvironment
Geohazardmapping(i.e.,areaspronetoerosionsandflooding,presenceoffaultlines
andvolcanoes)
Riskorhazards(i.e.,occurrenceoftyphoons,landslides,stormsurge)
2. Demographicprofile(i.e.,population,populationdensity,growth,fertility,anddeathrate)
3. Vulnerablepopulationneedingmorehealthcaresuchasyouth,IndigenousPeoples,
womenandchildrenindifficultsituations,thoselivinginGIDAs,UrbanPoor,Personswith
Disability(PWD)andSeniorCitizensinspecificgeographicallocations
4. Environmentalsanitation,sourcesandstatusofpotablewater
5. Economicsituation(i.e.,majoreconomicactivities,peoplessourcesofincome,andpoverty
incidenceandareasofconcentration)
6. Socialsituation(i.e.,education,peaceandorder)
7. Source(s)offood
8. Supportfacilitiessuchastransportation,communication,accesstoinformation
9. Ethnicityandreligion
10. Politicalsubdivision,administrativejurisdiction,incomeclass
Note:Analysisshouldincludepossibleimplicationsofdemographicandsocioeconomicprofileforhealthrisks,healthseekingbehaviorandconstraintsoropportunitiesfor
serviceprovision,serviceutilizationbycommunities&continuumofcare
LIPH Handbook | 61
1. Publicandprivatehealthcarefacilitiesandtheirgeographicaldistribution(locational
map)
a. Countbytype(No.offacilityperpopulationserved)
Hospital(Standard:PrivateandPubliccombined1bed:1000popn)
o Hospital(Private)
o Hospital(Public)
Clinic
o Public(healthcenters,maternityandlyingin,socialhygieneclinic,teencenters/
teenbayan,healthandnutritionpost,birthingcenter,etc.)
o Private(Medicalclinics,birthinghomes,SpecialtyClinics)
RHUs(1:20,000)
BHS(1:5,000)
b. Typeofservicesprovided(Accreditation/licensing)
Hospital(fromLevels13)
Primaryhealthcarelevel(ex.RHUwithPhilHealthOPB,TBDOTS,MCPPackage
Accreditation,privatebirthinghomeswithPhilHealthaccreditation&DOHLicensing)
2. ServiceUtilization
BedOccupancyRatio
AverageLengthofStay(asprescribedperlevel)
AdmissiontoConsultationRatio(std:1:10)
Typeofserviceutilized(Medical,Surgical,Obstetrics,Pediatrics)
Leadingcausesofadmissionandconsultation
Patientclassificationbytypeofpayment(Categories:paypatient,PhilHealth,
Nonpay/Charity)
UtilizationrateofPhilHealthbenefitsdisaggregatedintoquintiles&healthfacilities
bymunicipality,city,province
Utilizationofservicesasmanifestedbytheincomeofpublichealthfacilitiesfrom
PhilHealthcapitationsandreimbursements
3. Statusofsupplyofcommodities,suppliesandmedicines
4. Equipment
EquipmentinventorybasedonDOHlicensing/PHICaccreditationrequirements
5. Infrastructure(listofthoseneedingrepair,renovationandconstruction,aspartof
strategiestoimprovehealthofpopulationsorcommunitiesneedinginvestmentforhealth
(e.g.GIDAs)
6. Surveillanceunits,presenceandutilizationofreports
a. PESU/MESU/CESU/DESU
YES|NO
YES|NO
ANALYZED
STATED
TOTAL
ROW
SCORE
Page4of9
REMARKS
ANNEXB
62 |LIPH Handbook
7. EmergencyPreparedness,DisasterRiskMitigation&ManagementandDisasterResponse
Plan
C. HealthFinancing(Totalpoints14)
1. Sourcesofhealthcarefundsforthelast3years
a. Amount/ProportionofPS,MOOE,CapitalOutlay
b. SourcesProvincial/Municipal/City,othersources
2. ProportionofbudgetallocationforRHUandhospitalspreventive&curativecare
3. FundutilizationreportsofDOH&ODAgrants,reasonsforlowornonutilization
4. Percentageoflocallymobilizedfunds(orLGU)incomeutilizedforhealth
5. PhilHealth(proportionoftargetednumberofpopulationwithpaidupPHICpremium)
a. PercentageofpopulationenrolledwithPhilHealth(coverageofthepoorestofthepoor,
women)
b. PremiumsubsidiesandsharingschemesamongLGUs
6. Utilizationofrevenuesfromreimbursementsandcapitationfundsforquality
improvementofservices(RevenuesusedforinvestingforRHUs,hospitals,birthinghomes)
7. Ongoingspecialassistedprojects(localorforeignassisted)
D. Regulation(Totalpoints14)
1. ProportionofRHUaccreditedas:
a.PCBI,TBDOTS,andMaternityPackage
2. Proportionofpublic&privatebirthinghomeswithPhilHealthaccreditation&DOH
Licensing
3. HospitalLicensureandaccreditation(DOH&PHIC)
4. Drugmanagementsystempresenceofpublicandprivateoutletsthatprovideregular
supplyofessentialmedicinesandfamilyhealthcommodities(ex.BnB:Standard:BnB:
2Brgys,alternativedistributionpoints)
5. Recognition/Adoption/Implementationoflocalordinancesrelatedto:
o Hospital
MotherBabyFriendlyHospital
MilkCode
Breastfeeding
Newbornscreening(NBS)
WasteManagement
NationalVoluntaryBloodDonationProgram
o Field/RHU
MilkCode
ASINLaw
ResponsiblePetOwnership
YES|NO
YES|NO
ANALYZED
STATED
TOTAL
ROW
SCORE
Page5of9
REMARKS
ANNEXB
LIPH Handbook | 63
Otherthematicareasthatareinneedbythelocality
6. Localpoliciesrelatedtoimproveneonatal,infant,childhealth,andimprovematernal
health(i.e.,SkilledBirthAttendance&FacilityBasedDeliveries)
7. Localpoliciesrelatedtodisasterriskreductionandmanagement
E.Governance(Totalpoints14)
1. Structuresandstandardsthatgovernthelocalhealthsystemssuchaslocalhealthboards
ofindividualLGUs,ILHZs:
2. Financialmanagementsystem
3. Publicprivatepartnershipforhealth
4. Procurementsystem
5. PublicprivateReferralSystem
6. Monitoringsystemfortechnicalandfinancialaspects;operationalforM&Eboth
strategic3yearplan&AOP,withteamsmandatedtodoit
7. PlanforEmergencyPreparednessandResponse,DisasterRiskReduction&Management
F.HumanResourcesforHealth(Totalpoints14)
1. Currenthealthpersonneldistributionbytypeoffacility,inbothpublicandprivatesectors
o Preventive(MD/RN/MWtopopulationratio)
o CurativelicensingandPhilHealthaccreditationdeficiencies
2. Currenthealthpersonneldistributionbytheirgeographicallocation
3. Currenthealthpersonneldistributionbytheirtechnicalskillsortrainings(e.g.distribution
ofdoctors,nurses,midwives,etc.)
4. Competenciesofcurrenthumanresourcesforhealth
5. Capabilitybuildinggaps
6. Factorsthathinderorprogressdevelopmentofhumanresourcesforhealthof
implementation
7. Factorsthathinderorfacilitateimplementationofmanagementanddevelopmentofthe
HumanResourceforHealth
G.HealthInformation(Totalpoints14)
1. Structuresandstandardsonlocalhealthinformationsystem
2. UpdatedFieldHealthServiceInformationSystem(FHSIS)data
3. UpdateddatafromPhilippineIntegratedDiseaseSurveillanceandResponse(PIDSR)/
HospitalOperationsandManagementInformationSystem(HOMIS)/SurveillanceinPost
ExtremeEmergenciesandDisasters(SPEED)
4. UpdateddatafromSurveillanceunitsinplace,reportsgenerated
5. Otherhealthinformationsystemcurrentlyinplacesuchastrainingdatabases,
commoditymanagementsystem,etc.
6. Feedbackingoftheseinformationtorelevantstakeholders
ANALYZED
YES|NO
STATED
YES|NO
TOTAL
ROW
SCORE
Page6of9
REMARKS
ANNEXB
64 |LIPH Handbook
STATED
StrategyGeneralstatementasbasisforimplementingdifferentactivities
ObjectivesStatedSMART
ANALYZED
TOTAL
ROW
SCORE
ANNEXB
Page7of9
3. Criticalinterventionstoaddresshealththreats,theidentifiedgapsanddeficiencies
(shouldbeinconsonancewithVMGs,addressesobjectivesandarealignedwithPPAs)
B. CriticalTargets,Activities,OutputsAndOutcomes(TotalPoints10)
1. Clearobjectivesforeachinterventions,correlatedwithnational/regionalhealthsector
goals,targetsundereachpillarofDOHNationalImplementingFramework(e.g.6pillarsof
UniversalHealthCare)
2. Performanceindicators,guidedbyDOHImplementingFramework
3. Matrixoftarget,activities,outputs,outcomesforeachstrategy/intervention
4. Technicallyconsistent,doable,evidencebasedinterventions
5. Interventions:
a. Areprioritized
b. Havecriteriautilizedforprioritization
c. Withspecificinterventions/strategiesfortheyouth,women,poor,marginalizedorIPs
orGIDA
SinceservicedeliverycomponentofthePPAsdealswithhealthneeds,goalsareexpressedashealthoutcomes.Infinancing,regulationandgovernanceusegoalsasexpressedin
theNOH.Exampleofgoal/outcomederivedfrommaternalmortalityratioistoreducematernalmortalityratioconsistentwithMDG.
Definition:
A. Vision,Mission,Goals,andStrategies,CriticalInterventions,withSMARTobjectives(Totalpoints6)
1. Broaderperspectiveofthelocality:
a. Provincial/CityVision
b. Provincial/CityMission
c. Provincial/CityGoalsforHealth
d. Socioeconomicandpoliticalfactorsaffectingpeople'shealthinthelocality
2. Strategiesandobjectivestoaddresstheidentifiedproblems
V. OVERALLHEALTHSTRATEGYANDSPECIFICINTERVENTIONS(Totalpoints30)
REMARKS
YES|NO YES|NO
7. Statusofinfrastructure
*Thesearethefactorsthatexplainwhyperformanceindicatorsarebelow(inmostcases)nationalorregionalbenchmarks.Thesefactorsarethosethathavesomethingtodo
withconsumerhealthseekingbehavior,providercapacitytodeliverqualityservicesinaccessibleoutlets,M/CLGUcapacitytoprovidefinancingandenablingpolicies,PLGU
capacity to provide financing support, enabling policies and technical assistance to component LGUs, and NGA capacity to provide enabling policies, technical guidelines,
technicalassistance,etc.Thesearethefactorsthatarefoundinthesituationalanalysismatrix.
LIPH Handbook | 65
YES|NO
YES|NO
ANALYZED
STATED
TOTAL
ROW
SCORE
REMARKS
ANNEXB
1.Managementstructure(definewhowillmanageServiceDeliveryNetworks,procurement,
civilworks,logistics,communicationandcoordination,amongothers)
VII. PLANMANAGEMENT(Totalpoints5)
A. FinancialPlan(Costingtables)Totalpoints8
1. Sourcesoffunds(LGU,grantsfromDOHandotheragencies,otherfinancialoptions
includingincome/revenuefrominvestments)specificallydefinedbyLGU
2. Annualbreakdownofthecostshowingpriorityinterventions
3. Costsarewithintheallowableprices/feesforgoodsandservices,asmandatedby
governmentauditingandaccountingprocedures
4. Financialplanfollowsthegeneralprincipleofefficiency(valueformoney)
B. Timetable(Totalpoints4)
1. Timingofexpenditure(phasingofinvestmentsbasedonthecostingtables.The
timeframeshouldspecifywhentheseinterventionsandexpendituresaretooccur.
2. Timingofexpendituresareinconsonancewiththeexpectedattainmentoftargets
VI. COSTINGOFCRITICALINTERVENTION(TOTALPOINTS12)
Page8of9
Toaddressmajorgapsanddeficiencies,pleaseconsiderthefollowing:
i. Interventionhastobeexpressedasspecificactionandnotmerelystatementoftheproblem.Forexampleinfinancing,ifthegapislowandinconsistenttrendinLGU
budgetforhealth,theinterventionmayinvolvenotjustincreaseofbudgetorlobbyingtothemayorbutshouldincludeacomponentactionthatcanbringin
financingfromothersourcesandequivalentresourcemobilizationactivities,and
ii. Bringinnewandinnovativeinterventionthatcanmakeasignificantimpactinaddressinggapsanddeficienciesasopposedtousualtraditionalactivitiesalreadybeing
financedfromregularbudget.
1. Linktotheattainmentofsetgoals(clearandexplicit)
2. Doableinterventionsassupportedbyexistingorganizationalstructures(presenceof
managementstructure,policysupport)
3. Evidencebasedinterventionsthatrespondtotheidentifiedhealthneeds
4. Logicalsequencingandphasingofintervention
5. Measurabilityofinterventionsinterventionsarequantifiable
6. Investmentcostforthepoor,marginalizedorIPsorGIDAasapplicable
7. Realisticcostingofeachinterventionisfoundinthecosttables
(Thesearecoststobeincurredtoimplementaparticularintervention.Notethatthesearenewinvestmentsneedingresourcesinadditiontoregularbudgetstostrengthen
currenteffortsandtoundertakenewandinnovativeinterventions.SummaryTableandTableofAssumptionsintheCosting/FinancingSectionaregoodreferencesfor
reviewingthecostsintheLIPH.)
a. Unitcostavailable
b. Completecosting
Note:Lookfortheverticalandhorizontallogicofobjectiveswithproposedstrategiesandactivities
C. CriticalInvestments(TotalPoints14)
66 |LIPH Handbook
2.Publicfinancemanagementaccompaniestheinvestmentplan
3.Technicalassistanceneedsandpossiblesourcesoftechnicalassistanceareproperly
identified
4.CommunicationstrategiesfortheLIPH
5. ContractualarrangementswithDOH,othernationalgovernmentagencies,private
organizationstoimplementtheLIPH
Chairperson
ViceChairperson
Member
Member
1.Withpeoplewhoaremandated/taskedtomanagetheM&Esystem
2.Evidencebasedwithverifiableaccurateinformation
3.Monitorsandevaluatesprogressoftargetaccomplishmentswithmeansofverification
4.Monitorsandevaluatesfundutilizationwithmeansofverification
5.Monitorsandevaluatesdistributionofaccomplishmentswithmeansofverification
6.Withfeedbackmechanism
7.MonitoringandEvaluationtoolsareidentified
8.WithclearmechanismforutilizationofM&Eresults
9.Withclearprocessformonitoring,evaluation(e.g.,Frequencyofmonitoring)
10.InvolvementorroleofDOHRegionalOfficeintheM&Esystem
TOTALSCORE:Points
PERCENTAGE:%(ActualScore/TotalPerfectScoreX100)
RECOMMENDATION:
EndorseforDOHNationalAppraisalCommitteereview
RevisebasedonDOHRO'sCommentsandRecommendations
DOHRegionalOfficeReviewCommittee
VIII. MONITORINGANDEVALUATION(Totalpoints10)
YES|NO
YES|NO
ANALYZED
STATED
Member
Member
Date:
0
0.00%
TOTAL
ROW
SCORE
Page9of9
REMARKS
ANNEXB
Annex C
AOP Content and Forms
I. Cover Letter (1 page)
The Local Chief Executive (Mayor of the HUC/ICC and Governor) shall sign this
letter endorsing the AOP to the DOH RO through the Development Management
Officer (DOH Representative) assigned in the locality.
II. General Description
1. The Health Situation in the Province/City at the end of (Year)

Content of this can be culled out from the situational analysis exercises
for the LIPH. In particular, the Health Situation discusses the priority
problems that need to be addressed by the AOP. This may contain the
following, but not necessarily limited to:
a. Local Health System Performance as measured by the most current
LGU Scorecard, FHSIS, hospital statistical reports, surveillance data,
progress reports, and other local health data/information;
b. LGU performance that has impacted on peoples health, such as,
budgetary allocation for health, utilization of GAD resources, etc.;
c. Problems, challenges or positive learning on utilization of healthcare
services, PhilHealth benefits;
d. Proven best practices that can be expanded and scaled up. Report
of accomplishments in the preceding year, vis--vis what have been
planned; and
e. Narrative report on how much of the investment plan for health has
already been accomplished.
2. Local Priorities in Health:

This section describes how health problems in the barangays,
municipalities, cities and provinces are prioritized and arranged according
to urgency and magnitude, vis--vis organizational capability and effects
of inaction. In the preparation of the AOP, the Planning Team should
have an agreed criteria and evidence-based rating system (e.g. LGU
scorecard) in the ranking of these local priorities.

The identified health and health - related problems and priorities or

thrusts at the barangay, municipal, city and provincial levels have to be
evidence-based. These should be organized under each priority thrusts
of the DOH, its regional offices, and DOH-ARMM.
LIPH Handbook | 67
3. Major Thrust/s of the AOP (Year)

This section contains local health priorities and the DOH thrusts for
the year, applicable in localities where these matter. These local health
priorities should also contribute to the attainment of the Sustainable
Development Goals and the National Objectives for Health (NOH)
and must be based on the current DOH implementing framework (e.g.
Universal Health Care). This section needs to show that the local targets
and investment cost/resources are consistent with national targets and
resources.
This section clearly states Goals and Specific Objectives. Specific
Objectives are essentially subsets of health systems goals. Each goal
usually consists of several quantifiable objectives indicating exactly what
the LGU, and health facility/ service level want to achieve.

Goals and Specific Objectives need to be

a. SMART - sound objectives are made specific, measurable, attainable,
realistic and time-bound;
b. Specific for each priority intervention based on the situational analysis;
and
c. Formulated for the regional, provincial, city, municipal and barangay
requiring investments for health.
4. Adjustments in Proposed Interventions and Investments

This section highlights any additional investments within the specified

year, which were not previously indicated in the LIPH or which were
dropped in the previous year(s), but are now justified to be a priority. Any
adjustments or difference from what was specified in the LIPH should be
substantially justified or explained. The adjustments may include emerging
needs, or availability of new sources of investment funding from the LGU,
ILHZs, PPPs, DOH, and Development Partners.
It can highlight unimplemented programs and projects mentioned in

the previous years AOP. This includes Health Facility Enhancement
Program (HFEP) and Bottom-Up Budgeting (BUB) projects that can be
implemented in the coming year, therefore warrants their inclusion in the
next AOP.
68 |LIPH Handbook
5. Performance Indicators

Performance indicators are measurements of local health systems

output and are directly linked to the attainment of the program objectives.
This also describes the outputs identified for priority local interventions.
Specific outputs need to be identified for areas that have equity concerns,
such as, but not limited to:
a.
b.
c.
d.
e.
f.
GIDA and IPs;

Conflict-affected areas;
Urban Poor
Communities with challenges related to gender and youth;
Areas with Scorecard for Health results below national average; and
Other vulnerable and/or marginalized areas (e.g. disaster-stricken
areas).

1. Description

The AOP costing table shows the details with reference to the year under
consideration in the three-year investment or LIPH.
The activities in the AOP shall be appropriately timed and are interlinked to
ensure that the expected outputs are achieved. Costing and scheduling of
budgetary allocation shall be based on the sequencing of these activities.
The cost for each resource that is required for the conduct of an activity
may be estimated based on:
a. Target number persons participating in the activity;
b. The task itself; and
c. The duration or frequency of conduct.
Total cost of all activities in the annual operational plan will be reflected in
the total cost for the year. There should be value for money and efficiency
in quantifying the costs. The local resources shall be leveraged to ensure
institutionalization.
The AOP for the succeeding years (year 2 & year 3) should result in
incremental positive changes leading to the expected outcome of the
LIPH.
LIPH Handbook | 69
2. Forms
Form 1: Summary of Investment Cost by Instrument by Source

of Financing
Form 2: Cost Assumptions by Instrument by PPAs by Source of

Financing
Form 3: Annual Training Plan
Form 4: Annual Procurement Management Plan (Optional)
70 |LIPH Handbook
LIPH Handbook | 71
PLGU
LGU
Others
DOH
OTHERSOURCES
Date:
GRANDTOTAL
(PhP)
ANNEXC
%ofInstrumentsto
GrandTotal
AsaPercentageofGrandTotal
a
Note:
b
GrandTotal
INSTRUMENTSa
INVESTMENTCOSTBYSOURCE(PhP)
C/MLGU Others Regular
AOPCY:
PROVINCE/CITY:
REGION:
Form1.SummaryofInvestmentCostbyInstrumentbySourceofFinancing
72 |LIPH Handbook
Note:
Performance
Indicatorc
Q1 Q2 Q3 Q4
Total
Target
TARGET&TIMEFRAME
Unit
Expense Total
Coverage
Itemse
Cost
Categoryf Costs
LGU
Date:
DOH
ANNEXC
OTHERSOURCESg
SOURCEOFFINANCING
P/CLGU Others Regular Others
Programs/Projects/Activities(PPAs)areidentifiedpriorityinterventionsthataddresshealthneedsandhealthinequitiesamongtheunderprivileged,GIDAs,ICCs/IPs,
UrbanPoor,PersonswithDisabilities(PWDs),SeniorCitizens,women,andchildren
c
d
Coveragerefertolocationalcoverageofintervention
e
Itemsrefertosupplies,materials,andothergoods/commodities
f
ExpenseCategorye.g.training,gasoline,transportation,honorarium,etc.
g
Programs/Projects/
Activitiesb
INSTRUMENTSa
REGION:
PROVINCE/CITY:
AOPCY:
Form2.CostAssumptionsbyInstrumentbyPPAsbySourceofFinancing
LIPH Handbook | 73
Preparedby:
B.ContractOut
Scheme
A.Inhouse
TotalCost
COURSE/TRAININGPACKAGE
PARTICIPANTS
CATEGORY
NO.PERCATEGORY
(MHO,PHN,RHM)
AOPCY:
DURATION
(indays)
Province/City:
Region:
Form3.AnnualTrainingPlan
Approved:
FACILITATOR/
RESOURCESPEAKER
TOTALNO.
HeadofAgency
SCHEMEa
Date:
COST
ANNEXC
SOURCEOFFUNDING
74 |LIPH Handbook
Description
ContractPackage
No.
Preparedby:
TotalCost
Program/Project/
Activities
NAMEOFPROCURINGENTITY:
NAMEOFTHEPROJECT:
FUNDINGSOURCE:
AOP(Year):
PROCUREMENTSCHEDULE
Date:
Date
Date
Approved:
Date
Date
Date
HeadofAgency
Date
Date
Estimated
Modeof
Pre
Submission
Budget
Eligibility
Post
Procurement Procurement Advertisement/ PreBid
andReceipt Evaluation
(inPhP)
Posting
Conference Screening
Qualification
Conference
ofBids
Form4.AnnualProcurementManagementPlan(Optional)
Date
Awardof
Contract
ANNEXC
LIPH Handbook | 75
(year)
a) InternalBenchmark(performancelowerthanpreviousyear)?
b) ExternalBenchmark(RedPerformanceRatingasseeninLGU
scorecard)?
c) Emerging&reemergingdiseasesbasedonthetrackingofvital
indices&surveillanceunits?
B. LocalPrioritiesinHealth
1. Arethelocalhealthprioritiesandtheircausesidentifiedbasedon:
YES NO
Markwithan
(X)
Response
(year
A. HealthSituationintheProvince/City
1. ArethefollowingadequatelydescribedintheHealthSituation?
a) ForAOP1,isthereabaselineforeachspecificindicator
mentionedintheLIPH?
b) Arethereprevioushealthassessmentsthatcanbecomebasisfor
AOP1baselines?
c) ForAOP23,isthereapercentageincreaseordecreasefromthe
baselineforeachspecificindicatormentionedintheLIPH?
d) Aretherehealthrelated,nonhealthproblemsorchallenges
(socioeconomic,geographical/physical,andpolitical)thatneed
tobereflectedintheAOP?
e) Aretherebestpracticesthatneedtobescaledupintermsof
coverage&degreeofactivitiesthatneedtobecostintheAOP?
QUESTIONS
NumberofBarangays:
Population:
Reviewof
AOP
Province/City:
PartI.GeneralDescription
AOPAppraisalChecklist
LIPHSituationalAnalysisvisvistheAOP'ssituational
analysis:
LGUscorecard
Surveillanceunitreports
FHSIS,etc.
DOHRegionalOffice
RECOMMENDATIONS
DOHRegionalOffice
REMARKS
Assessment of the Province/Citywide health system

performance should be based on the set of indicators
agreedandapprovedintheLIPH:
LGUScorecard
FHSIS
SurveillanceUnitreports
AnnualStatisticalReportsofHospitals&birthinghomes
Surveys
monitoringreportsoncommodities&otherlogistics
vitalhealthindices
PhilHealth data on enrolment, utilization of PhilHealth
benefits,etc.
Status of Human Resources for health (BHS, RHU, CHO
andhospitals)
MEANSOFVERIFICATION
IncomeClass:
Date:
Annex D
AOP Appraisal Checklist
76 |LIPH Handbook
QUESTIONS
A. Interventions
1. AretheactivitiesforallinterventionsofpriorityPPAsaretimed
appropriatelywithcost&fundingsource?
a) HealthFinancing
b) HealthServiceDelivery
c) Policy,StandardsandRegulations
d) GovernanceforHealth
PartII.PlanningandCostingMatrices
d) Nationalpriorityhealthprograminitiativesareallpresentinlocal
healthprograms?
e) Environment,environmentalhealthanddisasterrelatedevents?
C. MajorThrustsoftheAOP
1. Willtheexpectedoutputofthelocalthrustscontributetothe
attainmentofRegional,NationalObjectivesforHealthandthe
MDGs?
2. DoestheAOPcontainSMART(Specific,Measurable,Attainable,
Realistic,Timebound)objectivesachievablewithintheyear?
3. Aretheprogramobjectivesdoneinresponsetothelocalhealth
needsrequiringprioritizationfortheyear?
4. Arethetargetsconsistentwithprovince's/city'sVision,Mission,
Goalsforhealth,andcountrysMDGs/PDP/NOHforObjectives?
5. Arethereobjectivesaddedfrompreviousyearduetoemerginglocal
situation?
D. AdjustmentsinProposedInterventionsandInvestments
1. IsthereanydeviationintheAOPcostingfromtheexpectedcost
basedontheLIPH?
2. Isthereajustificationorexplanationonthecostdeviations?
3. Summarylistingoflocalhealthprioritieswithjustification
YES NO
Markwithan
(X)
Response
CheckforinclusionofallinterventionsintheAOP
Matrices
InvestmentCost
Narrative
SituationalAnalysis
Justificationforthecostdeviation
TableofGoalsandObjectivesinthepriorityPPAsforthe
yearandcompareoranalyzethemvisvisthelocal
healthsituationandpriorities
DOHRegionalOffice
REMARKS
Narrative/SituationalAnalysis
MEANSOFVERIFICATION
LocalthrustsvisvisRegionalandNationalObjectives
forHealthandtheMDGs
ANNEXD
Page2of9
DOHRegionalOffice
RECOMMENDATIONS
LIPH Handbook | 77
QUESTIONS
YES NO
ConsistencyofthePPA&inthefinancialplan
Checkforinterventionsprioritizingthepoor(ruraland
urban),GIDA/IPareasincludedintheAOP
PhilHealthdatafromtheProvincial&RegionalOffices
includedintheAOP
DOHRegionalOffice
REMARKS
LGUplanning&developmentofficeincludedintheAOP
MEANSOFVERIFICATION
ValidateiftheactivitiesandtargetsspecifiedintheAOP
areappropriateandsufficient.Appropriatemeansthey
conformtothetechnicalstandardsprovidedbythe
differentDOHbureausandofficesthroughthe
respectiveDOHROs.Sufficientmeanstheyareadequate
toattaintheobjectivesorcarryoutthestrategiesbased
onLGUScorecardresults.
RedLGUScorecardResultswillrequiremoreorbetter
supportinterventionsthanpreviousyear
Verifyifthetimeframeorscheduleisproperlyindicated
foreachactivity.
Checkthepropersequenceofactivitiestoensurethat
therearenooverlapsanddelays.
Checkifresourcesidentified(staffing,budget,facilities,
equipment,etc.)visvistheresourcesneededand
technicalstandardsareadequateandappropriate.
(Qualitativeassessmentintheabsenceofprogram
standards)
LGUbudgetincludedintheAOP
Markwithan
(X)
Response
3. Areresourcessufficienttoreachthetargets?
a) Humanresourcesarecompetent,withcompleteteams;havethe
toolstocarryoutthetasks?
b) EnoughlogisticsfortheyearperactivityperPPA?
c) Eachtask/activityisproperlybudgeted?
4. DoestheAOPincludeprograminterventions/activitiesforEquity?
IsthereabudgetearmarkedforidentificationofthePoor?
DidtheProvince/CitymakeuseoftheNHTSforidentificationofthe
poor?
Isthereanincreasedenrolmentoftheidentifiedpoorfromlast
year'senrolment?
IstherebudgetearmarkedforLGUshareintheannualNHIP
premiumpaymentfornonNHTSfamilies?
Aretherestrategies/activitiesforthepoor,GIDAandother
disadvantages/marginalizedgroups/populations?
ForHUCs:WastheUrbanHEART/RUPusedforidentificationof
problematicbarangaysandequityconcernsforpriority
implementation?
e) HumanResourcesforHealth
f) HealthInformation
2. Aretheactivitiesandtargetsprogrammedforsupportinterventions
sufficienttocarryouttheinterventions/strategiesintermsoftiming
&resources?
a) HealthFinancing
b) HealthServiceDelivery
ANNEXD
Page3of9
DOHRegionalOffice
RECOMMENDATIONS
78 |LIPH Handbook
QUESTIONS
AretheM&Eresultscommunicatedandutilizedtoimprove
intervention?
6. DoestheAOPimplementtheprograminterventions/activitiesin
lightofeffectiveness?
Istherematchingofappropriateinterventions,resourceallocation,
visavispeopleshealthneeds?
AretheidentifiedPPAsadequatelyandcorrectlyfunded?
Arethereappropriatemonitoringandevaluationinstrumentsfor
eachidentifiedcriticalinterventions?
7. ArethereidentifiedContinuingQualityImprovement(CQI)activities
establishedtoenhanceimplementationprocessesandresults?
a) HealthFinancing
b) ServiceDelivery
8. DoestheAOPreflectafocusonResultsOrientation?
Isthebudgetedamountforeachcriticalinterventionproperly
dispensedandreported?
Arethereenoughqualified,competentserviceproviderstocater
totheneedsofthepoor?
Arethepooraccessingandutilizingthehealthservices?
PercentageofwomenwhoarePhilHealthenrolled,percentageof
pregnantwomendeliveringinMCPaccreditedbirthinghomes
5. DoestheAOPimplementtheprograminterventions/activitiesin
lightofefficiency?
Arethecompetencyandskillsappropriatelydistributedtorespond
tothecriticalinterventionsidentified?
YES NO
Markwithan
(X)
Response
MEANSOFVERIFICATION
CheckforinclusionofallinterventionsintheAOP
Matrices
SituationalanalysisbasedonLGUscorecard,FHSIS,etc.
PPAs
CostingMatrices
TrainingPlan
HumanResourceManagementandDevelopmentPlan
PScostforadditionalHumanResourcesforhealthas
LGUcounterpart
CostingMatrices
FundUtilizationReport
ProgressMonitoringReport
M&EPlan
ProgressMonitoringReport
Utilizationrateofhealthservices,&PhilHealthbenefits,
presenceofdemandgenerationactivitiesintheAOP
ANNEXD
Page4of9
DOHRegionalOffice
RECOMMENDATIONS
DOHRegionalOffice
REMARKS
LIPH Handbook | 79
Markwithan
(X)
Response
QUESTIONS
LocalGovernmentUnits(LGUs)
DepartmentofHealth(DOH)
DevelopmentPartners(DP)
Others
Amountand
Percentage
(Denominator
isTotalAOP
Cost)
(Pleaseindicatetheitemsrequested)
2. TotalcostofAOP
3. %ofAnnualCostfor:
a) MaintenanceandOtherOperatingExpenses(MOOEforHealth)
[vs.TotalBudgetforHealth]
*Thisisforconsiderationasbenchmarkinassessment.Thisisnot
prescribed.
b) CapitalOutlay(CO):
1) Hospital:
a. Infrastructure
b. Equipment
a)
b)
c)
d)
YES NO
IsthelinkbetweenInterventionandCostwithProblems/Major
Gaps,Goals,Objectives&Targetsgenerallyestablishedformostof
theprograminterventions(atleastfortheMDGs)?
Doestheinterventionconsiderthelifecycleapproachand
continuumofcareasabasisforensuingAOPs(AOP2,AOP3)?
9. Questiononunimplementedinterventions/activities?
Percentageofpreviousyear'sunimplementedinterventions/
activitiestocurrentyear'sinterventions/activities.
QUESTIONS
B. Costing
1. Aresourcesoffundsproperlyascribedto:
MEANSOFVERIFICATION
AOPCostMatrices:CostofExpenditures,i.e.MOOE
HealthFacilityDevelopmentsectionoftheAOP
Compareinvestmentsforhospitalsandhealthcenters
LGUcounterpartforthehealthfacilitydevelopment
LGUbudget
SummaryofInvestmentCost
MEANSOFVERIFICATION
Checkifsourceoffundsareproperlyand
correspondinglyindicatedforeachactivity.
Aretherepossiblesourcesoffundswhichwerenot
included?(DOH,PLGU,MLGU,CityBarangay,Other
NationalGovernmentAgencies,NGOs,PrivateSector
Others)
AOPCostMatrices
Justification
Interventions
Performanceindicatorsandtargets,etc.
Costing
Page5of9
DOHRegionalOffice
RECOMMENDATIONS
DOHRegionalOffice
REMARKS
ANNEXD
DOHRegionalOffice
RECOMMENDATIONS
DOHRegionalOffice
REMARKS
80 |LIPH Handbook
5) AreInvestmentsprogrammedappropriately?
4. Areinvestmentsfairlydistributed?
QUESTIONS
2) HealthCenter:
a. Infrastructure
b. Equipment
3) Others:
a. Infrastructure
b. Equipment
c. Vehicles
4) TotalCO:
c) ByFundSource(AnnualCost):
1) DepartmentofHealth(DOH)
2) LocalGovernmentUnits(LGUs)
a. Province
b. City/Municipality
c. Barangay
3) DevelopmentPartners
4) Others
QUESTIONS
a) Averagecostperperson
b) Averagecostperbarangay
c) Averagecostpermunicipality+componentcity/ies
Optional:
d) Lowesttotalinvestmentfora:
1) Barangay
2) Municipality
e) Highesttotalinvestmentfora:
YES NO
Markwithan
(X)
Response
Amountand
Percentage
(Denominator
isTotalAOP
Cost)
MEANSOFVERIFICATION
Assessdisparityfromaveragevaluefor
barangay/municipality
Checkconsistencywithfundagreement
Comparewithhistoricaldataorcomparableprovinces
aftercomputation:
o Totalcost/TotalPopulation
o Totalcost/#ofbrgys
o Totalcost/#ofmunicipalities
MEANSOFVERIFICATION
SummaryofInvestmentCost
DOHRegionalOffice
REMARKS
DOHRegionalOffice
REMARKS
ANNEXD
Page6of9
DOHRegionalOffice
RECOMMENDATIONS
DOHRegionalOffice
RECOMMENDATIONS
LIPH Handbook | 81
6. DoestheAOPcontainthesignaturesoftheapprovingofficialsofthe
LGUs?
1) Barangay
2) Municipality
5. Doestheplanreflectinterventionsforthevulnerableand
marginalizedsector?
QUESTIONS
(Pleaseindicatetheitemsrequested)
3. TotalPersonstobetrained
4. TotalDaysofTraining
5. CostofTraining:
a) TotalCostofTraining
b) TotalCostofTrainingas%ofAOPCost
c) AverageCostofTrainingperday
d) Averagecostperpersontrained
QUESTIONS
2. Willthetrainingplanenablehumanresourcestobecompetentin
addressingorcarryingtasksexpected?
A. TrainingPlan(refertoAnnexCForm3)
1. ArethecontentsoftheTrainingPlanconsistentwiththetraining
activitiesfoundintheAnnualOperationalPlan?
PartIII.AOPSupplementalPlans
Amountand
Percentage
(Denominator
isTotalAOP
Cost)
YES NO
Markwithan
(X)
Response
MEANSOFVERIFICATION
(6a)/(5)
(6a)/(4)
MEANSOFVERIFICATION
CheckthevalidityofthetrainingactivitieswiththeAOP.
Seeifthetargetsandotherrequireddataareconsistent
withthosefoundintheAOP.
Checkthepropersequenceofthetrainingactivitiesto
ensurenooverlaps&delays,whoaretheparticipantsto
betrained,areclear.
Signaturesoftheapprovingofficialsoftheprovince/city
ontheAOP.
PlanisproperlyendorsedbytheLCEstotheDOH
RegionalOffices.
BudgetforNHTSandGIDA/IP,etc.
DOHRegionalOffice
REMARKS
DOHRegionalOffice
REMARKS
ANNEXD
Page7of9
DOHRegionalOffice
RECOMMENDATIONS
DOHRegionalOffice
RECOMMENDATIONS
82 |LIPH Handbook
QUESTIONS
Markwithan
(X)
Response
C. FinancialPlan
1. Isthefinancialplanconsistentwiththetargetstobeachievedwithin
theyear,plannedactivities,andtasksperPPA?
2. Isthereaunifiedandstandardprocessfordisbursementand
reporting?
3. Isthereadequatetimingforthefinancialplantorealizeabudget?
7. DoesthePlanadequatelyfollowascheduledtimeandprocess?
5. Arethespecificitemstobeprocuredconsistentwithinternational
technologystandards,DOHstandards/priorities,rationalization
plans?
6. Arethereitemswhereprocuringasmallerquantitywillnonetheless
meetprogramgoalsandobjectives?
4. Arethecontractpackagesanditemspecificationsconsistentwith
thespecificationsrequiredbytheDepartmentofHealth?
YES NO
B. ProcurementPlan(Optional)
1. DothecontentsofthePlansupporttherequiredgoodsandservices
toachievethetargetsfortheyear?
2. IsthePlanconsistentwiththeprocurementactivitiesfoundinthe
AOP?
3. DoesthePlanoftheProvince/Cityconformtotherequirements
specifiedunderRA9184?
MEANSOFVERIFICATION
ANNEXD
Page8of9
DOHRegionalOffice
RECOMMENDATIONS
Checktimingforexecutionoffinancialplan
DOHRegionalOffice
REMARKS
CheckstandardDOHprocessfordisbursementand
reporting
Checktimeprocurementprocessfromprebidsto
awards
Checklogicalconnection/arrangementfromtimeof
procurementprocess(fromprebidstoawards),training
activities,financialplanandtheiralignmenttotargets,
activities,tasksperPPA.
Checkquantityofitemstobeprocured
CheckPlanifitemstobeprocuredwilldirectlycontribute
orsupportprogramgoalsandobjectives.
CheckthevalidityofthePlanactivitieswiththeAOP.See
iftheconsistentwiththosefoundintheAOP.
ChecktheconsistencyofthePlanwiththerequirements
ofRA9184.RefertoHandbookonPhilippine
GovernmentProcurement.
Checkifthecontractpackagedescriptionanditem
specificationsconformwithDOHspecifications:
o www.doh.gov.ph/hcrs
o SpecificationofMedicalEquipmentinHealth
CommoditiesReferenceSpecificationInformation
SystemDatabase,23November2009
LIPH Handbook | 83
DOHROReviewCommittee
Chairperson
ViceChair
OtherComments:
Recommendation:
Finalapproval
ForRevisionbasedonDOHRO'sCommentsandRecommendations
Member
Member
Member
Member
Date:
Page9of9
ANNEXD
Annex E
Competencies of Planning Teams
A. Technical Competencies
1. Problem Solving Skills
Definition:
Builds a logical approach to address problems or opportunities or
manage the situation at hand by drawing on ones knowledge and
experience base, and calling on other references and resources as
necessary.
Behavioral Indicators:
a. Undertakes a complex task by breaking it down into manageable
parts in a systematic, detailed way;
b. Thinks of several possible explanations or alternatives for a situation
and anticipates potential obstacles and develops contingency plans
to overcome them;
c. Identifies the information needed to solve a problem effectively;
d. Presents problem analysis and recommended solution to others
rather than just identifying or describing the problem itself; and
e. Acknowledges when one doesnt know something and takes steps
to find out.
2. Organizing and Prioritization Skills
Definition:
Establishes a systematic course of action for self and/or others to
ensure accomplishment of a specific objective.
a. Develops or uses systems to organize and keep track of information
(e.g., to-do lists, appointment calendars, follow-up file systems);
b. Sets priorities with an appropriate sense of what is most important
and weighs the demand involved;
c. Keeps track of activities completed and yet to be done, to accomplish
stated objectives;
d. Keeps clear, detailed records of activities related to accomplishing
stated objectives; and
e. Knows status of ones own work at all times.
84 |LIPH Handbook
3. Analytical Skills
Definition:
The ability to visualize, articulate, and solve both complex and
uncomplicated problems and concepts and make decisions that
make sense based on all available information.
a. Demonstrates appropriate problem identification skills based on all
relevant information and prioritizes them in relation to the goals and
objectives;
b. Applies planning concepts and visualize solutions to identified
problems and corresponding data gathered in a logical manner;
c. Arrives at decision points in response to an identified solutions set/
menu; and
d. Applies planning tools relevant to the identified solutions set/menu.
4. Aptitude for Technology
Definition:
The ability to apply in-depth specialized knowledge, skills, and
judgment by assessing and translating information technology into
responsive and effective planning solutions. Demonstrating how you
can use or manipulate data using Excel is a typical competency.
a. Identifies information needed, gathers, groups and analyzes them as
to significance;
b. Uses database and employ data management programs to assist in
data analysis; and
c. Translates data into meaningful narrative description to aid in
explanation of data.
LIPH Handbook | 85
5. Results-focused
Definition:
Refers to ability and drive for achieving and surpassing targets. This
is about showing passion for improving the delivery of services with a
commitment to continuous improvement in your planning process.
a. Demonstrates zeal and enthusiasm to stay the course with
consistency;
b. Identifies targets and achieve them;
c. Consciously plans the time relevant to realistically achieve targets;
and
d. Applies continuous quality improvement mechanisms to improve
outputs and outcomes.
B. Non-Technical Competencies

1. Time Management
Definition:
Sets priorities, goals, and timetables to achieve maximum productivity.
a. Sets a realistic time appropriate to achieve the objectives and goals;
b. Keeps track of activities completed and yet to be done, to accomplish
stated objectives;
c. Keeps clear, detailed records of activities related to accomplishing
stated objectives; and
d. Knows status of ones own work at all times.
2. Teamwork
Definition:
Demonstrating ability to work as part of a multifunctional team to
meet desired business goals. Simply put, show understanding of the
concept of collaborative effort for collective goals.
a. Knows ones role in the effort;
b. Appreciates and understands the role that other team members play,
maximizes talents of other members;
86 |LIPH Handbook
c. Seeks to understand the goals and objectives and cooperates with

the plan; and
d. Communicates ones thoughts and asks for feedback.
3. Relationship/Conflict Management
Definition:
The ability to leverage interpersonal skills to establish rapport and
develop relationships with all key stakeholders: suppliers, customers
or colleagues
a. Demonstrates understanding of team members /stakeholders
attitudes and team/ stakeholders dynamics;
b. Relates to team members in a way that positively stimulates goals
and outcomes; and
c. Applies management principles to disagreement/conflict situation to
arrive at a fair and sensible outcome.
4. Customer/Client Focused
Definition:
Putting customers first and demonstrating commitment to service
leading to satisfaction for both internal and external customers.
a. Ability to know history, position, and present state of customers/
clients;
b. Ability to know internal and external audiences in relation to client/
customer;
c. Demonstrates passion and commitment to respond to client needs
and anticipate future needs; and
d. Demonstrates client satisfaction thru feedback mechanisms and input
these to planning.
LIPH Handbook | 87
5. Professionalism
Definition:
The ability to think carefully about the likely effects on others of ones
words, actions, appearance, and mode of behaviour. The consummate
professional selects the words and actions most likely to have the
desired effect on the group or individual in question.
Behavioural Indicators:
a. Ability to think and reflect carefully about actions, words and behaviour
before, during and after they are made;
b. Keeps mode of behaviour appropriate to the situation at hand so as
to place oneself in proper perspective; and
c. Demonstrates composure towards co-workers, stakeholders and
clients/customers as appropriate and decorum befitting training.
References:
Web sources
a. http://humanresources.syr.edu/ online
b. http://www.morganmckinley.ie/article/top-10-competenciesplanning-professionals
88 |LIPH Handbook
Assessment Worksheet1
PLAN TO FIT, FIT TO PLAN
NAME:
POSITION/DESIGNATION:
OFFICE:
Instruction:
Kindly rate yourself using the following scale:
3 Highly Competent, 2 Competent, 1 Needs Improvement
Use the results of this assessment checklist for capacity development initiatives
for the Planning Teams
COMPETENCIES
RATINGS
3
A. TECHNICAL COMPETENCIES
I.
Problem Solving Skills
Builds a logical approach to address problems or

opportunities or manage the situation at hand by
drawing on ones knowledge and experience base,
and calling on other references and resources as
necessary.
II.
Organizing and Abilities to Prioritize
Establishes a systematic course of action for self and/

or others to ensure accomplishment of a specific
objective.
III.
Analytical Skills
The ability to visualize, articulate, and solve both

complex and uncomplicated problems and concepts
and make decisions that make sense based on all
available information.
Tool for self assessment for the LGU LIPH team
LIPH Handbook | 89
COMPETENCIES
RATINGS
3
IV.
Aptitude for Technology
The ability to apply in-depth specialized knowledge,

skills, and judgment by assessing and translating
information technology into responsive and effective
planning solutions. Demonstrating how to use or
manipulate data using Excel is a typical competency.
V.
Results Focused
Demonstrating ability and drive for achieving

andsurpassing targets. This is about showingpassion
for improving the delivery of services with a commitment
to continuous improvement in the planning process.
B. NON- TECHNICAL COMPETENCIES
I.
Time Management
Sets priorities, goals, and timetables to achieve

maximum productivity.
II.
Teamwork
Demonstrating ability to work as part of a multifunctional

team to meet desired business goals. Simply put, this
is about understanding and practicing concept of
collaborative effort for collective goals.
III.
Relationship/Conflict Management
The ability to leverage interpersonal skills to establish

rapport and develop relationships with all key
stakeholders: suppliers, customers or colleagues.
IV.
Customer/Client Focused
Putting customers first and demonstrating

commitment to service leading to satisfaction both
internal and external customers.
90 |LIPH Handbook
COMPETENCIES
RATINGS
3
V.
Professionalism
The ability to thinkcarefully about the likely effects

on others of ones words, actions, appearance, and
mode of behavior. The consummate professional
selects the words and actions most likely to have the
desired effect on the group or individual in question.
LIPH Handbook | 91
Annex F
Development of Vision, Mission, and Goal Statement
I. Vision Statement
Process: The development of the vision statement is best done in a workshop.
An initial brainstorming or similar guided creative process should
be done to allow the participants to come up with their pictures of
the future for health in their area as well as for their organization.
The following steps are suggested to arrive at a shared Vision.
Step 1: The Creative Process - The participants are asked
to describe how they would like the health situation in
their area/organization/facility to be by the end of the
three-year plan. Key words/phrases are the desired
responses here.
Step 2: Writing a Statement - The participants are then
asked to use each of the key words/phrases and write
them down in statements.
Step 3: Filling out the Worksheet - To facilitate the process,
the participants responses are written on the worksheet
column 1 is for key words/phrases; column 2 is for the
statements on the vision or how the participants would
like the health situation to be.
Step 4: Identifying Preferred Statements - All the
statements in column 2 are then rank-ordered according
to the preferences expressed collectively by the group.
Step 5: Crafting the Vision Statement - The ranked
statements are then reviewed and the group agrees as
to which of the top statements will be incorporated into
a single Vision Statement.
92 |LIPH Handbook
Sample Worksheet

Key Words
Productive constituents
Access to socialized health
services
Better quality of life
Complete and excellent
primary and secondary health
care services
NGO/GO/PO/LGU
Partnership
Healthy and productive
citizenry
Competent, dedicated
and committed health care
workers
Vision Statement to Consider
Rank
1. It is the vision of the GMA InterLocal Health Zone that the

population shall be healthy and
productive, as a result of joint
efforts of different stakeholders
working on self-managed and
sustained delivery of health
services.
2. A healthy and productive
citizenry.
3. A healthy and productive
citizenry working together for a
better quality of life.
4. The constituents of the GMA
Inter-Local Health Zone are
healthy productive and have a
better quality of life. An NGO/
GO/PO/LGU partnership for
health provides greater access
to complete and excellent health
care services that are socialized
and delivered by competent,
dedicated and committed health
workers.
4
3
1
Reference: Manual on The Integrated Health Planning System- Annex D-1. Dept of Health Internal Planning
Service and Asian Development Bank. December 2003
LIPH Handbook | 93
II.
Mission Statement
Process: Like the Vision Statement, a Mission Statement is best done in a
workshop. The process is similar to that of the Visioning process,
though the questions that are asked are different.
Step 1: The Creative Process The participants are asked
to respond (key words or phrases) to the following
questions.
1. Who are our primary clients?
2. What client needs should we serve?
3. What are our primary technologies?
4. Why or what for are we doing this?
Step 2: Writing a Statement The participants are then asked
to use each of the key words/phrases and write them
down in statements.
Step 3: Filling out the Worksheet To facilitate the process,
the participants responses are written on the worksheet
column 1 is for key words/phrases; column 2 is for
the statements on why are the participants doing what
they are doing.
Step 4: Identifying Preferred Statements All the statements
in column 2 are then rank-ordered according to the
preferences expressed collectively by the group.
Step 5: Crafting the Mision Statement The ranked
statements are then reviewed and the group agrees as
to which of the top statements will be incorporated into
a single Mission Statement.
94 |LIPH Handbook
Sample Worksheet

Key Words
All the residents covered
by the GMA ILHZ
Provide preventive and
curative health services
Sound
health
interventions
care
Health education
Defined minimum package
of services at each health
organization
Affordable to the poorest
of the poor
Sustainable
Judicious use of resources
With support of LGU
Peoples involvement
Mission Statement to Consider
Rank
1. It is the mission of the GMA ILHZ to

provide preventive and curative health
services at a cost most affordable to
the poorest of the poor through PHIC
and an effective integrated approach
supported by the government and
private sector.
2. To deliver comprehensive , high quality,
accessible,
affordable,
effective,
efficient, sustainable health services to
all residents of the Zone, through the
development and the use of appropriate
health care technologies and multisectoral partnerships.
3. GMA ILHZ shall improve the quality of
life of the citizens of the municipalities of
Gubat, Mina, and Anahaw by providing
quality, efficient, effective health care.
4. To ensure genuine commitment and
dedicated, involvement, partnership
and collaboration among the people,
health workers, LGUs and other health
care providers.
Reference: Manual on The Integrated Health Planning System- Annex E-1& 2. Department of
Health Internal Planning Service and Asian Development Bank. December 2003
III. Goals
Process: Goal setting is essential to good management.
The
accomplishment of the desired vision for health is hinged on the
proper identification of specific, measurable results that the health
facility organization will work on in the short term. These results
will reflect the key areas where efforts will be concentrated. It is
presumed that the collective effort of all the entities composing
the health organization will bring about the realization of the goals.
LIPH Handbook | 95
Annex G
Tools or Data Analysis
SWOT (Strengths, Weaknesses, Opportunities, Threats) Analysis
What is a SWOT Analysis?
SWOT analysis1 is a strategic planning tool used to identify the strengths,
weaknesses, opportunities and threats to an organization, process, or program.
SWOT analysis has been used extensively as a planning tool in business. In health
planning, it should be used only to inform key strategic decisions or changes in
direction. The SWOT framework or matrix (Figure 5) assists in understanding
the interaction between factors perceived to be favourable or unfavourable to a
specified goal. The purpose of the exercise is to emphasize strengths, minimize
weaknesses, capitalise on opportunities and mitigate threats for the key factors
related to this goal.
SWOT ANALYSIS
Helpful
Harmful
to achieving the objective
Strengths
Weaknesses
Threats
attributes of the environment
attributes of the organization
External origin Internal origin
to achieving the objective
Opportunities
W
T
Figure 5. SWOT Framework
1. Strengths:
characteristics
of
the
organization, process or program that
give it an advantage in achieving a stated
objective.
2. Weaknesses: characteristics that place
the organization, process or program
at a disadvantage in achieving a stated
objective.
3. Opportunities:
elements
that
the
organization, process or program could
exploit to its advantage.
4. Threats: elements in the environment that
could cause trouble for the organization,
process or program.
What are the strengths of SWOT analysis

SWOT explicitly addresses factors both internal and external to the organization
so is ideally suited for strategic planning. The simple framework for SWOT
means that it can be easily understood and applied in a range of ways and with
minimal instruction.
1
Web resource: http://www.businessnewsdaily.com/4245-swot-analysis.html Book Reference: Analysis Without Paralysis
12 Tools to Make Better Strategic Decisions SECOND EDITION By Babette Bensoussan and Craig Fleisher FT Press(October 2012)
96 |LIPH Handbook
Data requirements are not specified, although research and preparation on the
key items under discussion is recommended prior to analysis.
What are the limitations of SWOT analysis
SWOT is necessarily broad and the simplistic framework can lead to a less
systematic (brainstorming) analysis which provides many ideas but few solutions.
A skillful facilitator is needed to ensure discussions and results, provide
meaningful and actionable information. For best results, additional input both
prior to (assessment of internal and external factors) and following (prioritization)
the analysis is recommended. Additional tools can be utilized for this purpose2.
When and how would you use SWOT analysis?
SWOT analysis can be used to kick start a strategic discussion, or as part of
a more involved strategic planning process. It is usually applied broadly and at
a high level (at a health system or organizational level), particularly at times of
restructure or significant change. It can also be used to identify factors favorable
and unfavorable, to the introduction of a new health service or, for instance, a
health financing mechanism.
What are the steps in the SWOT analysis
SWOT analysis can be done individually but is best done in a group so that
different opinions and perspectives can be sought.
1. Decide on the objective or focus of your SWOT analysis
The scope of analysis will depend on questions such as whether it is
being used to analyze an organization or system as a whole or whether
there is a particular objective. SWOT might be used periodically to assess
the overall effectiveness of the health system and to identify specific
problems requiring sustained attention or changes in strategic direction.
For example, a push towards universal health coverage might identify
some key areas to focus on across a number of years. The SWOT might
be more specifically focused on the delivery of a specific priority health
program or to help develop the strategy for delivering a new program or
service.
For example, EFQM model a tool to explore deficits in leadership, process and performance (internal factors)
PEST-analysis a tool that identifies political, economic, social and technological developments (external factors)
MCDS Multiple Criteria Decision Support methods (prioritisation)
LIPH Handbook | 97
2. Research on the objective, topic or focus of the SWOT analysis

Although SWOT is a qualitative analysis, some preparation and
information gathering is necessary to help support or counter assertions
during the analysis.
Information around the major elements in the delivery of particular health
services and the external policy environment will be useful during SWOT
if that health service is to be the focus of discussion.
3. Identify strengths in the organization, process or program
These strengths should relate directly to the stated objective and are
internal to the organization or process under analysis. Questions to ask
include:
a. What do we consider we are doing well?
b. What relevant resources do we have?
c. What do we see as our strengths in this area?
If the objective is to improve primary health care services, strengths might
relate to access of the population to facilities or to health staff available or
to available funds and financing mechanisms for such services.
4. Identify weaknesses in the organization, process or program
Again, these weaknesses should relate to the stated objective. Questions
to ask include:
a. What are we doing poorly?
b. What could we improve?
c. What should we avoid?
A weakness in the system for improving primary health care services might
be community perceptions and knowledge of available services or poor
referral mechanisms. Weaknesses can be changed if certain strategies
to address them are developed. For instance, key strategies may include
increasing the number of health staff working in rural and remote areas.
98 |LIPH Handbook
5. Identify potential opportunities

Opportunities are factors external to the organization or process but
which may favourably affect the achievement of an objective. Questions
to ask include:
a. Where are opportunities favourable to our goals?
b. What are interesting trends could we take advantage of?
Opportunities for introduction of a new program might relate to the
existence of national guidelines and training programs or to the provision
of start-up funds. Internationally and nationally recognized goals, such
as the Millennium Development Goals also provide opportunities through
potential donor funding for programs addressing these issues.
6. Identify potential threats
Threats are factors external to the organization or process under analysis
which might inhibit the achievement of objectives. Questions to ask
include:
a. What obstacles might prevent us from reaching our objectives?
b. Are the requirements for what we offer changing?
c. Could any of the regulations threaten the aim of our organizations?
Threats might relate to the policy environment (e.g. introduction of new
policies or protocols for service delivery) or environmental factors (making
access to facilities difficult).
Sometimes, it is not clear whether a factor is an opportunity or a threat.
For instance private practice can be both an opportunity for improving
access to service (public-private partnership), or a threat leading to
poorer quality services (due to poor regulation). In SWOT analysis, such
items need to be identified as either an opportunity or a threat, not both.
7. Establish priorities from the SWOT
From the list of strengths, weaknesses, opportunities and threats, prioritize
which issues are the most important. For strengths and opportunities,
this will relate to the factors most favourable to the achievement of the
objective. Weaknesses and threats, relate to those that are the most
unfavorable.
LIPH Handbook | 99
Strengths
Weaknesses
1. Existing mechanism for delivering

vaccination through outreach
2. Sufficient HR to deliver services
3. High coverage of current
vaccinations
1. Current skills of health staff for

providing new vaccination
2. Standard forms and monitoring of
adverse effects not in place
3. Coordination of supplies for new
vaccine
Opportunities
Threats
1. Current legislation introducing new 1. Lack of national guidelines and

protocols for implementation of
vaccine
new vaccine
2. Nationally funded training programs
for introduction of new vaccines
2. Poor regulation and monitoring of
private sector providers
3. International support for vaccine
Figure 6. Simple SWOT Analysis (introduction of new vaccine)

8. Develop strategies to address priority issues from the SWOT
Once the major strengths, weaknesses, opportunities and threats for a
particular objective have been identified and are listed side-by-side in a
Matrix (see Figure 6. Simple SWOT Analysis), the group can analyze the
interactions between these elements. Questions to ask include:
a. Which strengths can be used to capitalize on opportunities?
b. Which strengths can be used to lessen threats?
c. Can opportunities be used to overcome identified weaknesses?
d. What strategies could be developed to strengthen current
weaknesses?
The strategies and associated activities can then be detailed and input
into relevant plans. Conducting SWOT analysis at different time periods
can help to monitor whether weaknesses have been overcome and
whether opportunities and threats have eventuated.
100 |LIPH Handbook
Bottle Neck Analysis

What is a bottleneck analysis?
Bottleneck analysis is an evidence-based method for considering different
aspects of delivering health services that may affect quality coverage
and to developing strategies to address these problems. The bottleneck
framework assumes that there are six coverage determinants contributing
to service delivery for effective health interventions: three on the supply
side, two on the demand side and one quality (see Figure 7. Bottleneck
Framework). The analysis rationale is based on the work of Tanahashi1,
subsequently adapted by Soucat and colleagues in the early 2000s2 .
BOTTLENECK ANALYSIS
Commodities
Human Resources
Physical Access
First Use
Continued Use
Quality
SUPPLY
DEMAND
QUALITY
From Tanashi T. Bulletin of the World Healt Organization, 1978, 56 (2)

http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_295-303.pdf
Figure 7. Bottleneck Framework
Commodities supply of essential

equipment and medicines
Human resources availability of key
staff for the intervention
Physical access population access to
the service
First use the service provided on first
use
Continued Use additional services on
second visit, or repeat use
Quality effective level of care for actual
health
What are the strengths of bottleneck analysis?

Bottleneck analysis allows for the simultaneous consideration of a range of
issues (one-stop-shop), based on actual data (evidence), contributing to quality
health services. The visual representation of the problem broken up into its
component parts assists analysis and the use of evidence limits the acceptance
of preconceived ideas and strengthens conclusions. The use of local data
facilitates an appreciation of its usefulness and improvements in data collection
by health planners.
Tanahashi T. Health service coverage and its evaluation. Bulletin of the World Health Organization.
1978;56(2):295-303.
2
Soucat A, Lerberghe W, Doip F, Nguyern S, Knippenberg R. Marginal budgeting for bottlenecks: A new
costing and resource allocation practice to buy health results. Draft Report. Washington DC: World Bank,
Institute of Tropical Medicine, UNICEF, WHO 2002.
1
LIPH Handbook | 101
What are the limitations of bottleneck analysis?

Data on six coverage determinants of service delivery are necessary for
bottlenecks analysis restricting interventions to be chosen, given current data
availability. The quality of the problem-solving analysis is dependent on the
facilitation and involvement of multi-stakeholder group which requires significant
coordination.
When and how would you use bottleneck analysis?
Bottleneck analysis can be used to improve planning for health services and to
strengthen health systems. It can be used to analyze one critical intervention for
which delivery has been identified as problematic (for instance low coverage in
the balanced scorecard). Alternatively several interventions can be selected to
represent different types of health services. For instance, expanded immunization
program (EPI) can be analyzed to uncover problems of outreach services or
facility-based delivery could be analyzed to represent all interventions offered
in a facility at the time of birth. Sometimes bottlenecks analysis is applied to a
particular health program, for example by examining the interventions that come
under the nutrition program.
What are the steps in the bottleneck analysis?
There are several steps in a bottleneck analysis. Some involve assembling
and validating data for analysis with involvement of health office and program
staff. Other steps, such as problem-solving analysis require a greater number
of stakeholders with an understanding of different aspects of health service
delivery.
1. Decide on the scope of the bottleneck analysis.

This step should involve a consideration of the main causes of death and
disability that exist in your target population in order to improve services
addressing these health issues. For instance, if pneumonia is a major
cause of death in children under five, services to prevent and treat this
illness might be selected. There might be a particular disadvantaged
population you want to consider in terms of health services (e.g. GIDA
population) or you might want to include the whole population in the
analysis.
102 |LIPH Handbook
2. Develop bottleneck chart

Once you have decided on the intervention(s) you wish to analyze and
the target population, you will need to develop a bottleneck chart using
available data. This will involve deciding the best indicators to use for each
coverage determinant. For instance, which equipment or commodity is
the most critical to delivering the intervention under analysis, which health
professional normally delivers the service, how easily can your target
population access the service? On the demand side, which coverage
determinant best illustrates first use of services, and continuous use
of services? What is the best indicator for quality? (see EPI example
Figure 8. Indicators for Expanded Program on Immunization). The best
indicators for which there are available data need to be selected.
SUPPLY
COMMODITIES
HUMAN
RESOURCES
DEMAND
ACCESS
QUALITY
% of months with no stock outs of pentavalent in

the past 12 months
% of midwives trained for EPI program
% of EPI outreached clinics conducted as
scheduled
FIRST USE
% of 0-12 months old given Pentavalent 1
CONTINUED USE
% of 0-12 months old given Pentavalent 1
QUALITY
% of 0-12 months old fully immunized (FIC)
Figure 8. Indicators for Expanded Program on Immunization
LIPH Handbook | 103
3. Validate /revise bottleneck chart

It is important to critically assess whether the indicators for the six
features of the health system accurately represent that particular health
service. By looking at the bottleneck chart, program managers and health
planners can identify if there are obvious errors in the chart. This might
be because the wrong indicators have been used. Or it may be the result
of using the wrong target population. The data being used may not be
the best quality and there might be a better alternative. In addition, the
denominator for demand and quality indicators should be the same (for
example, for EPI the denominator for demand and quality indicators is the
population of children 0-12 months). It is therefore not possible to have
a continued use value greater than utilization, or a quality value greater
than continued use. A review and revision of indicators or data should be
done prior to the bottleneck analysis.

4. Problem-solving (bottleneck) analysis

Ideally, the bottleneck analysis is done with a wide group of stakeholders1
to capture the many different perspectives on the problems of health
service delivery. Note that the problem-solving component of bottleneck
analysis can be combined with Problem Tree analysis (see next tool
description).
a. First, the main bottlenecks are identified (represented by the red
arrows in Figure 9. Simple Bottlenecks Analysis Example).
b. Next the specific problems related to the bottleneck are discussed
(pink boxes in Figure 9) until the underlying cause is identified. To
get to the underlying cause, it may be necessary to ask Why at least
three times since initial answers are likely to be superficial.
c. Finally, strategies (green boxes in Figure 9) are suggested to remove
the underlying problem. There may be a number of strategies
addressing a single constraint, some short-term and some requiring
a longer-term investment.
d. This process is repeated for all selected health interventions.
1 These might include health planners and policymakers, health facility managers, a variety of health professionals, representatives from the private sector, NGOs and civil society, barangay health workers and
hospital managers.
104 |LIPH Handbook
Pregnancy clinical care: Facility-based delivery

COMMODITIES: % lying-in clinics with
no stockout of delivery kits in the last six
months
22%
HR: availability of public midwives in relation

to population (1:5,000)
Create form and

process for daily
delivery kit stock, all
components
93.40%
ACCESS: % households within 1 hour

of a lying-in clinic
88.10%
FIRST USE: % deliveries by skilled

birth attendant (SBA)
53.20%
CONTINUED USE: % deliveries by SBA

in the facility
QUALITY: % deliveries by SBA in a facility
and post-partum check-up
No system for daily

checks or ideal
stock level
Staff will only order

when there is low/
no stock
48.60%
27.90%
Prefer
hilots
Low
knowledge of
FBD
No staff incentives for

PP chck-up
Weak
enforcement of
legislation on
hilots
Poor quality of
ANC counseling
No monitoring of
ANC quality
Incentive to
hilots to refer
BCC information
campaign of
benefits of FBD
Create ANC birth
preparedness
checklist form.
Use for quality and
monitoring
Figure 9. Simple Bottlenecks Analysis

(Facility-based Delivery)
5. Prioritization of strategies

Once the strategies for all interventions involved in bottleneck analysis

have been developed, these strategies are grouped into similar types
and prioritized based on criteria. These criteria are decided in advance
and may include: an assessment of impact of the strategy on health
outcomes; the cost of the strategy; whether they improve services for
vulnerable groups; feasibility to implement in the short, medium and
long term; acceptability within the current policy environment and; the
ability of the strategy to address problems in the delivery of numerous
interventions.
6. Detailing the strategies into plans and budgets

In order for strategies to be effective, they need to be funded and
implemented. The activities that are necessary for a strategy to be
successful therefore need to be detailed and included in plans and
budgets. Monitoring of the process (if the strategy was to train staff, did
they actually get trained) and outcome (did better training of staff lead to
better quality service) is necessary to understand whether strategies are
achieving their intended aim.
LIPH Handbook | 105
Problem Tree and Objective Analysis

What is a Problem tree analysis?
Problem tree analysis1 is a simple participatory technique to understand the
relationship between a range of problems around a central issue or topic (core
problem). Once identified, problems can be arranged in a hierarchy according to
whether they are a contributing cause or an effect of the issue under discussion
(See Figure 10). The problem tree is often part of a larger planning process and
is usually followed by an objective tree and the development of strategies that
will ultimately address the issue under discussion. It can be used in conjunction
with bottleneck analysis (during problem-solving phase) or as a stand-alone
method.
EFFECTS
Ultimate effect
(e.g mortality, morbidity)
Interim effect
Interim effect
Interim effect
CORE
PROBLEM
ISSUE/TOPIC
Contributing
cause
Contributing
cause
Underlying
problem
Underlying
problem
Contributing
cause
Contributing
cause
Contributing
cause
Contributing
cause
Figure 10: Problem Tree Framework
Web resource http://www.odi.org/publications/5258-problem-tree-analysis

Book reference: Root Cause Analysis: Simplified Tools and Techniques SECOND EDITION Bjorn Andersen and Tom
Fagerhaug ASQ Quality Press
106 |LIPH Handbook
CAUSE
ROOT CAUSE
Underlying
problem
What are the strengths of problem tree analysis?

The simple framework of the analysis means that problem tree analysis can be
applied wherever a problem is identified. Problem tree analysis breaks problems
down into their constituent parts, to understand the relationship between them,
in order to develop holistic solutions to core issues. Whilst it is recommended
to have as much information about the topic under discussion as possible, this
technique does not require any specific data collection, so it is useful where data
are scarce.
What are the limitations of problem tree analysis?
If the focus for the discussion is not well-defined, problem tree analysis can
result in a broad brainstorming exercise, and solutions may not be useful. Since
quantitative data are not explicitly used, the need for a wide variety of stakeholder
perspectives and good facilitation to focus discussion is critical for the best
outcomes.
When would you use problem tree analysis?
Problem tree technique is often used in project planning to provide a situation
analysis and gain a better understanding of a particular issue (and the
responsibility of different sectors). In health planning, it can be applied to an
intervention, a set of interventions or particular health issue that is of concern. It
could also be applied to a specific event (e.g. an outbreak of disease or maternal
death).
Steps in problem tree analysis
There are three main steps in the problem tree analysis: problem analysis;
objective analysis; development of strategies. It is necessary to have a wide
range of stakeholders contributing at all stages of the analysis and these will vary
according to the topic under discussion.
1. Problem analysis:
The definition of the problem can be done in a number of ways. A preidentified issue can be chosen prior to the analysis or the problem can
evolve from the analysis itself. For instance, low coverage of a particular
health service might be identified as an issue for discussion. Alternatively,
the core problem might emerge from a discussion on how to address
rising infant mortality. It is important to have a specific starting point for
the analysis to prevent discussion becoming too broad.
LIPH Handbook | 107
a. The problems associated with the issue under discussion are explored
with a relevant group of stakeholders. Only problems related to the
issue under discussion, that are real (not merely perceived) and that
are considered key issues should be included.
b. When all problems associated with a particular topic have been
identified, they are organized according to cause and effect and
the relationship they have with each other (see example Figure 11.
Simple Problem Tree Analysis Example).
High risk
pregnancies
unknown
Fewer interventions
to improve
outcomes for
mother and baby
LOW ANC 4+
Community
perceptions
Limited
knowledge
Communication
skills
Quality
of care
Access to
services
Geographical
access
Financial
access
Figure 11: Simple Problem Tree Analysis (Low ANC 4+)
108 |LIPH Handbook
CAUSE
Cultural
factors
Midwife
skills
CORE
PROBLEM
Fewer
facility- based
deliveries
EFFECTS
Higher maternal and

neonatal mortality
and morbidity
2. Objectives analysis:

Objectives analysis involves turning problems or reality into an improved

situation alternative reality (See Figure 12). At this stage, causes
that are likely to be responsive to change will become apparent. It is
recommended to find objectives for causes as far down the hierarchy as
possible, since addressing these causes will prevent subsequent issues
from arising. However, underlying causes (for example, relating to social
determinants of health, such as poverty) may not be readily amenable to
change. Other problems may be outside the scope of responsibility of
the health sector (for example, provision of safe drinking water). In some
instances simply changing negative statements to positive statements
can be done. For example, poor midwife communication skills can be
converted to improve communication skills of midwives. The overall
(core) objective is related to the core problem or issue. For instance,
Low ANC 4+ becomes increased coverage of ANC 4+.
EFFECTS
Reduced maternal
and neonatal
mortality and
Increased FBD
Increased
interventions to
improve outcomes
INCREASED
ANC 4+
Culturally
appropriate
ANC care
Improved
community
knowledge on
ANC
Improved
midwife skills
Improved
midwife
ommunication
skills
Improved
quality on
ANC service
Increased
access
Improved
physical
access
Improved
financial
access
STRATEGIES
Figure 12. Simple Objectives Tree

LIPH Handbook | 109
CAUSE
ROOT CAUSE
Improved community
perceptions
CORE
PROBLEM
Identifed
high risk
pregnancies
3. Development of strategies

For the objectives defined, strategies and activities that are actionable
need to be developed. Such strategies and activities should be
monitored to check that they are achieving the expected outcomes.
Subsequent problem tree analysis can be done periodically to check
whether existing problems have been addressed and whether new
problems have arisen.
110 |LIPH Handbook

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Local Investment Planning for Health

Handbook on Principles, Guidelines,

Local Investment Planning for Health

LIPH Handbook | iii

1.1 Planning Framework 4

2.1 Essentials in Planning 24

LIPH Content and Forms

Form 1. Summary of Investment Cost by

Form 2. Cost Assumptions by Instrument by

Form 3. Cost Assumptions by Instrument by

LIPH Appraisal Checklist 58

AOP Content and Forms

Form 1. Summary of Investment Cost by

AOP Appraisal Checklist

Competencies of Planning Teams

Tools for the Data Analysis

LIPH Planning Management Structure

Monitoring Checklist of the Planning Process

Types of Data and Possible Sources

Summary Workflow in Formulating LIPH/AOP

Sample Matrix on Health Strategy and Interventions 50

Workflow on Participatory Process in

Workflow Diagram in Formulating LIPH/AOP

Communication Diagram for Appraisal and

Simple SWOT Analysis

Indicators for Expanded Program on

Simple Bottlenecks Analysis

Problem Tree Framework

Simple Problem Tree Analysis (Low ANC 4+)

Figure 12 Simple Objectives Tree

LIPH Handbook | vii

Association of Barangay Captains

Annual Operational Plan

Barangay Health Worker

Bureau of International Health Cooperation

Bureau of Local Health Systems Development

City Health Office/r

Continuing Quality Improvement

Civil Society Organization

Department of Budget and Management

Department of Interior and Local Government

Development Management Officer

Department of Health Regional Office

Department of Social Welfare and Development

Field Health Services Information System

Geographically Isolated and Disadvantaged Areas

Health Facilities Enhancement Program

Health Policy Development and Planning Bureau

Human Resource for Health

Highly Urbanized City

Independent Component City

viii |LIPH Handbook

Indigenous Cultural Communities/Indigenous Peoples

Information, Education and Communication

Inter-Local Health Zone

Infant Mortality Rate

Local Chief Executive

Local Government Unit

Local Health Board

Local Health System

Local Investment Plan for Health

Millennium Development Goals

Monitoring & Evaluation