The Manual

On

Rural Health Unit

(RHU)

Operations

(Prototype Edition)

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 FOREWORD

The first Manual on Rural Health Unit (RHU Operations was issued in 1975 as a working
document on the nationwide operationalization of the Restructured Health Care Delivery System
(RHCDS) which was developed and pilot tested in Rizal Province. This was part of the General
Health Development Project that was the first to be financed by the World Bank in the country.

From the date of its implementation less than two (2) decades ago, major changes in health
organizations program priorities, interventions/strategies have been developed in response to the
changing health needs of our country and people.

Similarly, limitations/availability of resources for coping with the health needs also dictated the
interventions and strategies to be utilized.

The recent mandate to localize basic health services necessitated the devolution of certain
national authorities and resources to strengthen the implementation of health programs/services
by local communities. This called for changes never before realized to hasten the development
of local communities.

This Manual on RHU Operations, which is an output of painstaking efforts of the DOH Task
Force on the subject in collaboration with some of the field health workers is intended as a ready
guide and reference of the RHUs’ in its day to day activities.

It is recognized that the operations of the RHU are varied and multi-facetted. Therefore, specific
guidelines to direct the various functions/roles of the members of the RHU team as an individual
member are provided in separate handbooks (manuals) on the subject.

The latest editions of the following service manuals are therefore seen as accompanying
reference sets of this Main Manual:

1. Technical Services Reference Manual for RHU;

2. Manual for Public Health Nurse;
3. Operations Manual for Rural Sanitary Inspectors; and
4. RHM Service Manual

Health is a birthright of every Filipino and it is a constitutional mandate of the Department of

Health to ensure that this right is protected and enjoyed by everyone.

I hope that the RHU staff will find this Manual and its accompanying reference sets truly helpful
in its effort to provide the best health services to the general population, especially those in the
rural and far-flung communities, the poor and the underprivileged.

More power to all!

Juan M. Flavier, MD, MPH

Secretary of Health

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 1. THE DEPARTMENT OF HEALTH

This introduces the Department of Health (DOH) its organizational structure, powers and
functions, mission and vision, policies and strategies. It also traces the milestones in the
historical development of the organization from its early beginnings in 1577 to its present
status, as one of the government’s most efficient service institution.

The historical background of the DOH is a reflection of the rapid changes in health
technology and the emergence of health consciousness among the people not only among
those in the communities but also among national leaders who have given priority to health
in the national agenda.

Recognizing that health is a birthright, the DOH is organized for the specific vision that
every Filipino regardless of sex, age, creed and social status enjoys the right to health.

1.1 Historical Perspective:

The following events marked the evolution of the public health system of the DOH:

THE SPANISH REGIME:

A Spanish friar, Bro. Juan Clemente put up a dispensary for ministering medical
treatment to the poor in Manila. This was later expanded and organized into a
hospital, the San Juan de Dios Hospital.

The first organized isolation of the sick started in 1631 with the arrival of 150 lepers
from Japan. This was only done earlier whenever there was an epidemic of smallpox
and cholera, where victims were likewise isolated.

In 1805, the Spanish government with the introduction of smallpox vaccination

initiated real preventive work. A year later, the Central Board of Vaccination had the
responsibility of preventing smallpox and propagating the vaccine virus.

In 1690, a friar, Padre Juan de Peguero for the purpose of providing safe water for the
people of San Juan del Monte and Manila initiated a safe water supply system.

In 1863, various public health laws, particularly on housing, water supply, factory
sanitation and health for the regularly organized communities were enacted.

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 In 1876, the positions of Provincial Health Officers, known as “Medicos Titulares”,
and in 1888, the Superior Board of Health and Charity, headed by the Inspector
General (equivalent to the Director of Health), were created.

At the end of the Spanish regime, the presence of many hospitals, asylums,
orphanages, etc. ministering to the health and welfare of the Filipinos were noted.
This marked the beginning of the hospital system in this country.

THE AMERICAN REGIME:

Under General Order No. 15, the Board of Health, which was organized for the city
of Manila, was formally established on September 29, 1898 shortly after the
American Occupation of the Philippines.

Act. No. 1407 of the Philippine Commission abolished the Board of Health, and its
functions/activities were taken over by the Bureau of Health.

Act No. 1487 of the Philippine Commission in 1906, Repealing Act. No. 307
abolished the Provincial Board of Health to give way to the office of the District
Health Officer.

THE COMMONWEALTH PERIOD:

On May 31, 1939, Commonwealth Act No. 430 was approved providing for the
creation of the Department of Public Health and Welfare. However, it was not until
the 14th of January 1941 that the Department of Health and Welfare was formed by
Executive Order No. 317 signed on January 7, 1941. This gave the Secretary of
Health the supervision of the Bureau of Quarantine in the health department of
chartered cities, the provincial and municipal hospitals, dispensaries and clinics, etc.

THE JAPANESE REGIME

During the early part of the Japanese Occupation of the Philippines public health
services earlier developed were continued. By February 1942, however the Japanese
started to substitute reforms. The national organization was renamed the Central
Administrative Organization composed of six executive departments (health being
one of them). The Bureau of Health was mandated to function on its pre-war set-up.

Most public health activities were directed towards handling emergencies.

Towards the latter end of the regime, February 1944, Puericulture Centers were
reopened and were then established in the different municipalities and chartered cities
in the Philippines.

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POST LIBERATION PERIOD – (1945)

The Post Liberation Survey of Public Health Conditions among others indicated the
following problems:

- The incidence of malaria/TB/VD reached new and higher levels.

- Over 5,000 cases of leprosy, previously segregated were dispersed in the general
population.

- Widespread malnutrition.

- General sanitation problems in larger centers of population.

- Destruction of quarantine installations.

- The US Public Health Service (USPHS) gave priority to the different public
health programs as follows:

* Disease Control

- TB Control
- Malaria Control
- Leprosy Control
- Nutrition Program
- Immunization Program

* Environmental Sanitation

1950’s

R.A. 1082 and later amended by R.A. 1891 (the Rural Health Act) created the Rural
Health Unit (RHU) for every municipality in the country. A health team composed of
the doctor, nurse, midwife, and sanitary inspector/ clerk driver manned the RHU. The
unit provided health services on MCH, tuberculosis, environmental sanitation and
health education. For detailed provisions of the Rural Health Act on Population
Coverage (please refer to Annex B).

1960’s

The first 81 Rural Health Units were established in cooperation with FOA/Philcusa.

The Reorganization Act of (Executive Order 119) created 12 Regional Health

Offices each covering several provinces.

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 The organization of Regional Health Offices provided for a regionalization of health
services under the administration/supervision of the regional director who served as a
mini-secretary of health at the regional level.

1970’s

The eradication of smallpox worldwide in December 1979 due to the intensification

of the small fox vaccination rid the Philippines of this disease, which used to be a
disease of public health significance in the country.

The Restructured Health Care Delivery System (RHCDS) was instituted; Barangay
Health Stations expanded the coverage of the RHU to include remote areas and
communities. A BHS covered a population of 5,000 and was manned by the Rural
Health Midwife (RHM).

1980’s

Organization of the Family Planning Office in the Ministry of Health and launching
of the Population/Family Planning Program.

The Primary Health Care (PHC) concept was adopted as a strategy to improve
population coverage and to involve the community in its health care. Focus was given
to programs that have impact on improved health status of the people towards the
attainment of HEALTH FOR ALL.

Barangay/Volunteer Health Worker (B/VHW) were trained and utilized to assist in

providing health care to at least twenty (20) household each.

The integration of public health (preventive) and medical (curative) care led to the
creation of the Integrated Provincial Health Office (IPHO). District Health Offices
(DHO) were also established with the existing Emergency Hospitals and adjacent
RHUs as part of the catchment area.

The Milk Code or the “National Code for the Marketing of Breastmilk Substitutes,
Breastmilk Supplements and other Related Products” was signed as a law by the
President of the Philippines on October 20, 1986.

Republic Act No. 6675 or the Generic Act of 1988 was approved by the President of
the Philippines on September 13, 1988. The Act promotes, requires, and ensures the
production of an adequate supply, distribution, use and acceptance of drugs and
medicines identified by their generic names.

* The networking of hospital facilities established a system by which expertise and

resources are shared.

1990’s

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 DOH program thrusts were pursued with more vigor through the :

- Institution of the area program-based planning, including the strengthening of the

DOH financial management;

- Establishment of the Field Health Services Information System (FHSIS) and

computerization of health data;

- Partnership for community health development, with focus on strong linkages with
non-government organizations (NGOs) and other government organizations (GOs);
and,

- Integration of services for mothers and children.

1.2 ORGANIZATIONAL STRUCTURE:

1.3 DEPARTMENT OF HEALTH: ITS VISION/MISSION, POLICIES AND

MAJOR STRATEGIES

THE VISION:

Health For All Filipinos

DOH MISSION STATEMENT:

Guarantee equitable, sustainable and quality health for all Filipinos, especially the
poor, and to lead the quest for excellence in health

POLICIES:

PRIMARY HEALTH CARE

Primary Health Care (PHC) is the key strategy adopted by the DOH to health
development in this country.

PHC as originally defined in Alma Ata, in 1979 refers to the health care that is
available, adequate, accessible, affordable and acceptable.

PHC as a policy shall permeate as a core strategy in program thrusts of

government at all levels in order to enable people’s active participation and
involvement for better health and self-reliance.

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PREVENTIVE AND PROMOTIVE HEALTH

Preventive and Promotive Health will be the priority of the DOH and other health
partners and will not be limited to health programs. Hospitals and other centers
for curative care will be required to integrate preventive and promotive health
programs in health care delivery. Hospitals will not only be the centers for caring
for the sick, but will also become “centers of wellness”.

The DOH, in partnership with all sectors of society, will promote health and
prevent disease and disability in worksites, industrial areas, commercial centers,
schools, communities, hospitals, clinics and other places. Priority programs will
include the Expanded Program on Immunization, Safe Motherhood and Women’s
Health, Family Planning, Nutrition, Growth Monitoring and Promotion, Control
of Childhood Diseases, Prevention and Control of Cardiovascular Diseases and
Cancer especially the Smoke-Free Environment Campaign, Endemic Disease
Prevention and Control and Programs on social health problems like Human
Immunodeficiency Virus transmission (HIV/Acquired Immunodeficiency Disease
Syndrome (AIDS) and drug abuse.

PEOPLE EMPOWERMENT

Empowering people to achieve control over the decisions and conditions that
affect their health, shall be a major strategy toward attainment of Health in the
Hands of the People. Health care will be the responsibility of every individual and
will be less “doctor-centered” and increasingly “people-centered”.

Empowerment will be achieved through health information and education,

community organization and participation and other empowering approaches that
develop the capabilities for decision making in response to community health
needs.

POPULATION MANAGEMENT

The DOH recognizes the infiniteness of the natural resources base and the
challenge posed by meeting the needs of an unabated population growth.

The DOH believes in the spiritual value of human life but at the same recognizes
the freedom of women and men to chose the size of their families and to practice
family planning based on their own beliefs, religion and conscience.

The DOH will provide all individuals with equal access to information, service
and guidance in planning their families whether through natural or artificial
methods, as a means to attaining health and well being.

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 The DOH policy on population will be humane and gender-positive. Ensuring
women’s health and safe motherhood will be a priority, including at least 24
month spacing between pregnancies.

PERIPHERAL BIAS

Those who have been unserved and underserved by the government both in rural
and urban communities shall be the DOH priority targets especially the poor,
children, women, indigenous people, the aged and the disabled.

PHILIPPINE MEDICINE

The teaching and practice of medicine and allied professional shall be reoriented o
meet the needs of the majority of Filipinos and as such, all concerned institutions
and organizations shall be directed to develop and utilize teaching and training
materials, such as textbooks, instruments, curricula and technologies as well as
therapeutic modalities, based on experiences in the Philippines.

Partnership with Private Sector, Non-Government Organizations (NGOs), People’s

Organizations (POs) and other Government Agencies

The DOH will build a consensus for health care in the hands of the people by
lining up with other government agencies, local governments, the private sectors,
NGOs and POs who have over the past 20 years exhibited great efficiency and
flexibility in meeting the health needs of our people especially where government
has failed to make an impact.

The role of the private sector, which includes the professional health
organizations, civic groups, business and industry will be expanded to include
joint undertakings and social mobilization of programs, projects and ideas that
will redound to empowerment.

PESOS FOR HEALTH

In order to attain full realization of Health in the Hands of the People, budgetary
support is essential. Hence, all efforts will be exerted t increase the budget for
health in the process of national allocation of resources.

The DOH will explore other sources of health financing aside from government
allocation including community health financing, reforms in MEDICARE,
cooperative hospitals and health insurance among others.

PEACE BUILDING

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 Peace, is a pre-requisite for health. The DOH believes that Health in the Hands of
the People can only be attained in a democracy where there is trust and respect,
and where plurality of ideas and equality of all persons are recognized.

The DOH will promote peace initiatives in order to attain health goals among
victims of manmade disasters, crimes and violence. Emergency measures and
intersectoral health assistance will be ensured to prevent epidemics, injuries,
malnutrition, mental anguish and suffering among displaced communities and
internal refugees. Food, shelter, clothing, safe water, adequate environmental
sanitation, medicines and security will be available to all Filipinos, regardless of
tribe, religion and ideology.

POSITIONING FOR PERFORMANCE

In order to attain effectively and efficiency, the DOH will prioritize a process of
continuous assessment of the health situation, particularly its trends, patterns and
directions. It must apply critical thinking to the health situation in order to isolate
key factors and variables impinging upon health care.

MAJOR STRATEGIES:

Elevating Health to a Comprehensive and Sustained National Effort

Attaining Health for All Filipinos will require expanding participation in health and
health-related programmes whether as service provider or beneficiary. Empowerment of
the parents, families and communities to make decision on their health is a desired
outcome.

Advocacy must be directed to national and local policymakers to elicit support and
commitment to major health concerns through legislations, budgetary and logistical
assistance.

Advocacy can not only heighten demand for quality services but also generate resources
for health care and improve coverage. Communication and media attention can build and
sustain public awareness. So it is imperative that participation of advocacy groups be
promoted and a supportive mechanism be institutionalized and made operational.

Elevating health into a national effort must commence even at the planning and policy
formulation stage. Developing the national health plan is an opportune time for genuine
consultation and consensus building. This, in turn, will have to be translated into
provincial, city, municipal and barangay plans. All of these plans will strive to integrate
all health operations (public health and hospital), emphasize health promotion and disease
prevention and include disaster preparedness and mitigation.

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Promoting and Supporting Community-Managed Health Care

The vision of Health in the Hands of the People brings the government closest to the
people. It necessitates a process of capacity building of communities and organizations to
plan, implement and evaluate health programs at their levels. The DOH, in promoting
community-managed health care as a cornerstone to health, must manifest support to
community organizing and organizations, establish sustainable mechanism for
community-managed financial scheme and identify and develop indigenous health
resources.

Increasing Efficiencies in the Health Sector

The DOH will safeguard and strengthen the integration of health operations to maintain
the quality of health care. It will continue to enforce standards and regulations of health
establishment and health-related activities. The DOH will maintain disease surveillance,
program monitoring and health information systems.

It will also evolve an appropriate organizational structure responsive to devolution and

decentralization. The integrating, networking and linking of health operations and
organizations will enable the DOH to assume a flat, horizontal organization flexible and
accessible to collaborating agencies, groups and even communities.

Using appropriate technology will make the services and the resources required for their
delivery effective, affordable, accessible and culturally acceptable. Traditional medicine
will be promoted in this respect.

The development of health human resources must correspond to the actual needs of the
nation and the policies it upholds such as Primary Health Care. The DOH, together with
the educational institutions, will have to give this thrust form and substance.

Analysis of the health human resource situation, formulation of policies and plans and
monitoring the implementation will be essential. The DOH will continue to provide
support and assistance to both public and private institutions particularly in faculty
development of standard teaching materials. The DOH will sustain its effort on the
training and utilization of community health volunteers.

The DOH will ensure that rights and privileges of public health workers will be respected
as provided by the Magna Carta for Public Health Workers. The DOH, through a
continuing staff development and a comprehensive career path for health workers, will
take the lead role in keeping a pool of highly trained and motivated personnel.

The DOH, building on its success stories, will promote centers of excellence in public
health programs such as the Expanded Program on Immunization and the Baby Friendly
Hospital Initiative and pioneer institutions like the Research Institute for Tropical

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 Medicine. These will serve as venues for lessons learned and recognition for outstanding
performance.

Advancing Essential National Health Research

Essential National Health Research (ENHR) is an integrated strategy for organizing and
managing research using an intersectoral, multi-disciplinary and scientific approach to
health programming and delivery.

2. ORGANIZATION OF THE MUNICIPAL HEALTH CARE DELIVERY SYSTEM

2.1 Overview of the System

The health care delivery in a community is a partnership among government and non-
government organizations (NGOs) with an effective support from the community. The
government is represented in the municipality by the Rural Health Unit as part of the
municipal government in collaboration with the other agencies of government and the private
sector at operating that level, provides the leadership for in community health work.

The health regulatory and inspectorial services in the municipality are primarily the
concern of the RHU in cooperation with official agencies with such specific functions. In the
field of prevention and medical care, however, a strong participation and support of non-
government health/non-health organizations, where they are present may be encouraged.
Such participation may range from the assignment of geographical coverage of all public
health services (as may be done for voluntary non-profit agencies) or the referral of patients,
who are willing and financially able, to private medical practitioners. Support of such
agencies by the RHU may not only be through referrals but may take the form of actual
extension of services (follow-up of cases referred to them, giving of injections, etc.), use of
RHU facilities, provision of vaccines, etc.

Under such arrangement, the RHU is expected to provide or make available the medical
service to those who cannot afford the fees charged by private agencies or individual or who,
for one reason or another cannot obtain services from the latter.

The Barangay Health Stations (BHS) which is manned by the Rural Health Midwife, is
the lowest level of health care system. Located in the barangay, the BHS provides the first
contact of the community with the government health delivery system. Barangay Health
Workers (BHW) who are voluntary workers from the community and who are recruited and
trained by the RHUs assist the barangay health stations in the delivery of community health
services. Community involvement and participation are encouraged by way of case reporting,
involvement in sanitation/nutrition and other health projects such as health education, and
transportation of specimens. In medical cases, the barangays are very helpful in establishing
facilities for the sale of commonly needed drugs at government cost, assistance in the

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transportation of patients who may need further care in higher level health facilities and the
administration of simple remedies.

The total community health care delivery system may therefore be conceptualized by
analyzing the three-tiered levels of health care delivery system in the community as follows:

1st level - Barangay Health Station (RHM)

2nd level- Main Health Center (PHN)

3rd level- Main Health Center (MHO)

In a community, a patient is first cared for by the family, who may or may not
need any further medical care. If, however the patient needs further care, he is
referred to the Barangay Health Station (manned by the RHM), which is the first level
of contact with the government health care delivery system. If the assistance required
be beyond the capability of the RHM to provide, the patient is referred to the PHN
who is stationed at the Main Health Center (RHU) for further care. The level of care
given by the PHN is referred to as the second (2nd) level of health care.

Similarly, the cases which are not within the capability of the PHN are referred to
the Municipal Health Officer (MHO) who is also stationed at the Main Health Center
where the RHU is housed. The care given by the MHO is referred to as the third (3rd)
level of health care in the community. Thus, in the community there are three (3)
levels of health care provided by the RHU; namely, first level (RHM), second level
(PHN), and third level (MHO).

In the national system of health care delivery, the levels of health care provided
by the RHU are referred to as “primary” health care services.

Other higher level of health care services are provided through a system of
referrals to the district or provincial hospitals (secondary health care service center
and the regional hospitals/medical centers tertiary health care services) depending on
health care facilities/capabilities available thereat.

Other categories of health workers such as the public health dentist, laboratory
technician, nutritionist/dietician, etc. who are assigned to the community carry out
their functions as a member of the RHU team.

2.2 Rural Health Unit Structure

Usually located at the heart of the population of each municipality (near the
Municipal Hall) the Rural Health Unit (RHU) is headed by a Municipal Health Officer
(MHO) who exercises administrative supervision over his staff. The members of his staff
include a Public Health Nurse (PHN), a Sanitation Inspector (SI) and the Rural Health
Midwife (RHM). When available in the municipality, the Public Health Dentist, the

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 Laboratory Technician (Microscopist), Nutritionist- Dietitian are added members of the
RHU Staff, thus:

Organizational Structure of the RHU

Municipal Health Officer (MHO)

Public Health Public Health Sanitation Medical Nutritionist

Dentist (PHD) Nurse (PHN) Inspector (SI) Technologist Dietitian

Dental RHM RHM

Aide

Each RHU, depending on the population, covers several barangay/communities through a

network of Barangay Health Stations, each manned by a Rural Health Midwife (RHM- see
above).

Each BHS serves a population of 5,000.

In cases of domicillary attendance due to gravity of the case, the PHN and /or the MHO
may be summoned to the residence of the patient of assistance.

In the field of sanitation, the referral procedure is from the RHM to the Sanitation
Inspector (SI). Subsequent follow-up of action taken by the RSI may be done directly or during
regular meetings in the presence of the MHO.

It should be noted that under the RHU structure, the basic health services, which fall
within the competence of the RHM, are to be developed by her, with support and guidance from
the PHN and the MHO.

In dental health, the Public Health Dentist (PHD) renders dental service either at the
Main Health Center, Barangay Health Stations or Schools, receiving self referred patient as the
case.

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 FUNCTIONS/RESPONSIBILITIES OF THE RHU STAFF
(Based on D.O. 114 s. 1991)

MUNICIPAL HEALTH OFFICER (MHO)

A. Management:

As the head of the RHU team, the MHO is responsible for the whole range of management
functions – from planning to evaluation. He shall:

1) Make sure that the Area-based program planning methodology is correctly followed
by the RHU staff.
2) Present the RHU plan to the local health board and make sure that it is included in the
municipal development plan.
3) Negotiate for the RHU resource requirements from the local health board.
4) Call and chair regular monthly staff planning, consultation, operations and review
meetings.
5) Determine manpower needs and decide task assignments of RHU staff.
6) Recruits, assesses and recommends new staff for hiring.
7) Assess technical, managerial and communication skills of all RHU staff, especially
the supervisory skills of the RHU.
8) Reviews and approves the proposed training plan for RHU staff incorporating her/his
own training needs.
9) Provide on the spot training for specific needs to all RHU staff.
10) Organizes in-house courses for special topics as appropriate based on identified
weaknesses/problems.
11) Develops, plans and implements an appropriate system of staff assessment,
motivation and reward.
12) Periodically visits the barangay at least once a month and as often as the need arises
to counter check supervisory findings especially problems brought to his/her
attention.
13) Provides feedback to the higher level management regarding useful innovations
developed or problem areas encountered at the RHU level.
14) Reviews/approves tools indicators and schedules for supervision/evaluation.
15) Develops and enforces a system for proper management of logistics such as
memorandum receipts, proper requisition and issue auditing and accounting
procedures. This includes when to reorder supplies and decisions for proper disposal
of non-functioning equipment through proper condemnation procedures, etc.
16) Identifies/mobilizes community resources to augment government resources.

B. Health Care:

As a technical expert in individual care, the MHO:

1) Makes sure that all staff acquires the basic knowledge and skills required for the RHU
personnel.

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 2) Counterchecks the organization of the delivery of services (referrals, flow of patients,
etc.).
3) Translates the integration thrusts of the DOH- particularly those in maternal and child
care- into practical steps to deliver services from the point of view of the clients, not
the programs.
4) Attend to referred cases.
5) Conducts barangay level clinics in each barangay in the municipality at least once a
month and as often as the need arises.

C. Epidemiology and Statistics: As the epidemiologist of the RHU, the MHO:

1) Learns and practices all epidemiological skills necessary to do disease surveillance

and outbreak investigations.
2) Analyzes weekly disease surveillance reports and immediately reports outbreaks to
proper authorities using standard formats.
3) Conducts epidemiological investigation on all reported outbreaks as much as
possible.
4) In a confirmed outbreak, institutes appropriate control measures.
5) Determines the cause of death of persons dying without medical attendance and
issues the necessary death certificates.

D. As the head of the RHU, the MHO:

1) Is vice chairman of the Municipal Health Board.

2) Is responsible for all community health projects.
3) Represents the public health sector in gatherings/activities in the community.
4) Encourages active participation of the private sector and community groups in policy
developments, planning and others.
5) Undertake advocacy activities in articulating health concerns.

E. Legal and Medico –Legal:

1) Enforces all sanitary laws and regulations applicable to his municipality and shall
cause any violation to be duly prosecuted.
2) Enforces any internal quarantine regulations applicable to his municipality.
3) Recommends to the municipal council suitable ordinances or regulations for carrying
into effect the powers conferred by laws upon such body in respect to matters of
sanitation.
4) Conducts autopsies and other medico-legal clinical assessment.

F. Supervision by MHO

The MHO shall exercise supervision over all aspects of health work, keeping in mind that
supervision aims primarily to provide guidance, support, and encouragement to the health
workers so that they will be able to carry out their activities as prescribed. The MHO

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 exercises administrative supervision over his staff. However, in the field of technical
supervision, he shares this with higher level supervisors.

The MHO must see to the following:

1. That all his staff know their duties and responsibilities, the programs to be
implemented, and the contents of their operational manual;
2. That work at the MHC and BHS are proceeding as planned, and that they are
given the proper support and logistics necessary;
3. That the staff is timely informed of the programs in all BHS’s and the RHU as
a whole;
4. That the staff informs him of all the operational problems encountered, so that
needed corrections may be instituted.
In order that the above may be accomplished, the MHO, assisted by the PHN, must do
the following:

1. Adequately briefs the staff upon reporting to duty and periodically during
regular monthly staff meetings;
2. Visits regularly the BHS’s and make spot checks of randomly selected cases
or establishments/houses for report verification and technical audit;
3. Checks correctness and timeliness of submission of reports, and processes
them promptly in order to compare the actual performance with the expected;
4. Processes reports of inventory and provides the needed supply;
5. Checks action taken on referrals made by the staff with each other;
6. Sees to it that all members of the RHU, including himself, have an itinerary of
field visits; and,
7. Sees to it that in each MHC and BHS, daily schedules are posted and
whereabouts of staff are indicated;
8. Convenes a staff meeting within the first week of each month or as often as
needed, (preferably in the afternoon) to be attended by all the BHC and MHC
staff.

G. Coverage and Areas of Responsibility:

In case there are more than one RHU in the municipality, one of them will be designated
coordinator of the Rural Health Service. The functions of the coordinator is not that of
being the supervisor of the other MHO’s in the area, but that of:

- Seeing to it that the agreements as to area coverage of each unit is observed;

- Transmitting instructions through him to other MHO’s;
- Representing the Municipal Health Officers in council meetings;
- Consolidating RHU Reports for the municipality; and
- Providing any necessary support to other RHU’s.

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H. Activities of an MHO Upon Entrance to Duty:

As head of the RHU, the Municipal Health Officer assumes the leadership for the
directions that the RHU shall take. The activities he will undertake when reporting for the
first spell effort to serve the health needs of the community people. The following initial
activities need to be undertaken:

1. After the orientation/on the job training, the MHO meets with whoever staff are
present in the MHC and arranges for a meeting with his staff and the municipality
leaders.
2. Makes a courtesy call to the municipality mayor and other chiefs of allied forces, all
barangay heads, either in a mass meeting or through individual barangay visit.
3. Conducts inventory of supplies and equipment, checks vehicles and buildings of the
MHC, notes down results, and makes corresponding recommendations to the Mayor/
implementation and accomplishments.
4. Reviews the municipal are-based plan of the different programmes, report to the local
health board and explain the programs to be implemented.
5. Checks on whatever reports are due or delayed and accomplish them accordingly.
6. Meets with all staff receive briefings from them regarding their areas of coverage,
progress of programs, problems and barangay clinic inventories of supplies and
equipment. Finds out if staff have some personal problems that the MHO may be of
help.
7. Familiarize oneself with the following date:

- Population and number of houses by barangay and names of corresponding

barangay leaders.
- Vitals data on birth and deaths by barangay (CBR, IMR, MMR, Deaths without
medical assistance), and the common cause of deaths and sickness.
- Map of community showing the different barangays, the roads connecting them
(describing conditions and distance from the MHC) available transports and
important landmarks.
- The way in which the community is presently zoned for purposes of coverage by
health workers and the location of barangay clinics.
- The percentage of houses with safe water supply and the sanitary waste disposal
by barangays.
- Distribution by barangays of food establishments, schools and corresponding
enrollments.
- Information on health resources other than the RHU.
- Memo’s, circulars, operational manuals for Nursing Personnel, Midwives, and
Sanitation Inspectors and Public Health Dentists.
Items 1 to 6 are to be done as soon as possible within the first week of the MHO’s stay,
while the subsequent items are to be done within the first two months of the MHO’s
assignment.
PUBLIC HEALTH NURSE (PHN)

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PUBLIC HEALTH NURSE (PHN):

The PHN works closely with the MHO. She/He is a very important health care
provider. Together with the MHO, she supervises the RHMs and acts as the immediate
assistant to the MHO. If, for some reason, the MHO is not available or is not able to
execute his/ her functions, the PHN performs the MHO’s functions as appropriate to her
capabilities. Her perspective is essential in streamlining the activities of the RHMs she/he
supervises, most especially the community health activities.

Management:

The PHN assists the MHO in all of the management functions. To do this, the
PHN shall:

1) Provides technical assistance to RHMs in preparing their barangay-based

health plans.
2) Assists in drafting the RHU plan incorporating the RHU activities and
resources needed to make sure that the barangay based health plans are
accomplished.
3) Assists area program planning in identifying needs in staffing and task
assignments for RHU/BHS staff.
4) Recommends special strategies for organizing manpower such as mobile
teams or “bayanihan” teams.
5) Assists in the regular assessment of the technical, management and
communication skills of the RHMs.
6) Assists in the preparation of a training plan for all RHU staff based on the
training needs.
7) Conducts a post-training assessment of RHMs.
8) Attends supervisory skills development courses.
9) Conducts at least once a month supervisory visits of each RHM in their
barangays according to the RHM’s capability and performance. This shall
include preparation of supervisory checklists, indicators and tools; and
reporting to visit findings and problems. Difficulties and major or recurrent
problems shall be reffered to the MHO.
10) Enters into the supervisory book kept by RHMs all her monitoring findings
and recommendations and the date of the next visit. This will serve as a guide
for the RHM’s appropriate action and reference for the next monitoring visit.
11) Acts as the overall property custodian of the RHU. This includes requisition,
allocation, distribution and proper use of equipment, supplies and materials;
training of other RHU staff on the proper use of this material; proper
recording, reporting and accounting; and timely referral for repair of
nonfunctional equipment. She may be assisted by other RHU staff as
designated by the MHO.
12) Assists the MHO in developing or adapting tools for evaluating the RHU and
its programs and in implementing evaluation activities. This shall include

19
 recommendations on reward and discipline scheme as appropriate at the RHU
level.

Health Care:

The PHN shall recognize the special midwifery skills of the RHMs and must provide, in
technical guidance of the RHMs on the nursing aspect of the care of the individual
patient. To do this, the PHN shall:

1) Review the management by the RHM of a selected number of patients.

Her review shall focus on:
1.1 corrections of assessment of patient needs;
1.2 faithfulness to procedures according to available guidelines/rpotocols
on proper treatment; and,
1.3 appropriateness and adequacy of medications given, according to
national drug policy, the policy not to use anti-diarrheals and cough
medicines to children, the standard regimen of the DOH, among
others.

It shall, therefore, be the responsibility of the PHN to know these relevant policies
and communicate these to the RHMs.

2) Develops and adapts tools that will assist RHMs in systematically delivering
services in a client-based manner. Such tools can include, among others,
postersize treatment and management charts and flow charts pasted on walls;
or desk-top checklist or other materials.
3) Proposes clinic flow and management systems that will facilitate the smooth
flow of patients; easy retrieval of patient charts and records; and streamline
health education activities and services.
4) Attends to referred cases within her capability.
5) Assists the MHO in minor surgical cases treated at the RHU.

Epidemiology and Statistics: The PHN shall:

1) Proposes and prepares tools (e.g. graphs, tables and chart of selected
summative health indicators and special activities) for better analysis of
service delivery and performance results.
2) Teaches RHMs the standard case definition, and use these in disease
reporting.
3) Prepares a graph of weekly disease incidence in the municipality and display
these conspicuously.
4) Immediately alerts the MHO of any unusual increase in incidence of diseases
taking into consideration selected diseases that need to be reported within 24
hours after the case is seen.

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 4.1 Assists the MHO in outbreak investigations following proper guidelines
by collating preliminary reports and filling-up case investigation forms,
among others.
4.2 Plans and secures necessary resources needed for disease control
measures. This includes identification and calculation of resources
required such as vaccines, needles and syringes and other materials.

5) Supervises the RHM in accurate recording and timely reporting ad proper

utilization of health information.

Community Health and Organization:

1) Provides technical guidance to RHMs on proper identification of community

health problems and strategies to solve these. She may promote appropriate
attitudes and concepts by making sure that the objectives of community
participation and organization are clear to everyone and that effective
methodologies to inform and mobilize communities are used.
2) Oversees monitoring of PHC committees, BHW training, hilot training,
mothercraft and mothers’ classes and other community activities.
3) Reviews curricula for BHWs, hilots, mothers and other curricula or syllabi
used in health education activities. She shall make suggestions for
improvement as appropriate.
4) Proposes a municipal level health communication plan targetted at the general
public or specific sectors of the community.

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RURAL HEALTH MIDWIFE (RHM):

The RHM is the most peripheral first level health worker in the Department of Health
(DOH). She translates health programs and plans into direct services to clients.

Management : In Planning, budgeting and logistics management, the RHM

shall:

1) Prepares and submits an annual health plan for her catchment barangay
following the “area-based program planning” methodology, involving local
barangay officials and other community members. This includes:
1.1 collection of all necessary barangay level information needed in the plan;
1.2 identification of problems and its causes;
1.3 formulation of goals and measures; and
1.4 identification of activities and resources required to accomplish these
activities.

2) Submits a list of her training needs based on standard list of basic training
knowledge and skills required for the RHM.
3) Uses equipment, drugs and other supplies properly accordingly to standard
treatment and management guidelines issued by the DOH. This function shall
include proper recording and accounting of equipment, supplies and materials
received, disbursed and utilized/ distributed; and maintenance and referral for
repair of equipment.
4) Maintains properly the barangay health station and its premise.

Health Care:
The RHM shall:

1) Makes a thorough assessment of the total health needs of her clients and their
families.
2) Provides the range of basic Maternal and Child Health(MCH) services listed
in Annex B according to her assessment of the needs of her clients and their
families. These services should be provided in a continuing and
comprehensive manner and with particular attention to high risk individuals
and families.

Continuation of health care includes, among others, completion of primary

immunization doses so that all children are fully immunized before they reach one
year old; completion of tetanus toxoid (TT) doses of pregnant women before they
deliver; promotion and monitoring of growth from birth until the age of five
years; feeding of the underweight child until he/she is fully rehabilitated; and
regular prenatal, natal and pospartum care including family planning services.

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 3) Based on a family health care plan, provide all other basic health consultation
and referral services.
4) Conducts clinics in every barangay in her catchment area: at least once a week
if the barangay is accessible within 2 hours by regular routes; at least once a
month if the barangay can be reached only after 2 hours using the regular
routes.
5) Records all health services rendered, maintain a recording and filing system
and keep a supervisory record book for her supervisors’ comments and
recommendations.

Epidemiology and Statistics:

1) In disease surveillance and outbreak investigations, the RHM:

1.1 Reports disease incidence using the standard case definitions.
1.2 Monitors a selected number of diseases, by charting or graphing them on
weekly basis as they occur in her barangay/s.
1.3 Immediately alerts the MHO of any unusual increase in the disease
incidence of any of the selected diseases. For some diseases, reports are
needed within 24 hours after seeing the patient.

2) In the registration of births, deaths and other cases, the RHM shall report
births and deaths according to standard routine reporting formats.

3) In program accomplishment feedback, regularly and accurately reports service

performance using the field health services information system. She shall also
use information from this system in her routine management and health care
functions.

Community Health and Organization: To promote community participation in health

care, the RHM shall:

1) Identifies community leaders and health volunteers, local government and

NGOs’/People Organizations.
2) In coordination with the local government organization, NGOs’ and people
organizations, enhance the area-based barangay health plan using community
level information.
2.1 Community meetings and assemblies.
2.2 Health education sessions such as mothercraft and mothers’ classes,
“hilot” classes, barangay health workers trainings, household teachings
and others.
2.3 Community health promotion projects such as environmental sanitation.
2.4 Distribute and monitor utilization of IEC materials.

3) Organizes and monitors Barangay Primary Health Care committees and

actively participate in existing community health organizations in the
barangay/s.

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 4) Regularly follows-up and extends technical support to barangay health
workers, hilots and other health volunteers within her catchment areas.
5) Conducts an annual catchment area survey on sanitation.

Sanitary Inspector (SI)

Duties and Responsibilities:

The following are the duties of a rural sanitary inspector:

A. Administration

- Plans programmes for environmental sanitation together with the Municipal

Health Officer (MHO) and requests the necessary budget from the authorities
concerned.
- Participates in the total health programme, planning of the community, staff
meetings, community meetings, conferences and, training, etc.
- Prepares sanitation reports and maintains proper filing system and updates
sanitation records.
- Establishes good working relationship with the different community
organizations, especially the barangay, and involves them in planning and
implementation of the sanitation activities.
- Attends to complaints and legal matters in relation to his work.

B. Environmental Sanitation

1. Assists in the provision and maintenance of safe and adequate water supply to the
community.
2. Assists in the provision and maintenance of sanitary disposal facilities for human
excrement and sewage.
3. Assists in the provision of safe and wholesome food to consumers through
enforcement of sanitary rules and regulations and training of food operators and
food handlers.
4. Helps and promotes in the provision of sanitary storage facilities, and proper
collection and disposal of solid waste either by individual, group or municipal
system.
5. Conducts vermin density survey and assists in the elimination of breeding and
harborage places and conducts or guides organized control programme.
6. Assists in the provision of sanitary facilities and maintenance of the sanitary
condition in public places such as schools, public buildings, parks, palygrounds,
public transports, air and sea ports, swimming pools, bars, hotels, amusement and
recreational centers, etc.
7. Establishes close working relations with the environmental protection agencies.

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8. Carries out periodic inspection in accordance with the standard frequency for the
different fields of environmental sanitation, using the prescribed form and is
required to conduct inspection from time to time as the need arises.
9. Assists in the implementation of health education activities especially those
activities related to environmental sanitation.
10. Assists in the epidemiological investigation and institute measures to mitigate the
outbreak.
11. Gives technical advice and guidance along environmental health to
midwives/public health nurses in their assignment areas, when needed.
12. Distributes and monitors the utilization of sanitation IEC materials.

Other categories of health workers may be assigned to the RHU for some length of
time. As such, they work under the administrative supervision of the MHO as a
member of the RHU team. They include the following:

Public Health Dentist

He/She:

1. Provides leadership for the elderly development of the needed dental services
and facilities in their area of assignment.
2. Conducts community diagnosis to determine dental needs/problems and the
available dental resources in the community to help meet these needs.
3. Participate in area program based Dental Health Planning.
4. Develops action plan and implements Dental Health Program Based on area
based program planning.
5. Performs clinic procedures that are within the scope of the services in line
with the standard requirements of the Dental Health Service.

Scope of Sevices:

Case Findings
Preventive Services
Curative Services
Referrals
6. Implements accepted and proven preventive measures such as fluoride
utilization and/or pit and fissure sealants.
7. Initiates and participates in the development of Dental Health Education
Programs.
8. Establishes and maintains intra and inter sectoral linkages with government,
other non-government agencies in the implementation of the National Dental
Health Program.

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 9. Submits monthly, quarterly and annual reports of accomplishments and/ or
other reports required by the WHO, PHO Office of the Provincial Governor
and Provincial Board.
10. Disseminates and comply with approved itinerary of travel and other plan of
activities.
11. Maintains dental health records.
12. Participates in monthly staff development conferences.
13. Acts as adviser, resource person on dental matters.
14. Participates actively and integrate the dental service with other dental health
programs in the community.
15. Establishes functional 2-way referral and follow-up system.

Municipal Nutritionist-Dietitian

When available in the municipality, the Municipal Nutritionist-Dietitian performs

the following as a part of the RHU team:

1. Provides technical assistance to the RHM in organizing barangay for nutrition.

2. Conducts training on nutrition for BHW and other community volunteers.
3. Assesses the nutritional status of the community.
4. Prepares a community nutrition profile.
5. Prepares a family health/nutrition folder.
6. Provides technical assistance in the development of a municipal nutrition plan.
7. Helps the RHMs implement the following nutrition programs in the
municipality:

7.1 establishment of mothercraft nutrition and health center

7.2 promotion of exclusive breastrfeeding
7.3 provision of food prescription for dietary treatment and modification of
feeding habits
7.4 provision of food assistance to target groups
7.5 provision of micronutrient supplementation
7.6 conduct nutrition education and diet counselling
7.7 conduct OPT and growth monitoring
7.8 promotion of food fortification

8. Distirbutes, monitors utilization of Nutrition IEC materials.

9. Supervises, monitors and evaluates the nutrition program in the municipality.
10. Establishes and maintains linkages with other GOs and NGOs or nutrition
work.
11. Acts as technical resource person or nutrition.
12. Performs other task as may be assigned by the MHO.

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 3. GENERAL POLICIES RELATED TO RHU OPERATIONS
(Policy Guidelines)

3.1 Primary Health Care shall be adopted as the major strategy for the promotion /
protection of individual, family and community health.

Primary Health Care is defined as “ a practical approach to health development

that recognizes the interrelationship between health and the over-all socio-
economic development and by effectively providing among others essential
services that are based, accessible, sustainable, and a cost which the community
and government can afford”. (WHO)

3.2 The programs shall be carried out by the RHU following the
integrated/comprehensive approach

By integrated comprehensive approach, is meant the delivery of the widest

possible range of services to meet the health needs more effectively of the
clientele. For example: at every encounter between the health worker and
mother/child beneficiary at the point of service, the integrated comprehensive
Maternal and Child Health Service (CMCH) must be provided with the
total/integrated health of the mother/child in mind.

3.3 With regards to the health programs which are administered at higher levels
(programs not devolved to Local Governments and programs with wider coverage
and foreign-assisted programs) the area of RHU participation shall be those
defined by the central office concerned and by Manuals of Procedures provided
separately. Such participation are defined under the sub-section of this manual on
“Programs Conducted by the RHU”.

3.4 The implementation of the basic heath services shall be decentralized within the
community. However, the overall responsibility shall reside in the MHO. When
there is more than on Rural Health Physician (RHP) (official plantilla designation
of nationally-paid MHO in the community, the one duly designated by the mayor
is the overall coordinator of the RHUs.

3.5 The staff of the RHU shall have expanded roles in addition to their regular
functions in so far the basic health programs are concerned. However, such
assignment shall be within the scope outlined by their respective job descriptions,
those who belong to special programs but seconded to the RHU otherwise so
stated in the assigning order, are not covered by this provision.

3.6 The RHU shall maintain a close coordination and complementary relationship
with specific operational units of vertical health programs in the area as well as
other agencies, government or non-government such as peoples organizations,
women/youth groups, etc.

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3.7 The RHU staff t the BHS/MHC may not charge renumerations for services
rendered in the form of voluntary contributions.

3.8 Referral of cases from the RHU in the BHS to the PHN and MHO in the MHC
and vice versa from the MHC to other agencies within or outside the municipality
including hospitals and vice versa shall be strengthened/utilized effectively.

3.9 The ratio of rural health unit staff-to-clientele population served shall be reviewed
periodically to prevent overloading or understaffing and hence enable the health
staff to render quality health care and support services.

3.10 The staff of the RHU shall be covered by the provisions of the Magna Carta of
Public Health Workers (R.A. 7305)

Refer to Implementing Rules and Regulations of Magna Carta of Public Health

Workers for details 1991.

3.11 Each area of responsibility of an RHU shall further be subdivided into zones
which will be the catchment of the barangay health stations.

Each of the BHS is expected to over a population of more or less 5,000.

Whenever possible the division into which each unit should not cut or split up a
barrio or barangay into different BHS responsibility. The site of the BHS shall be
located by the PHN (refer to PHN Manual for criteria). Approval will be given by
the MHO.

3.12 In the event that there is more than one RHU in the community, the responsibility
shall be divided among them in the most practical and efficient manner. However,
one Main Health Center shall serve as the official headquarters for the whole
municipal health service designating the MHO who will be considered the over-
all coordinator of the community health service.
3.13 In the event that there are more than one (1) PHN or SI in the unit, the area shall
be further subdivided into zones for nurses and zones for the SI, respectively.

3.14 If another health agency, government or private is operating in the area of

responsibility for it shall be assigned. The nature of the assigned duties shall be in
accordance with its capability to be decided upon by the municipal health board
covering the place, and the staff in charge of the other health facility.

3.15 Barangay visits by the RHU shall be scheduled as follows:

- MHO- he shall visit each barangay health clinic at least once a month. In areas
which are of difficult accessibility, he is expected to visit them at least twice a
year, with a team organized from staff of the existing unit, and if available,
from the local medical/allied associations. The content of such visits will be
general morbidity and MCH clinics, collection of blood smears in malarious

28
 areas, school health activities, vital event registration, and public health
education.
- PHN- she shall visit each barangay health stations at least once a month for
purposes of technical and administrative supervision of the RHM.
Unscheduled visits are done whenever the need arises such as a call for
assistance from the RHU of a follow-up of a priority case.
- RHM- she shall visit each barangay within their area of coverage at least once
a week. They are expected, however, to hold clinic permanently in the
Barangay Health Station (BHS).
- SI- initially, he shall prepare an itinerary for the sanitary survey of the
community.

4. GENERAL ADMINISTRATION OF THE RHU

4.1 Conduct of Meetings.

Each RHU is expected to hold a staff meeting convened by the MHO within the first
week of each month and as often as the need arises.

Objectives:

- To follow-up the problems defined in the last meeting.

- To discuss solutions for the problems.
- To review the accomplishments in the last month (re-monthly report) as compared
with the targets and earlier accomplishments.
- To disseminate any new information received from the PHD (new instructions,
programs, memos, etc.).
- To plan the activities for the next month.
- Other matters

Agenda:

Items: Contents

Review of problems discussed - What problems were solved?

in last meeting - What problems remained unsolved?
- What action to be taken to solve the
problems?

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 - What has to be done in the meanwhile
(intermediate solutions)?

Problems encountered - each staff to bring up problems (supplies,

equipment, staff, claims, transport, comm.
support, etc., largely operational problems);
- formulate solutions to problems that be
solved logically;
- refer to those that need attention of
appropriate authority.

Review of last month - general observations from supervision

conducted by MHO, PHN, & other
supervisors who visited the place. These
should be in general terms & not directed to
any one staff (particular problems of one
staff should be discussed with him alone).
- salient features of last month report
(progress, shortcoming). This should be
prepared beforehand by MHO in
conjunction with PHN by going thru last
monthly report and comparing with previous
report and monthly targets.

Information - MHO should inform the staff of instructions

received new developments in the health
programme, etc. Other RHU staff should be
given the chance to inform the others on
matters considered of general interest (ex.
Opinion voiced by Barangay leaders on
health services, etc.).

Plan for the next month - Discuss future work plans to be

implemented in the next month, including
scheduling & review of itineraries, designate
responsibilities.

Minutes of Meeting:

The minutes of the meeting shall be made by the PHN, RHM or SI who shall be one of
the staff, appointed on a rotation basis by the MHO.

The minute should note only the following:

30
 - Problems discussed
- Problems solved
- Problems unsolved and who shall take action regarding them
- The salient points noted in the review, and work planning
- The tabulated review of accomplishment must be recorded for future reference

Note: RHU must maintain a separate folder for monthly meetings

Aside from the regular meetings, in the event that the municipality is served more
then one RHU, there should be a regular monthly meeting among the MHO’s, PHN’s,
SI’s and the PHD’s of all RHU’s. This meeting shall e called and chaired by the
designated MHO coordinator, and shall be held after the individual RHU monthly
meetings.

In this joint meeting the following shall be the principal subjects to be discussed:

- Accomplishment review of individual RHU’s and an analysis of how the

whole municipality stands in so far as overall targets are concerned;
- Discussion of any problems taken up in monthly individual meetings which
may be relevant to the other RHU’s.

4.2 Logistics Management

4.2.1 Inventories

Nature and Purposes:

This is the proper control of equipments and supplies, carried out thru
actual physical counts and inspections, recording and systematic filing of all
records and documents.

Responsibility:

The MHO is held responsible for all inventories of supplies, materials and
equipments issued to his office. In turn, the employees to whom he issues the
same are liable to him in the proper use, care, and reporting of the issued
items. No accountable staff shall be allowed to resign or to transfer or take a
leave of absence of more than one month without having been cleared of his
accountabilities. In the case of the RHM, PHN, and SI, his clearance, in so far
as the RHU is concerned, is issued by the MHO but prepared by and initialed
by the PHN. In the case of the MHO, the clearance is issued by the PHO but

31
 prepared by the Supply Officer of the province. Before the PHO signs the
clearance, he must also require a clearance of the MHO from the RHU level.
Such may be issued by the PHN or whoever is taking over as in-charge of the
RHU.

Designated Property Custodian of the RHU:

This function may be undertaken by the MHO or he may designate another

RHU staff member.

Preparation of Inventory Report of Supplies:

This is done on a monthly basis using the prescribed form. All BHC’s and
MHC’s must prepare this, the consolidation of which will be the RHU
Inventory Report. The inventory at the MHC and the consolidation for the
whole RHU shall be the duty of the designated property custodian of the
RHU, but signed by the MHO.

Inventory of the Equipment:

This is done on an actual basis using the prescribed form. The mechanics of
this activity is the same as in the inventory of supplies, except that notations
shall be made of those not in good working condition and those that are.

4.2.2 Provision of Supplies:

Supplies of the RHU’s are obtained on a monthly basis from the PHO’s and from
direct purchase made by the municipality. The supplies are received for the MHO
by the PHN, and are to be distributed to the BHC’s on a weekly basis on
quantities sufficient to maintain the stock at the end of the previous month to the
specified level.

This distribution does not need any formal request from the BHC. On the other
hand, it implies knowledge of the MHO and PHN of the prescribed levels of
stocks and of the balance of the BHC’s and MHC’s at the end of the previous
months as reflected in their reports.

In the event that RHU or BHC stocks are exhausted before the end of the period
for which they are intended, the MHO may make additional request to the
municipal government in behalf of the RHU or RHM may make the request to the
MHC for the BHC.

4.2.3 Provision of Equipment

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 Information on equipment needs reaches the MHO through direct request (written
or oral from the BHC’s report of the PHN, his own observations; or quarterly
inventory report.

Equipment badly needed must be requested by the MHO from the municipal
government. Periodic reminders of standing requests must be started in the
monthly report. If the need is urgent, personal follow-up of request may be done.

4.2.4 Maintenance:

Up-keep and reconditioning of all equipment in the RHU is essential in the

operations.

This is categorized as follows:

Maintenance of motor vehicles (for the RHU provided for such);

Repairs and maintenance of refrigerators;
Up-keep and maintenance of all medical instruments and accessories.

Per agreement with donor organizations like WHO, UNICEF and Department of
Health, Manila, all motor vehicles are supposed to be maintained by the local
government. All medical instruments provided by the PHO and appropriate repair
should be subject to availability of funds and usual accounting and auditing
procedures.

4.3 Records and Report Management

4.3.1 Records consist of the information kept in the rural health unit about the
work of the unit, health conditions in the community, as well as information in
administrative matters such as staff, equipment and supplies.

Records are usually written information kept in notebooks or files, which serve as
important tools in controlling, and assessing work. They are kept to help the
supervision to :
- Learn what is taking place
- Make effective decisions
- Assess effective decisions

Records should be accurate, accessible, and available when needed, and contain
information that is useful to management. Information should not be recorded
unless it is known to be accurate and unless there is a use for.

4.3.2 Reports:

33
 Reports are the information communicated to other levels of the health service. They
are also an important management tool for influencing future actions.

The RHU staff must be trained to prepare the require reports according to the
instructions given by the DOH.

Those who make written reports should keep copies of them. The reports then
become records.

4.3.3 Organizing and Maintaining RHU Records

- Keep RHU records current

- Keep the records where they are used. Ex. Keep the patient registry where the
patients are registered
- Place loose records in the folders at the end of everyday so they can be found
when they are needed
- Store files and RHU records in a specific place on a shelf, in a cupboard or in
file boxes where they can be found easily by the staff
- Clearly label the folders, drawers or boxes containing RHU records
- Keep confidential records in a locked drawer or cabinet
- Use a subject classification (Ex. Personnel, Correspondence, etc.) to organize
the filing system for the RHU. Other methods of filing are alphabetical,
numerical, and geographical.
- Give each file a number to make it easier to file the items in their proper place
and to see if any files are missing
- Clean out RHU files regularly to avoid cluttering with useless and outdated
material
- Burn any confidential files that need to be discarded

4.4 The Field Health Services and Information System.

4.4.1 The focus of FHSIS

The FHSIS focuses on the following public health services of the DOH:

Maternal and Child Care (MCH)

Expanded Program on Immunization (EPI)
Control of Diarrheal Diseases (CDD)
Nutrition
Family Planning
Maternal Care
Tuberculosis
Malaria

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 Schistosomiasis
Leprosy Control
Dental Health
Environmental Sanitation

The FHSIS provides the basic service data needed to monitor activities in each
of the above program. Additional information relevant to the above programs is
available from other sources: e.g., Hospital Information System, special surveys,
etc.

4.4.2 FHSIS Objectives:

The objectives of the FHSIS are to provide:

Summary data on health service delivery and selected programs indicators at

the barangay, municipality/city, district, provincial, regional and other levels.
Data which when combined with data from other sources, can be used for
program monitoring and evaluation purposes.
A standardized facility level database, which can be assessed for more in-
depth studies.

The FHSIS also:

Ensures that the data reported into the Health Information Services are useful
and accurate and are disseminated in a timely and easy to use fashion.
Minimizes the recording and reporting burden at the services delivery level in
order to allow more time for patient care and promotive activities.

- The FHSIS consists of four component parts, as follows:

4.4.2.1 Family Treatment Record. This is the document/form on which is

recorded the complaint of the patient on consultation, diagnosis (if available)
treatment and date of treatment.

4.4.2.2 The Target Client Lists. The second “building block’ of the FHSIS and are
intended to serve the following purposes:

To plan and carry out patient care and services delivery to clients, in general,
and groups of clients identified as “targets” or “eligibles” by one or another
program.
To facilitate the monitoring and supervision of service delivery activities.
To report services delivered.
To provide a clinic-level database which can be assessed for further studies.

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The target client lists maintained in the FHSIS are:

Target Group List for EPI

Target/Client List for Children 0 to 59 months
Target/Client List for Nutrition
Client List for Pre-Natal Care
Client List for Post-Partum Care
Client List for Family Planning (Non-Surgical Method)
Client List for TB Symptomatic
Client List for TB Cases Under Short Course Chemotherapy (SCC)
Client List for TB Cases Under Standard Regimen (SR)
Client List Leprosy Cases

4.4.2.3 The Tally/Report Forms- constitutes the only mechanism through which
data are routinely transmitted from one facility to another in the revised FHSIS.

4.4.2.4 Output Reports- these are reports/tables that are produced at the Provincial
Health Offices from data reported in FHSIS.

4.4.3 FHSIS Forms to be Accomplished and Submitted by the RHU.

4.4.3.1 On the occurrence of the event

- FHSIS/ E-1 Notification of Death Form

- FHSIS/ E-2 Maternal Death Report
- FHSIS/ E-3 Perinatal Death Report

4.4.3.2 Weekly

- FHSIS/ W-1A Weekly Report of Notofiable Diseases

- FHSIS/ W-1B Weekly Report of Notifiable Diseases

4.4.3.3 Monthly

- FHSIS/M-1 Monthly Field Health Service Activity Report

- FHSIS/M-2 Monthly Natality Report
- FHSIS/M-3 Monthly Mortality Report
- FHSIS/M-4 Monthly Laboratory Report
- FHSIS/M-5 Monthly Dental Health Service Report
- FHSIS/M-6 Monthly Family Planning Subsidized Surgical Procedure
Report
- FHSIS/M-7 Monthly Report of Social Hygienic Clinic and Laboratory

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 4.4.3.4 Quarterly

- FHSIS/Q-1 Quarterly Field Health Service Activity Report

- FHSIS/Q-2 Quarterly Dental Faculty Inspection Report
- FHSIS/Q-3 Quarterly Environmental Health Activity Report

4.4.3.5Annually

- FHSIS/A-1 Annual catchment area OPT tally sheet and summary report
- FHSIS/A-1A Annual catchmet area OPT form
- FHSIS/A-2 Annual catchment area population summary report
- FHSIS/A-2A Annual catchment area population survey form
- FHSIS/A-3 Annual household environmental sanitation summary report
- FHSIS/ENVI-A-3A Annual catchment area environmental health survey
form
- FHSIS/A-4 Annual nutrition report – Food supplementation program

4.4.4 Reporting Units

The RHU is a reporting unit of the Field Health Service Information System (FHSIS)

The RHU/MHC Report is not a consolidation of the BHS and RHU reports. It is a report
of services rendered by the RHU based personnel.

The lowest level of reporting unit is the Barangay Health Station (BHS) which is
expected to report health services provided to its defined catchment area.

A BHS can be considered a reporting unit if the following conditions are satisfied.

- It renders/delivers health services to a defined catchment area which may be

composed of one or more barangay.

- A midwife renders regular services to the area.

- Health services may be provided from any physical structure designated for the
purpose i.e., a BHS building barangay health center.

- The catchment area served is not a service area of any RHU.

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4.5 Managing the workplace

The MHO as head of the RHU should manages the workplace. To provide the
best possible service to the community to do this he must:

- Organize the staff facilities and equipment of the health center;

- Arranges protection for the health center.

4.5.1 Staff location and Patient Flow

Workstations in the health center should be set up so there is a smooth and

even flow of patients with no long waiting lines.

The patients can be attended to through the health center as follows:

In addition to the above station and services, an arrangement may be done so

some patients may attend health education/demonstration session in one are.

To reduce waiting time:

- Several services at one may be provided.

- Drugs that are prescribed frequently may be pre-packaged.
- Patients returning daily for the same treatment should go directly to the
treatment room.

4.5.2 Hours of Operation and Clinic Schedules:

Keep the health center open to the public for patient care from 8:00 A.M. to 3:00
P.M.

Use the time after 3:00 P.M. to complete records, etc.

Adjust the work schedule to meet any specials local needs.

Schedule of the RHU must include:

- General Clinics
- MCH Clinics
- Home Visits
- Community Projects and Meetings
- Barangay Visits

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4.5.3 Protecting the Health Center

The MHO has the full responsibility for the protection of the health center and the
equipment, supplies and records that are in it. This may be delegated to other
members of the team when the MHO is busy or away from the center.

A routine procedure for ensuring the security of the facility when it is closed
should be established. The following should be checked/inspected before closing the
health center for the night or weekend:

- Equipment including the refrigerator etc.

- Drugs/Vaccines
- Records
- Latrine
- All doors/windows

Make sure the health center is cleaned, supplies and records put away, and
equipment cleaned and put it in its proper place before the health center is closed.

4.6 Communication within the Outside the RHU

The importance of communication to human beings particularly, health workers cannot

be over emphasized. It is through communication that people are able to get their ideas
understood and appreciated. It is also through communication that there goals and
objectives are achieved.

Communication is for particular importance to the staff of the RHU in their dealings, not
only among themselves but also the community. The health workers should understand
accurately what the community is communicating to him. On the other hand, he should
be certain that the community understand what he is communicating.

4.6.1 Definitions:

- Communicating is the entire process of human beings interacts with each

other through the exchange of messages.
- Communication is sharing between two or more persons of information, ideas,
opinions, beliefs, emotions and other message, which they wish to express.
- A convenient way to define the communication process is to answer the
following questions:

Who says?

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 What to

Whom with

What effect?

4.6.2 Communication Among the RHU Staff

These guidelines will help team members to communicate with each other more
effectively:

- Make message and conversations as clear and simple as possible

- Ask for ideas, comments, and suggestions from team members.
- Listen actively to ideas, communicate and suggestions from team members.
- Be aware of team member’s moods and attitudes that may effect
communications.
- Explain work assignments to the team members.
- Ask team member’s questions are to make sure they understand the message
that is being sent.

4.6.3 Communication with people outside the RHU

Sometimes, it is not possible to share ideas or send messages personally. The

RHU staff therefore uses other ways to communicating with each other and with
other people in the community.

THE FOLLOWING LIST OF COMMUNICATION RESOURCES LOCATED AT THE

HEALTH CENTER:

COMMUNICATIONS USES OF COMMUNICATION COMMENTS

RESOURCES RESOURCES

Written communication Sending patients information for Written communication is the

referral to other health care most important and most
Letters facilities frequently used type of
Menus Reporting routine health communication in the RHU.
Notes information All communication must be in
Reports Requesting advice or assistance writing or confirmed in
Arranging a confirming interview, writing before it becomes
meetings, etc. with other agencies, official
government, non-gov’t and the
community

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Messengers including a team Delivering any kind of message, Messenger is an important
member, a community written or oral to supervisors communication resource,
leader, a patient etc. community members especially for RHU that lack
Bringing messages back to the telephone, radio or postal
RHU from Peso to US listed communications.
above

Telephone Consulting with supervisors If`available the telephone is

Reporting emergencies, like usually the quickest and most
breakdown of an equipment or convenient way for the RHU
disease outbreak to convenient outside the
Arranging patient referrals center
Coordinating with other agencies

Same as those above for telephone

Two-way radio Same as those above for telephone
The reply to a telegraph may not
be immediate, hence a drawback
in emergency situation
A two-way radio provide a
quick and convenient way to
communicate
However, two-way radio may
not always be available to the
RHU

Telegraph Telegraph are not as quick

and convenient as telephone

An advantage is that the RHU

gets a written records of
communication

4.7 Recruitment and Selection of Locally Hired Personnel:

Sometimes, the RHU staff may need to recruit and select “locally hired” personnel.
However, the local government authorized the positions and the salary levels.

4.7.1Job Descriptions:

The DOH, Health Personnel Office, with the help of the field staff develops job
descriptions for every job in the health center. The Civil Service Commission approves
the job descriptions before anyone is hired.

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 Before recruiting, the MHO provides a copy of the job descriptions of the personnel to be
recruited to his team members.

Step 1- Discuss the type of person with the staff members of the RHU.
Ask their help for good candidate.

Step 2- Together with the staff make a list of skills and abilities needed and
special requirements for the job. There’s list is used as guide for screening
candidate.

Step 3- advertised the job opening is the community including the summary of
duties, salary date when application is due, and what should included in
the application. Post notice of the jobs in the health center, market place,
etc.

Step 4- let the applicant file out a standard application form for non-professional
employees.

Step 5- Review all applications together with one or two members of the RHU
staff. Compare with qualifications (skills, abilities) and special
requirements listed.

Step 6- Interview the 3 best candidates. Ask other members of the RHU to
interview each of the 3 candidates. Ask for references to give opinion on
candidates past work records and behavior. Tell each candidate when and
how he will be informed of the final selection.

Step 7- Check the reference of the good candidates to obtain information of their
work records and behavior. If there are no good candidates, extend the
search for other persons interested in the job. Take time for a longer each
rather than hire someone who may not be able to do the job well

Step 8- Call the staff together and choose the best candidate for the job. Notify
personnel office of the choice.

Step 9- Report to the health board which candidate you plan to hire.

Step 10- Notify the candidate chosen. Make sure he will accept the job. Discuss
the duties, salary, hours with him. As soon as the candidate accepts notify
the other candidates that the job has been filled. Recommend candidate to
the municipal office concerned for processing.

4.8 PLANNING AT THE RHU LEVEL

4.8.1 Planning Defined:

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 Planning is a systematic process in which problems and their causes are
identified/analyzed and for which solutions/ interventions selected from possible
optioned are prescribed and allocated appropriate resources. Deliberate steps are
usually taken as a plan of action towards the solution of the problems.

4.8.2 Why Plan?

4.8.2.1Plans serve as guidelines in using limited resources of the RHU in the most
effective and efficient manner to achieve program levels.

4.8.2.2 Plans are requirements of higher authorities to justify budget proposals.

4.8.2.3 Plans provide the guide for making decisions as to which programs /
activities need priority attention, how and when the supplies are to be allocated to
the implementing units and how interrelated activities are to be synchronized to
achieve maximum effects.

4.8.2.4 Plans ensure that the implementation process is geared towards producing
the desired goal.

4.8.3 The Area Program Based Health Planning (APBHP)

It is a planning methodology that specifically designed the problems, goals,

strategies/activities and resource requirements of the area and the health program it is
addressing. The plan, therefore, is a realistic and implementable.

4.8.4 Basic Planning Steps in (APBHP)

4.8.4.1 Assessment of current health and program status

4.8.4.2 Setting of goals:

- Program goals – Guided by the prescriptions of the National

- Health Program. These are clearly stated, quantifiable, specified attainable and time
bound.

- Operational goals – Address the causes of factors of the problems identified in the
current assessment. General operational goals should be directed to achieve program
goal.

4.8.4.3 Formulations of measures or approaches towards achievement of goals.

4.8.4.4 Determining the set of activities, schedule, focus of responsibility and

resource requirement.

4.8.5 Planning at the BHS level

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 The primary plans at the BHS level is done by the Rural Health Midwife. The
MHO or PHN may assist her. The planning may be done individually at the BHS or it
may be done collectively in the workshop at the RHU or DHO levels. In either case, all
data needed for the planning exercise should be collected and organized prior to the
actual planning. The following data are minimally required at the DHS level:

- Program performance, by barangay of all programs in the proceeding year, or

latest available year.

- Demographic data, by barangay. This will be used to estimate population targets

for specific service.

- Other relevant institutional data, particularly those needed to assess on-program

related problems of the BHS, e.g. Facilities lacking in the clinic, client behavior
and attitudes, etc.

Planning at the RHU level.

The Municipal Health Officer and the Public Health Nurse are the primary
planing officers at the RHU level. Planning at this level consists of planning in individual
BHS and consolidation of all BHS plans under the RHU.

As a preparation, the following needs are to be undertaken:

- General Orientation on Area Program Based Planning (APBP). This is undertaken

in the province or district that covers the RHU.

- Agreement on schedules. Planning from BHS to IPHO lasts 3 months, from

October to December, at least one year prior to the plan period. Actual dates of
RHU planning are agreed upon in the province or district level.

- Agreement on Guidelines. MHO, PHN and RHM’s agree on the criteria for
problem analysis, which consist of the program parameters and the numerical cut-
off point for the parameters to be used as indicators of problems, as well
performance targets.

- Minimum data required for preparation and for planing include the following:

- Natality, morbidity, mortality statistic, for all BHS in catchment;

- Programs performance statistics, for all BHS in catchment;

- Demographic data, for all BHS catchment;

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- Socio-economic and other relevant data, for RHU catchment;

- BHS Plans accomplished according to instructions.

(Note – this corresponds to page 50 of The Manual on RHU operations

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