2 Rev CHT Guidebook 102411

Community Health Team

Guidebook For CHT Partners

This Community Health Team (CHT) Guidebook contains the information, approaches and instructions that

will help CHT Partners effectively help families recognize their health risks and needs, develop customized

health plans to address those needs, use their PhilHealth benefits, and find appropriate and accessible

health providers.

Included Modules:

Newborn Health

Infant Health

Child Health

Pregnancy / Prenatal Care

Postpartum Care

Family Planning

Chronic Cough Management

Department of Health

October 2011

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TABLE OF CONTENTS

LETTER TO THE CHT PARTNER

COMMUNITY HEALTH TEAM GUIDEBOOK

I. The CHT Partner: On the Frontlines of Community Health

3

A. Introduction: You and Your Community‟s Health 4

B. Your Role as a CHT Partner: An Overview of the CHT Process 5

C. The Family Health Guide: A Tool for Sharing Information With Families 8

D. Preparing for Your Role as a CHT Partner 10

II. The CHT Process: Guiding Families in Accessing Health Care

12

A. Steps and Tasks in the CHT Process 13

B. Pre-session: Setting the Family Health Hour 14

C. On-session: The Family Health Hour 16

1. PROFILE: Completing the Household Profile 17

2. ORIENT: Orientation on the Family Health Guide 26

3. ASSESS: Assessing Members‟ Health Risks 27

4. INFORM: Delivering Key Health Messages 29

5. PLAN: Assisting Families with Health Plan Implementation 30

6. MONITOR: Following-up and Monitoring Health Plan Adherence 34

D. Post-session: Reporting Summaries of Health Information

7. REPORT: Providing Summary Report to Rural Health Midwife 37

III. Health Plan Implementation Modules

40

A. Form 2A: Newborn Health (Ages 0-28 days) 41

B. Form 2B: Infant Health (Ages 29 days – less than 12 months) 48

C. Form 2C: Child Health (Ages 12 months – 5 years) 56

D. Form 2D: Maternal Health: Pregnancy/Prenatal Care 62

E. Form 2E: Maternal Health: Postpartum Care 70

F. Form 2F: Family Planning 76

G. Form 2G: Chronic Cough Management 84

BOOKLET NI NANAY AT NI BABY

FAMILY GUIDE TO PHILHEALTH: BENEFITS, CILMENTS AND RESPONSIBILITIES

LIST OF HEALTH PROVIDERS AND HEALTH EMERGENCY CONTACTS

Community Health Team Guidebook 3

I. The CHT Partner On the Frontlines of Community Health

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A. INTRODUCTION: YOU AND YOUR COMMUNITY’S HEALTH

Many Filipino families in our communities suffer from health conditions that could have been

prevented if they had only been treated early enough or had received the proper attention and

care. One of the largest hurdles is the limited capacity of these families to access health services,

because they often (1) do not know their health risks and needs, (2) have no financial means to

get the health services they need, (3) have little knowledge of available and appropriate health

providers in their area, and/or (4) do not have ready access to transportation that can bring

them to these providers.

To help break these barriers to health care use, Community Health Teams (CHTs) give direct

assistance to underserved Filipino families all over the country by helping them navigate or find

their way through the health system. CHTs are tasked to help especially the poorest families as

identified by the Department of Social Welfare and Development (DSWD) in the NHTS1,

including those covered by Pantawid Pamilya2.

As a CHT Partner, you will be assigned to some of these families within your community or purok

who are most in need of health assistance. You will be at the frontlines of giving them the

information and guidance they need to improve their ability to access health services.

1 Stands for the National Household Targeting System - a project of the DSWD that builds the database of households from

which the beneficiaries of national social protection programs will be identified.

2Pantawid Pamilya is a program where families are given cash to encourage them to use health services and keep their

children (aged 0-14 years old) in school.


B. YOUR ROLE AS A CHT PARTNER: AN OVERVIEW OF THE CHT PROCESS

As a CHT partner, your major role will be to guide families in

accessing health care, and thus manage their health.

The CHT Process is a cycle of major steps (each one broken

down into smaller steps, called „tasks‟) to follow in your

interactions with families. By understanding the CHT process,

you will be able to effectively perform your role as a CHT

Partner.

Figure 1 below shows the major steps in the CHT process. In a later section of this Guidebook (II. The

CHT Process: Guiding Families in Accessing Healthcare, p. 12), each of these steps (and its component

tasks) is described in more detail.

Figure 1. OVERVIEW OF MAJOR STEPS IN THE CHT

PROCESS.

Brief Description of Major Steps in the CHT Process

1. PROFILE

For discussion on protocol for conducting household profiles, see p. 17

CHT Tool: FORM 1 - Household Profile

UPDATE HOUSEHOLD PROFILE

RE-ASSESS

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In this step, you will make a household profile by getting basic information on each family member,

to identify which persons in the household are most in need of health care.

2. ORIENT

For discussion on protocol for orienting families, see p. 26

CHT Tool: Family Health Guide

In your role as a navigator, you should orient the the household to the different sources of health

information Available to them. The Family Health Guide is a set of booklets that you will be sharing

with the household. As a „talking book‟, you will show how the family how they can directly benefit

from the information the Family Health Guide contains. For a discussion of the component sections

of the Family Health Guide, see page 8.

3. ASSESS

For discussion on protocol for assessing health risks, see p. 27

See also individual Health Plan Implementation modules starting on p. 40

Material: Forms 2A-2G (Part 1) – Health Plan Implementation Forms

In this step, you will be making health risk assessments of individual members. Risk assessments will

focus primarily on the modules included in the CHT Guidebook; namely, pregnancy/pre-natal care;

post-partum care; newborn, infant and child health; family planning; and chronic cough management.

Other modules may be added to your materials later on depending on the needs of your region or

locality.

4. INFORM

For discussion on protocol for delivering health messages, see p. 29

Ssee also individual Health Plan Implementation modules starting on p. 40

Material: Forms 2A-2G (Part 1) – Health Plan Implementation Forms

Depending on the members‟ health risks, you will share key messages that will help them make

decisions about their health. You will also use other reference materials in your CHT Guidebook to

share related messages with the family member at risk.

5. PLAN

For discussion on protocol for assisting members in health planning, see p. 30

See also individual Health Plan Implementation modules starting on p. 40

Material: Forms 2A-2G (Parts 2 and 3) – Health Plan Implementation Forms

You will assist members in planning their health goals and use of health services. Using the

reference materials in the Family Health Guide, you will help members choose health service


providers and transport options, schedule visits for availment of services, and make

emergency plans if needed.

6. MONITOR

Detailed discussion on p. 34

Material: CHT Monitoring Forms; Forms 2A-2G (Parts 4, 5) – Health Plan Implementation Forms

Monitoring families means reminding members about their planned visits to health providers, and

checking on adherence to their health plans. If they are having difficulties with compliance to their

plans, you will also try to help them find ways to overcome these difficulties.

It is also important to remember that you will be periodically re-assessing the family to identify new

or emerging health needs as their circumstances change. The two dashed arrows in Figure 1 pertain

to this cyclical process:

a. Update the Household Profile

as the household members‟ health and other circumstances change (for

example, a previously pregnant woman already gave birth; a newborn baby

grows up and becomes an infant then a child; etc.). You will need to

monitor these changes and update the profile accordingly.

b. Reassess

every time the health status of a household member changes, you will need

to go through the CHT process again with that member, starting with

assessing his/her new health risk/s.

7. REPORT

Detailed discussion on p. Error! Bookmark not defined.37

Material: CHT Monitoring Forms

Periodically accomplish and submit summary forms to your supervising Midwife. The information you

give to the RHU/MHO will be indispensable in monitoring the overall health status of your

community and will also be valuable in helping the RHU make decisions about your community‟s

health programs.

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NOTE! Your PHO/MHO/CHO may expand the Health Plan Implementation Modules

depending on the priority health concerns of your province/municipality/city.

C. THE FAMILY HEALTH GUIDE: A TOOL FOR SHARING INFORMATION WITH FAMILIES

Helping families „navigate‟ the health system means giving them useful information necessary to

maximize their opportunities for getting health care. This includes information on their health risks and

needs, the health services available to them, and the means to obtain such services to safeguard their

health.

The Family Health Guide is an important tool which you will use throughout the CHT Process to guide

the family in accessing health care. It is a set of booklets containing integrated information that the

family needs to develop and implement sound health plans, that will lead them to the health services

they need.

The Family Health Guide is composed of:

1. Family Health Guide: A. Health Messages – a booklet for the family that contains helpful

information on how to have safe pregnancies and deliveries, prevent common childhood illnesses,

plan desired family size, and manage chronic cough.

The Family Health Guide also contains a space (“Our Family” page) for the family to write their

names (using the last name of the NHTS household head) and basic information such as their

NHTS household ID number, the name of the CHT partner and contact number, and the Family

Health Hour (day and hour of home visit).

2. Household Profile Form – identical to the Form 1 in your CHT Guidebook, this contains basic

information about household members, their health profile and other relevant information. This

form is included in the Family Health Guide so that you can show the family how they can, on

their own if needed, identify important health risks among themselves.

3. Health Plan Implementation Modules – These materials help families recognize their health

risks, know and understand the core messages appropriate to their specific health goals, develop

appropriate health plan/s, and schedule visits to health providers. The different Health Plan

Implementation modules for specific health concerns are shown in Table 1.


Table 1. HEALTH PLAN IMPLEMENTATION MODULES FOR SPECIFIC HEALTH GOALS.

Module Health Plan

Form

Health Goals

Newborn Health 2A (p. 41) To ensure proper care for babies (0-28 days old) by

helping the mother/parents recognize the importance of

newborn screening, BCG and Hepatitis B immunizations,

and exclusive breastfeeding.

Infant Health 2B (p. 48) To encourage full immunization of babies (29 days to

less than 12 months old) to protect them from common

illnesses

Child Health 2C (p. 56) To ensure that children (12 months to 5 years old) are

completely immunized, given deworming tablets and

micronutrient supplements to boost their immune

system, and common serious childhood illnesses are

prevented and/or treated early.

Maternal Health:


2D (p. 62) To help pregnant women have healthy pregnancies and

safe deliveries, through prenatal care and delivery in

health facility

Maternal Health:

Postpartum Care

2E (p. 70) To ensure that mothers are given prompt care after

delivery to avoid post-partum complications.

Family Planning 2F (p. 76) To help couples have the number of children they want

Chronic Cough

Management

2G (p. 84) To facilitate diagnosis and management of family

members with cough lasting more than 2 weeks

4. List of Health Providers and Health Emergency Contacts– a booklet that contains a list of

health providers that the family can turn to for health care, plus useful information on each

provider, such as clinic hours, PhilHealth accreditation status, and the services being offered. It

also contains a list of health emergency contacts or service providers which has the names and

contact information of available transport and service providers that the family can call on during

health emergencies.

5. Booklet ni Nanay at ni Baby – contains detailed information on the proper care for the mother

before, during and after giving birth, as well as for her newborn baby.

6. Family Guide to PhilHealth: Benefits, Availment and Responsibilities – contains basic

information on PhilHealth coverage, benefits of members and their dependents, and the steps

required to avail of these benefits.

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D. Preparing for Your Role as a CHT Partner

Before you begin going through the CHT Process with a family, there are some things you will need to

prepare so that you can maximize your guidance time with them. The preparation steps described below

may seem tedious at first glance, but remember that each of these steps is key to ensuring that the

process of guiding the families will go smoothly and have maximum benefits for them.

Prep Step 1: Make sure your materials are complete.

Get the following materials from your Rural Health Midwife (RHM) or CHT supervisor:

List of NHTS families assigned to you

This contains the names of the household head and members, their contact information

and household ID number. You may use this to locate and contact families for your first

home visits with them.

Family Health Guide

Make sure that the component booklets and references are complete (see p. 8) and

familiarize yourself thoroughly with their content.

Health Plan Implementation forms on:

Newborn Health (2A)

Infant Health (2B)

Child Health (2C)

Maternal Health: Pregnancy / Prenatal Care (2D)

Maternal Health: Post-partum Care (2E)

Family Planning (2F)

Chronic Cough Management (2G)

Prep Step 2: Pre-fill Form 1 and plan your visits.

Using the NHTS list of families, fill in the NHTS Household ID Number in the Household Profile

Form beforehand, for each family. Then, identify whom among the NHTS households assigned to

you are members of Pantawid Pamilya. Prioritize these families for home visits.

Prep Step 3: Schedule a Pre-Session.

Get the contact information of your assigned NHTS households, and set an appointment with the

household head and/or spouse or partner for the first meeting (or Pre-Session, see p. 14). Be

familiar with the background of the households under your care (for example, household setup,

religious/cultural beliefs and practice).


Prep Step 4: Practice.

Practice introducing the Family Health Guide, explaining what it is all about, and how the family

can benefit from it. Especially if you are unfamiliar with the area or with the families assigned to

you, you should also practice introducing yourself and what you do as a CHT Partner. Be aware of

your body gestures, mannerisms, facial reactions, tone and volume of voice.

Remember that to most effectively guide a family, you will need to know and understand very

well your CHT materials and the different parts of the Family Health Guide. You may ask your

RHM or CHT supervisor for help on topics with which you are unfamiliar or having trouble.

Finally, once you have scheduled a Pre-Session with a family, make sure that you meet them on

time! This will show families that you value their time and that you are serious about your intent

to assist them in managing their health.

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II. The CHT Process Guiding Families in Accessing Health Care


A. STEPS AND TASKS IN THE CHT PROCESS

The major Steps in the CHT Process were explained in section I.B. Your Role as a CHT Partner: An

Overview of the CHT Process (p. 5). Figure 2 below shows how each Step can be thought of as

representing a more specific Task or set of component Tasks, detailing the actual activities involved in

accomplishing each Step. The six Tasks are distributed over three phases of interaction with your

assigned households: the Pre-Session, the On-Session, and the Post-Session.

Figure 2. STEPS AND TASKS IN THE CHT PROCESS

Task 4. Help

family members

make their

Health Plans.

PHASE I: PRE-SESSION Task 1: Set the „Family Health Hour‟.

PHASE II: ON-SESSION: FAMILY HEALTH HOUR – HELPING FAMILIES FULFILL THEIR

HEALTH GOALS

Task 2. Complete

Household Profile to

identify members with

health conditions.

Task 3. Orient

household on

the Family

Health Guide.

4.a Assess the

members‟ health

risks.

Task 5. Follow-

up and monitor

health plan

adherence.

4.c Help

members

develop Health

Plans; Refer to

health provider

and transport. Task 6. Provide summary report

to Rural Health Midwife

4.b Deliver key

health action

messages.

PHASE III: POST-SESSION: RECORDS & REPORTING

PROFILE ASSESS

INFORM

PLAN

MONITOR

R

REPORT

ORIENT

TASKS

STEPS

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HELPFUL TIP! The ‘Buddy System’

If you feel uncomfortable about

meeting new families, another member

of your CHT could accompany you to

the Pre-Session, while you are still

getting to know them.

B. PRE-SESSION: SETTING THE FAMILY HEALTH HOUR

Your first meeting with the household is called the Pre-Session. During this brief visit, your main

objective is to simply come to an agreement with the household on when you can come back or

might have more time with them in a Family Health Hour.

The Family Health Hour is a specific day and time agreed upon by you and your assigned household.

During this time, the household can discuss with you their health concerns, while you can also help them

identify health risks and make plans to access health services to address their concerns. The Family Health

Hour is also known in this Guidebook as the On-Session.

The first household visit is critical. It determines whether the family will accept the health assistance you

offer or reject it altogether. This is the „make or break‟ point in providing health navigational support to

families. You can either „lose‟ families at this point, or get them hooked to your assistance in planning for

their health and using Available quality health services.

However, remember that some families might want to continue straight into the On-Session on your very

first visit with them. If you also have time to do so, then it would be best to agree. Be sensitive; as the

family‟s CHT Partner, you should adapt the Process to each family‟s particular needs and circumstances.

Here are some steps you can take to accomplish Task 1: Setting the Family Health Hour.

1. Greet the family and introduce yourself.

Upon arrival, look initially for the household head (as

designated in your NHTS list of families) and their

spouse/partner if available. If not present, you may ask for

the medical decision-maker or any responsible member

of the household.

If you are not yet known to the family, don‟t forget to give them your name and your designation

(for example,“I am Rosa dela Cruz, a barangay health worker/barangay nutrition scholar and your

Community Health Team Partner.”)

2. Inform the household of the purpose of your visit.

If you have an endorsement letter from your supervisor or RHU, share it with the household. Be

sure to let them know that your assistance and the process you will be guiding them through is

PHASE I: PRE-SESSION Task 1: Set the „Family Health Hour‟.


HELPFUL TIP! The Medical

Decision-Maker. Remember that

the person in charge of making

medical decisions for the family may

not necessarily be the household

head. Be sensitive to family

dynamics, or, if possible, you can also

ask the family directly. It will be

important to include the medical

decision-maker in future discussions

on the family’s health.

part of the local government‟s effort to improve the health of families in your municipality,

especially of mothers and children. Let them know that the process will include helping them

assess their health risks, and helping them access the health services they need.

3. Agree on the best time when you can regularly visit the household.

Finding the “best time” means that you need to decide on

a specific time and day when the family can sit down with

you to discuss their health concerns, preferably with both

the father and mother (or the primary Medical Decision-

Maker/s). Ideally, this should be after work and

household chores are finished, usually around afternoon

siesta. Ask the family for the maximum time they are

willing to give you to avoid disrupting their regular

schedules.

This “best time” is the Family Health Hour. During the

Family Health Hour, you will be visiting the family again to

discuss their health concerns, give them appropriate health messages, explain their PhilHealth

benefits, and point them to the health providers they can go to for quality care. activities.

4. Once the “Family Health Hour” is set, encourage the family to schedule it in their activities for

the week/month.

Make an appointment with the family if possible, emphasizing that the father‟s/partner‟s presence

is equally important in ensuring the health of the family. Again, try as much as possible to ensure

that the family‟s medical decision maker will always be present.

If the family is willing to give you more time, go to the steps in II.C. On-Session: The Family

Health Hour - Helping Families Fulfill their Health Goals on page 16.

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C. ON-SESSION: THE FAMILY HEALTH HOUR: HELPING FAMILIIES FULFILL THEIR

HEALTH GOALS

The Family Health Hour forms the largest part of your interactions with your assigned families. During

each Family Health Hour, you will have the following objectives:

a. To identify household members with health conditions (members “at risk”). To do this, you

will be using the Household Profile Form (Form 1).

b. To help at-risk household members recognize their health risks and give them important

messages about their health. To do this, you will be using Part 1 of the Health Plan

Implementation Forms (Forms 2A to 2G) and corresponding sections of the Family Health Guide

and/or Booklet ni Nanay at ni Baby.

c. To help at-risk household members make their own health plans, based on the health goals

that each member desires. To do this, you will be using Parts 2 and 3 of the Health Plan

Implementation Forms (Forms 2A to 2G).

Figure 2 (p. 13) shows how each of these objectives will be accomplished through On-Session Tasks 2 to

5. If you are not familiar with the figure yet, now would be a good time for you to go back and review it

before moving on. The next few sections will discuss each of the tasks in more detail.


IMPORTANT! Form 1 First.

Complete Form 1: Household Profile before moving on to any of

the other forms. This way, you can be sure that you have not

missed out on any member who might have health risks.

1. PROFILE (Task 2: Completing the Household Profile)

As the first part of assessment, the Family Roster and Health Profile is an important step to identify those

members of the family with health conditions and concerns.

Form 1: Household Profile Form will be your tool to collect basic information about the members of

the NHTS households. It directs you to the rest of the forms you need to assist the family in accessing

health care. You, as the CHT partner, will keep the accomplished Household Profiles.

This form has 3 main parts (see p.18):

Basic Information - basic data about the household including the date of visit, name of

respondent, and NHTS household ID number.

Family Roster and Health Profiles– a focused listing of all the members of the household,

including their names, relations, sex, ages, birthdays and answers to specific questions for women

of reproductive age (15-49 years old), children, and (for all members) chronic cough, PhilHealth

enrolment, and schedules for interview.

Notes – includes special instructions on how to accomplish the form.

PHASE II: ON-SESSION

Task 2. Complete



health conditions.

PROFILE

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Figure 3. OVERVIEW OF FORM 1: HOUSEHOLD PROFILE

Family Roster and Health Profiles

Basic

Information

Notes


STEPS TO FILLING UP FORM 1: HOUSEHOLD PROFILE

1. Introduce the Household Profile to the family.

Show the form to the household head, spouse/partner, or the health decision-maker who can provide

you with the necessary information.

Then, explain that you will be asking them for some health and related information so that, together,

you can assess the health risks of individual household members and later track their progress in

using the health services they need based on their health risks.

2. Fill up the Basic Information, following the instructions below (Table 2).

Table 2. INSTRUCTIONS FOR FILLING UP BASIC INFORMATION IN FORM 1.

Number

Item Instruction Example

1. DATE OF

VISIT

Write the current date using the

format mm/dd/yy.

August 10, 2011

08 / 10 / 11

2. NAME OF

RESPONDENT

Write the complete name of the

respondent using the format Last

Name, First Name, Mother‟s

Maiden Name.

A S. Cruz

CRUZ, A SANTOS

3. NHTS

HOUSEHOLD

ID NUMBER

This is a unique, pre-assigned 18-

digit number found in the NHTS

Household list. Copy the correct

and complete number into the

boxes on the form.

023452000-5413-00018

3. Fill up the Family Roster (Columns Number 4-8).

4. NAME

Ask for the complete names of ALL the members of the household starting from the

household head, followed by the spouse/partner, their son(s)/daughter(s) from eldest to

youngest, and lastly, other members of the household.

Write the names in PRINT and in CAPITAL LETTERS following the format Last Name, First

Name, Mother‟s Maiden Name.

5 4 1 3 0 0 0 1 8 0 2 3 4 5 2 0 0 0

20

Be careful to SPELL NAMES CORRECTLY. Incorrect spelling will create inconsistencies

between the list of NHTS households and the name on the PhilHealth ID.

Example: ASK : What is the name of the household head?

ANSWER: Joel C. Natividad

WRITE: NATIVIDAD, JOEL CRUZ

5. RELATIONSHIP to HOUSEHOLD HEAD

After the name of each member, immediately ask for the relationship of the member to

the household head. Write down the relationship as:

- HEAD (for the household head)

- SPOUSE / PARTNER

- SON / DAUGHTER

- OTHERS (Specify the relation, i.e. GRANDSON, FIRST COUSIN, etc.)

6. SEX

After completing the names and relationship to household head, ask for the sex of each

household member and write only F for females or M for males.

Example: ASK : Is _________ (name of member) male or female?

ANSWER: Female / Male

WRITE: F / M

7. AGE

Ask the age of each household member. How you write the answer will depend on the age

of the member.

For adults more than 19 years old

Write the age in completed number of years.

Example: 29 YEARS

For young persons age 10-19 years old

Write the age in years and encircle. This will serve as your cue that messages for

adolescents should be delivered to this member (see Family Health Guide A. Health

Messages: Caring for Adolescents, p.10).

Example: 17 YEARS


For newborns (babies 28 days or younger)

Write the age in days and encircle the age. This will serve as your cue that Form

2A: Health Plan Implementation Form on Newborn Health should be administered

to the newborn through the mother/father or any responsible member of the

household.

Example: 8 DAYS

For children age 29 days to less than 12 months

Write the age in completed months and encircle the age. This will serve as your

cue that Form 2B: Health Plan Implementation Form on Infant Health should be

administered to the child through the mother/father or any responsible member of

the household.

Example: 10 ½ months 10 MONTHS

For children age 12 months to less than 5 years

Write the age in completed years and encircle the age. This will serve as your cue

that Form 2C: Health Plan Implementation Form on Child Health should be

administered to the child through the mother/father or any responsible member of

the household.

Example: 2 years 3 months 2 YEARS

8. BIRTHDAY

Indicate the date of birth of the family member using the format mm/dd/yy. For unknown

or non-standard birthdates (i.e. for Indigenous Peoples), please refer to NHTS-PR listing or

the DSWD system for assigning birthdates.

Example: ASK : What is _________‟s (name of member) birthday?

ANSWER: October 30, 1980

WRITE: 10 / 30 / 80

9. FOR WOMEN 15-49 YEARS OLD

Questions 9a and 9b are for all women members of the household who are 15-49 years

old. For the family members who do not belong to this group, put a long dash (--).

9a. Currently pregnant

Ask the respondent if the woman member of the household who is 15-49 is

currently pregnant. For all those currently pregnant, write YES and encircle. This

22

will serve as your cue that Form 2D: Health Plan Implementation for Maternal

Health: Pregnancy/Prenatal Care should be administered to this woman. She may

also be assisted in developing Form 2F: Health Plan Implementation for Family

Planning to help ensure the health of the family after she has given birth.

If there are pregnant women in the household who are less than 15 or more

than 49 years old, include them in the profiling of pregnant women as well. Write

YES in the row corresponding to their names in this column (9a).

Example: ASK : Is _________‟s (name of member) currently pregnant?

ANSWER: Yes

WRITE: YES

ANSWER: No

WRITE: NO

THEN: Go to Question 9b.

9b and 9c Currently not pregnant

Ask if the woman had just given birth less than 6 weeks or 42 days ago (Column

9b); or given birth more than 6 weeks ago, or has never been pregnant (Column

9c).

Encircle any YES answer. If the YES is in Column 9b, this will be your cue that

Form 2E: Health Plan Implementation Form for Maternal Health: Post-Partum Care

AND Form 2F: Health Plan Implementation Form for Family Planning should be

administered to this woman.

If the YES is in Column 9c, this will be your cue that Form 2F: Health Plan

Implementation Form for Family Planning should be administered to this woman.

Example: ASK : When was the last time ____ (woman‟s name) was pregnant?

ANSWER Less than 6 weeks (or less than 42 days) ago

WRITE: YES in column 9b

(--) in column 9c

ANSWER: More than 6 weeks (or more than 42 days ago)

OR Never been pregnant

WRITE: NO in column 9b

YES in column 9c

.


HELPFUL TIP! Being sensitive. Keep in mind that not all

families or women (especially young or unmarried women) will

be open to questions on pregnancy or reproductive health. Be

aware of the cultural background and sensibilities of your

community. If you are unsure of how to ask certain questions,

ask the other members of your CHT or your CHT supervisor on

the best possible approach.

10. FOR ALL MEMBERS 10 YEARS OLD AND ABOVE

For each member of the household older than 10 years, ask if he/she has been coughing

for two weeks or more. If the answer is YES, encircle the answer. This will serve as your

cue that Form 2G: Health Plan Implementation for Chronic Cough Management should be

administered to this member.

Example: ASK : Is _________ coughing for more than two weeks?

ANSWER: Yes

WRITE: YES

ANSWER: No

WRITE: NO

11. FOR ALL MEMBERS 21 YEARS OLD AND ABOVE

Questions 11a and 11b are for household members who are 21 years old and older.

11a . Enrolment in PhilHealth

For each household member 21 years old and above, ask if the household

member is enrolled in PhilHealth. If the answer is YES, write the answer and go

to Question 11b.

If the answer is NO, write NO and encircle it. This will serve as your cue that this

member needs information on how to enroll in PhilHealth. You can then refer

the respondent to the Family Guide to PhilHealth: Benefits, Availment and

Responsibilities, in particular Section II. The Family is Not Enrolled in PhilHealth,

on p. 17.

Example: ASK : Is _________‟s (name of member) enrolled in PhilHealth?

ANSWER: Yes

WRITE: YES

THEN: Go to Question 11b.

24

ANSWER: No

WRITE: NO

11b . PhilHealth ID Number

For those who answered YES to Question 11a, ask for their complete and correct

PhilHealth ID Number. You should ask the members to show you their

PhilHealth ID cards if possible.

If there is a PhilHealth ID shown, copy the exact PhilHealth ID Number.

If the respondent does not know the PhilHealth ID Number, please indicate

“DON‟T KNOW”.

You may discuss the member‟s and his/her dependents‟ entitlements in

PhilHealth. Refer to the Family Guide to PhilHealth: Benefits, Availments and

Responsibilities, in particular Section I: "The Family is PhilHealth- Enrolled" (p. 4).

12. SCHEDULE OF INTERVIEW

If a health condition has been identified for a particular household member, ask that

person when s/he is available for a discussion with you on his/her health risks and plans.

If the person is available on the same day of your visit to the household, write the current

date in the format mm/dd/yy and go to the administering the appropriate Health Plan

Implementation Form.

If the person is not available on the day of your visit to the household, ask the member

when s/he might be available for a discussion. Write the agreed date under Column 12 in

the format mm/dd/yy.

As you may realize by now, after completing the Household Profile, members with specific health conditions

can be easily identified from Form 1. Using age as filter, you can identify newborns (0-28 days), infants (29

days to less than 12 months), children (12 months to less than 5 years old), adolescents (10-19 years old)

and women who are 15-49 years old. For members older than 10 years old, a screening question on cough

is asked, and for members 21 years old and above, a question on PhilHealth enrollment is asked.

Figure 4 summarizes how the family members identified in Task 2 can be routed to specific Health

Plan Implementation modules and messages depending on their health risks.


Figure 4. LINKS BETWEEN FORM I PROFILES OF HOUSEHOLD MEMBERS (TASK 2) AND

HEALTH PLAN IMPLEMENTATION FORMS AND/OR HEALTH MESSAGES (TASK 4).

Task 2. Complete



health conditions.

PROFILE

21 years old & above

Health Messages:

Family Guide to PhilHealth:

Benefits, Availment and

Responsibilities

Form 2D: Maternal Health:

Pregnancy / Pre-natal Care

Form 2F: Family Planning

Form 2E: Maternal Health:

Post-Partum Care

15 to 49 years old,

females only

Form 2G: Chronic Cough

Management

10 years old & above

10 to 19 years old

Health Messages:

Family Health Guide: Caring

for Adolescents

Form 2C: Child Health 1 to less than 5 years

Form 2B: Infant Health 29 days to less than 12

months

0 to 28 days Form 2A: Newborn Health

4.b Deliver key

health action

messages.

INFORM

4.c Help

members develop

Health Plans

PLAN

4.a Assess the

members‟ health

risks.

ASSESS

26

2. ORIENT (Task 3: Orientation on the Family Health Guide)

Now that you have completed the Household Profile, during this part of the session, you will be giving

the family an overview of the Family Health Guide. Your major task will be to share the purpose of the

Family Health Guide and to briefly go over its various components and how the family can benefit from it

and the information it contains.

STEPS TO ORIENTING THE HOUSEHOLD ON THE FAMILY HEALTH GUIDE

1. Show the Family Health Guide to the members of the household.

Give the Family Health Guide to the couple/medical decision-maker of the household and give them

a few minutes to browse through it. Allow them to discover what the Family Health Guide is for

instead of telling them. Affirm if their idea is correct and explain if incorrect. Never say “Wrong”. The

first step in the convincing the family is to help them learn on their own with your guidance.

2. Give a brief overview of the Family Health Guide.

Discuss briefly the contents of the Family Health Guide (see p. 8 for a description of the Family Health

Guide). Explain how they could benefit from each component. Once the family has seen all the parts

of the Family Health Guide, go to making individual health risk assessments for those at-risk

members you identified from the Household Profile.

PHASE II: ON-SESSION Task 3.

Orient family

on Family

Health Guide.

ORIENT


3. ASSESS (Task 4a: Assessing Members’ Health Risks)

Task 4a is the first part of helping family members make their Health Plans. Your main tools for this task

are the Health Plan Implementation Forms 2A to 2G. Each Health Plan Implementation Form is

divided into 4 parts (see Figure 5 below). To accomplish Task 4a, you will be using Part 1 (Health Risk

Assessment and Key Health Messages) of the Health Plan Implementation Forms. For more

detailed discussions of the different Health Plan Implementation modules, see pages 40 onwards.

Figure 5. PARTS OF A SAMPLE HEALTH PLAN IMPLEMENTATION FORM (FRONT ONLY).

Task 4. Help

family members

make their

Health Plans.

4.a Assess the

members‟ health

risks.

ASSESS


FORM 2A: Health Plan Implementation for NEWBORN HEALTH

A1 Was the baby delivered in a health facility? ________

A2. Was the baby provided with any of the follow-

ing? (please check if Yes)

Newborn assessment/screening BCG

Hepatitis B

**If without check in any of the above, provide Message B2

A3. Do you only give breast milk (exclusive breast-

feeding) to your baby?

A4. Does your baby have any of the following dan-

ger signs? (please check ,if Yes)

Convulsions

Stopped breastfeeding/poor sucking

Feels hot or cold Foul smelling discharge or blood form cord

Yellowish soles/eyes/skin

No or less movement

Fast or difficult breathing

**If with check in any of the above, provide Message for A4

Part 1: HEALTH RISK ASSESSMENT & KEY HEALTH MESSAGES (Indicate Y, if ‘yes’; N if ‘no’)

Message for A1

Bring your baby to a health provider for ap-propriate newborn care services.

Message for A2

Newborn screening is important because it can save babies from mental retardation and death and it can help in the early detection of illnesses.

Newborn screening is available for free for sponsored members in Philhealth accredited government facilities (Refer to section on Inpatient Coverage of the Philhealth Module in your Family Health Guide).

Have your baby immunized with BCG and Hepatitis B to protect him/her from prevent-able diseases.

You may also refer to your Mother and Child Book on “What I Need During the First Few Weeks after Birth”.

Message for A3

Giving your baby breast milk only for the first 6 months (with no other liquid like milk for-mula or water and other semi-solid foods) will protect him/her from ear infections, diar-rhea and respiratory illnesses.

You may also refer to your Mother and Child Book on “Feeding Recommendations from birth to 6 months”.

Message for A4

Bring your baby to a health provider if you observe any of these signs.

Bring with you this form (2A), your PhilHealth card, Member Data Record (MDR), and the baby’s Birth Certificate.

On your way to the health facility

Keep your baby warm

Breastfeed your baby every after two hours (if the baby is able to breastfeed)

Part 3: HEALTH PLAN (to be filled out with the help of the CHT partner)

Health Goal

Referral Provider/s (name and address)

(use the list of health providers in the Family Health Guide)

Date of initial visit (mo/day/year)

To bring my baby to the health provider for newborn care services

To bring my baby to health provider for newborn screening, BCG and Hepa B immunization

To exclusively breastfeed my baby

3.2 Plan for EMERGENCY Cases (If check in any item in A4)

Reasons for Emergency Referral Emergency transport providers (name and

contact no.)

Health Service Providers (name and address)

Consultation for immediate assessment and management of danger signs

Part 4: ACTIONS TAKEN (to be filled out by the midwife, nurse or doctor) (Please accomplish/update the Immunization Schedule in the Mother and Child Book )

Name and address of health provider:

Services provided: (specify antigens and schedule, example: BCG, HepaB1 within the 1st 24 hrs or HepaB1 after 24hrs)

Date of consultation:

Instruction of the provider:

Schedule of next check-up:

3.1 Plan for REGULAR Cases

Part 2: GENERAL INFORMATION (to be filled out with the help of the CHT partner)

Name of Mother (Last name, first name, middle name)

NHTS HH ID:

Name of CHT partner (Last name, first name, middle name) Date of Visit:

Name of Newborn (Last name, first name, middle name) Date of Birth:

PART 1: HEALTH RISK ASSESSMENT &

KEY HEALTH MESSAGES

PART 2: GENERAL

INFORMATION

PART 3:

HEALTH PLAN

PART 4:

ACTIONS TAKEN

28

During the Family Health Hour, Task 4a (or ASSESSMENT) is done simultaneously with Task 4b (or

INFORMING). Together, Tasks 4a and 4b make up PART 1 of the HEALTH PLAN

IMPLEMENTATION FORMS.

STEPS TO ASSESSING MEMBERS‟ HEALTH RISKS

1. Ask the questions on the left side of Part 1.

Questions should be directed to the particular family member with the health condition that may be

risky. For newborns, infants, and children, ask the parents or any responsible member of the

household. For adolescents, you may ask him/her directly, with or without his/her parents or

guardians.

Write the responses on the spaces provided. Depending on the response, you should then follow the

instructions on the form to either go to another question or to deliver the corresponding key health

message.

2. Deliver the corresponding key health message where you are directed to go.

Part 1 of the Health Plan Implementation Forms also contains directions on which key health

messages should be given to the respondent.

Health messages are discussed in more detail in the next section.

Some messages are to be given REGARDLESS of the respondent‟s answer; others are only given in

response to SPECIFIC answers. Be aware of the flow of questions and messages, and follow these

carefully.


HELPFUL TIP! Adolescents (age

10 to 19 years old) are a special

group with unique health needs

and varying sensibilities. They

should be directed to the messages

in the Family Health Guide. Don’t

forget to remind them that they

can always approach their health

provider if they have any questions

or concerns about their health.

4. INFORM (Task 4b: Delivering Key Health Messages)

Task 4b is the second part of helping family members make their Health Plans. As mentioned in the

previous section, in reality, assessing is done simultaneously with informing. Again, as for Task 4a,

your main tool for this task is Part 1 (Health Risk Assessment and Key Health Messages) of the

Health Plan Implementation Forms. For more detailed discussions of the different Health Plan

Implementation module, see pages 40 onwards.

To accomplish this task, you should deliver the Key Health Message indicated in Part 1 which

corresponds to the instructions on the Form. Key health messages are designed to be short and concise.

These represent your main and initial message for the member at risk.

Most often, you will notice that Key Health Messages end with a prodding to the member (or the

member‟s parent/primary care giver if the member is a newborn, infant or child) to seek care from a

health provider for specific health needs. Delivering these messages is a major part of your roles as a

CHT Partner and health navigator for the family.

BEYOND THE KEY HEALTH MESSAGES

If you feel that a particular message needs more explaining, or if the

family member would like to know more, you may refer to the

Family Health Guide for more information and messages that you

could point out to that particular member whom you are assessing

and informing.

Flash cards may also be used in subsequent home visits to

reinforce messages you have given before, or to emphasize certain

aspects of the members‟ health condition. Flash cards can also be a

valuable resource during small group discussions, such as during

mother‟s classes, health classes, Tumpukan sa Barangay, purok

meetings, and more.

Task 4. Help

family members

make their

Health Plans.

4.a Assess the

members‟ health

risks.

ASSESS


4.b Deliver key

health action

messages.

INFORM

30

The Booklet ni Nanay at ni Baby will also be a valuable reference to you, as it contains a wide array of

health messages that are relevant to mothers, newborns, infants, and children.

Finally, the Family Guide to PhilHealth: Benefits, Cilments, and Responsibilities will also be important

as you share with the family how enrollment in PhilHealth can benefit them in their particular situations.

5. PLAN (Task 4c: Helping Members Develop Health Plans)

Task 4c is the third and last part of helping family members make their Health Plans. You will be using

Part 2 (General Information) and Part 3 (Health Plan) of the Health Plan Implementation Forms.

For more detailed discussions of the different Health Plan Implementation module, see pages 40

onwards.

Health plans are made by members and belong to the members. You may write the information

yourself, or the member may do so. What is important is that the family member recognizes that the

plans written on the form are his/her plans, not your (the CHT partner‟s) plans. It is important to impart

to the family member a sense of ownership and responsibility to adhere to the plan. If you are the

one writing the information, you will need to accomplish this part of the Health Plan Implementation

Form working closely with the member concerned, or with the parent or primary care-giver if the

member is a newborn, infant, or child.

Once a member or respondent has completed Part 2 and 3, you should leave the Health Plan

Implementation Form with him/her. You can copy the information into your logbook for record-

keeping purposes, but the form belongs to the family member. Remind them that they should:

a. Keep the form safe, in a place where it will not get damaged or lost;

b. Bring the form with them when they visit the health provider as planned;

c. Remind the health provider to fill up the appropriate part of the form (Part 4 if it is the initial visit

to the provider, or Part 5 on the back of the form for follow-up or succeeding visits); and

d. Bring the form back home with them after visiting the health provider.

4.c Help members

develop Health

Plans; refer to health

provider and

transport.

PLAN


Task 4. Help

family members

make their

Health Plans.


STEPS TO HELPING MEMBERS DEVELOP HEALTH PLANS

1. Fill up Part 2 (General Information).

In the spaces provided, write down the information asked. Depending on the type of form (see

Health Plan Implementation Modules, p. 40), these will include the complete name of the respondent,

the complete and correct NHTS household ID number, the name of the CHT partner (your name), and

the date of visit (the date the health plan was accomplished).

For newborns, infants, and children, there are separate spaces for the child‟s name and birth date, as

well as space for the name of the child‟s parent or primary care-giver.

2. Fill up Part 3 (Health Plan).

For the first 5 Health Plan Implementation forms (Forms 2A to 2E - Newborn Health, Infant Health,

Child Health, Pregnancy/Pre-Natal Care, and Post-Partum Care), the Health Plan is divided into

two parts (Regular Cases, and Emergency Cases).

a. Regular cases

In this section, “regular cases” refers to those situations in which the health goal is not an

emergency. Regular cases would include, for example, referrals for immunization, counseling, or

follow-up checkups.

i. Health Goal

Health goals are outcomes that the member desires based on his/her realization of

his/her health risks. For example, for newborns, a health goal might be “To bring

my baby to a health provider for newborn screening.”

Place a check next to the health goal of the member, or, if the member‟s goal is

not included in the choices given, place a check next to “OTHERS”, then write the

goal on the space provided.

If the member has more than one health goal, check all those that are applicable.

ii. Referral Provider/s

Once a member has indicated his/her health goals, show the member the List of

Health Providers and Health Emergency Contacts, one of the component

booklets in the Family Health Guide. Help the member look for those health

32

providers or facilities in the vicinity that offer the services they need, are easily

accessible, and are affordable.

Many of the providers in the List are PhilHealth-accredited. If the member is

covered by a PhilHealth enrolment, show him/her the benefits and availments

applicable to his/her health needs. If the member is not covered by PhilHealth,

you can likewise encourage them to seek enrolment so that they can avail of the

appropriate benefits. You should refer to the Family Guide on PhilHealth:

Benefits, Availments and Responsibilities in guiding the family on these matters.

If the family has questions regarding PhilHealth of which you are uncertain, you

can refer them to your local PhilHealth Coordinator for further guidance.

iii. Planned Date of Visit

This is the date, decided by the member, when he/she will visit the health provider

indicated in the previous column.

b. Emergency cases

In this section, “emergency cases” refers to those situations in which the respondent or member

needs urgent treatment or care.

Part 1 of Forms 2A to 2E contains a list of “DANGER SIGNS” to watch out for in particular age

groups or conditions. As the CHT Partner, you should look for these danger signs in the member

during your visit with the family. It is also part of your task to teach the respondent or member

to watch out for these signs at all times, and to let them know that these signs could indicate a

serious health condition in him/her or his/her child.

If any of these signs are present at the time of your visit, you should make an urgent

referral to the nearest health provider for emergency care.

If none of these signs are present at the time of your visit, but had occurred some time in

the past before your visit, you should make an urgent referral to a health provider

for assessment.

If none of these signs are present at the time of your visit, and had never occurred in the

past, you should still fill out the section for emergency cases so that, in the event of

an emergency, the family already has a plan for who to go to for help, and how

to get there.


i. Health Goal

For emergency cases, the health goal is always “Consultation for immediate

assessment and management of danger signs.” Place a check next to this health

goal if the member is in need of emergency care.

ii. Emergency Transport Provider/s

Show the member or respondent the List of Health Emergency Contacts, and

help them choose the Emergency Transport Providers that they would approach in

case of an emergency. Note the Transport Provider‟s name and contact number/s

on the form. If possible, choose more than 1 so that the family has alternatives.

iii. Health Service Providers

Again, show the member or respondent the List of Health Emergency Contacts

and help them choose the emergency health service providers to whom they

would go in case of an emergency. Note the provider‟s name and contact

number/s in the form. If possible, choose more than 1.

3. Ask for the member or respondent‟s consent.

Finally, after the health plan has been made, jointly review it with the respondent. If the respondent

agrees to the plan, have him/her name and signature affixed in the space provided at the bottom of

Part 3: HEALTH PLAN. Once the form has been signed, give the form to the respondent.

For newborns, infants and children, it is the parent or primary care-giver who will sign here.

For adolescents who have been administered Health Plan Implementation Forms (i.e., a pregnant

adolescent), they will affix their own signatures to the bottom of Part 3.

4. Copy the information in the Health Plan Implementation form in your CHT Monitoring Form.

The Health Plan Implementation form stays with the family but you need to know the information it

contains for you to be able to remind the respondent/concerned household member on the

scheduled provider visits. This is why it is important for you to copy the information in Parts 2 and 3

of the Health Plan Implementation form in the corresponding CHT monitoring form (see Tables 4-8

for examples).

Make sure that you also get the accomplished Form 1: Household Profile to easily track household

members that you need to assist with health plan development and implementation.

34

6. MONITOR (Task 5: Following-up and Monitoring Health Plan Adherence)

Monitoring a member‟s adherence to his/her plans begins with the member‟s visits to a service provider.

This is recorded in Part 4 (Actions Taken) and Part 5 (Service Utilization and Monitoring Form) of

the Health Plan Implementation Forms.

Both Parts 4 and 5 are to be filled up by the Health Service Provider. Remind the member to bring

the form to every visit to the Service Provider, and to be responsible for checking that the Service

Provider fills out these sections completely.

As the CHT Partner, you will be using Parts 4 and 5 as a basis for monitoring adherence to health

plans.

Part 4: Actions Taken

This will be filled-up by the Health Provider as soon as the respondent or newborn, infant or

child is brought to the facility. This will serve as your starting point for monitoring compliance

to the instructions of the provider. Part 4 includes the following:

• Name and address of health provider

• Services provided

• Date of consultation

• Instructions of the provider

• Schedule of next visit to provider for check-up.

Part 5: Service Utilization Monitoring Form

This is located at the back of the Health Plan Implementation Form (see Table 3, below). This

should be filled out by the service provider if there are follow-up visits to the initial visit

recorded in Part 4, using one row of the form per visit. If only one visit was necessary, then

only Part 4 need be filled out and Part 5 can be left blank.

Task 5. Follow-

up and monitor

health plan

adherence.

MONITOR

R



Part 5 contains the following information:

• Date of consultation – recorded by the health provider as the date of the client‟s visit, in

the format of mm/dd/yy.

• Name and address of provider – the health provider should indicate his/her name and

address of the facility where the family member was served

• Service/s provided or commodities prescribed – brief description of the services

provided/commodities prescribed during the client‟s visit to the health facility

• Instruction of the provider – based on the findings of the health provider, he/she will make

the necessary referral to higher level facilities and suggest schedule of visit

• Schedule of next visit to provider for checkup - this should be recorded in the

corresponding column following the format: month/day/year.

Table 3. SAMPLE SERVICE UTILIZATION AND MONITORING FORM.

Part 5. Service Utilization and Monitoring Form for Newborn Health

Date of Consultation

(month/day/year)

Name and address of provider

Services Provided

Instructions of the provider

Schedule of next visit to provider

for check-up

36

STEPS TO FOLLOWING-UP AND MONITORING HEALTH PLAN ADHERENCE

1. Visit the family again to check on the members‟ adherence to their health plans.

In the succeeding household visits, you should review the following:

(For Forms 2A to 2E): Booklet ni Nanay at ni Baby – check if the appropriate sections were

completely filled out by the Health Provider. Make sure also that Part 4 of the Health Plan

Implementation Form has been completely filled out, and that the Form has been attached to the

Booklet ni Nanay at ni Baby. This will enable you to determine whether they sought and obtained

health care services as discussed during your earlier visit where you and the family completed the

Health Plan Implementation Forms. This portion will also tell you if the member was referred by

the health provider to a higher level of care.

Copy the pertinent details into the CHT Monitoring Forms or your logbook (for templates, see

the examples on pages Error! Bookmark not defined. toError! Bookmark not defined.).

(For all Forms): Part 4 (Actions Taken) and Part 5 (Service Utilization Monitoring), if

applicable – check to see if these sections were duly accomplished by the health provider.

Especially for those members whose health plans require repeated visits to a health provider (such

as, for example, multiple pre-natal care visits for pregnant women), routinely check the Service

Utilization Monitoring Form to know the provider‟s instructions and the schedule of next visit to

the facility. You should also constantly remind concerned household members to comply with

the provider‟s instructions and follow their scheduled provider visits.

Copy the pertinent details into your CHT Monitoring Forms/Logbook.

D. POST-SESSION: REPORTING SUMMARIES OF HEALTH INFORMATION


7. REPORT (Task 6: Provide Summary Report to Rural Health Midwife)

Using your CHT Monitoring Form/logbook, record and update the health profile of the NHTS household

members assigned to you. You can add “NHTS” under the „Remarks‟ column or in the portion where you

write notes for each client or family member.

a. Record family members according to their health condition, using separate logbook tables for: (1)

Newborn and Infant Health; (2) Child Health; (3) Maternal Care; (4) Family Planning; and (5) Chronic

Cough Management. From these five, select the appropriate logbook table to record basic

information for each NHTS-PR family member you assist, include the following information: name,

age or birthdate, address, health services needed, health services provided, and date of initial or follow-

up visit to health provider (see the Sample CHT Monitoring Forms/Logbook templates in Tables 4

to 8).

b. For the recording of health services provided, ensure that you record antenatal care (ANC) visits

(specify in the Remarks section if the respondent has already reached 4 or more), facility-based

deliveries (FBD), Vitamin A, fully-immunized child (FIC), exclusive breastfeeding up to 6 months (EBF),

and modern family planning use.

c. You should also note in your logbook, for each health service recorded, whether this was provided by

a private or public health provider.

d. If the NHTS family member was able to use his/her PhilHealth to pay (partially or fully) for the health

service, test, medicines or drugs, note this in the „Remarks‟ column, as „used PhilHealth‟.

Table 4. SAMPLE CHT MONITORING FORM/lOGBOOK FOR NEWBORN AND INFANT HEALTH.

NEWBORN & INFANT HEALTH MONITORING

NAME

(Last,

First,

Middle)

AGE ADDRESS HEALTH SERVICE

NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

REYES,

ANA CRUZ

10

months

Lot 3, Blk

8, Purok 2,

Brgy

Laging

Handa

Immunization 9/30/2011 Hep B3

immunization

11/5/2011

for

measles

vaccine

NHTS

Laging

Handa

Health

Center

(public)

38

Table 5. SAMPLE CHT MONITORING FORM/lOGBOOK FOR CHILD HEALTH.

CHILD HEALTH MONITORING

NAME

(Last, First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

CRUZ, B

SANTOS 4 years

Lot 4, Blk

1, Purok 3,

Brgy

Laging

Handa, QC

Vitamin A

supplementation 10/12/2011

Vitamin A

supplementation

10/19/201

1 NHTS

Delgado

Hospital

(private)

Table 6. SAMPLE CHT MONITORING FORM/lOGBOOK FOR MATERNAL HEALTH.

MATERNAL HEALTH MONITORING

Table 7. SAMPLE CHT MONITORING FORM/lOGBOOK FOR FAMILY PLANNING.

FAMILY PLANNING MONITORING

NAME

(Last, First,

Middle)

AGE

FIRST

TIME

USER OF

FP

METHOD?

(Y/N)

ADDRESS

HEALTH

SERVICE/

COMMODITIES

NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE /

COMMODITIES

PROVIDED

(Specify

Quantity of

Commodity)

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

FLORES,

CORA

HEBRON

25 No

Lot 1, Blk 6,

Purok 4,

Brgy Laging

Handa

Pills (1 cycle) 10/5/2011 Pills (1 cycle) 10/27/201

1 NHTS

LM Midwife

Clinic (private)

NAME

(Last, First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

REYES, ANA

CRUZ 35

Lot 3, Blk

8, Purok 2,

Brgy

Laging

Handa

Pre-natal checkup 9/30/2011 NHTS

Laging Handa

Health Center

(public)


Table 8. SAMPLE CHT MONITORING FORM/lOGBOOK FOR CHRONIC COUGH MANAGEMENT.

CHRONIC COUGH MANAGEMENT MONITORING

NAME

(Last, First,

Middle

AGE ADDRESS

HEALTH

SERVICE/

DUGS

NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE/DRUGS

PROVIDED

(Specify name

and quantity of

drugs)

DATE OF

NEXT VISIT REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

FLORES,

JOCELYN 36 years

Lot 1, Blk

6, Purok 4,

Brgy

Laging

Handa

Checkup 10/5/2011 Sputum exam 10/27/2011 NHTS

Maco Rural

Health Unit

(public)

2. The CHT monitoring forms/logbook shall be submitted to the RHM during the monthly meeting

for reconciliation with the TCL. These forms/logbook shall be returned to you for safekeeping.

3. During your monthly meeting with the RHM, also show her/him the accomplished family profiles

(Form 1) of NHTS households assigned to you. Update the RHM on the following:

a. Number of assigned NHTS households you visited vis-à-vis the number of NHTS households

assigned to you

b. Number of assigned NHTS-PR households with at least one health use plan

c. Number of assigned NHTS households with PhilHealth ID

40

III. Health Plan

Implementation

_____Modules____

Included Modules:

Newborn Health

Infant Health

Child Health


Postpartum Care

Family Planning

Chronic Cough Management


HEALTH PLAN IMPLEMENTATION FORM 2A:

NEWBORN HEALTH (0-28 DAYS)

This form will be used for newborns (0 to 28 days old).

Step 1: Route from Form 1 (Household Profile).

In the example shown in Figure 6, B Cruz Santos is 20 days old. As directed, you will go to accomplishing

FORM 2A: Health Plan Implementation for NEWBORN HEALTH (0-28 days) with the parent or

primary care-giver who can provide information as the respondent.

Figure 6. EXAMPLE OF ROUTING A NEWBORN HOUSEHOLD MEMBER FROM FORM 1 TO FORM 2A.

42

Step 2: Assess member‟s health risks and deliver key health messages.

Ask the questions under Part 1 (see Figure 7). Ask each question in order, then deliver the

corresponding key health message to the parent or primary care-giver, where you are directed to go.

Remember that the Key Health Messages found in Form 2A are your initial and most important messages

for the parent or primary care-giver of the newborn. You may refer to the appropriate sections in the

”Booklet ni Nanay at ni Baby” or the Family Health Guide, A. Messages: Caring for Newborn (p. 6)

for more information. Flash cards (Card 4) may also be used in subsequent home visits to reinforce or

emphasize certain aspects of the newborn condition.

Figure 7. SAMPLE FORM 2A: HEALTH PLAN IMPLEMENTATION FOR NEWBORN HEALTH.


QUESTIONS and KEY HEALTH MESSAGES (refer the respondent to the Family Health Guide, A.

Health Messages, Caring for Newborn on p. 6 while conducting this health risk assessment)

A1. Was the baby provided with any of the following? (Please check, if yes)

Appropriate newborn care is provided during the first few weeks after birth to ensure his/her

survival. These newborn services include:

a) Advice on exclusive breastfeeding until the baby is 6 months of age;

b) Newborn screening to detect some congenital conditions that could cause mental

retardation and even death if not managed early in life; and,

c) Immunization with BCG and Hepatitis B to protect him/her from preventable diseases

Place a check next to the services that the newborn has already received.

Newborn assessment/screening

BCG

Hepatitis B

Regardless of the answer to Question A1, deliver the Message for A1, then go to Question

A2.

o If none or only 1 or 2 of the services were checked, then emphasize that the baby must be

brought to a skilled health provider to receive appropriate newborn care. Babies less

than 1 week old should be referred immediately to a health facility for newborn

screening and immunization.

o For the items that were checked, commend the parent/care-giver and reinforce their

action by sharing the Message for A1.

Message for A1

• Newborn screening (NBS) is important because it can help in the early detection

of diseases like mental retardation

• Bring your baby to a doctor, nurse, midwife or any skilled health provider for

newborn screening 24-72 hours after delivery

• Newborn Screening (NBS) is free for dependents of PhilHealth-sponsored

members in accredited government facilities. (Refer to Section A on INPATIENT

COVERAGE, p. 7 and Table 2, p. 8 of the Family Guide on PhilHealth)

• Have your baby immunized with BCG and Hepatitis B vaccines to protect

44

A2. Do you only give breast milk (exclusive breastfeeding) to your baby?

Newborns should start breastfeeding within the first 1 ½ hours of life. Exclusive

breastfeeding means giving the baby only breastmilk (without milk formula, water, or other

foods) and should be done for the first 6 months of life. Aside from being completely

adequate for the nutritional needs of babies, exclusive breastfeeding has also been proven to

protect babies from ear infections, diarrhea, and respiratory illnesses.

Ask the question, then write the response on the form: Y if „Yes‟, and N if „No‟.

Regardless of the answer to Question A2, deliver the Message for A2, then go to Question

A3.

o If the answer is “No”, then emphasize the importance of exclusive breastfeeding for the

health of the newborn.

o If the answer is “Yes”, then commend the parent/care-giver and reinforce their action by

sharing the Message for A2.

A3. Does your baby have any of the following danger signs?

Danger signs are conditions that could point to a more serious illness or complication of a

disease. If a baby shows danger signs, it is important to bring him/her immediately to the

nearest health facility for urgent attention and treatment.

him/her from TB and Hepatitis B

• Refer to your Booklet ni Nanay at ni Baby - "Ang Aking Mga Pangangailangan sa

Unang Linggo ng Aking Pagsilang", p. 24

Message for A2

Breast milk is adequate for your baby's needs for the first 6 months. (Exclusive

Breastfeeding)

Breastfeed starting at birth up to 2 years and beyond

Breastfeeding for the first 6 months (without milk formula, water or other

foods) will protect your baby from ear infections, diarrhea and respiratory

illnesses respiratory illnesses.

Refer to your Booklet ni Nanay at ni Baby, p. 26 - “Tagubilin sa Pagpapakain”.


Place a check next to the danger sign that the newborn is showing or has shown in the past.

Convulsions

Stopped breastfeeding / poorly sucking

Feels hot or cold to touch

Foul-smelling discharge or blood from cord stump

Yellowish soles / eyes / skin

No or less movement

Fast / difficulty breathing

Regardless of the answer to A3, deliver the Message for A3 and accomplish Part 3.2 of the

Health Plan Implementation Form.

o If the baby is showing danger signs at the time of your visit, immediately refer the child to

the nearest health provider for emergency care.

o If the baby is not showing danger signs at the time of your visit, but has shown danger

signs some time in the past, refer the child to a health provider for assessment.

o If the baby is not showing and has never shown danger signs, instruct the parents /

primary care-giver to watch out for these signs, and to refer to their Health Plan for

Emergency Cases (the completed Part 3.2 of the Health Plan Implementation Form for

Newborn Care) so that they can bring their child immediately to their planned Emergency

Providers in case they observe any of these signs in their child.

Step 3: Help members develop health plans.

Parts 2 (General Information) and 3 (Health Plans) are accomplished with the parents or primary care-

giver who can provide the necessary information.

Message for A3

• Bring your baby to a health provider if you observe any of these signs.

• Bring with you Form 2A, your PhilHealth card, Member Data Record (MDR) and

the baby‟s birth certificate.

• On your way to the health facility:

- Keep your baby warm

- Breastfeed your baby every two hours (if baby is able to feed)

46

Part 2 (General information) includes information such as complete name of the respondent, complete

and correct NHTS household ID number, complete name, date of birth of the newborn, and your name as

the CHT partner.

Part 3 (Health Plan) is divided into two parts:

a. Part 3.1: Referral for regular cases (Newborn screening, BCG and Hepatitis B immunization).

Place a check next to the Health Goal that the parent or primary care-giver has

identified based on his/her child‟s health risks. Then, continue to fill out the

health plan as described previously (p. 30).

Possible Health Goals for newborns (regular cases) include:

To bring my baby to health provider for newborn care services

To exclusively breastfeed my baby

Others

b. Part 3.2: Referral for emergency cases (Newborn with signs of danger in HRA Question A4)

Fill out the Health Plan for Emergency Cases as described above (p. 30)

Don‟t forget to ask the newborn‟s parent or primary care-giver to affix his/her signature in the space

allotted at the bottom of Part 3 as a sign of his/her consent to the Health Plan.

Before giving the Health Plan Implementation form to the respondent, fill out the CHT Monitoring

Form/Logbook for Newborn and Infant Health based on the information contained in Parts 2 and 3. Use

this referral information to remind the respondent of his/her scheduled visit to the provider.

Step 4: Follow-up and monitor health plan adherence.

On your subsequent visits to the household, you may use Flash card 4 to reinforce newborn care

messages. Check if the Health Plan has been adhered to by reviewing the following:

Booklet ni Nanay at ni Baby (particularly Tala ng Aking mga Bakuna on p. 25) completely filled out

by the Health Service Provider

Parts 4 (Actions Taken) and 5 (Service Utilization Monitoring Form) of Form 2A (see Table 9) to

be filled out by the provider in the absence of the ”Booklet ni Nanay at ni Baby”


Table 9. SAMPLE SERVICE UTILIZATION AND MONITORING FORM FOR NEWBORN HEALTH.

Part 5. Service Utilization and Monitoring Form for Newborn Health


(month/day/year)


Services Provided



for check-up

Copy the details in Form 2A Parts 4 and 5 or in Tala ng Aking Bakuna in the Booklet ni Nanay at ni Baby

in your CHT Monitoring form/Logbook for NEWBORN AND INFANT HEALTH MONITORING (see

Table 10). In case the latter is used, ask if the baby was examined for newborn screening.

Table 10. SAMPLE CHT/BHW LOGBOOK MONITORING ENTRY FOR NEWBORN AND INFANT HEALTH.

NEWBORN AND INFANT HEALTH MONITORING

NAME

(Last,

First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

REYES,

ANA CRUZ

1 day

Lot 3, Blk

8, Purok 2,

Brgy

Laging

Handa

Newborn

screening

Nov. 28,

2011

Newborn

screening

Dec. 3,

2011

NHTS;

used

PhilHealth

Laging

Handa

Health

Center

(public)

48

HEALTH PLAN IMPLEMENTATION FORM 2B:

INFANT HEALTH (29 DAYS-LESS THAN 12 MONTHS)

This form will be used for infants who are 29 days to less than 12 months old.


In the example shown belows (Figure 8), Reggie is 4 months old. As directed, you will go to

accomplishing Form 2B: Health Plan Implementation for Infant Health (29 days-Less Than 12

Months) with the parent or primary care-giver who can provide information as the respondent.

Figure 8. EXAMPLE OF ROUTING AN INFANT HOUSEHOLD MEMBER FROM FORM 1 TO FORM 2B.



Ask the questions under Part 1 (see Figure 9 below). Ask each question in order, then deliver the

corresponding key health message to the parent or primary care-giver.

Remember that the Key Health Messages found in Form 2B are your initial and most important messages

for the parent or primary care-giver of the infant. You may refer to the appropriate sections in the

”Booklet ni Nanay at ni Baby” or the Family Health Guide A. Messages: Caring for Infants and

Children (p. 8) for more information and messages relevant to infants.

Figure 9. SAMPLE FORM 2B: HEALTH PLAN IMPLEMENTATION FOR INFANT HEALTH.

50


Health Messages, Caring for Infant and Child on p. 8 while conducting this health risk

assessment)

Check the immunization card of the baby when asking the respondent the following

questions:

B1. Did your baby receive his/her first OPV, DPT & 2nd Hepa-B scheduled on the 6th week

after birth?

o If the answer is “No” (or the immunization card shows that the baby has not yet received

the vaccines), deliver Message for B1 and emphasize that the infant must be brought to a

skilled health provider to receive the right immunizations.

o If the answer is “Yes” (or the immunization card shows that the baby was already

immunized) and the baby is 10 weeks or above, ask Question B2. Go directly to Question

B4 if the baby is below 10 weeks.

B2. Did your baby receive his/her second OPV & DPT scheduled on the 10th week after

birth?

o If this is not yet received by the baby, deliver Message for B2 to B3, then ask Question B4.

Message for B1

• You can get free OPV and DPT from the health center. This helps prevent your

baby from having infectious diseases that may lead to permanent disability and

even death.

Message for B2 to B3

• Follow the schedule of immunization to ensure that your baby is fully immunized by age 12 months

• Bring your baby to the health center before he/she is 1 year old to complete his/her immunization:

BCG, DPT 1,2,3, OPV 1,2,3; Hepa 1,2,3 and measles

• Bring your baby's immunization card or Booklet ni Nanay at ni Baby every time you bring him/her to

your health provider


o If this is already received by the baby and he/she is 14 weeks or above, ask Question B3.

Go directly to Question B4 if the baby is below 14 weeks.

B3. Did your baby receive his/her third OPV, DPT & Hepa B scheduled on the 14th week

after birth?

o If the answer is “No”, deliver Message for B2 to B3, then ask Question B4.

o If “Yes” and the baby is 6 months or below , ask Question B4. Go directly to Question B5 if

the baby is above 6 months.

You may refer to your Booklet ni Nanay at ni Baby, p. 25 - “Tala ng Aking mga Bakuna ” for

more information on the right immunization schedule.

B4. (For babies 0-6 months old) Is your baby exclusively breastfeeding?

Regardless of the answer to Question B4, deliver the Message for B4, then go to Question

B5.

o If the answer is “No”, emphasize the importance of exclusive breastfeeding for the health

of the infant.

o If the answer is “Yes”, commend the parent/care-giver and reinforce their action by

sharing the Message for B4.

B5. (For babies 6-11 months old) Was your baby given Vitamin A?

.


B6.

o If the answer is “No”, emphasize the importance of Vitamin A supplementation for the

health of the infant.

Message for B4

• Breastfeeding for the first 6 months (without milk formula, water or other foods) will protect your

baby from ear infections, diarrhea and respiratory illnesses

• Breast milk is adequate for your baby's needs for the first 6 months

52



B6. (For babies older than 6 months) Is your baby eating solid food?


B7.

o If the answer is “No”, emphasize the importance of complementary feeding for the health

of the infant, and of growth monitoring for checking nutritional status of the infant.



B7. Does your baby have any of the following signs?

Place a check next to the sign that the infant is showing.

Cough

Diarrhea (soft stools at least 3 times a day)

Fever

Swelling of hands and feet

Convulsions

Regardless of the answer to B7, deliver the Message for B7 and accomplish Part 3.2 of the


o If the infant is showing danger signs at the time of your visit, immediately refer the child to

Message for B5

Your baby must receive Vitamin A at 6-months old. Do this every 6 months

until 5 years old.

Vitamin A increases your baby‟s resistance to infectious diseases and helps

prevent blindness.

Message for B6

Refer to “Booklet ni Nanay at ni Baby” on page 26 for “Tagubilin sa

Pagpapakain mula anim na buwan hanggang 12 buwan”

Refer to “Booklet ni Nanay at ni Baby” on page 29 for “Pagsubaybay sa aking

paglaki at Pagbabago”

Poorly or unable to breastfeed,

eat or drink

Vomits everything

Chest indrawing

Fast or difficulty in breathing

Very sleepy/unconscious



o If the infant is not showing danger signs at the time of your visit, but has shown danger


o If the infant is not showing and has never shown danger signs, instruct the parents /



Infant Health) so that they can bring their child immediately to their planned Emergency





Part 2 (General information) includes information such as complete name of mother, complete and

correct NHTS household ID number, complete name, date of birth of the infant and your name as the

CHT partner.


Part 3.1: Referral for regular cases (Immunization and common childhood illnesses, Exclusive

Breastfeeding, Complementary Feeding and Vitamin A Supplementation).



health plan as described previously (p. 30).

Possible Health Goals for infants (regular cases) include:

To bring my baby to health provider on the scheduled immunization date/s

Message for B7

• Immediately bring your child to a health provider if you notice any of these

signs

• Bring with you Form 2B, your PhilHealth card, Member Data Record (MDR) and

the baby‟s birth certificate.

54

To exclusively breastfeed my baby for 6 months

To ensure that my baby receives vitamin A supplementation every 6

months

To ensure that after 6 months, my baby receives proper solid food

(Complementary Feeding)

To bring my baby to a health facility for consultation, growth monitoring

and treatment

Others

Part 3.2: Referral for emergency cases (Infants with signs of danger in HPI Question B9)

Fill out the Health Plan for Emergency Cases as described above.

Finally, don‟t forget to ask the infant‟s parent or primary care-giver to affix his/her signature in the space

allotted at the bottom of Part 3, as a sign of his/her consent to the Health Plan.


Form/Logbook for Newborn and Infant Health based on the information contained in Parts 2 and 3. Use

the referral information to remind the respondent of his/her scheduled visit to the provider.


On your subsequent visits to the household, you may use Flash cards 4 and 5 to reinforce messages for

the newborn and infant. Check if the Health Plan has been adhered to by reviewing the following:



Parts 4 (Actions Taken) and 5 (Service Utilization Monitoring Form) of Form 2B see Table 11

below) to be filled out by the provider in the absence of the ”Booklet ni Nanay at ni Baby”


Table 11. SAMPLE SERVICE UTILIZATION AND MONITORING FORM FOR INFANT HEALTH.

Part 5. Service Utilization and Monitoring Form for Infant Health


(month/day/year)


Services Provided



for check-up

Copy the details in Form 2B Parts 4 and 5 or in Tala ng Aking Bakuna in the Booklet ni Nanay at ni Baby

in your CHT Monitoring form/Logbook for NEWBORN AND INFANT HEALTH MONITORING (see

Table 12).

Table 12. SAMPLE CHT MONITORING FORM/LOGBOOK ENTRY FOR INFANT HEALTH

INFANT HEALTH MONITORING

NAME

(Last,

First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

REYES,

ANA CRUZ

10

months

Lot 3, Blk

8, Purok 2,

Brgy

Laging

Handa

Immunization 9/30/2011 Hep B3

immunization

11/5/2011

for

measles

vaccine

NHTS

Laging

Handa

Health

Center

(public)

56

HEALTH PLAN IMPLEMENTATION FORM 2C:

CHILD HEALTH (12 MONTHS-LESS THAN 5 YEARS)

This form will be used for children who are 12 months to less than 5 years old.


In the example shown below (Figure 10), Kristoffer Santos Cruz is 4 years old. As directed, you will

accomplish Form 2C: Health Plan Implementation for Child Health (12 Months-Less Than 5 Years)

with the parent or primary care-giver who can provide information as the respondent.

Figure 10. EXAMPLE OF ROUTING A CHILD HOUSEHOLD MEMBER FROM FORM 1 TO FORM 2C.



Ask the questions under Part 1 (see Figure 11 below). Ask each question in order, then deliver the

corresponding key health message to the parent or primary care-giver.

Remember that the Key Health Messages found in Form 2C are your initial and most important messages

for the parent or primary care-giver of the child. You may refer to the appropriate sections in the

”Booklet ni Nanay at ni Baby” or the Family Health Guide A. Messages: Caring for Infant and Child

(p. 8) for more information and message relevant to children.

Figure 11. SAMPLE FORM 2C: HEALTH PLAN IMPLEMENTATION FOR CHILD HEALTH.

58



assessment)

C1. Has your child been fully immunized against common childhood diseases, which are

preventable, before his/her 1st birthday?

Fully immunized means the child received the ff: BCG, HepaB1,2,3; OPV1,2,3; DPT1,2,3;

measles before his/her 1st birthday)

Ask the question , then write the response on the form: Y if „Yes‟, and N if „No‟.

o If the answer is „Yes‟, request to see the immunization or ECCD card/”Booklet ni Nanay at

ni Baby” and review if all immunizations have been given as scheduled and the child is

fully immunized, then go to Question C2.

o If the answer is „No‟, deliver the Message for C1, then go to Question C2.

C2. Has your child received the following in the last 6 months?

Place a check next to the services that the child received within the last 6 months.

Vitamin A supplementation

Deworming tablets

Regardless of the answer to Question C2, deliver the Message for C2, then go to Question

C3.

o If only one or none of the items are checked, emphasize the importance of Vitamin A and

deworming to the health of children.

o If both items are checked, then commend the parent/care-giver and reinforce their action

by sharing the Message for C2.

Message for C1

• Complete your child‟s immunization [tuberculosis (BCG), diphtheria, tetanus

and whooping cough (DPT); polio (OPV), Hepatitis B and measles] to protect

him/her from infectious diseases that may lead to permanent disability or

death

• Free vaccines are available in your health center

• Bring with you ECCD card or Booklet ni Nanay at ni Baby during immunization


C3. Does your child have any of the following signs?

Place a check next to the sign that the child is showing.

Cough

Diarrhea (soft stools at least 3 times a day)

Fever

Swelling of hands and feet

Convulsions

Poorly or unable to eat or drink

Vomits everything

Fast or difficulty in breathing

Very sleepy/unconscious

Regardless of the answer to C3, deliver the Message for C3 and accomplish Part 3.2 of the


o If the child is showing danger signs at the time of your visit, immediately refer the child to


o If the child is not showing danger signs at the time of your visit, but has shown danger


o If the child is not showing and has never shown danger signs, instruct the parents /



Infant Health) so that they can bring their child immediately to their planned Emergency


Message for C2

• Your baby must receive Vitamin A at 6 months old. Do this every 6 months until

5 years old. Vitamin A increases your baby‟s resistance to infectious diseases

and helps prevent blindness.

• Deworming tablets help prevent intestinal worms. It impairs healthy nutrition,

reduces appetite and leads to mal-absorption of nutrients that cause stunting,

under-nutrition and anemia. Give your child deworming tablets at 1 year old.

Do this every 6 months.

60





correct NHTS household ID number, complete name, date of birth of the child, and your name as the

CHT partner.


a. Part 3.1: Referral for regular cases (Children completing immunization, Vitamin A

Supplementation, deworming and treatment for common childhood illnesses).



health plan as described previously (p. 30)

Possible Health Goals for newborns (regular cases) include:

To have my child completely immunized

To bring my child to the health facility for vitamin A and deworming

To bring my child to a health facility for consultation and treatment

Others

b. Part 3.2: Referral for emergency cases (Children with signs of danger in HRA Question C4)

Fill out the Health Plan for Emergency Cases as described above (p. 30).

Finally, don‟t forget to ask the newborn‟s parent or primary care-giver to affix his/her signature in the

space allotted at the bottom of Part 3, as a sign of his/her consent to the Health Plan.

Message for C3

• Bring your child to a health provider immediately.

• Bring with you Form 2C, your PhilHealth card, Member Data Record (MDR) and

the child‟s birth certificate.



Form/Logbook for Child Health based on the information contained in Parts 2 and 3. Use the referral

information to remind the respondent of his/her scheduled visit to the provider.


On your subsequent visits to the household, you may use Flash card 5 to reinforce messages on child

health. Check if the Health Plan has been adhered to by reviewing the following:



Parts 4 (Actions Taken) and 5 (Service Utilization Monitoring Form) of Form 2C (see sample on

Table 13) to be filled out by the provider in the absence of the ”Booklet ni Nanay at ni Baby”

Table 13. SAMPLE SERVICE UTILIZATION AND MONITORING FORM FOR CHILD HEALTH.

Part 5. Service Utilization and Monitoring Form for Child Health


(month/day/year)


Services Provided



for check-up

In your succeeding household visits, copy the details in the Form 2C Part 4 and 5 on your CHT

Monitoring Form/Logbook under CHILD HEALTH MONITORING (see Table 14 below).

Table 14. SAMPLE CHT/BHW LOGBOOK MONITORING ENTRY FOR CHILD HEALTH.

CHILD HEALTH MONITORING

NAME

(Last, First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

CRUZ, B

SANTOS

4 years

Lot 4, Blk

1, Purok 3,

Brgy

Laging

Handa, QC

Vitamin A

supplementation 10/12/2011

Vitamin A

supplementation

10/19/201

1 NHTS

Delgado

Hospital

(private)

62

HEALTH PLAN IMPLEMENTATION FORM 2D:

MATERNAL HEALTH: PREGNANCY / PRENATAL CARE

Once a pregnant woman member of the household is identified from the Family Profile List (Form 1)

under the column for women 15-49 years of age, go to accomplishing Form 2D, which is the Health Plan

Implementation (HPI) for pregnancy/ Prenatal Care. There may be more than one pregnant woman in the

household, or there may be a pregnant woman outside the age range (<15, >49), and in this case, a Form

2D should be prepared for each of them. If during the first visit, a pregnant woman in the household is

identified to be in need of immediate attention, go to accomplishing the Part 3.2 of Form 2D

(Emergency Case Referral) for her and immediately refer to the nearest health provider. Otherwise

this task can be done during the second visit.


In the example shown below (Figure 12), A Santos, 42 years old, is found pregnant. The CHT partner will

go to interview her as the respondent, and record her answers in Form 2D.

Figure 12. EXAMPLE OF ROUTING A PREGNANT HOUSEHOLD MEMBER FROM FORM 1 TO FORM 2D.



Ask the questions under Part 1 (see Figure 13 below) . Ask each question in order, then deliver the

corresponding key health message to the pregnant woman, where you are directed to go.

Remember that the Key Health Messages found on Form 2D are your initial and most important

messages for the pregnant woman. You may refer to the appropriate sections in the ”Booklet ni Nanay

at ni Baby” or the Family Health Guide A. Messages: Caring for Pregnant Women (p. 11) for more

information and message relevant to this period.

Figure 13. SAMPLE FORM 2D: HEALTH PLAN IMPLEMENTATION FOR PREGNANT / PRENATAL CARE.

64



assessment)

D1. How many months are you pregnant?

D2. How many pre-natal visits did you have?

If the mother has had prenatal visits during her current pregnancy, check her “Booklet ni

Nanay at ni Baby” (if available) and review the service provider‟s instructions together with

the pregnant mother.

Ask the question, then write the responses on the form.

- Write the number of months the mother is pregnant

- Write the number of pre-natal visits made

Regardless of the answers to Questions D1 and D2, deliver the Message for D1 and D2, then

go to Question D3.

D3. Are you experiencing any of the following danger signs?

Place a check next to the sign that the respondent is experiencing or has experienced.

Severe headache

Vaginal bleeding

Convulsions

Fever

Severe abdominal pain

Paleness

Regardless of the answer to D3, deliver the Message for D3 and accomplish Part 3.2 of the


o If the respondent is experiencing danger signs at the time of your visit, immediately refer

Message for D1 and D2

• Healthy pregnancy means a healthy baby

• Have at least 4 prenatal check-ups (at least 1 visit during the first 3 months; at

least 1 visit during the 4th to 6th months; and at least 2 visits during the 7th to

9th months). Receive Tetanus Toxoid.

• Ask your health provider to help you accomplish "Plano sa Paghahanda sa Oras

ng Panganganak at Emergency" in your Booklet ni Nanay at ni Baby, p.14


her to the nearest health provider for emergency care. The pregnant mother‟s Health

Plan Form may be filled up along the way or at the health facility.

o If the respondent is not showing danger signs at the time of your visit, but has shown

danger signs some time in the past, refer her to a health provider for assessment.

o If the respondent is not experiencing and has never experienced danger signs, instruct her

to watch out for these signs, and to refer to her Health Plan for Emergency Cases (the

completed Part 3.2 of the Health Plan Implementation Form) so that she can go

immediately to her planned Emergency Providers in case she experiences any of these

signs.

D4. Are you going to deliver in a health facility?


Regardless of the answer to Question D4, deliver the Message for D4, then go to Question

D5.

o If the answer is “No”, emphasize the importance of facility-based delivery for the health of

the mother and her child.

o If the answer is “Yes”, then commend the mother and reinforce her decision by sharing the

Message for D4.

Message for D3

• Go to the nearest health provider immediately if you are experiencing any of

these danger signs

• Bring Form 2D-1, your PhilHealth card and Member Data Record (MDR)

Message for D4

Give birth at a health facility to promptly manage possible complications

during childbirth

Use your PhilHealth benefits. See the “Family Guide on PhilHealth” if you are

a member or dependent, p.7

66

D5. Are you going to have check-up visits after your delivery?



D6.

o If the answer is “No”, emphasize the importance of post-partum checkups for her health.


Message for D5.

D6. Are you aware of the essential care for your baby within the first 24 hours of his/her

life?



D7.

o If the answer is “No”, emphasize the importance of essential newborn care for her baby‟s

health .

o If the answer is “Yes”, then commend the mother and reinforce her knowledge by sharing

the Message for D6.

Message for D5

Visit your health provider on the 3rd and 7th day after delivery for check-up,

early detection and management of complications.

Message for D6

The first 30 minutes of your newborn baby‟s life is critical. Breastfeed your

newborn and keep him/her dry and warm through skin-to-skin contact

Within 24 hours from chilbirth, your baby must undergo Newborn Screening

(NBS) and should be immunized for BCG and Hepatitis B


D7. Do you intend to practice family planning after giving birth?


Regardless of the answer to Question D7, deliver the Message for D7.

o If the answer is “No”, emphasize the importance of family planning to the mother‟s health

and the health of her family.


Message for D7.


Parts 2 (General Information) and 3 (Health Plans) are accomplished with the pregnant woman. In case

the pregnant woman has already sought prenatal consultation/s, then you can jointly refer to the Birth

and Emergency Plan that is found in the “Booklet ni Nanay at ni Baby” that has been prepared by the

pregnant woman with assistance from the service provider.


correct NHTS household ID number, and your name as the CHT partner.


a. Part 3.1: Referral for regular cases

Place a check next to the Health Goal that the pregnant woman has identified

based on her health risks. Then, continue to fill out the health plan as

described previously (p. 30).

Message for D7

Space your children 3-5 years apart to allow your body to fully recover

Go to your health provider to know the right Family Planning (FP) method for

you and your partnerFamily Planning methods which are effective and suit

your needs

68

Possible Health Goals for pregnant women (regular cases) include:

To have 4 or more prenatal checkups (preferably in a PhilHealth-accredited

facility)

To develop a Birth and Emergency Plan with the health provider

To deliver in a health facility (preferably PhilHealth-accredited)

To receive care within 12 hours, 3 days and 7 days after delivery for myself

and my baby

To receive family planning counseling

Others

b. Part 3.2: Referral for emergency cases (Pregnant women with danger signs in D3)


Refer back to the list of danger signs in Part 1 Health Risk Assessment question

D3 when identifying the reason for emergency referral, which can be stated as

“Consultation for immediate assessment and management of danger signs”.

These danger signs can also be found in the “Booklet ni Nanay at ni Baby”.

Identify and list down the name/s and contact number/s of the emergency

transport providers and the name and address of the health service provider

selected by the respondent.

Finally, don‟t forget to ask the pregnant woman to affix her signature in the space allotted at the bottom

of Part 3, as a sign of her consent to the Health Plan.


Form/Logbook for Maternal Care based on the information contained in Parts 2 and 3. Use the referral



In your subsequent visits to the household, you may use Flash cards 2 and 3 to reinforce messages on

pregnancy and prenatal care. Follow-up on the pregnant mother whether she sought and obtained

health care services as discussed during the first visit and followed the referral message (if they were

referred further) and the instructions of the provider. If you find out that the pregnant mother has not

gone to any service provider or health facility as advised during your first visit, ask for the reason/s why


so that you can find a way to assist the pregnant mother in seeking consultation. If the problem concerns

lack of money for transportation, for instance, you may refer the mother to the list of emergency

transport network or seek transport assistance from barangay officials.

To check whether the health plan has been adhered to, review the following:

Booklet ni Nanay at ni Baby – check the services provided by the Health Service Provider with the

to the pregnant woman.

Parts 4 (Actions Taken) and 5 (Service Utilization Monitoring Form) of Form 2D (see Table 15

below) to be filled out by the provider in the absence of the ”Booklet ni Nanay at ni Baby”

Table 15. SAMPLE SERVICE UTILIZATION AND MONITORING FORM FOR MATERNAL HEALTH (PREGNANCY).

Part 5. Service Utilization and Monitoring Form for MATERNAL HEALTH (PREGNANCY)


(month/day/year)


Services Provided



for check-up

Note that once Form 2D has been accomplished, also accomplish Form 2F: Health Plan

Implementation for Family Planning.

Copy the details in Form 2D Parts 4 and 5 (or in the Booklet ni Nanay at ni Baby) in your CHT

Monitoring Form/Logbook for MATERNAL HEALTH MONITORING (see Table 15 below).

Table 16. SAMPLE CHT MONITORING FORM FOR MATERNAL HEALTH: PREGNANCY.

MATERNAL HEALTH MONITORING (PREGNANCY)

NAME

(Last, First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

REYES, ANA

CRUZ

35

Lot 3, Blk

8, Purok 2,

Brgy

Laging

Handa

Pre-natal checkup 9/30/2011 NHTS

Laging Handa

Health Center

(public)

70

HEALTH PLAN IMPLEMENTATION FORM 2E:

MATERNAL HEALTH: POSTPARTUM CARE

Once a female member of the household is identified to be in the postpartum period (she is within 42

days of giving birth) in the column “9b For women 15-49 years old” of the Household Profile (Form 1),

accomplish Form 2E, or the Health Plan Implementation for Maternal Health: Postpartum Care

during your planned visit. In case there is more than one postpartum woman in the household, this Form

2D should be prepared for each of them. If during the first visit you find a postpartum mother in the

household who needs immediate medical attention, your priority is to assist her and facilitate her referral.

Fill-out the Part 3.2 Emergency Case Referral of Form 2E and immediately refer. Otherwise this task

can be done during the second visit.


In the example shown below (Figure 14), C Santos, 28 years old, is found to be in her postpartum period.

Go to interviewing C as the respondent and record her answers in Form 2E.

Figure 14. EXAMPLE OF ROUTING A POSTPARTUM HOUSEHOLD MEMBER FROM FORM 1 TO FORM 2E.




corresponding key health message to the postpartum mother as directed.

Remember that the Key Health Messages found on Form 2E are your initial and most important

messages for the postpartum woman. You may refer to the appropriate sections in the ”Booklet ni

Nanay at ni Baby” or the Family Health Guide A. Messages: Caring for Mothers After Giving Birth

(p. 13) for more information and message relevant to postpartum mothers.

Figure 15. SAMPLE FORM 2E: HEALTH PLAN IMPLEMENTATION FOR POSTPARTUM CARE

72


Health Messages, Caring for Mothers After Giving Birth on p. 13 while conducting this health

risk assessment)

E1. Were you checked by a doctor, nurse or midwife immediately after giving birth?


Regardless of the answer to Question E1, deliver the Message for E1, then go to Question E2.

o If the answer is “No”, emphasize the importance of having postpartum checkups from a

professional health service provider.

o If the answer is “Yes”, then commend the mother and reinforce her action by sharing the

Message for E1.

Additionally, inform the mother that:

She needs to receive one Vitamin A capsule within one month after delivery to increase her

body resistance against infections.

It is important to exclusively breastfeed her newborn baby until six months of age.

It is important that she bring with herthe newborn baby when she goes for postpartum check-

up.

E2. Are you experiencing any of the following danger signs?

Place a check next to the sign that the respondent is experiencing or has experienced.

Difficulty breathing

Paleness

Severe headache

Message for E1

Complications may arise within 42 days after delivery. You are at risk. Visit

your health provider to detect and treat possible complications following

these schedules:

- Within 12 hours after delivery

- On the 3rd day

- On the 7th

day

If you have not visited a health provider 7 days after delivery, go for

postpartum check-up immediately

Difficulty in urinating

Severe vaginal pain

Engorged and painful breast

Heavy vaginal bleeding


Fever

Foul-smelling vaginal discharge

Regardless of the answer to E2, deliver the Message for E2 and accomplish Part 3.2 of the


o If the respondent is experiencing danger signs at the time of your visit, immediately refer

her to the nearest health provider for emergency care. The postpartum mother‟s Health

Plan Form may be filled up along the way or at the health facility.

o If the respondent is not showing danger signs at the time of your visit, but has shown

danger signs some time in the past, refer her to a health provider for assessment.

o If the respondent is not experiencing and has never experienced danger signs, instruct her

to watch out for these signs, and to refer to her Health Plan for Emergency Cases (the

completed Part 3.2 of the Health Plan Implementation Form) so that she can go

immediately to her planned Emergency Providers in case she experiences any of these

signs.


Parts 2 (General Information) and 3 (Health Plans) are accomplished with postpartum mother. In case the

postpartum mother has already sought postnatal consultation/s, then you can jointly refer to the Birth

and Emergency Plan that is found in the “Booklet ni Nanay at ni Baby” that has been prepared by the

pregnant woman with assistance from the service provider.

Part 2 (General information) includes information such as complete name of the postpartum mother,

complete and correct NHTS household ID number, and your name as the CHT partner.


a. Part 3.1: Referral for regular cases

Message for E2

• Go to the nearest health provider immediately if you are experiencing any of

these danger signs

• Bring Form 2E, your PhilHealth card and Member Data Record (MDR)

74

Place a check next to the Health Goal that the postpartum woman has

identified based on her health risks. Then, continue to fill out the health plan

as described previously (p. 30).

Possible Health Goals for postpartum mothers (regular cases) include:

To receive care within 12 hours, 3 days and 7 days after delivery

Others

b. Part 3.2: Referral for emergency cases (Postpartum mother with danger signs in E2)


Refer back to the list of danger signs in Part 1 Health Risk Assessment question

E2 when identifying the reason for emergency referral, which can be stated as

“Consultation for immediate assessment and management of danger signs”.

These danger signs can also be found in the “Booklet ni Nanay at ni Baby”.

Identify and list down the name/s and contact number/s of the emergency

transport providers and the name and address of the health service provider

selected by the respondent.

Finally, don‟t forget to ask the postpartum mother to affix her signature in the space allotted at the

bottom of Part 3, as a sign of her consent to the Health Plan.


Form/Logbook for Maternal Health based on the information contained in Parts 2 and 3. Use the referral



In your subsequent visits to the household, you may use Flash card 3 to reinforce messages on post-

partum care. Ask the postpartum mother on whether she sought and obtained health care services as

discussed during the first visit.

If the postpartum mother has not gone to any service provider or health facility as advised

during your first visit, inquire about the reason/s and find a way to assist her in seeking care.

If the mother is worried that no one will take care of the children when she goes to the facility,

make the necessary arrangements to have someone from the community to watch over the

children while she is away.


Check health plan adherence by reviewing the instructions of the health provider in Parts 4 (Actions

Taken) and 5 (Service Utilization Monitoring Form) of Form 2E (see Table 16).

Table 16. SAMPLE SERVICE UTILIZATION AND MONITORING FORM FOR MATERNAL HEALTH

(POSTPARTUM).

Part 5. Service Utilization and Monitoring Form for MATERNAL HEALTH (POSTPARTUM)


(month/day/year)


Services Provided



for check-up

Note that once Form 2E has been accomplished, also accomplish Form 2F: Health Plan

Implementation for Family Planning.

Copy the details in Form 2E Parts 4 and 5 in your CHT Monitoring Form/Logbook for MATERNAL

CARE (see Table 17).

Table 17. SAMPLE CHT MONITORING FORM FOR MATERNAL HEALTH: POSTPARTUM.

MATERNAL HEALTH MONITORING (POSTPARTUM)

NAME

(Last, First,

Middle)


NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE

PROVIDED

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

REYES, ANA

CRUZ 35

Lot 3, Blk

8, Purok 2,

Brgy

Laging

Handa

Post-natal checkup 9/30/2011 10/6/11 NHTS

Laging Handa

Health Center

(public)

76

HEALTH PLAN IMPLEMENTATION FORM 2F:

FAMILY PLANNING

Form 2F is intended for pregnant women and non-pregnant women aged 15 to 49 yrs old identified in

the Form 1 Household Profile. This definition is important, because if the pregnant woman is not within

the age group, but pregnant e.g. adolescent, then she should still be referred for Family Planning.


The example below shows 4 types of women with different cases:

A – married, pregnant four years ago but not currently pregnant

B – recently gave birth, single mother

C – single, never been pregnant

D – pregnant adolescent

You need to help these women recognize possible health risks. Each should have her own Form 2F.

Figure 16. EXAMPLE OF ROUTING HOUSEHOLD MEMBERS FROM FORM 1 TO FORM 2F.



The Family Planning Module is slightly more complex than the others, because of the different scenarios

that are possible for the respondents who will be administered Form 2F. As an aid to understand the

flow of questions, study Figure 17 below to visualize how the four types of cases in the example would

answer Part 1 of their Health Plan Implementation forms.

Figure 17. FLOWCHART FOR FORM 2F, PART 1.

LEGEND

A – married, pregnant four years ago

but not pregnant now

B – recently gave birth, single mother

C – single, never been pregnant

D – pregnant adolescent

YES

(A, D)

F1. Do you have

a spouse/

partner now?

Accomplish

PARTS 2 and 3

NO

(B, C)

YES

(B)

NO

(C)

F2. Did you

have a partner

before?

F4. Do you

want to have a

child/ another

child?

YES

(D)

When or

how soon

from now?

SOON

(Within 1

year)

(D)

NO

(A, B)

LATER (More than 1 year)

F5, F6. Are you

currently using

any FP Method?

YES

(A)

GO TO

F7 and F8

NO

(B)

F3. How many living

children do you have?

____ (Fill in the blank)

78

HELPFUL TIP! Adolescents 15-19 years old and

Form 2F. For adolescent girls who have been

routed to Form 2F through the family profile, and

have answered NO to both Questions F1 and F2,

share the messages in the Family Health Guide:

Caring For Adolescents (p. 10) instead of

proceeding to referral for FP counselling. You may

also refer the teenager to providers of

adolescent reproductive health services if they

are available in your locality. Ask your CHT

supervisor or RHM for help if you are unsure of

what to do in such situations.

QUESTIONS and KEY HEALTH MESSAGES (see Figure 17 above; refer the respondent to the

Family Health Guide, A. Health Messages, Planning for a Healthy Family on p. 14 while

conducting this health risk assessment)

F1. Do you have a spouse / partner now?

A partner is defined as any one with whom the respondent has a sexual relationship. This

question is meant to identify those respondents who are currently sexually active.

If the answer is Yes, write “Y” then skip Question F2 and go to Question F3.

If the answer is No, write “N” then go to Question F2.

Example:

Both A and D have current partners, and so will both proceed directly to Question F3.

Neither B nor C have current partners, so they will go to question F2.

F2. Did you have a partner before?

A partner is anyone with whom the respondent has had a previous sexual relationship.

If the answer is Yes, write “Y” then go to Question F3.

If the answer is No, write “N” then proceed to filling out Parts 2 and 3 of Form 2F.

Example:

B had a previous partner with whom she has a son. She would then go to F3.

C has no history of any sexual relations.

Therefore, if F1 and F2 are succeedingly

answered with „NO,‟ the respondent is

directed to Part 2, and does not need to

answer questions from F3 to F7. From Part 2,

you, the CHT partner would guide her to Part

3 and develop the Health Plan, specifically

the 1st Health Goal. To go to a health

provider for Family Planning counselling

should still be among C‟s health goals. In C‟s

case, since she is an adolescent, the health

provider is expected to raise awareness on

Family Planning methods, prevention of Sexually Transmitted Illnesses (STIs) and other topics

pertinent to the Adolescent Module.


F3. How many living children do you have?

Regardless of the answer to F3, write the answer then go to Question F4.

If the woman has no living children, write “0”.

If the woman has living children, write the number of children (i.e, “1”, “2”, etc.).

Example:

Both A and B will answer Question F3 and proceed to Question F4.

F4. Do you (or your spouse/partner) want to have a/another child?

Regardless of the answer to F4, write the answer then deliver Message for F3 and F4.

If the answer is Yes, write “Y” then ask the follow-up question: “If yes, when?”

o If Yes but soon (within 1 year), skip Questions F5-F7 and proceed to Parts 2 and

3 of Form 2F, and refer for fertility counselling.

o If Yes but later (more than 1 year from now), go to Question F5.

If the answer is No, write “N” then go to Question F5.

F5. Have you or your spouse/partner ever used any modern Family Planning method?

You will need this information to tag whether the woman is a new acceptor of FP method or not

during the monitoring activities. For example D has no history of any FP method, and may be

referred to become a new acceptor. If the respondent asks what are the FP methods, use the list

of modern FP methods listed in F6.

Message for F3 and F4

• Go to your health provider for counselling on family planning if:

• You do not want to have a child or another child

• You want to have a child later

• If you want to have a child soon, consult your provider to help you on fertility

concerns

• For more information you may refer to the Family Health Guide.

80

F6. Are you or spouse/partner currently using any Family Planning Method?

If the woman specifies that she is currently not using any method, the CHT partner should no

longer ask the remaining questions. You go to Part 2 and 3 to develop the Health Goals.

If a woman said „YES‟ to a Traditional method, you will no longer ask the remaining questions.

Deliver message F5 and F6. After delivering the message, guide the woman in filling the Part 2

and 3 of the HPI

F7. What method are you/your partner currently using?

If the answer is „YES‟ to a Modern FP method, you need to ask the specific modern FP method

currently being used by the woman (or spouse/partner). Check the modern FP method‟s currently

being used by the woman/partner.

For example, suppose A uses pills, her partner uses condoms. Given this, A has to be reminded

that they need to go to a health provider since commodities like pills and condoms follow a

schedule. Inform her that she and her partner need to have an adequate supply of pills and

condoms. Also, A might need to consult a health provider regarding her use of pills. Deliver

message for F7.

8. Are you (/your) partner satisfied with the current FP method you are using?

If the respondent is not satisfied with their current FP method, deliver Message for F8.

Message for F5 and F6

• Space your children 3-5 years apart

• Go to your health provider for counseling on FP.

• Your health provider can advise you on effective Family Planning methods that

suit your needs

Message for F7

• Visit your health provider for check-up and re-supply of Family Planning

commodities (e.g. pills, condoms)

Message for F8

• Your health provider can help you choose an appropriate method for you (or

spouse/partner).



The Health Plan and Referral form is divided into three main parts, (i) General information, (ii) Referral to

provider, and (iii) Actions taken during the first visit for FP counselling. The general information simply

asks for the name of the woman and the NHTS ID. Copy the information from the HRA or the family

profile.

In the example, C is referred to a provider for FP counselling, check the appropriate box and fill in the

name of the provider and the scheduled visit. You would use this to check on the woman whether she

actually visited a provider or not.

Suppose the woman is a current user of a method (pills), check the appropriate box and fill in the name

of the provider and the scheduled visit. You would use this to check on the woman whether she actually

visited a provider or not.

82

Don‟t forget to ask the patient/caregiver to affix his/her signature in the space allotted at the bottom of

Part 3, as a sign of his/her accountability and ownership of the Health Plan.


Form/Logbook for Family Planning based on the information contained in Parts 2 and 3. Use the referral

information to remind the respondent of his/her scheduled visit to the provider. Tell the respondent to

request the provider to give detailed instructions, especially the schedule dates of re-supply for

commodities like condoms and pills. Remind her to bring the Health Plan Implementation Form

when she visits the provider so the latter can fill out the Service Utilization Form section.


You should remind the woman that during the visit to a health provider, she should request the provider

to be specific in terms of writing the services provided. For example, if pills and counselling were given

during the visit, the woman should request the provider to specifically write that they gave the family pills

and counselling.

In the box where a provider should fill in the instructions, inform the woman to request the providers to

be specific in terms of filling this up. For example, if FP method is advised, the woman should request the

provider to specify the method and instruction. For example, if BTL or NSV is instructed, the family

should prompt the provider to specify the schedule and referral facility. Inform the woman that you

would need these details when checking up on them during your regular visits.

\

a. FP service/commodity given or bought-provider should fill this out with the appropriate FP

services given or bought. If the commodity (e.g. pills, condoms) is bought, the pharmacist, nurse,

or attendant should assist the family in filling this out

b. Date the service/commodity is given or bought- the provider should fill this in following the

mm/dd/yy form


c. Name of facility - If the FP method is a service, say IUD insertion. The provider should fill in the

name of the facility. If the FP method is a commodity (say pill or condom), the

attendant/pharmacist should write the name of the store.

d. Next service/purchase date - For FP commodities like pills, condoms, DMPA, the health

provider should fill in these dates. Suppose during 1st visit conducted by the woman/family for FP

counseling, the provider could actually fill in advance these scheduled dates in order to remind

the woman/family that she needs to get those commodities on the specified date.

Case: Woman was provided with pills during the FP counselling, was asked to return back or

purchase pills on specific dates.

In the succeeding household visits, follow-up on the woman whether she sought and obtained the FP

services/commodities from the health provider. Copy in the CHT Monitoring Form/Logbook details of the

health services availed by the woman (contained in Parts 4 and 5 of Form 2F). You will use this to remind

the respondent to get pills or purchase the pills on or before the dates.

Table 18. SAMPLE CHT MONITORING FORM/LOGBOOK ENTRY FOR FAMILY PLANNING.

FAMILY PLANNING MONITORING

NAME

(Last, First,

Middle)

AGE

FIRST

TIME

USER OF

FP

METHOD?

(Y/N)

ADDRESS

HEALTH

SERVICE/

COMMODITIES

NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE /

COMMODITIES

PROVIDED

(Specify

Quantity of

Commodity)

DATE OF

NEXT

VISIT

REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

CRUZ,

AILEEN 25 No

Lot 1, Blk 6,

Purok 4,

Brgy Laging

Handa

Pills (1 cycle) 10/5/2011 Pills (1 cycle) 10/27/201

1 NHTS

LM Midwife

Clinic (private)

84

HEALTH PLAN IMPLEMENTATION FORM 2G:

CHRONIC COUGH MANAGEMENT

Once a member of the household (ages 10 years old and above), has cough of more than 2 weeks is

identified,, accomplish Form 2G, or the Health Plan Implementation for Chronic Cough Management

during your planned visit. In case there is more than one chronic cough patient in the household, this

Form 2G should be prepared for each of them.


Take for example the case of Ken Santos below (Figure 18). He has been identified to have cough of

more than 2 weeks duration. You need to help his mother fill up Form 2G: Health Implementation Plan

for Chronic Cough Management.

Figure 18. EXAMPLE OF ROUTING A HOUSEHOLD MEMBER WITH CHRONIC COUGH FROM FORM 1 TO FORM 2G.




corresponding key health message to the patient/caregiver, where you are directed to go.

Remember that the Key Health Messages found on Form 2G are your initial and most important

messages. Refer to the Family Health Guide: A. Health Messages - Caring for Family Members With

Chronic Cough (p. 19) for more information.

Figure 19. SAMPLE FORM 2G: HEALTH PLAN IMPLEMENTATION FOR CHRONIC COUGH MANAGAMENT

86

QUESTIONS and KEY HEALTH MESSAGES (see Figure 17 above; refer the respondent to the

Family Health Guide, A. Health Messages, Caring for Family Members with Chronic Cough on p.

19 while conducting this health risk assessment)

G1. Have you consulted a health provider regarding your cough for more than two weeks?

If family member has not yet consulted a health provider for the cough of 2 weeks or more,

explain that he or she may have TB.


If the answer to Question G1 is “No”, deliver the Message for G1, then go to Question G2.

o If the answer is “Yes”, then go to Question G2.

G2 . If consulted a health provider, what was the diagnosis?

If chronic cough is due to TB, place a check next to the sign indicating TB and deliver the

Message for G2a (TB).

Message for G1

Go to the health center for checkup and testing.

Message for G2a (TB)

Go to a TB-DOTS provider immediately for treatment

TB can be treated. Free Anti-TB Drugs are available at the health

center or any DOTS facility

Patient needs to take anti-TB drugs for at least 6 months AND must

be supervised by a treatment partner

Improper treatment of TB may lead to more serious complications.

Because TB is an infection transmitted thru air, it may spread to other

members of the family, especially children.

TB may cause death if left untreated or not properly treated.

Return to the health center/DOTS facility for your follow-up tests/

check-ups


If the answer to the diagnosis is NOT TB, and a condition or disease that also presents as

chronic cough, deliver Message for G2b (Other non-TB diseases).


Parts 2 (General Information) and 3 (Health Plans) are accomplished with chronic cough patient.

Part 2 (General information) includes information such as complete name of the postpartummother,

complete and correct NHTS household ID number, and your name as the CHT partner.

Part 3 (Health Plan) is the section for Referral.

Place a check next to the Health Goal that the patient has identified based on

his/her health risks. Then, continue to fill out the health plan as described

previously (p. 30).

Possible Health Goals for chronic cough patients include:

To go to the health facility for check-up, testing and treatment

To go to the health facility for scheduled follow-up

To continue treatment/resupply of medication (for TB patients)

Others

Don‟t forget to ask the respondent/care-giver to affix his/her signature in the space allotted at the

bottom of Part 3, as a sign of his/her accountability and ownership of the Health Plan.


Form/Logbook for Chronic Cough Management based on the information contained in Parts 2 and 3. Use

the referral information to remind the respondent of his/her scheduled visit to the provider.

Message for G2b (Other cough-like diseases)

Take your medicines as prescribed by your health provider

Improper use of medicines may worsen your condition and

could lead to a more serious illness

Go back to your health provider for follow-up

88

Remind the respondent to bring the Health Plan Implementation Form when he/she visits the

health provider so the latter can fill out the Service Utilization Form section in the Health Plan

Implementation Form.

The duly accomplished 2G Health Plan Implementation Form with the action taken written should

be stapled to the NTP ID Card if the patient is diagnosed with TB.


In your subsequent visits to the household, you may use Flash card 12 to reinforce messages on cough of

two weeks or more. This visit is also a good opportunity to discuss/review the health messages on

chronic cough management in the Family Health Guide.

Ask the patient/caregiver on whether he/she sought and obtained health care services as discussed

during the first visit.

If the respondent fails to go to a health service provider as agreed in the Helath Plan, ask

about the reason/s for not going to the provider and find a way to assist her in seeking care.

If the respondent is worried that no one will take care of the children or the household, make

the necessary arrangements to have someone from the community to watch over the children

while the patient or caregiver is away.

Review with the patient Parts 4 (Actions Taken) and 5 (Service Utilization Monitoring Form) of Form

2G (see Table 19). This form, when duly accomplished, serves as a tracking tool for patient compliance to

instructions on medications if any, and when to return for her follow-up visit; or if and when the patient

complied in making an actual visit to a higher level - service provider when further referred.

Copy the details in the Form 2G Parts 4 and 5 or NTP ID card in the CHT Monitoring Form/Logbook

for Chronic Cough Management (Table 20).


Table 19. SAMPLE SERVICE UTILIZATION AND MONITORING FORM FOR CHRONIC COUGH MANAGEMENT.

Table 20. SAMPLE CHT MONITORING FORM/LOGBOOK FOR CHRONIC COUGH MANAGEMENT.

CHRONIC COUGH MANAGEMENT MONITORING

NAME

(Last, First,

Middle

AGE ADDRESS

HEALTH

SERVICE/

DUGS

NEEDED

DATE OF

VISIT TO

PROVIDER

HEALTH

SERVICE/DRUGS

PROVIDED

(Specify name

and qnty of

drugs)

DATE OF

NEXT VISIT REMARKS

HEALTH

SERVICE

PROVIDER

AND TYPE

(Public/

Private)

FLORES,

JOCELYN 36 years

Lot 1, Blk

6, Purok 4,

Brgy

Laging

Handa

Checkup 10/5/2011 Sputum exam 10/27/2011 NHTS

Maco Rural

Health Unit

(public)

Figure 19 below shows a sample NTP ID card. It contains information on the following: (a) name of

the DOTS facility; (b) name of the patient; (c) address of the patient; (d) name of treatment partner; (e)

90

disease classification and category; (f) type of patient; (g) date of start of treatment; (h) sputum

examination results; and (i) calendar to monitor intake of anti-TB medications.

Figure 19. NTP ID Card

Note to CHT: Copy the

details from the NTP ID

card to your own records.

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