EXECUTIVE BRIEFER

I. Subject Training of 2018 Field Health Services Information System (FHSIS) Manual of Procedures
(MOP) for Batch 4 Regional and Provincial/City Coordinators and Program Counterparts
 24-27 July 2018. Gems Hotel and Conference Hall, Antipolo, Rizal
 Organized by the Epidemiology Bureau (EB)
II. Premise Relevant national laws and policies (See Annex A for further details)
(Relevant  RA No. 10625 (issued 23 Jul 2012) “An Act Reorganizing the Philippine Statistical System,
laws and repealing for the Purpose EO 121 entitled, “Reorganizing and Strengthening the Philippine
policies) Statistical System and for Other Purposes”
 EO No. 352 (issued 1 Jul 1996) “Designation of Statistical Activities That Will Generate
Critical Data for Decision-Making of the Government and the Private Sector”
o Annex 1 of EO No. 352 (issued 14 Feb 2017) identifies the FHSIS, as one the
official sources of data for decision making and prescribes monthly data collection,
requires data to be disaggregated at the national, regional and provincial level, and
data dissemination must be one (1) month after the reference month
 DOH DM No. 2017-0073 (issued 8 Feb 2017) “Population to Be Used in the Preparation of
Statistical Reports for CY 2017-2021”
III. Action  For your information: of meeting activities (FHSIS team will share final report)
Requested  For approval: content of final version of MOP (pending submission since revisions need to
be done following feedback from batch 1-4 trainings) with the target date for cascading being
1 September 2018
IV. The objectives of the training were to:
Objective  describe the rationale, definition, data source and reporting frequency of indicators to be
tracked through the FHSIS, especially those newly introduced in this version;
 demonstrate the ability to use and accomplish the forms and tools recommended in recording
and reporting data requirements;
 apply the set of principles and guides in the validation, analysis, and interpretation;
dissemination, and utilization of the FHSIS reports;
 state their respective roles and functions in the management and implementation of the
system in coordination with the other players; and
 develop an action plan to improve the implementation of FHSIS in their respective localities
V.  The FHSIS is a nationwide facility-based recording and reporting system that provides
Background information to Local Government Units (LGUs) and the DOH as the basis for decision
making relative to the management and implementation of public health programs. As per
EO 352, it is one of the statistical systems recognized by the PSA as critical for decision
making.
 The MOP was last updated in 2012. The latest version includes new indicators for services
on family planning, maternal care, child care (immunization, nutrition, deworming, oral
health, care management), oral health (all ages), infectious disease prevention and control,
non-communicable diseases prevention and control and mortality.
 The previous batches were trained on 10-13 April, 15-18 May and 26-29 June, 2018.
VI. Key Training Organization: The training was primarily moderated by the consultant who spearheaded
Discussion the updating of the MOP, Ms. Eireen Villa. Participants of the training included FHSIS
Points coordinators and program counterparts from RO-NCR, RO-4A, RO-4B, RO5 and PHO/CHOs
from multiple jurisdictions in Luzon. The central office was also represented by staff from
HPDPB, EB and TSC. Materials distributed to participants included the draft 2018 MOP and a
facilitator’s training guide.

Introduction: Ms. Villa provided an overview of the methodology used to revise the MOP:
 An FHSIS performance implementation review (PIR) by EB in 2016, data reconciliation
workshop and M&E data governance committee meeting conducted by HPDPB in 2017
provided inputs for the enhancement of the MOP.
 The initial draft of the 2018 MOP was presented to national and regional program
coordinators, FHSIS coordinators and local implementers (midwives, nurses, sanitary
inspectors, etc) for further review and validation. Follow up meetings with concerned DOH
offices were also conducted to tackle unresolved issues.

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 EXECUTIVE BRIEFER
 Selected facilities in Laguna and Marikina were also tapped for MOP pre-testing.

Program Indicators: The definition, frequency of reporting and limitations of each indicator in the
MOP for each program were discussed. Discussions were moderated by representatives from the
DPCB, although only family planning was represented by the national program lead/manager.
Several concerns were raised including interpreting definitions (e.g. adding AND/OR to indicator
criteria, measuring new versus current service user), feasibility of collecting data, how long
clients should recall use of a particular service/intervention, and identifying whether reporting
should be cumulative or periodic (refer to Section VII. Issues for details).

Validation, Analysis and M&E. Basic techniques to validate data, descriptive statistics parameters
and definitions for monitoring completeness, timeliness and accuracy were briefly discussed.
Sample templates for monitoring were also provided, although many regional offices have
already developed their own systems and worksheets for M&E.

Training Outputs and Decisions:

 All concerns raised regarding indicator definitions were logged by the FHSIS national team
for consolidation and further consultation with national program managers, with the goal to
identify ways to simplify data collection forms or to pair down the number of indicators
included in the MOP
 Hospitals will be included in the facilities required to report family planning indicators
 KMITS will update eFHSIS once the indicators are finalized
 MOP reproduction for training purposes at the local level will be shouldered by regional
offices, although some ROs raised this as a concern. It was proposed that further funding
support can be requested from national program managers, but this was yet to be confirmed.
 EB will consolidate good practices developed by regional and provincial offices and
disseminate this inventory to FHSIS coordinators at all levels.
 EB will provide the soft copy of the final MOP by 1 September 2018. ROs are requested to
begin training in December 2018.

Conclusions:
 The training was an opportunity for DOH regional and provincial offices to share their
innovations and ways they adapt training materials to their local context. For example,
regional offices provided incentives through a program that rewarded consistent performance
of local implementers. Other offices conducted weekly validation of data with barangay
health workers. Other innovations also involved creating localized data collection forms,
while others developed their own monitoring worksheets to track timely reporting.
 Further attention is needed in pairing down the number of indicators, as many of the
participants were concerned that the number of data forms that need to be completed and
work involved in data entry and aggregating data will take away time from patient care.
 Indicator definitions still need to be refined as several concerns were raised by participants.
VII. Issues  eFHSIS / iClinisys, the electronic form of the system, is still not adopted nationwide, with
many local implementers still using paper forms for collection.
 Without eFHSIS, individual-level data are not made available for higher levels of
reporting. Only aggregate data (e.g. counts of users and services) are received by PHOs,
ROs and the central office. Hence, individuals can easily be double reported in the system
and performance reporting by jurisdiction skewed. Furthermore, rates reported by the system
are considered an underestimation, and typically require validation with the National
Demographic and Health Survey (NDHS).
 For denominator calculations, the basis of the multiplication factor (either PSA or EB
estimates) and census population (whether from the 2010 or 2015 census) needs to be
confirmed. Also, it was not addressed whether the population for the denominator would be
based on the projected population of the year the data were collected or the last census
population released by the PSA (in this case, the 2015 census population).
 The fields required to calculate the numerator and denominator are not consistently
indicated in the definition.

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 EXECUTIVE BRIEFER
 The definition of some indicators does not match the field on the form (e.g. TCL of
dosage of vitamin A).
 Particular fields are repeatedly requested by different programs, which adds to the
burden of data collection of local implementers.
 Cumulative versus periodic reporting needs to be clarified. For example, when reporting
morbidity, cumulative quarterly reporting is requested whereas periodic quarterly reporting
is requested for some service utilization indicators.
 The process of performance reporting does not reflect the SDN model. It is difficult to assess
performance for services that require follow up or repeat use of services (e.g. family
planning services and commodities).
 The appropriateness of using the FHSIS (being an administrative database) versus
surveys as the mode of data collection for some indicators is unclear. for example, the
nutritional status of children, whether they receive exclusive breastfeeding is difficult to
measure when family’s visit the barangay health center. The criteria for exclusive
breastfeeding requires further qualifiers, which may be difficult to capture on paper form
(e.g. assessment of the child’s food intake, the duration of breastfeeding, use of pacifiers)
and can also be time consuming for the health worker.
 Important risk groups are not captured by some indicators. For example, increased risk
of alcohol dependence only captures data for individuals 25yo and above, while in the
literature it is clear that those younger are also vulnerable to dependence.
VIII. Resources needed (budget, logistics, HR): N/A
IX. Options or alternatives, cost-benefit analysis or cost-effectiveness analysis: N/A
X. Scope and Implications: N/A
XI. Proposed For TSC to consider:
Next Steps  Revisiting engagement with EB and DPCB-FHO on finalizing basis of multiplication
factor and population projection estimates (whether PSA or EB estimates), as these are
critical to standardize reporting of indicators across programs and jurisdictions
 Creating an inventory of duplicate fields across forms as a means to inform future
planning to streamline data systems and simply data collection and reporting

For EB to consider:
 Cascading an inventory of guidelines relevant to each section of the FHSIS and the
contact information of the national program manager responsible for each program
included in the FHSIS, as it is clear from the training that there remain clarifications
around indicator definitions and care pathway that need to be addressed
 Continued coordination with national program managers to seek funding for MOP
reproduction by regional offices, as it would be the program managers who would most
benefit by supporting local training efforts

For DPCB program managers to consider:

 Revisiting the need to report at the barangay level the counts or aggregate data of service
utilization. Many of the services offered by programs are continuous in nature or require
consistent follow up. As the policy directive going forward is to adopt an SDN model,
service utilization should be measured more comprehensively and should reflect referral
pathways at different facility levels and a broader catchment area (e.g. provincial/city).
 Reducing the number of indicators measured and data collected to only what is relevant
for planning and M&E, and match indicators to global standards when appropriate.
 Evaluate whether the FHSIS should be the mode of data collection for some indicators, as
some data are collected through multiple avenues (surveys e.g. NDHS or systems e.g.
PIDSR)
XII. Annexes Annex A – Details on Relevant Laws and Policies
Annex B - Agenda
XIII. Prepared Allen Alcantara, MD and Clarissa Encisa, MPH
by

Noted by:

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 MARIA ROSARIO S. VERGEIRE, MD, MPH, CESO IV
Assistant Secretary
Office for Health Regulation
Department of Health

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 Annex A. Details of Relevant Laws and Policies

RA 10625 (issued 23 Jul 2012) “An Act Reorganizing the Philippine Statistical System, repealing for the
Purpose EO 121 entitled, “Reorganizing and Strengthening the Philippine Statistical System and for Other
Purposes”

 Structural and functional reorganization of the then “Philippine Statistical System”, thus creating the
“Philippine Statistics Authority (PSA)” as the highest policy-making body on statistical matters and designates
the data it produces as the official and controlling statistics of the government.

EO 352 (issued 1 Jul 1996) “Designation of Statistical Activities That Will Generate Critical Data for Decision-
Making of the Government and the Private Sector”

 Section 1. Activities designated by the NSCB (now PSA) shall be Annexed to the Order, and adopted by the
government as a means of generating critical data for decision making in the government and private sector
 PSA Res 2 (issued 15 May 2000) “Approving the Guidelines for the Modifications to the Designated
Statistical Activities”, allows for regular updating of the list of official statistical systems, as approved by the
PSA Board, and its required metadata including the frequency of data collection, geographic disaggregation,
schedule of availability and agency responsible
 Annex 1 of EO 352 (issued 14 Feb 2017) identifies the FHSIS, as one the official sources of data for decision
making and prescribed monthly data collection with data disaggregated at the national, regional and provincial
level, and data dissemination being one (1) month after the reference month

DOH DM 2017-0073 (issued 8 Feb 2017) “Population to Be Used in the Preparation of Statistical Reports for
CY 2017-2021”

 Requires compliance of DOH regional directors, program managers, FHSIS coordinators

 Provides population estimates for CY 2017-2021 prepared by the Epidemiology Bureau based on 2015 census
population and provincial growth rates indicated in the 2010 census population projections. Estimates were
vetted by the internal M&E governance working group prior to release of memo.

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