MHO/ CHO Guide For Training, Deployment and Mobilization of Community Health Teams (CHTs)

MHO/ CHO Guide For Training, Deployment and

Mobilization of Community Health Teams (CHTs)

Preparing for CHT Mobilization at the Municipal/City Level

The Municipal Health Officer/City Health Officer will play a vital role in the Training, Deployment and Mobilization of Community Health Teams (CHTs) in his/her Local Government Unit (LGU). All of the following activities will have to be immediately initiated and implemented by the MHO/CHO prior to the undertaking of the training of the CHT Management Group and Partners at the municipal level.


A. Assessing the Local Health SituationB. Securing Local SupportC. Organizing, Managing and Sustaining CHTsD. Securing the list of NHTS-PR FamiliesE. Determining CHT Partner Requirements and

Matching with FamiliesF. Preparing the List of Health ProvidersG. Preparing for the Municipal Level Training of

CHT Partners

Assessing the Local Health SituationWHY?• To know what to prepare for in terms of what health

risk assessments (HRAs), health use plans (HUPs) that CHTs will need when CHTs are deployed

• To know which types of providers will need to be oriented in terms of possible patient load (Section F, Instructions on Preparing the List of Providers, Page 32)

• To prepare a briefer or health situationer for presentation to the LCE in order to generate support for CHT deployment (Section B, Securing Local Support at the Municipal or City Level, Page 14)

WHAT?• top causes of morbidity and mortality; • number of maternal, infant and under-5

deaths; and • top three causes of maternal, infant and

under-5 deaths. The proposed source of information is the FHSIS

from 2009 to 2010. MHO/CHO and the PHN will fill up the following tables:

Assessing the Local Health Situation

TABLE 2. MUNICIPAL/CITY HEALTH DATA ON MATERNAL, INFANT AND UNDER-FIVE DEATHS,

2008-2010Municipality/City:_________________________________________________Province: ________________________________________________________Date Accomplished: _______________________________________________Name, Signature and Designation of Person who prepared the table: ____________________

(1) (2) (3) (4) (5) (6)Health Indicator Source of

Data2008 2009 2010 Remarks

1. Number of Maternal Deaths

FHSIS Reports

Top (3) Causes of Death 1.1 1.2 1.3 2. Number of Infant Deaths Top (3) Causes of Death 2.1 2.2 2.3 3. Number of Under-five Deaths

Top (3) Causes of Death 3.1 3.2 3.3

TABLE 3. MUNICIPAL/CITY HEALTH DATA ON THE TOP 10 CAUSES OF MORBIDITY,

2008-2010.Municipality/City:_________________________________________________Province: ________________________________________________________Date Accomplished: _______________________________________________Name, Signature and Designation of Person who prepared the table: ________________________________________________________________

(1) (2) (3) (4) (5) (6)Health

IndicatorSource of Data 2008 2009 2010 Remarks

Top Ten Causes of Morbidity

FHSIS Reports 1. 1. 1. 2. 2. 2. 3. 3. 3. 4. 4. 4. 5. 5. 5.

6. 6. 6. 7. 7. 7. 8. 8. 8. 9. 9. 9. 10. 10. 10.

TABLE 4. MUNICIPAL/CITY HEALTH DATA ON THE TOP 10 CAUSES OF MORTALITY,

2008-2010.Municipality/City:_________________________________________________Province: ________________________________________________________Date Accomplished: _______________________________________________Name, Signature and Designation of Person who prepared the table: ________________________________________________________________

(1) (2) (3) (4) (5) (6)Health

IndicatorSource of Data 2008 2009 2010 Remarks

Top Ten Causes of Mortality

FHSIS Reports 1. 1. 1. 2. 2. 2. 3. 3. 3. 4. 4. 4. 5. 5. 5.

6. 6. 6. 7. 7. 7. 8. 8. 8. 9. 9. 9. 10. 10. 10.

• Secure from the PHO (c/o Ms. Aurora Doria) the cleaned data (2010)on the 5 MDG indicators of the LGU:– Contraceptive Prevalence Rate (CPR)– Fully Immunized Children (FIC)– Facility-Based attendance by skilled birth attendants– Vitamin A supplementation– Case Detection Rate (CDR) and Cure Rate (CR) for TB


The data will be inculcated in the Letter to the Community Health Team (CHT) Partner.

The Local Health Situation can be used as baseline data to determine improvements in the local health programs, especially in FP-MNCHN and TB programs, that can be attributed to the CHT activities.

It can also be used by the MHO/CHO to convince the LCE on the importance of the CHTs as part of the health delivery system in the LGU.


NEXT

• LETTER TO THE COMMUNITY HEALTH TEAM PARTNER• (TO BE MODIFIED BY THE P/M/CHO)• • Dear CHT Partner, • • The families assigned under your care have long endured the risk of dying from causes

that can be prevented simply by knowing how to go about getting the medical services they need.

• • [Insert here the number of maternal, infant and under-five child deaths in the

province/city/municipality. Discuss barriers to health care use and factors contributing to maternal and child deaths (e.g., financing, physical access to health providers and health-seeking behaviour of families, information on available health providers.) Refer to Section A of Preparing for CHT Organization, Training & Deployment: Guide for MHOs/CHOs.]

• • Now you have a chance to help these families break these barriers to accessing health

services. As their CHT Partner, your role is to directly communicate with underserved families --especially those covered by PantawidPamilya --to give them the information they need to recognize their health risks, plan for their health, and access the medical services they need. You serve as their link to the local health system - introducing them to the wide array of services it offers, giving them real options in health care and enabling them to make informed decisions about their health.

•




CHT Partners

Securing Local Support1. MHO/ CHO will convey to the LCE and other

concerned local agencies on the importance of the CHT, specifically its navigation function, in improving the health status of poor families; and what the LGU can do to support their mobilization or deployment. a. The MHO/CHO can cite the enabling statutes/policies on CHT mobilization:

- DILG Memo Circular 2011-145- Joint Memorandum Circular No. 2011-0073

(DOH, DSWD, DILG, DepED)

Health Navigational Assistance

• Giving families the information they need to maximize opportunities to use health services

• Assisting families in recognizing health risks and managing such risks through health plans

• Linking families to health providers and health emergency contacts

• Guiding families in using their Philhealth benefits

1. The MHO/CHO will conduct advocacy meetings with the SB and the LIGA to gain support for KP-CHT and request for a resolution of support and possible funding for the sustainability of the project, at least up to 2016.

2. The MHO or CHO is responsible for ensuring that resources are available to support and sustain CHT activities in the municipality/ city.

Securing Local Support

TABLE 5. INVENTORY OF AVAILABLE RESOURCES FOR THE LGU TO SUPPORT

AND SUSTAIN CHTType of Resources (1)

CHT activity or component needed (2)

Source (3)

Amount/ Quantity

(4)Access Requirements (5)

Data of availability

(6)Example 1: TA for Training the CHT trainors at the LGU level – prototype training materials and resource persons.

CHT TOT, municipal level

DOH – CHD

Good for 15 trainors

Letter of request from the MHO/ CHO to the CHD; follow up calls to CHD

October 15

Example 2: MNCHN Grants Money

CHT training and deployment or TEV support for CHT members

DOH – CHD

PhP 10,000

Submission of Fund Utilization Report (FUR) to CHD, including accomplishment of Annex C (Template for CHT) in the DOH Department Order 2011 - 0219

As soon as the FUR is accepted

Example 3: Local Health budget under MOOE: MNCHN training fund

CHT training LGU budget for health

PhP 50,000

Program of work approved by the Mayor

As soon as the program of work is approved




CHT Partners

Organizing, Managing & Sustaining CHTsMHOs/CHO should ensure the mobilization of CHTs.

RHU - MHO, PHN, RNheals

BHS - RHM

Organizing, Managing & Sustaining CHTs

The CHT Management Group:1. Punong Barangay – Chairman2. Rural Health Midwife – Co-chairman3. Brgy. Chairman on Health – Member4. Brgy. Nutrition Scholar – Member5. Others –Purok leaders, etc.- Member

The RHM is not only the co-chairman but also the frontline service provider in the BHS as well as the one responsible for collecting, recording and reporting the FHSIS data.




CHT Partners

Securing the List of NHTS-PR households

MHO requests NHTS list from PHO

MHO disaggregates NHTS

list by barangay

MHO distribute

s barangay level lists to RHMs for CHTs

Securing the List of NHTS-PR households

The list should be secured as early as possible to facilitate the identification of the families to be served by the CHTs in every barangay.

The MHO/CHO should exert effort to get the list in whatever way possible and wherever the list is available.




CHT Partners

Determining CHT volunteer requirements and matching with families

• How many CHT volunteers are needed?- Necessary adjustments based on

characteristics of barangay and number of NHTS-PR families

• Who are available for the tasks?- Mostly active BHWs who will be screened prior to training. Additional volunteers will have to be recruited if necessary

• Who are matched to families?

TABLE 6. NUMBER OF REQUIRED CHT VOLUNTEERS PER BARANGAY

Barangay Number of NHTS

Households

Volunteers needed

Characteristic of

Barangay

Recommended

adjusted number of

CHT volunteers

No. of available

CHT volunteers

No. of additional volunteers

to be recruited

Ambonao 189 10 High density

poblacion

4 17 None

Ambuetel 100 5 Difficult terrain

10 14 None

Lawaan 300 15 long travel time

30 15 15

Santa Elena

400 20 With celphone network

8 12 none

Riovista 300 15 Has 4Ps assembly

6 5 1


Characteristic of Barangay

1. Barangays with high population density such as poblacion areas – CHT partner can walk to the residence or less tha 30 minutes ride: 1 is to 50 families

2. Barangays with difficult terrain, with minimal available transportation, long time travel snf high cost of travel- more tha an hour ride just to reach 1 family: 1 is to 10


Characteristic of Barangay

3. Barangays with available communications (cellphones and radios) : 1 is to 50 families

4. Barangays with other venues to for monitoring the families like 4Ps assemblies: 1 is to 50

TABLE 7. ADJUSTED NUMBER CHT VOLUNTEERS PER BARANGAY


Households

Volunteers needed

Characteristic of

Barangay

Recommended

adjusted number of

CHT volunteers

No. of available

CHT volunteers


to be recruited


poblacion

4 10 None


10 30 20


30 15 15

Santa Elena


8 12 none


6 5 1


Number of Available CHT VolunteersThe MHO, PHN and assigned Rural Health Midwife in a

barangay will have to evaluate the possible BHWs who will be trained as CHT Partners:a. Educational attainment – based on local BHW Registry (if no registry, just survey BHWs)b. Dedication to work – based on RHMs evaluationc. Age – capacity to perform required tasks

* Not all the BHWs will be selected/trained except in barangays where their number is inadequate.

TABLE 8. LIST OF CHT VOLUNTEERS PER BARANGAY (SCREENED)

Barangay assignment Names of CHT volunteers Address of CHT volunteer Ambonao Ablaza, Norma Purok 6, Sta. Elena Baron, Jennifer 10 Rizal St., Poblacion Dela Cruz, Erlinda Mabini St., Poblacion Guzman, Rogel 25 Calle Real, Poblacion ..... ..... ..... .....

Total 17Ambuetel Badoy, Nene Sitio 8, Purok 7, San Jose Caluhib, Princess Sitio 9, Purok 8, San Jose Dela Paz, Christina Sitio 7, Purok 9, San Jose ..... ..... ..... .....

Total 14


Number of Available CHT VolunteersIf the recommended adjusted number of CHT volunteers

exceeds the number of available CHT volunteers, the MHO, PHN and assigned Rural Health Midwife of the barangay should recruit additional CHT Partners. (Section C, Criteria for Recruiting Additional CHT Partners, Page 26)

The total recommended adjusted number of CHT volunteers is the number of future CHT Partners to be trained at the municipal level.

TABLE 9. ADJUSTED NUMBER CHT VOLUNTEERS PER BARANGAY


Households

Volunteers needed

Characteristic of

Barangay

Recommended

adjusted number of

CHT volunteers

No. of available

CHT volunteers


to be recruited


poblacion

4 17 None


10 14 None


30 15 15

Santa Elena


8 12 none


6 5 1


Matching CHT Partners to NHTS families The MHO, with the supervising midwives, should be

responsible for matching CHT Partners to NHTS families, and make the necessary assignments and adjustments to ensure that the navigational functions of the CHTs are utilized properly. (Section C, Allocation of Available CHT Partners to Families, Page 27)




CHT Partners

Preparing the list of Providers Accessible to NHTS householdsThis list is important because it will form part of the

Family Health Guide, the CHT Guidebook and in filling up the Health Plans (Forms 2A to 2G)– All available public and private health facilities and

individual providers – Services offered, professional fees, room and

board rates and cost of treatment for selected conditions; their address, phone number and other contact details; operating hours; and the type of their PhilHealth accreditation.

Health Service Providers

• Hospitals -- e.g. medical centers, regional hospitals, LGU hospitals, DOH hospitals

• Lying-in clinics • Outpatient clinics -- e.g. RHUs, private doctor

clinics or private practising midwives.• Outpatient laboratory and ancillary services

e.g. laboratory units, imaging centers, dialysis units

TABLE 10. TEMPLATE FOR THE LIST OF HEALTH PROVIDERS

LIST OF HEALTH PROVIDERSMUNICIPALITY/MAIN HEALTH CENTER OF ______________ (specify name of municipality/city)

Health Provider Address/Contact

Information/ Operating Hours

Type of Facility

PhilHealth Accreditatio

n

Service Offered/ Schedule/ Rates

Pregnancy,

delivery, postpartu

m

Newborn

FP Child care

Chronic

cough

Others (1)

Others (2)

Hospital1. 2. 3. Lying-in Outpatient clinic Outpatient laboratory and ancillary services

Preparing the list of Emergency Health ContactsThis list is important because it will form part of the

Family Health Guide, the CHT Guidebook and in filling up the Health Plans (Forms 2A to 2E)– Create a list of emergency health contacts; names,

address, contact number or radio frequency, including services for transportation to and from the health facilities.

TABLE 11. SUGGESTED TEMPLATE FOR REGISTRY OF EMERGENCY HEALTH SERVICE

PROVIDERSProvince: Eastern Samar . Date of Preparation / Update: October 2011 .Municipality: San Julian .

Emergency need Name of Contact Mobile/Landline/ Radio frequency

Address Service cost Area covered

A. Medical assistance (e.g., feeding, emergency care, medication administra-tion, ambula-tion, emer-gency delivery, suturing, etc.)

Linda Garcia (Midwife)

0917-4567920 No. 25 Rosal St., San Julian (Non-working hours/days)

P600.00 per delivery (weekends & holidays) Other services: Free

San Julian municipality

Melinda Santos(PHN)

0932-2347890 2373 Dahlia St., Campidhan, San Julian

Free San Julian municipality

A. Transport to health facility Coun. Eric Soler (for municipal ambulance)

0918-8752340 No.2 Bougainvillea St., San Julian (Non-working hours/days)

Ambulance driver: P100.00/dayAmbulance use: FreeGasoline use: replace as needed

Any point in Samar and Leyte

June Abesia (head, tricycle drivers’ group)

0922-8364660 Pagbabangnan, San Julian (near St. Clare Chapel)

Tricycle fare for 1st 5 km – P10.00; add P2.00 for every km thereafter

San Julian, Dolores, Taft

A. Referral to higher level facility

Dr. Cherry Santillan (MHO)

0915-4485290055-4567892

No. 14 Sampaguita St., San Julian (Non-working hours/days)

None San Julian municipality

Dr. Mark Sales(PHO)

0922-8376779055-7658903

125 Campana St., Bunacan, San Julian(Non-working hours/days)

None Eastern Samar




CHT Partners

Preparing for the Municipal Level Training of CHTs

1. Determine the training team 2. Determine trainees’ current capacities 3. Prepare the FAQ CHT 4. Prepare the CHT training design 5. Secure funding for CHT training 6. Conduct of a separate training-orientation

material for CHT management 7. Organize all CHT training materials and conduct

a dry-run for the CHT training

TABLE 12. TRAINERS’ PROFILE INFORMATION

Name of Trainor

Age Educational Attainment

Current Designation

Office Address

Contact No. / Cell Phone /

Landline

Date Trained as a CHT Trainer

Dr. Chito Mendoza

40 MMD; Masters in

Public Health

PHO Albay PHO, Athena Street, Legaspi

City

09273837547 September 30, 2011

TABLE 13. PROFILE OF TRAINEESName

of Trainee

Age Address Educational

Attainment

No. of Families Covered

(if a trainee is a BHW)

Religion Current PhilHealt

h member?

Yes or

No

Current/ Previous

Work Expe-rience

Preferred Language

for the training(English, Tagalog,

Visayan or Others)

Maria del

Barrio

41 1230 Industria

Street, Pababag

Island, Tawi Tawi

Grade 5 40 Muslim No BHW for 10 years

Visayan

THANKS!!!

MHO/ CHO Guide For Training, Deployment and Mobilization of Community Health Teams (CHTs)

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