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Afhf Level 2

This document is a self-assessment checklist for adolescent-friendly health facilities in the Philippines. It contains standards for facilities to provide accessible, confidential, and respectful health services to adolescents. Facilities must ensure adolescents are aware of available services, services align with national standards, and privacy and individual rights are protected. Facilities also must maintain records and have referral processes in place. The checklist is used by local health departments and the Department of Health to evaluate facilities and ensure they meet adolescent-friendly criteria.

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ela bachii
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2K views

Afhf Level 2

This document is a self-assessment checklist for adolescent-friendly health facilities in the Philippines. It contains standards for facilities to provide accessible, confidential, and respectful health services to adolescents. Facilities must ensure adolescents are aware of available services, services align with national standards, and privacy and individual rights are protected. Facilities also must maintain records and have referral processes in place. The checklist is used by local health departments and the Department of Health to evaluate facilities and ensure they meet adolescent-friendly criteria.

Uploaded by

ela bachii
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

Republic of the Philippines

Department of Health

LEVEL 2
Adolescent-friendly Health Facility
SELF-ASSESSMENT AND FACILITY OBSERVATION CHECKLIST
Adopted from the Department Memorandum 2017-0098: Adolescent-friendly Health Facility (AFHF) Standard Evaluation Tool
Health Facility Name: Name of the Head of the Facility:

Address: Contact No.: Date of LGU Self-Assessment:

Instruction for LGU: This form contains self-assessment for AFHF Levels 2 and 3. In the appropriate box under LGU self-assessment
column, place a mark check (√) if the health facility is (Yes) compliant or (No) non-compliant. Please do not forget to affix the names
and signatures of the health facility respondents at the last part (3 rd page) of this SAF.

LEVEL 2 – AFHF Self-Assessment and Monitoring Tool


Item LGU Self DOH Recommendations
Assessment Assessment

YES NO YES NO

Is the health facility Level 1 Adolescent-


friendly Health Facility LGU-Certified?

National Standards for Adolescent Service Package


1. Adolescents in the catchment area of the facility are aware of the health services it provides and find the facility easy to
reach and obtain services from it

o Simple signage strategically posted


indicating the facility as an
“Adolescent
Friendly Health Facility”

o Action plan for information dissemination

o Plan for outreach program /


advocacy campaign

o Available IEC materials on different


family health programs, displayed on a
rack /
conspicuous place
* IEC materials should include directory
of other agencies/organizations where
services can be obtained
2. The services provided by health facilities to adolescents are in line with the accepted package of health services and
are provided on site or through referral linkages by well-trained staff effectively.

o Policy regarding flexible time schedule


/ Adolescent health schedule of the
facility
o Policies for the provision of
adolescent services

o Policies for payment schemes (if


applicable)

o Certificates of training on the


minimum training courses
prescribed by DOH for
adolescent focal persons and other
providers
*AJA / ADEPT / Comprehensive Mgt of
Adolescent Training for HSP

Page 1 of 3 DOH AFHF-SAF-LEVELS 2-3


o Directory of organizations – name,
address, services provided, contact
number and contact person (for referral)

o Referral logbook – name, age, address,


clinical impression, when referred,
reason for referral, result of referral

o Referral forms available

o Accomplishment Report showing the


services given at the health facility as
well as those given by other agencies,
individuals and peer counselors
3. The health services are provided in ways that respect the rights of adolescents and their privacy and
confidentiality. Adolescents find surroundings and procedures of the health facility appealing and acceptable.

o There are separate rooms for


consultation, treatment, and
counseling. If there are limited rooms,
there are at least curtains to separate
each provider.
*Conversation between provider and
client cannot be heard by others

o Protocols and guidelines for


patient provider interaction

o Policies and procedures to ensure


privacy and confidentiality is posted
o Individual records are kept in
separate envelopes

o All records are kept in a safe place,


preferably in a separate room or a
filing
cabinet with lock and key

o Individual treatment Records that


show the chief complaint, findings on
examination, clinical impression and
management of clients
Is the health facility compliant (Yes) to all
or majority of items above? (If Yes,
proceed and start the Level 3 AFHF
assessment below)

To be filled-up by DOH Assessment Team

Date of L2 DOH Assessment Conducted: Regional Assessment Result:

Compliant Non-Compliant

Overall Recommendations:

Names and Signatures of Names and Signatures of


Health Facility Respondents: DOH Assessment Team:

Acknowledged by:
Page 3 of 3 DOH AFHF-SAF-LEVEL 2

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