Form C

Social Development Sector

A. Social Welfare and Development Services
Indicator Means of Verification

1 Availability of primary prevention services Copy of documents related to the

for sexual and gender-based violence and implementation of the program
human trafficking

Trained service provider on handling

gender-responsive cases management
Conduct of annual 18-day campaign to End
Violence Against Women (VAW)
Conduct of human rights education session
for women and men in the community

Capability-building seminar on VAW and

GAD for Barangay VAW Desk Officers

2 Availability of response system services and Copy of documents related to the

facilities for SGBV and human trafficking implementation of the program
victims/survivors

Crisis intervention center or DSWD certified

alternative community-based care initiative

Temporary shelters
Separate or private room for conduct of
interview and investigation
Referral system to other service providers

Free legal assistance for indigent survivors

Financial assistance for indigent victims

survivors
3 Availability of structures, services, and Copy of documents related to the
facilities for the reintegration of SGBV nad implementation of the program
human trafficking victims/survivors
Trauma counseling or theraphy for
victims/survivors and their relatives
Livelihoo and skills training for victim
survivors
Employment assistance for victim survivors

Counseling and rehabilitation for

perpatrators
4 Availability of gender-sensitive pre- Copy of documents related to the
marriage counseling services through implementation of the program
integration of the following core messages
in pre-marriage counseling modules

Reproductive Health and Responsible

Parenthood (RPRH)
Shared duties and responsibilities of parents

Gender Sensitivity
Violence Against Women and Their Children
(VAWC) concepts and consequences

Gender-fai child rearing strategies or

practices
ctor

Corresponding Office Status of

Score Responsible Collection
4 MSWDO

4 MSWDO

4 MSWDO, MPS
MSWDO, MHO
Form C
Social Development Sector
B. Health Services
Indicator Means of Verification

1 Availability of responsible parenthood and Copy of documents related to the

reproductive health (RPRH) services and implementation of the program
facilities for pre-pregnancy planning

Family planning promotion/education

Family planning counseling on:
Responsible parenting
Informed choice and voluntarism
Family planning methods
Fertility awareness
Oral contraceptive pills
Female and male condoms
Procedure for depomedroxyprogesterone
acetate (DMPA) injection

Procedure for intrauterine devices (IUD)

insertion and removal
Procedure and/or referral for sub-dermal
implants
Procedure and/ore referral for No Scalpel
Vasectomy (NSV)
Procedure and/or referral for Bilateral Tubal
Ligation (BLT)
Natural Family Planning (NPF) Methods

Risk Assessment by history

Management of minor side effects
Routine checkup/ follow-up of clients
Follow-up of dropouts/ defaulters
Referral for major compilation related to
use of contraceptives
2 Availability of RPRH services and facilities Copy of documents related to the
for antenatal care implementation of the program
Family planning counseling on:
Responsible parenting
Informed choice and voluntarism
Four pillars of family planning
All family planning methods
Fertility awareness
Pregnancy test kit
Micronutrient supplementation
Tetanus toxoid immunization
Oral health services
 Antenal administration of steroids in
preterm labor
Referral of complicated/high-risk
pregnancies
3 Availability of RPRH services and facilities Copy of documents related to the
for labor and delivery implementation of the program

Monitoring progress of labor using

partograph
Identification of early signs and symptoms
and management of abnormalities;
prolonged labor; hypertension;
malpresentation; bleeding; preterm labor;
and infection

Basic Emergency Obstetric and Newborn

Care (BEmONC) provider, such as:

Parental administration of oxytocin

Parental administration ol loading

dose of anticonvulsants
Parental administration of initial
dose of antibiotics
Performance of assisted delivery
during imminent breech

Removal of retained products of

conception
Manual removal of retained
placenta
Birth attendants trained on gender sensitive
handling of labor and delivery

Gender -and culture-sensitive birthing

facility
Provision of Comprehensive Emergency
Obstetric and Newborn Care (CeMONC)
services, such as:

Caesarean Section
Blood Transfucion
BTL
Postpartum IUD
4 Availability of RPRH services and facilities Copy of documents related to the
for postpartum care implementation of the program
Identification of early and symptoms of
postpartum complications
Referral of post-partum complications
Maternal nutrition
Famliy planning counselling
 Birth spacing
Return to fertility
All family planning methods,
including lactayional amenorrhea
method

Provision of family planning services (e.g.,

pills, condoms, injectable, NFP, IUD and
subdermal implants)

Management of postpartum
complications
Prevention and management of
abortion complications
Removal of retained products of
conception
Treatment of infection
Anti-Tetanus Serum (ATS) injection

5 Availability of RPRH services and facilities Copy of documents related to the

for adolescent and youth implementation of the program
Counseling services and education for male
RH and male responsibility in all areas of
sexual health

Guidance counseling and education on

sexuality and RH
Adolescent Pregnancy Package
Youth center/s
6 Availibility of RPRH services and facilities Copy of documents related to the
for reproductive tract cancerts and other implementation of the program
gynecological disorders

Visual inspection of the cervix using acetic

acid wash (VIA)
Screening examination for PAP smear
specimens
Clinical breast examination
Ultrasound for basic diagnostics
Treatment of breast and reproductive tract
cancers and other gynecological conditions
and disorders

Counseling for patient and family

7 Availability of RPRH services and facilities Copy of documents related to the
for Human Immunodeficiency Virus (HIV), implementation of the program
Acquired Immune Deficiency Syndrome
(AIDS), and Sexually Transmitted Infections
(STIs)

Prevention of mother-to-child transmission

(PMTCT) of HIV
 Home-based care for people living with HIV

HIV Testing
HIV Counseling
Anti-retriviral therapy
Diagnosis and management of STIs
8 Availability of Minimum Initial Service Copy of documents related to the
Package (MISP) for RPRH in crisi situation implementation of the program

Gender -sensitive coordinator for the

delivery of services
Referral system
Free condoms
Eseential drugs, basic equipment, and
supplies
Clean delivery kits provided to birth
attendants and visibly pregnant women

Medical services and psychological support

available for survivors
Safe blood transfussion
9 Availability of health services and families Copy of documents related to the
for SGBV and human trafficking implementation of the program

Medico-legal examinations
Treatment of injuries
Pregnancy Tests
Fertility management
Contraceptives
Rape kit
Counseling on the psychological effects of
VAW
Referral to other health service
providers/specialist
Assistance in case proceedings
10 Availability of health services and facilities Copy of documents related to the
for mental health clients implementation of the program
Training programs for mental health service
providers
Mental health care services integrated in
the basic health care services
Essential medicines, and supplies for mental
health clients
Accessible mental health facilities
Referral system for mental health related
services
 Public housing facilities, vocational training
and skills development programs, disability
or pension benefits

Multi-stakeholder network for the

identification, management and prevention
of mental health conditions

Short-term in-patient care in small

psychiatric/neurologic ward for clients
exhibiting acute psychiatric/neurologic
symptoms

Partial hospital care for clients exhibiting

psychiatric symptoms
Out-patient services in collaboration with
existing mental health programs at primary
health care centers in the same area

Home care services for clients with special

needs
Services/facilities for substance-induced
mental health conditions provided in
coordination with drug rehabilitation
centers

Referral system involving other public and

private health and social welfare services
providers

11 Percentage of households with access to Total No. of households

safe drinking water that passed the
Philippine National Standards for Drinking No. of households with access to safe
Water (PNSWD) of the DOH drinking water
% of households with access to safe
drinking water
12 Percentage of households with sanitary Total No. of households
toilet
No. of households with sanitary toilets

Percentage of households with sanitary

toilets
ctor

Corresponding Office Status of

Score Responsible Collection
4 MHO

4 MHO
4 MHO

MHO
MHO

MHO

MHO
MHO

MHO

MHO
MHO

MHO
Form C
Social Development Sector
C. Safety and Protection Services
Indicator Means of Verification

1 Availability ofservices and facilities for Copy of documents related to the

children at risk implementation of the program

Developmental activities (e.g. leadership

skills, character building)
Family Drug Abuse Prevention Program
Psychosocial intervention
Family theraphy
Development of foster families
Eduaction assistance
Youth resource center
Alternative Learning System
2 Availability of services and facilities for Copy of documents related to the
children in conflict with the law (CICL) implementation of the program
Developmental activities (e.g. leadership
skills, character building)
Family Drug Abuse Prevention Program
Development of foster families
Education assistance
Psychosocial and therapeutic programs
Financial assistance and support services to
families of CICL
Legal Assistance
Youth Detention Home/ Youth
Rehabilitation Center
Referral Network and Mechanism
3 Availability of services and facilities for Copy of documents related to the
displaced women and children in situations implementation of the program
of armed conflict
Women-friendly spaces in relocation sites

VAW Desks in evacuation centers or camps

for internally displaced persons (IDP)

Separate health and sanitation areas

Adequate lighting in facilities/areas and
pathways frequented by women and girls
 Presence and visibility of capable security
personnel handling conflict-related SGBV
and human trafficking

Presence of capable psychosocial personnel

handling conflict-related SGBV and human
trafficking

Provision of conflict-trauma healing

4 Existence of separate detention center/s Copy of documents related to the
for women detainees at the LGU Police implementation of the program
Stations

5 Availability of gender-sensitive services and Copy of documents related to the

facilities for women and children with implementation of the program
disabilities

At least 1% of all positions in the LGU are

reserved for/occupied by female PWDs of
which at least half of the 1% are women

Capacity-building programs for PWDs

Existtence of Persons with Disability Affairs
Office (PDAO)
Issuance of certification signed by LGU
Health Office for non-obvious disabilities

Existence of organizations for PWDs headed

by women
Livelihood opportunities available for PWDs

Relevant activities/undertaking are provided

to enhance the health, physical fitness and
the economic and social well-being of PWDs

Establishment of Health Desks for PWDs in

RHUs
ctor

Corresponding Office Status of

Score Responsible Collection
4 MSWDO

4 MSWDO

4 MHO
 MHO

MHO, MSWDO
Form C
Social Development Sector
D. Education-related services and facilities
Indicator Means of Verification

1 Availability of scholarship programs to Non-traditional field/courses offered

enable marginalized groups to enter into
non-traditional fields Number of scholars enrolled (SDD)

2 Availability of alternative learning programs Alternative Learning programs offered

for marginalized groups
Type of sector of marginalized group
Number of students (SDD)
3 Availability and use of Sex Disaggregated Title of program/projet in which SDD was
Data on education in planning and program used
development
Type of SDD used
year implemented
ctor

Corresponding Office Status of

Score Responsible Collection
4 DepED, MMO

4 DepED, MMO

4 DepED, MMO
Form C
Social Development Sector
E. Housing
Indicator Means of Verification

1 Availability of housing programs, services, Copy of documents related to the

and facilities that are responsive to implementation of the program
marginalized sectors

Women are consulted on local housing

development
Women are involved in community planning
and development
The practical needs of women are
considered in the design of the housing
structure, especialy their privacy and
personal space

The special needs of elderly and differently

abled women are considered in the design
of the housing structure

Safety ofwomen and girls outside the home

is ensured
Housing has potable water
Housing has access to adequate power
distribution system
Housing has sewerage and solid waste
disposal facilities
Primary roads and transportation facilities
are accessible
Housing location has viable employment
opportunities
2 Availability and use of SDD on housing and Title of program/project where SDD was
shelter in planning and program used
development

Type of SDD used

year implemented
ctor

Corresponding Office Status of

Score Responsible Collection
4 MEO

4 MEO
Form C
Social Development Sector
F. Social Infrasructure
Indicator Means of Verification

1 Existence of express lanes for senior Total No. of places managed or owned by
citizens, persons with disability, and LGU
pregnant women in places and structures
managed or owned by the LGU No. of places managed or owned by LGU
with express lanes
Percentage of places managed or owned
by LGU with express lanes
Photo documentations

2 Perventage of LGU managed places or Total No. of places managed or owned by

structures with lactation stations with LGU
necessary equipment and facilities No. of places managed or owned by LGU
with lactation stations

Percentage of places managed or owned

by LGU with lactation stations
Photo documentations
3 Availability of separate functional toilets for Total No. of places managed or owned by
women and men with clean and running LGU
water in places and structures managed or
owned by the LGU No. of places managed or owned by LGU
with functional toilets

Percentage of places managed or owned

by LGU with functional toilets

Photo documentations
4 Availability of diaper-changing facility in Total No. of places managed or owned by
places and structures managed or owned by LGU
the LGU
No. of places managed or owned by LGU
with diaper changing station
Percentage of places managed or owned
by LGU with diaper changing stations

Photo documentations
5 Existence of lying-in facilities in the LGU Referral reports
Accomplishment reports
Photos of lying-in facilities
others
6 Adequate of lighting in streets and public Photos of street/public places with
spaces as possible deterrent to crimes adequate lighting
against women and children
6 Adequate of lighting in streets and public
spaces as possible deterrent to crimes
against women and children

List of public places with adequate

lighting
Accomplishment reports
Copy of crime rate report per barangay

Others
7 Existence of accessible multi-purpose hall Total No. of barangays
for out-of-school youth, women, senior
citizens, minors, displaced families, Ips and No. of barangays with multi-purpose halls
PWDs in barangay

% of barangays with multi-purpose halls

Photo documentations, relevant reports

8 Existence of day-care centers in all Total no. of barangays

barangays of the LGU
No. of barangays with day care centers

% of barangays with day-care centers

photos/relevant reports
ctor

Corresponding Office Status of

Score Responsible Collection
4 All Offices,
MTO, MEO

4 All Offices,
MTO, MEO

MEO

4 MEO, MHO

MHO

MEO, MPS
 MEO, MPS

MEO, MMO

MEO, MSWDO
Form C
Economic Development Sector
A. Entrepreneurship, Business and Industry Services
Indicator Means of Verification

1 Availability of livelihood and enterprise

training program for women

Product design and development Training Design

Marketing and promotions Documentation report
Backyard Gardening Actual photos of training
Aquaculture and livestock raising list of participants
Basic entrepreneurial management Profile of trainers
Financial literacy Others
Organizational development
Community participation skills development

Occupational hazard and safety

Labor rights
Environment-friendly livelihood
technologies
Sustainable development
2 Provision of assistance to cooperatives for Types of assistance provided to
women entrepreneurs coopertaives for women entrepreneurs

year provided
Total number of women beneficiaries
3 Existence of women entrepreneur groups Name of women's group or coopertaive
or cooperatives organized by the LGU to
improve their production and marketing
capabilities

Total number of members

Specify if organized by CSOs or LGU

4 Availability of capital or credit programs Title of credit programs or facilities

and facilities for entrepreneurs, especially available
women
Specify if program is:
Private cooperative
LGU Initiative in cooperation
with other organizations
Fully funded by the LGU
 Amount of credit or capital provided per
person/ credit portfolio
Total number of beneficiaries

5 Availability and use of SDD on MSMEs for Title of program/project where SDD was
planning and program development used

Type of SDD Used

Year implemented
Sector

Corresponding Office Status of

Score Responsible Collection
4 MSWDO,
MAGO, LEIPO,
PESO, MMO

4 MMO, CSO

4 MMO, CSO

MMO, CSO
LEIPO, BPLO,
PESO
Form C
Economic Development Sector
B. Agriculture Services
Indicator Means of Verification

1 Availability of agriculture-based training Title of training programs conducted

program offered or organized by the LGU for Number of women farmers trained
women farmers
Specify if training is:
Private cooperative or bank
initiative
LGU Initiative in cooperation
with other organizations
Fully funded by the LGU
2 Provision of assistance to cooperatives for Types of assistance provided to
women farmers coopertaives for women farmers
year provided
Total number of women beneficiaries
3 Existence of women farmer groups or Name of women's group or coopertaive
cooperatives organized by the LGU to
improve their production and marketing
capabilities Total number of members

Specify if organized by CSOs or LGU

4 Availability of credit programs and facilities Title of credit programs or facilities

for farmers, especially women available

Specify if program is:

Private cooperative
LGU Initiative in cooperation
with other organizations
Fully funded by the LGU
Total number of beneficiaries

5 Availability and use of SDD on agriculture in Title of program/project where SDD was
planning and program development used
Type of SDD Used
Year implemented
6 Availability of women - friendly farm List of women-friendly farm
implement or equipment implement/equipment
Photos of women friendly farm
implement/equipment
Others
Sector

Corresponding Office Status of

Score Responsible Collection
4 MAGO

4 MAGO

4 MAGO

MAGO

MAGO

MAGO
Form C
Economic Development Sector
B. Fishery Services
Indicator Means of Verification

1 Availability of fishery-based training Title of training programs conducted

program offered or organized by the LGU for Number of women fisher folk trained
women fisher folks
Specify if training is:
Private cooperative or bank
initiative
LGU Initiative in cooperation
with other organizations
Fully funded by the LGU
2 Provision of assistance to cooperatives for Types of assistance provided to
women fisher folks coopertaives for women farmers
year provided
Total number of women beneficiaries
3 Existence of women fisher folk groups or Name of women's group or coopertaive
cooperatives organized by the LGU to
improve their production and marketing
capabilities Total number of members

Specify if organized by CSOs or LGU

4 Availability of credit programs and facilities Title of credit programs or facilities

for fisher folks, especially women available

Specify if program is:

Private cooperative
LGU Initiative in cooperation
with other organizations
Fully funded by the LGU
Total number of beneficiaries

5 Availability and use of SDD on fisheries in Title of program/project where SDD was
planning and program development used
Type of SDD Used
Year implemented
Sector

Corresponding Office Status of

Score Responsible Collection
4 MAGO

4 MAGO

4 MAGO

MAGO

MAGO
Form C
Environmental Sector

Indicator Means of Verification

1 Provision of gender-responsive services and Copy of documents related to the

facilities for victims and survivors of implementation of the program
calamities and natural disasters

Relief goods for specific family members

with hygiene kit for women
Counselling services for victims and
survivors
Presence of security personnel to ensure
saftey and order in evacuation centers

Presence of women and children friendly

spaces in evacuation centers
Separate functional and well-lit toilets for
men and women with locks
Bathing facilities with privacy and source of
water
Space for pregnant women
Breastfeeding room
Conjugal rooms for married couples
2 Availability of gender-responsive Copy of documents related to the
environmental programs, services and implementation of the program
facilities

Women are mobilized alongside men for

community efforts toward CCA-DRRM

Women are made to participate in

environment and natural resources
management, CCA-DRRM governing and
decision making bodies

Practical gender needs of women are

considered in the construction or
rehabilitation of drainage syustems, sanitary
landfills, MRFs, etc

Core GAD messages are integrated in IEC

campaign to increase awareness on ENR
management, CCA and DRRM

Gender-based knowledge products are

developed in the vernacular
3 Existence of women's groups organized by Name of women's group
LGU for environmental conservation and
protection

Total number of members

Specify if organized by CSOs or LGU and
indicate their partners if applicable

4 Availability of SDD on disaster and natural Title of program/project where SDD was
calamities in planning and program used
development

Type of SDD Used

Year implemented
or

Corresponding Office Status of

Score Responsible Collection
4 MDRRMO

4 MDRRMO,
MENRO, MEO
MENRO, CSO

MDRRMO