Workshop

Evaluation Form for GPBP Project Briefs (DOH)

Name of LGU: _________________________________________________
Instruction: Please evaluate your Project Briefs according to the inputs made in the earlier presentation and provide your remarks in the
column/s
provided.
REQUIRED CONTENTS
I. BASIC INFORMATION
NAME OF PROJECT

Title of the prescribe project (if

Training, specify the training/s
and
the
number
of
participant/s in each training;
if HFEP infra, specify if
upgrading, expansion or new
construction;
if
HFEP
Equipment
specify
what
package) e.g. Diversified
Trainings-WASH: 20 pax,
BEmONC: 10 pax, Training
of
additional
Peer
Educators:
20
pax
e.g
HFEP-New Construction of
New BHS at Brgy. A e.g.
HFEP-Equipment TB DOTS
package

CITY/MUNICIPALITY
PROPOSED
IMPLEMENTING
NATIONAL GOVERNMENT
AGENCIES
OBJECTIVES

Project # 1
INTENSIFIED TB
CONTROL
PROGRAM
(Diversified
Training of 11
RHU staff, 1 MHO,
7 barangay
captain, 28 BHWs
on Early TB
detection ,
Smearing,
Swabbing and
sputum collection,
TB prevention,
Proper way of
handling TB
patients and TB
treatment course)
San Vicente,
Ilocos Sur
DOH

DOH
write the specific objectives of
the proposed project

To address the
drastic
widespread of
Tuberculosis

REMARKS
Project # 2 Project # 3

Project # 4

TARGET PHYSICAL
OUTPUT

who will be trained with what

e.g. 10 RHU Personnel
trained on Voluntary HIV
Counseling and Testing,
what will be produced after
project implementation e.g A
Newly Constructed
Functional BHS at Brgy. A
and its catchment Brgys
B and C with a total
population of 5,500

infection in the
locality through
early case
detection.
11 RHU staff, 1
MHO, 7 barangay
captain, 28 BHWs
will be trained on
Early TB detection
, Smearing,
Swabbing and
sputum collection,
TB prevention,
Proper way of
handling TB
patients and TB
treatment course.
The said project
will craft a Stop
TB core team of
the Municipality of
San Vicente and
one extension
group per
barangay.
Furthermore, A
certain day per
barangay will be
assigned as TB
day to cater the
patients need
right at their door
step.

LOCATION OF PROJECT
TARGET BENEFICIARIES

name of barangay where the

project will be implemented;
for trainings, leave it blank
who will benefit the project

Constituents of

BUDGET
LGU COUNTERPART
TOTAL

e.g. Constituents of San Carlos

City
how much is requested from
the DOH
how much is the counterpart

San Vicente

NGA budget + LGU

Counterpart
II.

PROJECT RATIONALE AND OBJECTIVES:

For the past five years, a mark increase in the number of patients diagnosed with TB.

III.

PROJECT DESCRIPTION:
Brief description of the project

IV.

PROPOSED BUDGET

BUDGET ITEM
e.g. WASH Training: 10 pax x 6,000= 60,000.00
e.g. Training for Additional Peer Educators: 20 pax
x 6,200
e.g. BEMONC Training 20 pax x 25000 =
e.g. Construction of New BHS at Brgy A =
Total

MOOE
60,000.00
124,000.00

Evaluated by:

Noted:

______________________
MPDC/DOH-REP.

Capital Outlay (CO)

500,000.00
600,000.00

________________________
Provincial DILG Focal Person

TOTAL BUDGET
60,000.00
124,000.00
500,000.00
600,000.00
1,284,000.00