COMPARATIVE ANALYSIS ON THE EXTENT OF IMPLEMENTATION OF NEWBORN SCREENING AMONG

HOSPITALS IN THE PROVINCE OF TARLAC

SURVEY QUESTIONNAIRE
This survey is voluntary. All responses are anonymous. Your answers will be used to calculate group scores and no time will
your individual score be reported in this study. By completing this survey you are consenting to participate in this study.
Direction: Please fill in the appropriate answers to the following questions by writing on the blanks or checking the box whichever is
applicable. Please answer every question honestly.
I. PERSONAL DATA
1. Name:<optional>:
_________________________________
2. Name of Institution______________________________________
a.1. Bed Capacity _______________________________
a.2. Level of accreditation________________________
3. Sex____________________________

4. Age____________________________
5. Highest educational attainment_____________________________________
6. Number of trainings related to NBS__________________________________
7. Length of Service as an NBS implementer____________________________

II. EXTENT OF IMPLEMENTATION ON NBS. For the following items, place a check mark () on the column that corresponds
to your answer on the scale:
Numerical Rating
3

Statistical Rating

2.36 3.00

1.68 2.35

1.00 1.67

Descriptive Equivalence

Highly Implemented (HI)

Moderately Implemented (MI)

Not Implemented (NI)

Interpretation
An indicator that the all provisions are met.
Implementation is above the set standard. No
significant modification needed at the moment
An indicator that the not all of the provisions
are met. Standards are met; however,
improvement/s is/are recommended.
An indicator that provisions are not met or
observed. Implementation is below the set
standards. Significant modifications are needed
at the moment.

Indicator

Lead
Agency

Newborn Screening Provisions

1.

2.

3.

4.

5.

Extent
of Required Evidence
Remar
Implementati
ks
on
0
1
2
Fully utilize the efforts and
MOA with DOH/ NIHP/
resources of various offices
PHIC
within the:
Financial Statements
DOH;
Budget Allocations
NIHP;
PHIC
Establish
the Advisory
List of Advisory Committee
Committee on Newborn
on Newborn Screening
Screening (ACNBS)
Members
Organizational Chart
Coordinate
with
the
MOA with DILG
Department of the Interior
and Local Government for
implementation
of
the
NCNBSS
Coordinate with the NSRC
MOA with NSRC
for the accreditation of NSC
Manual of Operations
and preparation of defined
Policy
testing protocols and quality
Hospital Memo
assurance programs
Coordinate with any health
Membership
with
professional societies in an
Professional Societies
advocacy campaign on
behalf of the comprehensive
NBS system

Factor
Affecting
Implementati
on

6. Integrate NBS in the current

health care delivery system.
NBS shall be an integral part
of
all
public
health
programs. It should be a
routine
procedure
for
newborns in public and
private health, hospital and
birthing facilities
7. Ensure that a network for
the prompt recall of positive
cases is established in
collaboration with LGUs,
government agencies and
other
Non-Government
Organizations
8. Ensure that a network of
facilities for referral and
management of all positive
cases is established
9. Formulate protocols in the
referral and management of
the positive cases in
collaboration
with
the
Philippine
Society
for
Pediatric Metabolism and
Endocrinology and the IHG
NIHP
10. Develop referral centers and
identify referral teams in
strategic areas for referral

Manual of Operations
Policy
Hospital Memo

MOA with NGOs

Referral Forms
LogBook

Referral Forms
LogBook

Manual of Operations
Policy
Hospital Memo

Manual of Operations
Policy
Hospital Memo

Health
Facilities

and management of patients

with any of the disorders
11. Ensure
quality
and
sustainability
of
NBS
system
through
the
establishment of NSRC as
well as its attendant
requisites
1. Integrate NBS in its delivery
of health services;
2. Serve as collecting health
facility for NBS;

3. Ensure that adequate and

sustained NBS services such
as information, education,
communication, screening,
recall and management of
identified cases are being
provided in the hospital;
4. Establish a NBS Team that
will be responsible for the
following: collection of
samples, sending of samples
to accredited NSC, prompt
recall of positive patients,
referral and management of
patients;

Referral Forms

Manual of Operations
Policy
Hospital Memo
Action Plan

Manual of Operations
Policy
Hospital Memo
List of Recipients
Manual of Operations
Policy
Hospital Memo
IEC strategies such
Pamphlets
Consultation Logbook
Patients Chart

as

Manual of Operations
Policy
Hospital Memo
Organizational Chart
Job Description (Duties and
Responsibilities)

5. Establish an appropriate
financial system that will
ensure
effective
and
efficient collection of fees
and payment of NBS
services to the NSC;
6. Conduct orientation and/or
training of hospital staff on
NBS;
7. Monitor and evaluate the
implementation of NBS
within in the institution;

8. Define creative financial

packages to make NBS
accessible
particularly
among the economically
deprived populace.
9. Presence of the following
facility:
Minimum of one
hundred (100) square
meters working floor
area
Area
for
blood
collection
and
storage
Five
(5)
work-

Financial Statement
Annual Budget

Attendance Sheet
Feedback Forms
Documentation
Certificates
Attendance Sheet
Feedback Forms
Documentation
Certificates
Monitoring Forms
Financial Packages
Flyers

Minimum of one hundred

(100) square meters working
floor area
Area for blood collection
and storage
Five (5) work-benches to
run the five (5) tests. Each
work bench approximately
three (3) ft. long and five
(5) ft. wide.

Advisory
Committ
ee
on
Newborn
Screenin
g
(ACNBS
)

benches to run the

five (5) tests. Each
work
bench
approximately three
(3) ft. long and five
(5) ft. wide.
Sink
for
waste
disposal
Source of de-ionized
water
Waste
disposal
facilities for any
hazardous materials
generated
1. Review
annually
and
recommend conditions to be
included in the NBS panel
of disorders;

2. Review and recommend the

standard NBS fee to be
charged by NSCs;

3. Review the report of the

NSRC on the quality

Sink for waste disposal

Source of de-ionized water
Waste disposal facilities for
any hazardous materials
generated

Attendance Sheet
Feedback Forms
Documentation
Certificates
Monitoring Forms

Attendance Sheet
Feedback Forms
Documentation
Certificates
Monitoring Forms
Financial Statements
Performance
Appraisal
Form

4.

Newborn
Screenin
g Fees.

1.

2.

3.

4.

assurance of the NSCs; and

Recommend
corrective
measures
as
deemed
necessary.
The government and private
health facilities are highly
encouraged to develop a
scheme providing partial or
full subsidy depending on
the financial capability of
the parents;
A standard NBS fee
covering all program costs
shall be implemented by all
NSCs, as approved by the
ACNBS.
A
payment
schedule shall also be
imposed on all participating
health institutions so that the
NSC may stay financially
solvent;
A health facility may collect
a reasonable fee for the
collection of samples, which
shall not be greater than the
maximum allowable service
fee prescribed by DOH.
NSRC shall collect the
percentage of the NBS fees
earmarked for the DOH Centers
for
Health

Quality Assurance Audit

Incident Reports
Documentations

Financial Packages
NBS Fees Form

Financial Packages
NBS Fees Form

Financial Packages
NBS Fees Form
Budget

Financial Packages
NBS Fees Form
Budget

NBS
Specime
n
Collectio
n Kits

Usage of
NBS
Fees

Development (CHD) or its

future equivalent from all
hospitals, birthing facilities
and other collecting units;
1. All
hospitals,
birthing
facilities,
Rural
Health
Units, Health Centers and
other
collecting
units
throughout the country shall
have
NBS
Specimen
Collection Kits at all times;
2. The cost of the NBS
Specimen Collection Kits
shall be based on the amount
prescribed by the ACNBS;
3. Members of the PHIC may
apply for reimbursement of
the cost of NBS Specimen
Collection kits;
1. At least four percent (4%) to
the DOH - CHDs or its
future equivalent for:
Follow-up service of
patients with positive
screening result by
personnel hired for
the NBS unit based
at CHD;
Education and other
activities
directly

NBS Specimen Collection

Kits
Kit Inventory

NBS Specimen Collection

Kits
Kit Inventory
Kit Fees
PHIC Forms

Financial Statement
Annual Budget

related
to
the
provision of NBS
services;
Staff development of
the personnel of the
NBS unit based at
the
CHD,
i.e.
attendance
of
training
seminars
and official meetings
of the DOH and the
NIHP,
Capital outlay, i.e.
vehicle
Maintenance
and
operating expenses
of the program vii.
Cost
of
repeat
samples
due
to
insufficient
and
unsatisfactory
samples of patients
in their catchment
area
2. At least four percent (4%) to
the NSC for human resource
development and equipment
maintenance and upgrading;
3. At least four percent (4%) to
the NIHP-NSRC for overall
supervision, training and

Financial Statement
Annual Budget

Financial Statement
Annual Budget

continuing
education,
maintenance of national
database, quality assurance
program and monitoring of
the national program; and
4. The
balance
for
the
operational
and
other
expenses of the NSC.
Testing
Capabilit
y

1. Analyzing a minimum of
one hundred and fifty (150)
samples a day utilizing
testing methods approved by
the NSRC
2. Testing for the following
disorders included in the
NBS package currently
approved by the ACNBS for
NBS:
Congenital Adrenal
Hyperplasia (CAH)
Congenital
Hypothyroidism
(CH)
Phenylketonuria
(PKU)
Galactosemia (GAL)
Glucose 6 Phosphate
Dehydrogenase
Deficiency (G6PD)
3. Interpreting and reporting

Strategic Plan
Training Needs Assessment

Financial Statement
Annual Budget
Strategic Plan
List of Recipients
Accomplished Forms
Test Results

List of Recipients
Accomplished Forms
Test Results for
Congenital Adrenal
Hyperplasia (CAH)
Congenital
Hypothyroidism
(CH)
Phenylketonuria
(PKU)
Galactosemia (GAL)
Glucose 6 Phosphate
Dehydrogenase
Deficiency (G6PD)

List of Recipients

Personne
l

test results for each disorder

based on pre-determined
analytical
ranges
and
expected norms.

1. A licensed physician with at

least one (1) year training/
orientation and experience
in running a NBS program
or three (3) years of
equivalent experience in a
closely allied situation as
approved by the NSRC.
2. A licensed
biochemist,
chemist,
medical
technologist
or
microbiologist with at least
one (1) year of satisfactory
training/ orientation in NBS
Laboratory Management or
three (3) years of experience
in related field

Accomplished Forms
Test Results for
Congenital Adrenal
Hyperplasia (CAH)
Congenital
Hypothyroidism
(CH)
Phenylketonuria
(PKU)
Galactosemia (GAL)
Glucose 6 Phosphate
Dehydrogenase
Deficiency (G6PD)
HR Files with the necessary
documents
Appointment
Service Record
Certificates

HR Files
with
necessary documents
Appointment
Service Record
Certificates

the

Equipme
nt/
Instrume
nt/
Reagents

3. Three appropriately licensed

scientists
(biochemist,
chemist,
medical
technologist
or
microbiologist) with at least
three
(3)
months
of
laboratory
testing
experience in performing the
tests specified or one (1)
year of equivalent testing
experience in a clinical
laboratory.
4. A licensed nurse with at
least three (3) months of
experience working/training
in NBS or six (6) months of
equivalent experience in a
public
health
case
management program.
Following equipment/ instrument/
reagents are available:
Database system compatible
with that of the NSRC
Equipment appropriate for
performing analytical testing
on dried blood spots (3 mm
diameter - ~1.5 L serum)
for
Congenital
Hypothyroidism, Congenital
Adrenal
Hyperplasia,
Phenylketonuria,

HR Files
with
necessary documents
Appointment
Service Record
Certificates

the

HR Files
with
necessary documents
Appointment
Service Record
Certificates

the

Database system compatible

with that of the NSRC
Equipment appropriate for
performing analytical testing
on dried blood spots (3 mm
diameter - ~1.5 L serum)
for
Congenital
Hypothyroidism, Congenital
Adrenal
Hyperplasia,
Phenylketonuria,
Galactosemia and Glucose6-Phosphate Dehydrogenase

Galactosemia and Glucose6-Phosphate Dehydrogenase

deficiency
Fume hood necessary for
any of the analytical
procedures specified
Automated puncher capable
of cleanly punching 3 mm
paper punches
Manual paper punch capable
of cleanly punching 3 mm
paper punches
Multiple pipettor capable of
delivering
appropriate
reagent volumes for any of
the procedures specified (i.e.
generally considered to be
volumes of 10 ml, 50 ml or
100 ml)
Eppendorf
pipettes,
if
deemed
appropriate,
calibrated
to
deliver
volumes of 100 ml and 200
ml
Filter paper collection cards
(S&S 903) compatible with
those designed for use by
the NSRC
Lancets
with
tip
approximately 2.0 mm long

deficiency
Fume hood necessary for
any of the analytical
procedures specified
Automated puncher capable
of cleanly punching 3 mm
paper punches
Manual paper punch capable
of cleanly punching 3 mm
paper punches
Multiple pipettor capable of
delivering
appropriate
reagent volumes for any of
the procedures specified (i.e.
generally considered to be
volumes of 10 ml, 50 ml or
100 ml)
Eppendorf
pipettes,
if
deemed
appropriate,
calibrated
to
deliver
volumes of 100 ml and 200
ml
Filter paper collection cards
(S&S 903) compatible with
those designed for use by
the NSRC
Lancets
with
tip
approximately 2.0 mm long
sufficient for heelprick
Disposal
system
for

sufficient for heelprick

hazardous
and
nonhazardous materials
Disposal
system
for
Drying rack for horizontal
hazardous
and
nonhazardous materials
drying of filter paper
collection cards
Drying rack for horizontal
drying of filter paper
collection cards
1. Storage area of used filter
paper cards (a small room
with
temperature
and
humidity
control
is
preferred)
2. Freezer with temperatures
maintained between 20 to
10 C
3. Refrigerator capable of
maintaining
constant
temperatures between 4-8 C.
Note: The content of the questionnaire is based from RA 9288 Implementing Rules and Regulations

CONTENT VALIDITY OF THE QUESTIONNAIRE

Indicators

The directions given are clear in all sections of the data-gathering

instrument.
Each item is clearly stated.
Each item is readable, i.e. the items are easily read.
Each item is attractive to read: enough space is provided to avoid crowing
among the items.
The data-gathering instrument is comprehensive, i.e. it covered all areas
that are important in the study.
Each item is focused on a particular thought or idea.
The items are objective, i.e. the responses to be elicited are neither biased
nor reactive.
The items are formulated in accordance to the explicit or implicit
objectives of the study.
The items are systematically arranged according to a desirable sequence.
The items do not overlap with each other, no duplication of items is
observed.
*Note: This will be used to validate the above questionnaire involving 5 experts

Evaluators
B
C
D

AWM

DI