NDP MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

ACCOMPLISHMENT Total for

FUNCTIONS MOVs Monthly Target the
JAN FEB MAR Quarter

1. Regular Household Visits Number of Weekly TsekAP report 4

to NHTS families Form 1 submitted on-time
a. New Profiling No. of Poor Families newly Profiled
b. Updating Profile No. of Poor Families updated Profile
c. Provsion of No. of Poor families/individuals given
appropriate appropriate intervention
interventions
d. monitoring health No. of Poor Families/individual
status of NHTS Families monitored
e. referral Timely submission of Weekly TsekAP actual
report Form 2/referral logbook
2. Assist on BHB Document support for Functional 80% of
Functionality BHB coverage
a. Facilitate Copy of approved resolution on 80% of
organization/ organizational structure coverage
reactivation of BHB
b. Facilitate preparation copy of approved health Action Plan 80% of
of Barangay Health coverage
Action Plan
c. BHB Meeting Minutes of BHB meeting 80% of
coverage
3. Assist on CVHW Supportive Supervision Conducted
Supervision
a. Meeting/ Training Minutes of Meeting monthly
b. Reporting BHW Report monthly
c. Mentoring Minutes of mentoring monthly
4. Assit in the conduct of Monitoring & Evaluation conducted
Monitoring and evaluation of
various health programs quarterly

Participate in DQC @
quarterly
BHS level
5. Participation on the Provision of Health Services
implementation of
PRIORITY health programs

5.1. FAMILY PLANNING

No. of clients w/ unmet Masterlist
needs referred for Total No.
counseling of clients
w/ unmet
needs for
MFP x 65% /12
 No. of clients w/ unmet New Acceptor on FP Form1
needs provided service Total No.
of clients
w/ unmet
needs for
MFP x 65% /12 X
50%

No. of FP defaulters logbook: HH visits

followed up actual
5.2. NIP- FIC
No. of EPI defaulters
tracked actual
5.3. Nutrition- PEM
No. of OPT reports Copy of OPT report validated 100% of
validated coverage
Status Report 90% of
Deworming/ MDA coverage
5.4. NTP- CDR
Assist in TB casefinding List of clients referred for dssm 90% of
activities identified
presumptive
TB
Assist on TB List of clients followed up
caseholding 90% of
cases in
coverage
area
5.5. EOH
Participate in CLTS No. of HH participated in advocacy
activities meetings/attendance sheets 10% of HH w/o toilet
counselled
6. Assist in the conduct of Zero Reporting of Cases
disease surveillance;
Immunizable Diseases 4
Vector-Borne Diseases 4
Water-Borne Diseases 4
7. Conduct of Advocacy Advocacy meetings conducted
and health education & IEC
activities for different DOH
programs
Updating HPN/ DM record of clients served
Registry & monitoring of once monthly
clients
Recruitment and
assessment for NVBSP once monthly
activity
Conduct IEC: mothers attendance sheet, minutes, etc
Class/ Pabasa sa once monthly
Nutrition/ FDS
8. Assist in the submission Timely submission of report
of report
FHSIS report monthly
SDN report monnthly
Special Health Event monthly
9. Coordinates with the PHA
for data consolidation and
reporting monthly

10. Participates in data HEM Monitoring (HEARS, RHA)

gathering and response
during health emergencies actual
and disasters

12. Assist the MHO/PHN in Technical Assistance provided to MHO

the conduct of PIR, MDR
and Death/Mortality reviews

Participates in PIR quarterly

Participates in MNDR monthly
13. Performs other related
functions given by actual
supervisor
Remarks
(Reason of variance)
 RHMPP MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

ACCOMPLISHMENT Total for Remarks

Monthly
FUNCTIONS MOVs the (Reason of
Target JAN FEB MAR Quarter variance)

1. house-to-house health education and Counselling conducted on

awareness campaigns conducted for reproductive health (List of
reproductive health and health Clients counselled) monthly
maintenance;
Usapan Series monthly
2. Conduct home visit to households for Monitoring & Referral of
monitoring and proper referral of pregnant pregnant and post-partum
and post-partum mothers mothers (List of referred or
monitored )
Tracking of pregnant and post- Monitoring list of pregnant and
partum post-partum mothers
monthly
Referral of pregnant and post- Referral logbook of pregnant
partum and post-partum mothers
actual
3. Report submitted on status of Status report & update on
families/household visited especially the pregnant and post-partum
pregnant and post-partum mothers; mothers referred or moni- monthly
tored / TCL
4 ANC
2 PP
4. Assisted the conduct of health Advocacy campaign
education and advocacy campaigns on conducted on MNCHN+FP
MNCHN and demand generation (Attendance sheet presented) weekly
activities and provision of FP services;
5. Facilitate community participation in BHW/ Barangay Report
implementation and monitoring of submitted monthly
MNCHN programs and projects;
6. Provided direct maternal, handle Facility Based Deliveries
deliveries and direct child care services handled/ assisted, NBS coverage
(preventive and curative under DOH performed pop X
guidelines) in coordination with the Rural 2.7% X
Health Midwife; 80%
/12
List of actual deliveries
Handle FBD handled
Provide Newborn Care List NBCare clients
Refer immediately complicated List of clients referred
cases
actual
7. Maintains referral systems for Accomplish Referral form &
difficult/complicated pregnancies in the logbook monthly
SDN;
8. Referred new FP acceptors for New FP Acceptor counselled actual no.
counseling and FP provision and assist in and referred of
the inventory of DOH procured FP WRA X
commodities; 35% /12

9. Manned the birthing facility together

with the Rural Health Midwife; 40H/wk
24/7 Health Facility Operation
10. Participate in the conduct of maternal Paticipated to MNDR, naternal
and neonatal death review (MNDR) and death report submitted
surveillance activities with the PHN and actual
MHO;
11. Participate the data gathering and HEM MISP (Minimum Initial
response during health emergencies and Service Package)-FP report &
disasters on FP/MNCHN related concerns Monitoring (HEARS, RHA) actual

12. Perform other related functions

assigned subject to the approval of the actual
DOH.
 UHCI MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

ACCOMPLISHMENT Total for Remarks

Monthly
FUNCTIONS MOVs the
Target JAN FEB MAR (Reason of variance)
Quarter

1. Assist MHO in formulating project Copy of Project

proposals for priority health programs Proposal monthly
and project.
2. Prepare Activity Report of the health Copy of Activity Report
unit monthly

3. Assist the MHO in developing and Documentation on

implementing management system Health System monthly
towards UHC Management

4. Assist MHO and DMO in formulating Approved LIPH-AOP-

and in adopting a Local investment Plan WFP actual
for Health in the area

5. Assist the MHO for compliance and Application submitted/ actual

processing of Philhealth Accreditation of Certification Achieved
the health facility

MCP+
TB-DOTS
PCB
6. Assist the MHO in assessing and Assessment/evalua-
evaluating the HRH competencies and tion report
recommend appropriate actions.

Conduct training Inventory quarterly

Submit Training requirement of
HRH quarterly
7. Conduct health data analysis, analysis report monthly
monitoring and evaluation
LGU Scorecard (DCF) FHSIS report quarterly
Technical Roadmap/ Health data Mun./Brgy.al
Board Roadmap/
Health data
Board quarterly
8. Disseminate updates on program and Dissemination of DOH
administrative information to deployed Guidelines & Issuances monthly
HRH

9. Assist the MHO and the DMO in Referral logbook

establishing SDN-referral system in the activity report monthly
Inter-local Health Zone (ILHZ)

SDN Profile quarterly

SDN Mapping & Directory quarterly
10. Participate in data gathering and RHA, HEARS actual
response during health emergencies and
disasters

11. Performs other related functions given pictures/journal actual

by supervisor
 NUTRITIONIST-DIETICIAN MONTHLY PERFORMANCE REPORT
Name & Signature:
Area of Assignment:
FUNCTIONS
1. Nutrition Planning
a. conduct nutritional
assessment
b. assist in local nutrition
planning
2. Delivery of Nutrition
Services
a. organize/reactivate
IYCF support groups
b. conduct counselling on
IYCF for mothers(AP,PP
and BF)
c. conduct micronutrient
supplementation
Population Covered:
No. of NHTS Families:
ACCOMPLISHMENT Total for
MOVs Target the
JAN FEB MAR Quarter
OPT Report 80% of 0-71 mos
children
Approved LNAP 100% of coverage
their OPT LGUs assisted
on LNAP
No. of organized and 50% of coverage
functional IYCF LGUs assisted in
support group the organization/
reactivation of
IYCF support group
No. of mothers 20 mothers
counsellled on IYCF counsellled on IYCF
monthly
No. and % of 6-11mos No. of 6-11 mos X
given VAC 95% / 12
No. and % of 12-59mos No. of 12-59 mos X
given VAC 95% / 12
No. and % of PP given No. of PP X80%
VAC divided by 12
No. and % of sick 100 % of sick
children given VAC children
No. and % of AP given Total population of
iron supplement coverage area X 2.7%
X 80% / 12
No. and % of PP given Total population of
iron supplement coverage area X 2.7%
X 80% / 12
No. and % of anemic 100 % of anemic
children given iron children given iron
No. and % LBW % of Low Birth
infants given iron weight infants given
iron
 NUTRITIONIST-DIETICIAN MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

ACCOMPLISHMENT Total for

FUNCTIONS MOVs Target the
JAN FEB MAR Quarter

3. Management of Severe
Acute Malnutrition
c. identify 0-59mos children List of identified 50% of identified SAM
with SAM 0-59mos children with cases admitted to
SAM OTC
b. assist in the manage- List of identified SAM 50% of identified SAM
ment of identified 0-59mos cases admitted to cases admitted to
children with SAM OTC and treated OTC and treated
4. Nutrition Promotion and
Advocacy

a. assist in the conduct of >No. of meetings 1 LGU / month

information/ dissemination conducted
activities on Nutrition poli- > minutes of meetings
cies to stakeholders > attendanbce sheets

b. conduct nutrition edu- >No. of meetings 6 nutrition classes

cation activities conducted organized
> minutes of meetings 6 IYCF group
> attendance sheets counselling con-
ducted

5. Nutrition in Emergencies
a. assist in the conduct of No. of RNA activities 100% conduct of
rapid nutritional assessment conducted RNA
during emergencies
a. assist in the provision of Journal of activities 100% provision of
nutrition services during condcuted services during
emergencies emergencies

6. Reporting
a. Prepare, analyze and sub- Copy of reports of monthly
mit report on time as re- submitted
quired both by the DOH
Central and Regional Office

7. Participate in data gathering Monthly journal of health 100% provision of

and response during health events/special projects services during
emergencies and disasters; participated emergencies

8. Perform other related Activity report/journal/

functions as may be assigned pics
as necessary
Remarks

(Reason of
variance)
Remarks

(Reason of
variance)
 FHA MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

Monthly ACCOMPLISHMENT Total for the Remarks

FUNCTIONS MOVs (Reason of
Target JAN FEB MAR Quarter variance)

1. Assist the health facility in the List fo clients with unmet Total No.
identification of clients with unmet Modern Family Planning of WRA x
Modern Family Planning (MFP). (MFP) 65% /12
2. Assist in coordinating all demand Coordination activity
generation activities carried out by with POPCOM on FP
both the health and population Campaign 4
offices at the municipality.

3. Assist on providing health No./List of Clients

information / education including provided with IPC &
interpersonal communication (IPC) Counseling service
and counseling service.
A. Usapan series List of clients/pax 4
B. Family Development Sessions List of clients/pax 4
C. Outreach missions Pictures/Journal 1
D. Post Partum Family Planning Pictures/Journal
in hospital-based facilities actual

4. Assist on the mapping of FP Facility mapping/

available MFP services in health Inventory/ List of
facilities / clinics including birthing services offered
clinics (both public and private)
offering full range of MFP services
within the service delivery network
up to the tertiary level facility Quarterly
including conduct of outreach
missions and provision of (post-
partum family planning) PPFP in
hospital-based facilities.

5. Prepare and update the existing Updated Roster of

roster of service providers in the services including fees
service delivery network. 1
6. Provide FP counseling and Clients served on Total No.
services to augment existing FP counseling and FP of clients
services where needed in close services Family Health w/ unmet
coordination with the MHO/CHO/FP Fair, Family Planning needs for
focal person in the health facility. Day MFP x
65% /12
7. Assist on the referral of clients List of Clients referred to
for appropriate MFP services to private-public FP
health providers within the service Clinics/ Hospital actual
delivery network (SDN)

8. Coordinate with CSOs (birthing Name of Agency

facilities/clinics) and all hospitals in coordinated for FP
the SDN on FP service provision services 1
specifically in providing PPFP
services.

9. Organize / coordinate with FP List of clients on GIDA/

providers/ health staff for the Urban poor communities
conduct of regular FP outreach conducted with FP 1
missions in identified areas with outreach missions
high MFP demand

10. Assist the health facility in Name of facilities

ensuring availability of FP assisted
commodities & supplies
A. Inventory of FP Inventory report on FP 100% of
Commodities commodities and health
supplies facilities
B. Preparation of Monthly Monthly consumption 100% of
Consumption Report reports health
facilities
11. Provide assistance in
monitoring of municipal level
benchmarks
a. Tracking of FP Client 100% of
health
facilities
b. Documentation of Documentation of FP 90% of
municipal activities on FP activities municipal
activities FP
activities
c. Preparation and No. of reports sub- 90% of
submis- mitted health
sion of facility reports facilities
d. Status updates/reports No. of status reports on
on FP implementation
FP implementation in the provided to monthly
municipality/city MHO/CHO/DMO
 DENTIST MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

Monthly ACCOMPLISHMENT
FUNCTIONS MOVs Target JAN FEB

a. Conducts community
dental surveys and diagnosis of
A. Conduct community dental the area of assignment on oral
surveys and diagnosis on oral health and prepare an Annual
health of area of assignment Area-Based Oral Health Plan to
and prepare Annual Area-based be submitted to the LGU
Oral Health Plan to be submitted to
LGU.
B. Implement oral health program b. Implements Basic Oral
for prophylaxis, education and health care services which
awareness. includes:
1) Preventive Services
C. Perform preventive and promo-
tive dental health care services
as diagnostic and curative which-
ever is necessary.
D. Implement and supervise oral i. Oral Examination/ Case Finding
care activities in the community.
E. Maintain facilities and dental
equipment in good working con- ii. Oral Hygiene Program
ditions at all times.
F. Integrate oral health program
activities with the overall frame- · Oral prophylaxis (with priority for pregnant women and children)
work of the health unit in the
delivery of health services.
8.Enhance and sustain logistics
management
system.
- keeps records of supplies, meds,
etc. · Daily Supervised Tooth brushing drill
received and released
- submits inventory/ reports of logistics

9. Facilitate health education and

awareness campaign
- coordinates with other HRH and
RHU staff in health information iii. Pit and Fissure Sealant Program
dissemination activities

iv. Fluoride Utilization Program

2) Curative Treatment Services
and intervention
i. Permanent filling
ii. Gum treatment
iii. Atraumatic restorative
treatment
iv. Temporary Filling
v. Extraction
vi. Treatment of post
extraction complications
vii. Drainage of localized oral
abscesses
3) Promotive services
4) Rehabilitative and habilitative
services
5) Risk behavior education/
counselling
6) Oral health instructions/
advice
7) Referral and follow up of
dental clinical cases
c. Implements and
supervise oral care activities in
the community
d. Maintains facilities and
dental equipment in good
working condition at all times.

e. Establishes and
operationalize an effective two-
way referral and follow-up
systems for cases not within the
scope and capability for the
RHU with other agencies and
practitioner

f. Integrates oral health

program activities with the
overall framework of the health
unit in the delivery of health
services
g. Participates in data
gathering and response during
health emergencies and
disasters

h. Performs other related

functions as may be assigned
RT

Remarks
CCOMPLISHMENT Total for (Reason
MAR the Quarter of
variance)

men and children)

 PHARMA MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

Remarks
ACCOMPLISHMENT
Monthly Total for (Reason
FUNCTIONS MOVs Target JAN FEB MAR the Quarter of
variance)
Collate utilization and copy of reports monthly
inventory reports submitted
Drug utilization Reports Drug utilization reports monthly
of all DOH commodi-
ties in the PMIS
Assess Pharmaceutical Assessment report/ quarterly
Supply Chain Manage- analysis report
ment of Primary Health
facilities

Disseminate program Attendance sheet monthly

updates such as but
not limited to PNF, DPRI
and others.
Perform other related Activity report/ journal/ actual
functions as may be pics
assigned by the super-
visor from time to time.
 PHA MONTHLY PERFORMANCE REPORT

Name & Signature: Population Covered:

Area of Assignment: No. of NHTS Families:

ACCOMPLISHMENT Total for Remarks

Monthly
FUNCTIONS MOVs the (Reason of
Target JAN FEB MAR Quarter variance)

1.Assist the MHO/UHC Status Report:

implementer in the installation of SDN-Referral of
effective M&E systems for UHC ILHZ monthly
programs

2. Assists in the collection and Health Facility

validation of health related Profile, Quarterly
data/ information report on Brgy w/
- coordinates with other HRH, Health worker,
RHU staff and the commu HSPME Report & monthly
nity in the collection of time- Weekly TsekAp
ly and accurate data Report

3. Participate in the analysis of Trend of Health

health related data/ informa- Diseases,
tion. Notifiable Diseases monthly
- provides feedback/ analysis
data gathered

4. Assists in encoding/updating HSPME (Health

of data/information in the est- sector
ablished DOH information Performance
systems into the establish- Monitoring &
ed database & Evaluation), monthly
FHSIS/iClinicSys Weekly TsekAP
Report

5. Coordinate to facilitate sub- iClinicSys

mission of health reports/ implementation
data/information to DOH and eFHSIS monthly
Regional Office and Central Reporting
Office.

6. Enhance and sustain logis- Acccounting &

tics management system. Inventory of DOH
- keeps records of supplies, Supplies (HEM
meds, etc. received and re- commodities,
monthly
leased vaccine, etc)
- submits inventory/ reports of
logistics

7. Participate in data gathering, HEM Monitoring

disease surveillance and res- (HEARS, RHA)
ponse during health emerg- actual
encies and disasters
8. Perform other related Pictures/ journal
functions as may be assigned actual
subject to the approval of DOH.
 MT MONTHLY PERFORMANCE REPORT

Name & SignatPopulation Covered:

Area of AssignNo. of NHTS Families:
Remarks
ACCOMPLISHMENT Total for
FUNCTIONS MOVs (Reason
JAN FEB MAR the Quarter of
variance)
1. Laborator
Perform y Exam
laboratory Performa
examinati nce
ons Report

a. TP X
direct 0.00554/
sputum 12x 70%
smear
microscop
y

b.
complete
blood
count
c.
hemoglob
in count
d.
urinalysis
e
.fecalysis
f.
others
2. Functiona monthly
Maintain l
laboratory laboratory
facilities, facilities,
supplies supplies
and and
equipmen equipmen
t in good t
working
condition
at all
times.

3. Properly monthly
Maintain filed
and labora-
secure tory
record of records of
laboratory patients
patients.

4. Minutes
Conduct of IEC/
health No. of
informatio barangay
n and s reached
dissemina on
tion in the outreach
communit activities
y related
to
laboratory
procedure
s
5. Provide TA on
technical Laborator
assistanc y
e related Procedur
to es
laboratory
procedure
s

6. Copy of
Prepare, reports of
analyze
and submitted
submit
report on
time as
required
both by
the DOH
Central
and
Regional
Office.

7. 2. No. of
Participat monthly
e in data health
gathering events/sp
and ecial
response projects
during participat
health ed
emergenc
ies and
disasters;
8. Activity
Perform report/jour
other nal/
related pics
functions
as may
be
assigned