PHC/Planning unit Communication Monitoring Tool for Routine Immunization (RI)&

Intensified Mission Indradhanush (IMI)

Name of the state……………Name of the district………….. Type of monitoring–RI /IMI/Others

Date of visit…………………….Name of the Block……………..Name of the PHC/Planning unit……………SM Net Block: Yes/ No
Name of the Monitor…………………..Designation………………………..
Agency: Government/ WHO/ UNICEF/ CORE/ AIH/ ITSU/ IPE Global/ JSI/ NIPI/ UNDP/ Others………

Observation at PHC/Planning unit (Monitor will visit PHC/urban planning unit and meet Medical officer incharge and Block
IEC incharge/BEE and fill following observations)

Q 1.1Does the PHC/Planning unit has a communication plan for Routine Immunization(Please see hard/soft copy): Yes/ No
Q 1.2 Communication plan includes: (a) Mid media plan-Yes/No (b) Social mobilization plan-Yes/No (c) Advocacy plan-Yes/No
(d) Capacity building plan-Yes/No

Q 2.1Is the PHC/Planning Unit has a communication plan for IMI-(Please see hard/soft copy): Yes/ No/NA
Q 2.2 Communication plan includes: (a) Mid media plan-Yes/No/NA (b) Social mobilization plan-Yes/No/NA
. (c) Advocacy Plan-Yes/No/NA (d) Capacity building plan-Yes/No/NA

Q2.3 Is IMI communication plan in template as per IMI guideline (17C template): Yes/No/NA

Q3PHC/planning unit level IEC/ IPC activities done for RI and IMI (Cumulative data as on date of visit for current FY)
Fill only for IMI plan, if monitoring done during IMI.
S No Activities/ Materials If, activity planned then check the status of activity in numbers:
Please tick, whichever activity is planned
3.1.1 Poster Received: Distributed
3.1.2 Banner Received: Distributed:
3.1.3 Hoardings Received: Distributed:

3.1 Mid Media Plan 3.1.4 Leaflets Received: Distributed:

3.1.5 Wall Paintings Planned: conducted:

3.1.6 IMI stickers Planned: conducted:

3.1.7 Street plays/Folk shows Planned: conducted:

3.1.8 Others Planned: conducted:
3.2.1 School Rallies Planned: conducted:
3.2.2 Mother Meetings Planned: conducted:
3.2.3 Influencers Meetings Planned: Conducted:
3.2.4 Community Meetings Planned: Conducted:
3.2 3.2.5 Miking/ Drum beating Planned: Conducted:
Social Mobilization Plan/
3.2.6 Local Announcements Planned: Conducted:
IPC
3.2.7 NCC/NYK orientation Planned: Conducted:

3.3.1 Block Task Force Meeting held in Number of Meetings Members attended last Block Task
last 3 mobths held_________ Force meetings: Medical Officers/
CDPOs/ Education Officer/ Partners/
SDM/ Tehsildar/ Block development
officers
3.3.2 Meeting with key religious leaders Meeting Held: Yes/No, Total religious leaders/ influencers
and participated___
influencers Planned If yes, Number of
Meetings held
Advocacy Plan ___________
3.3

3.41Whats app 3.4.2 Facebook Whats App group formed

3.4 Social media Plan for IMI: Yes/No/NA
3.4.3 Twitter 3.4.4 SMS
Whats app group formed
for RI: Yes/No

3.5.1 IPC training of ANM Total No. of ANMs in Total No. of ASHAs in PHC/Planning
3.5 Capacity Building (Please (BRIDGE) PHC/Planning unit__________
share cumulative data for unit__________
training) 3.5.2PC training on MR (ASHA & Total no. of ASHAs trained in
Moilizers (BRIDGE) Total no. of ANMs trained BRIDGE______
in BRIDGE______
Q4Observe for following IEC materials at health facility
Q 4.1 Have you seen any IEC material related to RI and IMI at this health facility- Yes/ No;
Q 4.2 If Yes What all (multiple options) - Poster/ Banner/ Hoarding/ Wall paintings/ others (specify) ……………
Q 4.3 Is any of these materials with IMI/RI tagline (“Paanch Saal Saat Baar”)*- Yes/ No
Q 4.4IsImmunization schedule displayed at Health facility? Yes/ No
Q 4.5Is any IEC material related to new vaccine displayed at Health Facility: Yes/ No, If yes for which Vaccine: IPV- Yes/ No,
Penta: Yes/ No, Rota- Yes/ No, Pneumococcal- Yes/ No, MR- Yes/ No

Q5 Is there any IEC nodal person at PHC/Planning Unit or Block level - Yes full time position/ Yes person with additional charge/
Position Vacant/ No such position

Q6.1 Is there any supervisory plan at PHC/Planning unit for IMI/RI: Yes/No
Q6.2 Is anyone in planning unit using android app or NCCVMRC site for communication monitoring- Yes/No

Q 7 How many SCs have submitted their communication plan for IMI campaign? __________out of ___________ SCs

Q8 Availability of logistics at PHC/ Planning Unit-

Q 8.1) ORS packets-Yes/No; Q 8.2) Iron syrup-Yes/ No; Q 8.3) Zinc tablets- Yes/No Q8.4) Vit. A – Yes/No

Any other relevant comments:

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