AAP Form

Partner(Select other if not listed)‫اﺳﻢ اﻟﺸﺮﻳﻚ‬

TYF

Organization‫اﺳﻢ اﻟﻤﻨﻈﺔ اذا ﻟﻢ ﺗﻜﻦ ﻣﺪرﺟﺔ ﻓﻲ اﻟﻘﺎﺋﻤﺔ اﻋﻼ‬

In case your organization is not listed above

Quarter ‫اﻟﺮﺑﻊ‬

Quarter 2

No. of Districts ‫اﺟﻤﺎﻟﻲ ﻋﺪد اﻟﻤﺪﻳﺮﻳﺎت‬

Project Location/s
1
* Governorate ‫اﻟﻤﺤﺎﻓﻈﺔ‬

Ta'iz

* District‫اﻟﻤﺪﻳﺮﻳﺔ‬

Maqbanah

* Number of health Facilities

‫ﻋﺪد اﻟﻤﺮاﻓﻖ اﻟﺼﺤﻴﺔ‬

* Number of Mobile Teams ‫ﻋﺪد اﻟﻔﺮق اﻟﻤﺘﻨﻘﻠﺔ‬

» Total Number of feedback received during reporting period througth the following modalities:
‫اﺟﻤﺎﻟﻲ اﻟﺘﻌﻠﻴﻘﺎت اﻟﺘﻲ ﺗﻢ ﺗﻠﻘﻴﻬﺎ ﺧﻼل اﻟﻔﺘﺮة اﻟﻤﺸﻤﻮﻟﺔ ﺑﺎﻟﺘﻘﺮﻳﺮ ﺧﻼل ﻛﻞ وﺳﻴﻠﺔ ادﻧﺎه‬

* Hotlines ‫اﻟﺨﻄﻮط اﻟﺴﺎﺧﻨﺔ‬

* Help Desks ‫ﻣﻜﺎﺗﺐ اﻟﻤﺴﺎﻋﺪة‬

* Suggestion Boxed ‫ﺻﻨﺪوق اﻟﻤﻘﺘﺮﺣﺎت‬

* Face-to-Face Interviews ‫ﻣﻘﺎﺑﻠﺔ وﺟﻪ ﻟﻮﺟﻪ‬

* Monitoring Methods ‫ﻃﺮق اﻟﻤﺮاﻗﺒﺔ‬

* Focus Group Discussion/Consultative Meeting ‫ اﻻﺟﺘﻤﺎع اﻻﺳﺘﺸﺎري‬/ ‫ﻣﺠﻤﻮﻋﺔ اﻟﻤﻨﺎﻗﺸﺎت اﻟﺒﺆرﻳﺔ‬

* Social media ‫وﺳﺎﺋﻞ اﻟﺘﻮاﺻﻞ اﻻﺟﺘﻤﺎﻋﻲ‬

* Informal feedback ‫اﻟﻤﻌﻠﻮﻣﺎت ﻏﻴﺮ اﻟﺮﺳﻤﻴﺔ‬

Other ‫أﺧﺮى‬

» Total Number Feedback and complaints during reporting period

‫اﺟﻤﺎﻟﻲ اﻟﺘﻌﻠﻴﻘﺎت واﻟﺸﻜﺎوى ﺧﻼل ﻓﺘﺮة اﻟﺘﻘﺮﻳﺮ‬

* Number of new complaints received ‫ﻋﺪد اﻟﺸﻜﺎوى اﻟﺠﺪﻳﺪة اﻟﺘﻲ ﺗﻢ اﺳﺘﻘﺒﺎﻟﻬﺎ‬

* Number of complaint cases acted upon ‫ﻋﺪد اﻟﺸﻜﺎوى اﻟﺘﻲ ﺗﻢ اﻟﺒﺖ ﻓﻴﻬﺎ‬
* Number of pending cases of complaints ‫ﻋﺪد اﻟﺸﻜﺎوى اﻟﺘﻲ ﺗﻢ ﺗﺄﺟﻴﻠﻬﺎ‬

* Number of new requests for assistance or information received ‫ﻋﺪد ﻃﻠﺒﺎت اﻟﻤﺴﺎﻋﺪة اﻟﺠﺪﻳﺪة أو اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﺴﺘﻠﻤﺔ‬

Describe what was asked in information requests ‫ﺻﻒ ﻣﺎ ﻧﻮع اﻟﻤﻌﻠﻮﻣﺎت اﻟﺘﻲ ﺗﻢ ﻃﻠﺒﻬﺎ‬

* Number of new positive feedback received ‫ردود اﻻﻓﻌﺎل اﻷﻳﺠﺎﺑﻴﺔ اﻟﺘﻲ ﺗﻢ ﺗﻠﻘﻴﻬﺎ‬

» Channels used for distribution of information during reportign period‫اﻟﻘﻨﻮات اﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﺘﻮزﻳﻊ‬
‫اﻟﻤﻌﻠﻮﻣﺎت ﺧﻼل ﻓﺘﺮة اﻟﺘﻘﺮﻳﺮ‬

* Radio broadcast ‫اﻟﺒﺚ اﻷذاﻋﻲ‬

Yes

No

* Noticeboards ‫ﻻﻓﺘﺎت ﺗﻨﺒﻴﻪ‬

Yes

No

* Public meetings ‫اﺟﺘﻤﺎﻋﺎت ﻣﺤﻠﻴﺔ‬

Yes

No

* schools ‫ﻣﺪارس‬

Yes

No
* newspapers ‫ﺻﺤﻒ‬

Yes

No

* SMS ‫رﺳﺎﺋﻞ ﻗﺼﻴﺮة‬

Yes

No

* Printed materials
‫ﻣﻮاد ﻣﻄﺒﻮﻋﺔ‬

Yes

No

* Social media
‫وﺳﺎﺋﻞ اﻟﺘﻮاﺻﻞ اﻷﺟﺘﻤﺎﻋﻲ‬

Yes

No

Other (specify) ‫اﺧﺮى‬

Yes

No

» People consulted during reporting period (focus group discussions, etc.) ‫ﻋﺪد اﻷﺷﺨﺎص اﻟﺬﻳﻦ ُاﺳﺘﺸﻴﺮو‬
‫ﺧﻼل ﻓﺘﺮة اﻟﺘﻘﺮﻳﺮ‬

* Number of girls or women consulted before implementation of projects

‫ﻋﺪد اﻟﺒﻨﺎت واﻟﻨﺴﺎء اﻟﺘﻲ ﺗﻢ اﺳﺘﺸﺎرﺗﻬﻦ ﻗﺒﻞ ﺗﻨﻔﻴﺬي اﻟﺒﺮﻧﺎﻣﺞ‬

* Number of boys and men consulted before implementation of projects

‫ﻋﺪد اﻷوﻻد واﻟﺮﺟﺎل اﺳﺘﺸﻴﺮو ﻗﺒﻞ ﺑﺪء ﺗﻨﻔﻴﺬ اﻟﺒﺮﻧﺎﻣﺞ‬
* Number of girls or women consulted during implementation of projects
‫ﻋﺪد اﻟﺒﻨﺎت واﻟﻨﺴﺎء ُاﺳﺘﺸﺮن أﺛﻨﺎء ﺗﻨﻔﻴﺬ اﻟﺒﺮﻧﺎﻣﺞ‬

* Number of boys and men consulted during implementation of projects

‫ﻋﺪد اﻷوﻻد واﻟﺮﺟﺎل ُاﺳﺘﺸﻴﺮو اﺛﻨﺎء ﺗﻨﻔﻴﺬ اﻟﺒﺮﻧﺎﻣﺞ‬

* Number of girls or women consulted for the exit of projects

‫ﻋﺪد اﻟﺒﻨﺎت واﻟﻨﺴﺎء ُاﺳﺘﺸﺮن ﻓﻲ ﻧﻬﺎﻳﺔ اﻟﺒﺮﻧﺎﻣﺞ‬

* Number of boys and men consulted for the exit of projects

‫ﻋﺪد اﻷوﻻد واﻟﺮﺟﺎل ُاﺳﺘﺸﻴﺮو ﻓﻲ ﻧﻬﺎﻳﺔ اﻟﺒﺮﻧﺎﻣﺞ‬

Remark