DOH - SPMS Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, _____________________________ Midwife II, of Provincial DOH Office - ______, commit to deliver and agree to be rated on the attainment of the following targets in
accordance with the indicated measures for the period of JULY 1 to DECEMBER 31, 2022.

Name of Employee:
Approved By: Date:

__________________________
July 11, 2021
DMO IV
5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor

RATING
Success Indicator
Strategic Goals and Objectives Actual Accomplishment Remarks
(Target + Measure) Q E T A
(1) (2) (3) (4)
CORE FUNCTIONS
To ensure access to effective, IMPLEMENTATION OF HEALTH PROGRAMS
safe and quality health care 1. MATERNAL CARE
service 1.1. PRENATAL CARE
No of pregnant women tracked N/A ✓ N/A
100% (Actual) of pregnant women given
✓ ✓ ✓
appropriate prenatal services as scheduled
100% of pregnant women assisted in completing
✓ ✓ N/A
the birth plan
To ensure access to effective, 1.2. DURING DELIVERY
safe and quality health care 100% of deliveries assisted/ attended consistent
✓ ✓ N/A
service with BEmONC standards
To ensure access to effective, 1.3. POST PARTUM CARE
safe and quality health care
service

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 RATING
Success Indicator
Strategic Goals and Objectives Actual Accomplishment Remarks
(Target + Measure) Q E T A
(1) (2) (3) (4)
To ensure access to effective,
safe
CORE and quality health care
FUNCTIONS 100% (Actual) postpartum women provided with
service at least 2 postpartum services 7 days after ✓ ✓ ✓
delivery
100% (Actual) postpartum women initiated
N/A ✓ N/A
breastfeeding after delivery
100% (Actual) postpartum women given
complete iron folate supplementation (90 tabs) N/A ✓ N/A
24 hours after delivery
100% post partum women given complete Vit. A
supplementation after delivery and after 1 week N/A ✓ N/A

To ensure access to effective, 2. CHILD CARE

safe and quality health care 100% (Actual) of children thoroughly assessed
service and appropriately managed for common ✓ ✓ N/A
childhood illnesses utilizing IMCI manual
100% (___) of 6 to 11 months children given
N/A ✓ ✓
Vitamin A supplementation as scheduled Based on TCL
95% of 0-11 months children Fully Immunized N/A ✓ N/A Annual target
100% (___) of 6 to 59 months children given
micronutrient supplementation and/or Vitamin A N/A ✓ ✓
in October 2022 Based on TCL
100% (___) of 12-59 months children given
N/A ✓ ✓
deworming tablets in July 2022 Based on TCL
100% (___) of 0 to 24 months children monitored
N/A ✓ ✓
growth monthly Based on TCL
100% (Actual) of Moderately Acute Malnourished
(MAM) children monitored and provided N/A ✓ N/A
appropriate intervention
100% (Actual) of Severely Acute Malnourished
(SAM) children monitored and referred to N/A ✓ N/A
appropriate health facility

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 RATING
Success Indicator
Strategic Goals and Objectives Actual Accomplishment Remarks
(Target + Measure) Q E T A
(1) (2) (3) (4)
CORE
To FUNCTIONS
ensure access to effective, 3. FAMILY PLANNING
safe and quality health care 100% (___) of Women of Reproductive Age
service (WRA) assessed for unmet needs for Modern ✓ ✓ N/A
Family Planning
100% (___) of clients provided with Famiy
✓ ✓ N/A
Planning Counseling
100% of clients provided with appropriate
✓ ✓ N/A
services
100%(___) men (20 y/o and beyond) provided
✓ ✓ N/A
information on Male Involvement on RPRH
100%(___) adolescent boys (10-19 y/o)
✓ ✓ N/A
provided information of Reproductive Health
To ensure access to effective, 4. HEALTH EMERGENCY AND DISASTER
safe and quality health care 100% (actual) reportable incidents/events
service monitored and reported using appropriately filled- ✓ ✓ N/A
out forms/ tools
100% of incidents/events assisted N/A ✓ N/A
To ensure access to effective, 100% of clients needing further intervention
safe and quality health care and/or specialized care were referred to the RHU ✓ ✓ ✓
service or higher health facilities
SUPPORT FUNCTIONS

100% (13) of correct and complete documents

To ensure timely submission of
correct and complete reports
To strengthen coordination,
Collaboration and partnership
with other agencies and private
sector
To increase capacity of DOH-
HRH in order to improve
workplace performance
as required by P/CDOHO submitted on or earlier ✓ ✓ ✓
than the set deadlines (DTR, MAR, IPCR)
100% (Actual) of application for leave
accomplished properly and submitted within the ✓ ✓ ✓
prescribed timelines
100% (Actual) of meetings and other activities
(seminars, workshops, trainings, health
N/A ✓ N/A
promotion activities) attended/ conducted with
after activity report/s
100% of the requirements for Primary Care
Workers' Certification complied by December 15, N/A ✓ ✓
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 RATING
Success Indicator
Strategic Goals and Objectives Actual Accomplishment Remarks
(Target + Measure) Q E T A
(1) (2) (3) (4)
CORE FUNCTIONS
100% (2) Attendance to Learning Development
N/A ✓ ✓
Interventions from July- December 2022

RATING
Total Overall Rating
Final Average Rating
Adjectival Rating
Comments and Recommendation for Development Purposes

Discussed With: Assessed by: Date: Final Rating by: Date:

I certify that I discussed my assessment of the
perfomance with the employee

Midwife II DMO IV DMO V

Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average

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