BHW Monthly Report in SDN Profiling

City/ Municipality: ______________________

Name of BHW: ___________________________________ Barangay:

Indicator JAN FEB MAR APR MAY JUNEJULY AUG SEPT OCT NOV DEC
Total Number of Families
Total Number of Households
No. and % of CCT-HHs
No. and % of Non-CCT-HHs
Total NHTS HHs
NHTS Coverage
Number with access prior to Initial Profiling (to be accomplished
only once)
No. and % of LVP (Located, Visited, Profiled/ Updated)
No. and % of NL (Not Located – transferred or not found)
No. and % of NV/F (Not Visited or Followed up)
No. and % of NHTS Household w/ at least 1 member given
health referral
No. and % of NHTS Family w/ at least 1 member given health
referral
No. and % of NHTS Family w/ at least 1 member who
Received Service
No. and % of NHTS HHs w/ at least 1 member who Received
Service
Health Indicators
No. of newborns seen and referred
No. of infants seen and referred
No. of underfive children seen and referred
No. of pregnant women seen and referred
No. of PP women seen and referred
No. of NPNP women seen and referred
No. with FP unmet seen and referred
No. of HH members with cough seen and referred
 SDN Profiling Consolidation Report
City/ Municipality: _________________________________ Name of HRH: __________________________
Number of Barangay: ______________________________ For the Month of: __________________________

Indicator BHW 1 BHW 2 BHW 3 BHW 4 BHW 5 TOTAL

Total Number of Families
Total Number of Households
No. and % of CCT-HHs
No. and % of Non-CCT-HHs
Total NHTS HHs
NHTS Coverage
Number with access prior to Initial Profiling
No. and % of LVP (Located, Visited, Profile
Updated)
No. and % of NL (Not Located – transferred or not
found)
No. and % of NV/F (Not Visited or Followed up)
No. and % of NHTS Household w/ at least 1
member given health referral
No. and % of NHTS Family w/ at least 1 member
given health referral
No. and % of NHTS Family w/ at least 1 member
who Received Service
No. and % of NHTS HHs w/ at least 1 member who
Received Service
Health Indicators
No. of newborns seen and referred
No. of infants seen and referred
No. of underfive children seen and referred
No. of pregnant women seen and referred
No. of PP women seen and referred
No. of NPNP women seen and referred
No. with FP Unmet Need
No. w/ FP unmet seen and referred

No. of HH members with cough seen and referred

 NDP PERFORMANCE REPORT
for the month of _________________

ACCOMPLISHMENT
ACTIVITIES Target Indicate Name & Number of Families of the barangay Means of Verification

1. Conducts regular visits to priority household with health problems.

No. of newborns seen and referred
No. of infants seen and referred
No. of underfive children seen and referred
No. of pregnant women seen and referred
No. of teenage pregnancy seen and referred
No. of PP women seen and referred
No. w/ FP unmet seen and referred
No. of HH members with cough seen and referred
2.213% of Pop SDN Family Profile report v4.1
2.213% of Pop SDN Family Profile report v4.1
12.5% of Pop SDN Family Profile report v4.1
2.7% of Pop SDN Family Profile report v4.1
5% of 2.7%Pop SDN Family Profile report v4.1
2.7% of Pop SDN Family Profile report v4.1
12.325% of Pop SDN Family Profile report v4.1
SDN Family Profile report v4.1

No. of HPN/ DM clients 36% of Pop

2. Provides appropriate interventons on identified health concerns of families.
Fully Immunized children (FIC) vaccinated 95% Target Client List
First Trimester pregnant women registered & 85% Target Client List
provided AP care
4 ANC Care provided 85% Target Client List
PP Home visit conducted 85% Target Client List
Children weigthed and recorded as New in OPT 85% Copy of OPT reports validated
registry (0-59 months)
Follow- up weighing, validation and analysis 85% Copy of OPT reports validated
conducted among 0-59 months children
New Acceptor Identify, counselled and referred for 65% Target Client List
FP services
Follow-up FP services facilitated/provided 65% Target Client List
Supervised TB client for Caseholding 90% Target Client List
3.Prepares health status reports of families/households visited
No. and % of families with access prior to Initial 100% SDN Family Profile report v4.1
Profiling
No. and % of families LVP (Located, Visited, Profile 100% SDN Family Profile report v4.1
Updated)
No. and % of families NL (Not Located – SDN Family Profile report v4.1
transferred or not found)
No. and % of families NV/F (Not Visited or Followed up) SDN Family Profile report v4.1
No. and % of NHTS Family w/ at least 1 member actual Referral Logbook
given health referral
No. and % of NHTS Family w/ at least 1 member 100% of refferals Target Client List
who provided/Received Services
4. Assist in the conduct of implementation, monitoring and evaluation of health programs
Assist on BHB Functionality Copy of approved BHB resolution,
action plan and minutes of meeting
(current)
Coverage of services provided in the conduct of Accomplishment report in special
Special Health Acitivity/campaign for the month campaign (BHS)

No. and % of NIP defaulter tracked actual Target Client List

No. and % of client in Pregnancy tracking actual Target Client List
No. and % of FP defaulter tracked actual Target Client List
No. and % of children 0-59 months identified as actual Target Client List
SAM/ MAM
No. and % of NTP client tracked actual Target Client List
5. Conducts Health Education and training
BHW Orientation/ Training / Meeting 100% Minutes of BHW Mentoring,
orientation and copy of TA plan
FGD: mothers classes, BF class, Nutr.,etc. actual Attendance sheet, Activity report
Barangay/ Community assembly 100% Attendance sheet, Activity report
Individual Counselling/advices actual Health Education Logbook
Advocacy to ZOD-CLTS 100% List of HH participated in advocacy
meetings; attendance sheets

6. Coordinate with PHA to ensure timely data collection and reporting

FHSIS report 6 Copy of FHSIS reports submitted
on-time
MNCHN reports (including maternal death and 6 Copy of MNCHN reportS submitted
neonatal death) on-time
MHSPME reports 6 Copy of MHSPME reports submitted
on-time
SDN report (Family Profiling V4.1) 6 Copy of SDN reports submitted on-
time
7. Assists in the conduct of disease surveillance
Active surveillance of 0-59mos children with 6 Copy of OPT reports validated
SAM/MAM
Immunizable Diseases 24 Copy of weekly FHSIS reports
submitted
Vector-Borne Diseases 24 Copy of weekly FHSIS reports
submitted
Water-Borne Diseases 24 Copy of weekly FHSIS reports
submitted
8. Monitors adverse events of vaccines
Assess evidence for adverse events following 24 Immediate Reporting
vaccination
9. Participates in data gathering and response during health emergencies and disasters Copy of HEM (HEARS, RHA)
reports
Assist in DRRM-H Institutionalization 4 Accomplished Assessment checklist

10. Performs other related functions given by Compliance report

supervisor

Prepared & submitted by: Catchment Area:

Name & Signature of HRH

 DOH - SPMS Form 3
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
I, _______ (NAME OF HRH)_____, NDP- , of the PDOHO- E. SAMAR , commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period ________ to
DECEMBER 31, 2019.
________________________________________
. Name of Employee: Date:
_______
Approved By***: Date:

Name of DMO Supervisor

5- Outstanding 4- Very Satsfactory 3- Satisfactory 2- Unsatisfactory 1- Poor
RATING
Output Success Indicators Actual Accomplishment (g) Remarks
T
(Targets + Measures) Q E A
(a) (b) (c) (1) (2) (4) (d)
(3)
A. STRATEGIC FUNCTIONS: Consider multiplier factor/ province, and the existing capacity of the
Conduct activities and provide services in RHU-HRH)
Basis: Comments of Prog Coord, NOH, FHSIS, local initiatives
in support to the institutionalization
of HCPN in the barangays assigned.
A. 1. Conduct profiling and risk assesssment to families in % families profiled/ total # families /bgy verify target HSPMu.TSEKAP
assigned barangays.
Target: 90% families profiled with risks identified
A.2. Provides appropriate interventions to address the identified % families with health risks provided intervention / total # of families profiled
health concerns of families.
Target : 90% provided intervention
A.3.Prepares health status reports of families / bgy Target: : # bgys with monthly health status report / Total # of assigned bgys
90% of bgys with health status reports
A. 4 .Conduct health facility mapping / updating in coordination Target: : # of health facilities mapped/updated in assigned bgys/ total # health
with DMO and partners facilities
100 % of health facilities mapped /updated annually
B. CORE FUNCTIONS :
To ensure access to responsive , quality ,acessible health
services to clients in the barangays
B.1 ADVOCACY for all priority programs Target : # of advocacy activities done/ month
2 advocacy meetings/ month /bgy dmo target/month
B.2 SUBMISSION OF MONITORING REPORTS
Weekly report : Surveillance report ( PIDSR pt person)
Larva survey (cluster and outbreak
Monthly : Health risk assessment report (HRH w/ bgys)
FHSIS monthly report (Nurse )
OSM report (PHA)
Monthly report/ Kadre
Pregnancy tracking (Nurse, Midwife)
Linelist of teenage pregnancy
AHDP Status report
FP unmet needs tracking
Linelist of deliveries attended/ assisted
Comprehensive social benefits /services ( WIA ./ KIA )
Larva survey (normal times )
As needed : Post activity report (Team Leader)
Health facility mapping
Health equipment monitoring
Quarterly : HFEP ongoing status report
Annual :
B.3.1 .Family Health services
Safe motherhood % of pregnant women w/ 4 pren visits/ total # of pregnant
Target :95%
Safe delivery % of deliveries attended by trained health professionsl/ Total # of deliveries OSM updates: denominator: # of actual deliveries

Target 90%
Antenatal defaulter tracking % prenatal defaulters tracked monthly / total # of defaulters
Target: 100%
Postpartum care % of post partum women provided with 2/more postpartum visits / total # of deliveries

Target :95%
Infant care: Immunization % of eligible children fully immunized / total # eligible children
Target :95%
Immunization defaulter tracking % immunization defaulters tracked monthly / total # of defaulters/bgy local initiative , not in FHSIS

Target: 100%
Nutrition services : Nutrition assessment % of eligible children with nutrition assessment /total # of eligible children
Target :95%
Micronutrient supplementation
Vit A : % of elig children provided with Vit. A 6-59 mos / eligible pop
Target : 95 % HRH capacity MNP

MNP % of elig children given complete MNP /total # of eligible children age groups: 6-11: 90
sachets for 6 mos (.5
sachet/day) total : 90
sachets
Target: 95 % 12-23 mos: 180 sachets(.5
sachet/day)
Ferrous supplementation for LBW and Pre-term % of LBW and pre-term infants given complete iron supplementation /total preterm + given to Inf w/ LBW + pre-
term infants
LBW
Prioritize MAM
May also give MNP to
older children
.6 ml/day up to 3 mos
(equiv to 15 mg elem
iron) 3 bots/ child

Target :95% identific is based on profiling

Ferrous supplementation for Pregnant % of pregnant with complete iron + folate /total # of pregnant (10-49 yo) Preg- 180 tabs. 1/day x 6 mos

Target :95% PP+90 tabs. 1/day x 3 mos

Ferrous supplementation for Lactating mothers % of post partum with complete iron + folate /total # of post partum (10-49 yo)

Target :

Calcium supplementation % of elig pregnant given complete calcium supplements/total # pregnant (10-49) start giving at 5 mos- 1 tab 500 mg 3 x
delivery daily =450 tabs/
mother
Target: 30%
Deworming for Pregnant % pregnant given 1 dose deworming tab / Total # og pregnant Give 1 deworming tab start on 2nd-3rd trimester
Target: 95 %
Adolescent Health services # of adolescents reached through HYO , PYP sessions,ASRH sessions / total # of HYO= 25 pax / session
adolescents
Target: 50 % not listed in the NOH and FHSIS

Family Planning % of 15-49 yrs old women with unmet need referred to facilities with trained service pop x 22.8 % ( E.Samar)
provider / WRA
less than 5% Numerator : based on proiling

% of WRA with unmet needs as new acceptors Denominator : based on proj pop x 22.8%

100%
FP Defaulter tracking % of defaulters tracked / total # of defaulters
100%
B.4 .Enviromental & Occupational Health Program % of doubtful water sources identified and referred for sampling/total # water sources Advocacy on the 3 criteria :

Target : 100% avail 24/7, (-) coliforms, loca w/in HH premises

Updating of masterlist of HH w/o sanit toilets safely managed 2 conditions :not shared,
connected to sewerage/contained

B.5. VECTOR-BORNE DISEASES

Dengue Control Program : DTF in bgys ,schools % of bgys with functional dengue task force / total # of bgys covered not listed in the FHSIS/NOH

100% only listed as part of surveillance

Target : # of schools with functional DTF/ Total # schools covered

100%
During normal times : every 2 weeks # of bgys with larva survey results submitted and analyzed with feedback to partners
/ total # of bgys covered
During clustering/ outbreak : weekly 100%
B.6 . COMMUNICABLE DISEASES CONTROL PROGRAM
TB: Casefinding % of TB symptomatics with sputum exam/ Total # of TB symptomatics identidied
Target : 90 %
TB Treatment % of (+) cases cured / Total # of (+) cases registered
Target :92 % Not listed in FHSIS
TB Defaulter tracking % of defaulters tracked / total # of TB caeses ongping tx
Target : 100 %
Leprosy control Program : Casefinding # new cases identified
Target : less than 5 % of previous year
Rabies : # coordination meetings in support to rabies control Gap : HRH
Target : 2 mtgs during the rating period
HIV # MARPS PROVIDED CONDOMS /Total # of MARPS NOH: Art tx covergae
 Target :100 %
Schistosomiasis : Mass treatment % elig population given praziquantel/ total elig pop
Target : 85 %
Leprosy # of cases seen within the rating period pls comment
Target : less than 5 % from previous years Limited # of HRH trained on Leprosy

B. 7 . NON COMMUNICABLE DSE CONTROL PROGRAM

PHILPEN : Risk assessment % elig population conducted risk asessment / total # of elig pop Start screening at age 20 .

Target : 58 % of the pop

Update Registry on HPN/DM % bgys with updated registry on HPN/DM/ total # bgys covered
Target: 100%
Tobacco Prevention & Control : Profiling % of bgys with masterlist of smokers / total # of bgys covered REVIEW PROFILE 2018: SMOKERS

Target : 100 % 2020 and onwards : include the prevalence of

smoking / bgy
Provision of BTI % of smokers provided BTI/ total # of smokers GAP: HRH orientation on BTI

Target : 100 %
Cancer Prevention & Control % bgys with masterlist of women 21 yo and above REFERRED for screening on cervical ca not done
Target : 100 % BASED ON PROFILE
Voluntary blood donation Program % bgys with established and updated blood type registry Mapping of HF for Cervcal screening

Target : 100%
Drug Program % of PWUDS assessed using ASSIST BI Tool /total # of PWUDS NOH: completion rate
Target : 85 % Not listed in FHSIS
B. 8 . Health Facility development
Health infra % on ongoing health infra inspection assisted quartely /total # of onging infra projects
Target : 100 %
HFEP equipment Target : % HF provided equipment monitored for functionality within rating period
Target : 100%
B.9 . RESU-HEMS :
Zero Reporting of notifiable diseases /
Target : 1 report/ week/ facility
# outbreak response activities participated within the rating period
Target : actual # response
# Rapid health asessment report submitted
Target : as needed
C. GOVERNANCE
Increased support to health through participatory governance # of bgys with updated health data boards/ total # of bgys covered

Target :100%
Organized community support groups to health % of priority community support groups organized and functional
Target : 6/6 organized functional groups
School Dengue Task force
Bgy Dengue Task Force
Breastfeeding support group
HL club
Bgy Rabies Control Com
Bgy Health Board
C. Performs other related functions given by supervisor 90% Performance on other related functions assigned subject to the approval of the
DOH.
RATING
Average Rating Final Rating per Function
Function Percentage Distribution Remarks
per Function
Core Functions 70%
30%
Strategic Functions
Final Average Rating (i)
Adjectival Rating (j)
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

DMO IV DMO V
Employee Supervisor Next Higher Supervisor
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
General Rating Scale:
Num. Adj.
5 O

4 VS

3 Satisfactory

2 Unsatisfactory

1 Poor
 Description
Performance exceeded expectations by
30% and above.
Performance exceeded expectations by
15% to 29%
Performance met 90% to 114% of the
planned targets.
Performance only met 51% to 89%
Performance failed to deliver most of the
targets by 50% and below.