Annex D
DOH - SPMS Form 4 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No:
Effectivity:
I, HAZEL JOY V BULASA, of the PDOHO BUKIDNON , commit to deliver and agree to be rated on the attainment of the folllowing of the targets in accordance with the indicated measures for the
period of January to June , 2024.
Name of Employee: HAZEL JOY V. BULASA Date: January 8, 2024
Approved By: Date:
KAREN Y. GARCES,RN
July 1, 2024
Name of Supervisor
RATING5 – Outstanding
Success Indicator 4 – Very SatisfactoryRemarks/Justification of
Output Actual Accomplishment Q E T 3 – Satisfactory
A
(Target + Measure) Unmet Targets
(1) (2) (3)2 - Unsatisfactory
(4)
1 - Poor
CORE FUNCTIONS: 80 %
A. Rural Health Midwife Placement Program
Conducted 351 house to house health
1.Conducts 100% house-to-house Conduct 320 house to house health education and
education and awareness campaign for
health education and awareness awareness campaigns for reproductive health and
reproductive health and maintenance were 5 5 3 4.333
campaigns fro reproductive health maintenance were conducted on schedule date with
conducted on scheduled date with excellent
and health maintenance excellent results
results
2. Conducts 100% home visit to Conducted 351 home visits to households for
Conduct 320 home visits to households for monitoring
households for monitoring and proper monitoring and proper referral of pregnant and
and proper referral of pregnant and post partum 5 5 3 4.333
referral of pregnant and post-partum post partum mothers on scheduled date clearly
mothers on schedule date clearly presented
mothers presented
3. Reports 100% status of Reported 351 status of families/households
Reports 320 status of families/households visited
families/households visited especially visited especially the pregnant and post partum
especially the pregnant and post partum mothers on 5 5 3 4.333
the pregnant and post-partum mothers on scheduled date with excellent
schedule date with excellent results
mothers results
Gave Quality Prenatal Care to 30 Pregnant
a. Give Quality Prenatal Care to 29 Pregnant Women
Women 30 days ahead of scheduled date 5 4 3 4.000
on the schedule date with minimal complaints
without complaints .
b. Follow up and give FP services to 10 women with Followed up and gave FP services to 36 women
unmet need on the schedule date with minimal with unmet need 5 days ahead of scheduled 5 5 3 4.333
complaints. date and without complaints.
c. Track and refer high risk 5 Pregnant women for Tracked and referred high risk 7 Pregnant
hospital delivery on schedule date with minimal women for hospital delivery 30 days ahead of 5 4 3 4.000
complaints. scheduled date without complaints.
4. Facilitate 100% community
participation in implementation and
monitoring of MNCHN programs and
projects
4. Facilitate 100% community Monitored 17 0-6 Months Exclusively
d. Monitor 29 0-6 Months Exclusively BreastFeeding
participation in implementation and Accurately and with excellent result BreastFeeding Accurately and without 5 3 3 3.667
monitoring of MNCHN programs and complaints.
projects
Followed up and referred 36 Pregnant women
e. Follow up and refer 29 Pregnant women for FBD on
for FBD 30 days ahead of scheduled date and 5 5 3 4.333
schedule date and with minimal complaints
without complaints.
Gave Quality Postpartum Care to 40 Post
f. Give Quality Postpartum Care to 19 Post Partum
Partum Mothers on the scheduled date and 5 5 3 4.333
Mothers on the schedule date and excellent results
without complaints.
g. 19 Fully immunize children on schedule date and with 22 Fully immunized children on scheduled date
4 4 3 3.667
minimal complaints. and without complaints.
h. Track 3 Immunization defaulter on schedule date and Tracked 5 Immunization defaulter 7 days ahead
5 4 3 4.000 ACTUAL
with minimal complaints of scheduled date and without complaints
Maintained 9 referral systems for
5. Maintains 100% referral systems Maintains 5 referral systems for difficult/complicated
difficult/complicated pregnancies in the SDN
for difficult/complicated pregnancies pregnancies in the SDN was maintaine on schedule 5 4 3 4.000
was maintained on scheduled date without
in the SDN date excellent result.
errors.
Maintained and Covered 1 Barangay Health
6. Maintains Barangay Health Maintain and Cover 1 Barangay Health Station/s without
Station/s with all aspects of work thoroughly 5 5 3 4.333
Station/s complaints.
covered
Conducted 6 Monthly BHW and other
Conduct 6 Monthly BHW and other volunteers meeting
7. Leadership and Management volunteers meeting within 8 hours with 100% 5 5 3 4.333
within 8 hours with 100% attendance with no mistakes.
attendance without complaints.
a. Conduct 6 IEC activities on HIV/AIDS on scheduled Conducted 12 IEC activities on HIV/AIDS 5
5 4 3 4.000
date and with excellent results days ahead of scheduled date without errors.
Conducted 12 IEC/advocacy on Teenage
b. Conduct 6 IEC/advocacy on Teenage Pregnancy on
8. Conducts health education Pregnancy 5 days ahead of scheduled date 5 4 3 4.000
scheduled date with excellent results
activities without errors.
c.Conduct 6 IEC/advocacy/activities to ensure Conduct 12 IEC/advocacy/ activities to ensure
implementation of nutrition Program in the LGU on implementation of nutrition Program in the LGU 5 4 3 4.000
scheduled date and with excellent results 5 days ahead of date and with no minor errors.
9. Paticipates 100% in data gathering Participated 6 in data gathering and response
Participates 6 in data gathering and response during
and response during health during health emergencies and disasters on
health emergencies and disasters on FP/MNCHN 4 4 3 3.667
emergencies and disasters on FP/MNCHN related concerns on scheduled
related concerns on scheduled date with minimal error
FP/MNCHN related concers date without error
Referred 37 new FP acceptors for counseling
Refers 9 new FP acceptors for counseling and FP
and FP provision on scheduled date without 5 4 3 4.000
10. Refer 100% new FP acceptors for provision on schedule date with excellent results. errors.
counseling and FP provsion and
assist in the inventory of DOH
procured FP commodities
Assists in the inventory of 6 DOH procured FP Assisted inventory of 6 DOH procured FP
5 5 3 4.333
commodities on schedule date with no mistakes commodities on scheduled date without errors.
4.1000
SUPPORT FUNCTION: 20%
1. Assist 100% in the conduct of Assists in the conduct of 12 health education and Assisted in the conduct 20 of health education
health education and advocacy advocacy campaigns on MNCHN and demand and advocacy campaigns on MNCHN and
campaigns on MNCHN and demand generation activities and provision of FP services on demand generation activities and provision of 5 5 3 4.3333
generation activities and provision of scheduled date with all aspects of work thoroughly FP services on scheduled date with all aspects
FP services cover of work thoroughly covered
Participated 10 data gathering and response
2. Participates 100% in data gathering Participates 6 data gathering and response during
during health emergencies and disaster on
and response during health health emergencies and disaster on scheduled date 5 5 3 4.3333
scheduled date with all aspects of work
emergencies and disaster with all aspects of work thoroughly cover
thoroughly covered
Performed 16 other related functions as may be
3. Performs 100% other related Performs 5 other related functions as may be assigned
assigned subject to the approval of DOH on
functions as may be assigned subject subject to the approval of DOH on scheduled date with 5 5 3 4.3333
scheduled date with all aspects of work
to the approval of DOH all aspects of work thoroughly covere
thoroughly covered
AVERAGE RATING (CORE FUNCTIONS) 4.3333 3.4667
RATING
Final Rating per
Function (Average Adjectival
Function Percentage Distribution* Average Rating per Function Final Average Rating Remarks
Rating x Percentage Rating
Distribution)
Core Function 80% 4.1000 3.2800
4.1467 VS
Support Function 20% 4.3333 0.8667
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
HAZEL JOY V. BULASA
ROSTON G. GARCES, MD, PHSAE July 1, 2024 KAREN Y. GARCES,RN July 1, 2024
Employee Supervisor Supervisor
Legend: 1 - Quuality 2 - Efficiency 3 - Timeliness 4 - Average; *In the event that there is no Strategic Output, the percentage distribution is as follows: Core output-80% and Support output-20%
