Annex D
DOH - SPMS Form 4 Document Code:
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No:
Effectivity:
I, DYESEBELL E. ZOLINA, 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 JULY TO DECEMBER, 2024.
Name of Employee: DYESEBELL V. ESPINOSA-ZOLINA,RM Date: JULY 1,2024
Approved By: Date:
KAREN Q. YEE-GARCES,RN,MN
DECEMBER 13,2024
DMO IV
5 – Outstanding
RATING
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 175 house to house health
1.Conducts 100% house-to-house Conduct 134 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 for reproductive health maintenance were conducted on scheduled date with
conducted on scheduled date with excellent
and health maintenance excellent results
results
2. Conducts 100% home visit to Conducted 21 home visits to households for
Conduct 14 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 scheduled date clearly presented
mothers presented
3. Reports 100% status of Reports 60 status of families/households visited
Reports 14 status of families/households visited
families/households visited especially 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
scheduled date with excellent results
mothers results.
a. Give Quality Prenatal Care to 14 Pregnant Women Gave Quality Prenatal Care to 21 Pregnant
5 5 3 4.333
on the scheduled date with minimal complaints Women on scheduled date with no complaints .
b. Follow up and give FP services to 14 women with Followed up and gave FP services to 24 women
unmet need on the scheduled date with minimal with unmet need on scheduled date and with 5 5 3 4.333
complaints. no complaints.
c. Track and refer high risk 14 Pregnant women for Tracked and referred high risk 21 Pregnant
hospital delivery on scheduled date with minimal women for hospital delivery On scheduled 5 5 3 4.333
complaints. date with no complaints.
4. Facilitate 100% community
Monitored 21 0-6 Months Exclusively
participation in implementation and d. Monitor 14 0-6 Months Exclusively BreastFeeding
BreastFeeding Accurately and with no 5 5 3 4.333
monitoring of MNCHN programs and Accurately and with excellent result
complaints.
projects
monitoring of MNCHN programs and
projects
Followed up and referred 21 Pregnant women
e. Follow up and refer 14 Pregnant women for FBD on
for FBD on scheduled date and with no 5 5 3 4.333
scheduled date and with minimal complaints
complaints.
Gave Quality Postpartum Care to 21 Post
f. Give Quality Postpartum Care to 14 Post Partum
Partum Mothers on the scheduled date and with 5 5 3 4.333
Mothers on the scheduled date and excellent results
no complaints.
g. 21 Fully immunize children on scheduled date and 28 Fully immunized children on scheduled date
5 5 3 4.333
with minimal complaints. and with no complaints.
h. Track 30 Immunization defaulter on scheduled date Tracked 45 Immunization defaulter on
5 5 3 4.333
and with minimal complaints scheduled date and with no complaints
5. Maintains 100% referral systems Maintains 6 referral systems for difficult/complicated Maintained 8 referral systems for
for difficult/complicated pregnancies pregnancies in the SDN was maintained on scheduled difficult/complicated pregnancies in the SDN 5 5 3 4.333
in the SDN date excellent result. was maintained on scheduled date no errors.
Maintained and Covered 6 Barangay Health
6. Maintains Barangay Health Maintain and Cover 6 Barangay Health Station/s without
Station/s with all aspects of work thoroughly 5 5 3 4.333 fixed
Station/s complaints.
covered
Conducted 10 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 with no complaints.
a. Conduct 6 IEC activities on HIV/AIDS on scheduled Conducted 12 IEC activities on HIV/AIDS on
4 5 3 4.000
date and with excellent results scheduled date and with very good results
Conducted 12 IEC/advocacy on Teenage
b. Conduct 6 IEC/advocacy on Teenage Pregnancy on
8. Conducts health education Pregnancy on scheduled date with no 5 5 3 4.333
scheduled date with excellent results
activities complaints
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 5 3 4.333
scheduled date and with excellent results on scheduled date and with no errors.
9. Participates 100% in data gathering Participated 12 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 5 5 3 4.333
emergencies and disasters on FP/MNCHN related concerns on scheduled
related concerns on scheduled date with minimal error
FP/MNCHN related concers date with no error
Referred 17 new FP acceptors for counseling
Refers 10 new FP acceptors for counseling and FP
and FP provision on scheduled date with 5 5 3 4.333
provision on scheduled date with excellent results.
10. Refer 100% new FP acceptors for excellent result
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 12 DOH procured FP
5 5 3 4.333
commodities on scheduled date with no mistakes commodities on scheduled date with no errors.
13. HRH-NHWSS MR/TD/HPV Conducts 399 MR/TD/HPV SCHOOL BASED Conducted 399 MR/TD/HPV SCHOOL BASED
SCHOOL BASED IMMUNIZATION IMMUNIZATION ACTIVITY on scheduled date with all IMMUNIZATION ACTIVITY on scheduled date
ACTIVITY apects of work thoroughly covered with all apects of work thoroughly covered 5 5 3 4.3333 ACTUAL
4.3167
SUPPORT FUNCTION: 20%
1. Assist 100% in the conduct of Assists in the conduct of 6 health education and Assisted in the conduct 14 of health education
health education and advocacy advocacy campaigns on MNCHN and demand and advocacy campaigns on MNCHN and
campaigns on MNCHN and demad 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 covered of work thoroughly covered
Participated 6 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 3 3 3.6667
scheduled date with all aspects of work
emergencies and disaster with all aspects of work thoroughly covered
thoroughly covered
Performed 6 other related functions as may be
3. Performs 100% other related Performs 6 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 3 3 3.6667
scheduled date with all aspects of work
to the approval of DOH all aspects of work thoroughly covered
thoroughly covered
AVERAGE RATING (CORE FUNCTIONS) 3.8889 3.1111
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% 4.3167 3.4533
4.2311 VS
Support Function 20% 3.8889 0.7778
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
DYESEBELL E.ZOLINA,RM ROSTON G. GARCES, MD, PHSAE KAREN Q. YEE-GARCES,RN,MAN
Employee MHO DMO IV
Legend: 1 - Quality 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%
