key HMIS indicators tracking format

Name of facility ___________________________________________ Date_______________________

S.No Selected indicator (KPI) Current Previous Cumulative Target Previous year the Investigatio Remark
Month month to date same reporting n need
Performance performance Performance period (Yes, No)
performance
1. Total new and repeat family
planning acceptor
2. ANC1

3. ANC4

4. ANC8

5. Total Number of pregnant

women tested for syphilis
6. Deliveries attended by Skilled
Birth attendant
7. Early Postnatal Care Coverage

8. Emergency unit Mortality rate

9. Outpatient attendance (new

and repeat)
10. Pentavalent 1 vaccine
11. Pentavalent 3 vaccine
12. Measles 1
13. Full immunization
14. Vitamin A
15. TB case detection
16. Still birth rate
17. Maternal death rate
18. Neonatal death rate
19. Malaria cases per 1000
population
20. Currently on ART
21. Essential drug availability
22. Iron and folic acid
supplementation
23. Children attended GM and
promotion session
24. PMTCT
25. Number of Birth Notification
given
26. Death Notification
27. Newly enrolled to care
28. Cervical Cancer Screening
29. Number of under 5 children
treated for pneumonia
30. Total number of teenage girls
positive for pregnancy
Feedback report format for lower supervisory units (on Data quality)
Name of facility ______________________Name of department_____________________

Date feedback was given_______________________

Health worker who received feedback (name and position)__________________________________________

Main strengths (completeness, timeliness, consistency, accuracy)

Weakness and challenges (completeness, timeliness, consistency, accuracy)

Way forward

Name and signature of a person providing feed back_________________________________________________

Feedback report format for lower supervisory units (on routine performance)
Name of facility ______________________Name of department _________________________________

Date feedback was given_______________________

Health worker who received feedback (name and position)__________________________________________

Main strengths

Weakness and challenges

Way forward

Name and signature of a person providing feed back_________________________________________________

 Department level performance review checklist
Name of facility ______________________ Name of Department_________________ Date_______________

S No Indicators Current month plan Achievement Remark (Achieved/Not

achieved)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
NB: - In case achievement is less than 60% it needs justifications and investigation

Justifications for gaps in performance_________________________________________________________________________

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
 Availability of performance monitoring chart
Name of facility _________________________________________Month__________________

SNO Departments Availability of Remark (Updated/not

performance monitoring updated)

chart (Yes/No)

1. EPI

2. Adult OPD

3. Under 5 OPD

4. Emergency OPD

5. Family planning

6. ANC/delivery/PNC

7. ART

8. TB
 Participatory performance review meeting at Health facility level
Name of facility __________________________________________

Date: _______________, Time meeting started ________________ Time meeting ended__________________

Agendas:___________________________________________________________

____________________________________________________________

_____________________________________________________________

______________________________________________________________

Discussion (minutes of main ideas):

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
_______________________________________________________________________________________________________

Main gaps identified

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________________________________________________________________
Proposed solution and way forward

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________

Participants

Name department Signature

1.

2.

3.

4.

5.

6.

7.

8.
 Participatory performance review meeting at community level
Name of facility _____________________________________________

Date: _______________, Time meeting started ________________ Time meeting ended__________________

Agendas:___________________________________________________________

____________________________________________________________

_____________________________________________________________

______________________________________________________________

Discussion (minutes of main ideas):

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
_______________________________________________________________________________________________________

Main gaps identified

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________________________________________________________________
Proposed solution and way forward

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________

Participants

Name Role Signature

1.

2.

3.

4.

5.

6.

7.

8.