HEALTH INDICATOR
11
Nat'l Target
NATALITY
Proportion of births attended
by skilled health personnel
90%
90%
MATERNAL CARE
Proportion of Pregnant
Women with 4 or more
prenatal visits
90%
Proportion of Pregnant
Women given TT2 plus
80%
80%
12.3% (50% of
age group)
80%
CHILD CARE
Proportion of infants given:
BCG
HepB1
Penta Vaccines, OPV antigens,
MCV1,MMR, MCV2, Rota Virus
vaccines
OPV antigens
MCV1
MMR
MCV2
Rota Virus vaccines
Proportion of Fully Immunized
Children
Proportion of Infants
exclusively breastfed until 6th
month
95%
95%
95%
95%
95%
95%
95%
95%
95%
70%
90%
100%
Yes
Evaluated by:
_______________________________
Signature Over Printed Name
Position: _______________________
Date:__________________________
*Overall Rating: ________________
*Please provide overall rating for the HRH from 1-10 with 10 being the highest a
One can rate up to one decimal places as necessary.
Current Year
34(100%)
6(100%)
34(100%)
6(100%)
45(122%)
11(122%)
40(121%)
13(163%)
27(82%)
4(50%)
52(113%)
22(183%)
35(106%)
6(75%)
34(92%)
34(92%)
6(60%)
6(60%)
21(54%)
30(300%)
37(95%)
42(108%)
36(92%)
36(92%)
6(15%)
8(80%)
8(80%)
7(70%)
7(70%)
6(60%)
42(108%)
8(80%)
32(110%)
11(157%)
42(124%)
8(89%)
34(100%)
No
6(100%)
Philippines
of Health
OFFICE I
EVALUATION
REMARKS
NS TAKEN / STRATEGIES
Noted by:
REMARKS
Recommendation: ________________________________________
REMARKS
REMARKS
________
Department of Health
REGIONAL OFFICE I
PERFORMANCE EVALUATION
PROJECT: NURSE DEPLOYMENT PROJECT
PERIOD OF EVALUATION:
NAME:
Area of Deployment:
Name of Barangay
Total Population:
No. Of p
Number Deliveries:
HEALTH INDICATOR
Natality
Proportion of births
attended by skilled health
personnel
Facility Based deliveries
MATERNAL CARE
Proportion of Pregnant
Women with 4 or more
prenatal visits
Proportion of Pregnant
Women given TT2 plus
Pregnant women given
complete iron w/ folic acid
Proportion of 10-49 yrs old
women given iron
Proportion of Post partum
women given Vit. A
CHILD CARE
Proportion of infants given:
BCG
HepB1
Penta Vaccines, OPV
antigens, MCV1,MMR,
MCV2, Rota Virus vaccines
OPV antigens
MCV1
MMR
MCV2
Rota Virus vaccines
No. Of w
Target
90%
90%
90%
80%
80%
12.3% (50% of
age group)
80%
95%
95%
95%
95%
95%
95%
95%
95%
Accomplishm
ent
No. Of p
ACTIONS
Proportion of Fully
Immunized
Children
Proportion of
Infants(FIC)
exclusively
breastfed
Infant/Children
given until
6th
month
Vitamin A
Supplementation by Age
Group
Proportion of infant referred
for Newborn Screening
Mortality ( Had there been any case
of the following in your area? :)
95%
70%
90%
100%
Yes
No
Maternal
Neonatal
Infant
Under-five
Perinatal
Evaluated by:
_______________________________
Signature Over Printed Name
Position: _______________________
Date:__________________________
Recommendation: ________________
Noted by:
____________________
Development Manageme
TION
STRATEGIES
________________________
ment Management Officer IV