1 of 53

आ‍.व‍.२०७९/८० मा सम्पादित स्वास्थ्य कार्यक्रमहरुको �पालिका स्तरीय बार्षिक समीक्षा

मिति :

स्थान :

मालिका गाउँपालिका

गाउँकार्यपालिकाको कार्यालय

............प्राथमिक स्वास्थ्य केन्द्र/ स्वास्थ्य चौकी/ सामुदायीक स्वास्थ्य ईकाई

Annual Health Review

................Rural/Municipality

2 of 53

Target population

Details	Number
Total Population
Exp. Live Births
00 - 11 Months
02 - 11 Months
12 - 23 Months
00 - 23 Months
06 - 23 Months
00 - 35 Months
00 - 59 Months
06 - 59 Months
12 - 59 Months
00 - 14 Years
Total: 10-19 Years
Male: 10-19 Years
Female: 10-19 Years
Female: 15-44 Years
WRA 15-49 Years
MWRA 15-49 Years
Expected Pregnancy
60 & + Years

Source : HMIS 2079/80

Map of catchment area showing HF, EPI, ORC clinics, FCHV

Hand-draw picture also worked

Service out late

No. of EPI clinic :

No. of PHC-ORC Clinic :

No. of FCHV :

……………. :

Annual Health Review

................Rural/Municipality

3 of 53

Name of HF

Replace the picture by own HF picture

MMS Score

The picture with the HF team is recommended.

Annual Health Review

................Rural/Municipality

4 of 53

Our new innovations

Family Health profile :

Yes/NO

Digitalization (EHIRRS):

Yes/NO

admin.name	HMIS	FHP
Population	16570	14726
ExpLiveBirths	251
Pop00to11Months	277	129
Pop02to11Months	232	122
Pop00to23Months	559	295
Pop00to35Months	844	477
Pop00to59Months	1420	840
Pop06to23Months	419	224
Pop12to23Months	281	166
Pop12to59Months	1146	711
Pop06to59Months	1283	769
Pop00to14Years	4313	2899
FemalePop10to19Years	1232	1064
MalePop10to19Years	1260	1126
Pop10to19Years	2492	2190
FemalePop15to44Years	3748	2942
WRA15to49Years	4194	3325
MWRA15to49Years	3330
Expected Pregnancy	321	56
Pop60plusYears	2788	2505

Target Population

Annual Health Review

................Rural/Municipality

5 of 53

मानव संशाधन

पद	स्वीकृत दरवन्दी संख्या	पदपूर्ति	कार्यरत			अध्यायन बिदामा रहेको
पद	स्वीकृत दरवन्दी संख्या	पदपूर्ति	स्थायी	करार- दरवन्दी	करार-अन्य	अध्यायन बिदामा रहेको
मेडिकल अधिकृत
हे.अ./सि.अ.हे.ब.
स्टाफ नर्स
अ.न.मी.
अ.हे.ब.
ल्या.अ./ल्या.टे.
का.स.
अन्य
जम्मा

Annual Health Review

................Rural/Municipality

6 of 53

‍औजार/उपकरण सम्बन्धी विवरण

औजार/उपकरणको नाम	संख्या	हालको अवस्था (संख्यामा)		विग्रेको मध्ये मर्मत गरी काम लाग्न सक्ने
औजार/उपकरणको नाम	संख्या	संचालनमा	विग्रेको	विग्रेको मध्ये मर्मत गरी काम लाग्न सक्ने

Annual Health Review

................Rural/Municipality

7 of 53

न्यूनतम सेवा प्रदान गर्न अति आवश्यक औजार-उपकरणहरू

औजार-उपकरणको नाम	संख्या	कैफियत

Annual Health Review

................Rural/Municipality

8 of 53

स्वास्थ्य संस्थाको भौतिक संरचना तथा अन्य पूर्वाधार सम्बन्धी विवरण

सि.नं.	बिबरण	अवस्था
१	स्वास्थ्य संस्थाको स्वामित्वमा (जग्गाधनी पूर्जा) रहेको जग्गा	छ	छैन
	जग्गा भए क्षेत्रफल (रोपनि )	...............रोपनि
२	स्वास्थ्य संस्थाको आफ्नै भवन	छ	छैन
३	भवनको किसिम स्वास्थ्य मन्त्रालयको मापदण्ड अनुसार	भएको	नभएको
४	भवनको कोठाहरू पर्याप्त	भएको	नभएको
५	सेवाग्राही र सेवा प्रदायकहरूको लागि छुट्टा छुट्टै शौचालय सुविधा	भएको	नभएको
६	खानेपानीको नियमित उपलब्धता	भएको	नभएको
७	टेलिफोनको उपलब्धता (Landline, Mobile)	भएको	नभएको
८	बिद्युतको उपलब्धता	भएको	नभएको
९	सोलार ब्याकप	भएको	नभएको
१०	इन्टरनेट सुबिधा	भएको	नभएको
११	एम्वुलेन्स सेवाको उपलब्धता	भएको	नभएको
१२	मोटर जाने सडक देखि स्वास्थ्य संस्था सम्मको दूरी (कि.मी.)

Annual Health Review

................Rural/Municipality

9 of 53

Service out-late

गाउँघर क्लिनिकको बिबरण

खोप क्लिनिकको बिबरण

सि.नं.	गाउँघर क्लिनिकको नाम	स्वास्थ्य संस्थाबाट पैदल दूरी (घण्टामा)

सि.नं.	खोप क्लिनिकको नाम	स्वास्थ्य संस्थाबाट पैदल दूरी (घण्टामा)

Annual Health Review

................Rural/Municipality

10 of 53

आ.व. २०७९/८० को आय व्यय विवरण

विवरण	रकम

विवरण	रकम

आ.व.को अन्त्यमा मौज्दात रकम रु.

आय तर्फ

व्यय तर्फ

Annual Health Review

................Rural/Municipality

11 of 53

स्वास्थ्य संस्थामा आ.ब. २०७९/८० मा मौज्दात शून्य भएका औषधि एवं अन्य सामग्रीको (सूचिकृत मध्ये) विवरण (कुनै पनि समयमा)

नाम (स्पेसिफिकेसन खुल्ने गरी	मौज्दात सुन्य रहेको अबधि

नाम (स्पेसिफिकेसन खुल्ने गरी	मौज्दात सुन्य रहेको अबधि

Annual Health Review

................Rural/Municipality

12 of 53

HMIS Reporting Status

FY 2079/80

Annual Health Review

................Rural/Municipality

13 of 53

Report of HF and Service availability information �entered in DHIS-2

Annual Health Review

................Rural/Municipality

14 of 53

Average no. of People Served

Persons

Annual Health Review

................Rural/Municipality

15 of 53

Immunization Achievement %

Annual Health Review

................Rural/Municipality

16 of 53

Fully immunization ward declaration

Date :
No. of fully immunized children:
Photo:

Annual Health Review

................Rural/Municipality

17 of 53

Drop out rate in percentage

Annual Health Review

................Rural/Municipality

18 of 53

Immunization Categorization

Categories		Locate our HF
Cat - 1	Coverage >= 90% Drop out < 10% ( High coverage & low dropout)
Cat - 2	Coverage >= 90% Drop out > 10% ( High coverage & high dropout)
Cat - 3	Coverage < 90% Drop out < 10% (low coverage & low dropout)
Cat - 4	Coverage < 90% Drop out >= 10% ( low coverage & High dropout)

२४ – ५९ महिना मा खोप शुरु गरेका बच्चा संख्या :

........ जना

* Drop out Penta 1st Vs MR2

Annual Health Review

................Rural/Municipality

19 of 53

Vaccine wastage rate in %

Annual Health Review

................Rural/Municipality

20 of 53

% of children registered for growth monitoring

A photo during growth monitoring is recommended

Annual Health Review

................Rural/Municipality

21 of 53

Average number of growth monitoring visits�(0-23 months)

times

Please follow the new protocol.

Annual Health Review

................Rural/Municipality

22 of 53

% of children exclusive breast feeding and complimentary feeding

Annual Health Review

................Rural/Municipality

23 of 53

% of Pregnant women receiving�Iron tablets for time & albendazole tablets

Annual Health Review

................Rural/Municipality

24 of 53

% of Pregnant women receiving� 180 Iron tablets & 180 calcium tablets

Annual Health Review

................Rural/Municipality

25 of 53

% of Vitamin A & Iron distribution to Post partum mother

Annual Health Review

................Rural/Municipality

26 of 53

Vitamin "A" & Albendazole Campaign

2078/79

Vita "A"
Albendazole

Kartik

20 (2.8%)
26 (3.6%)

Baishak

20(2.80%)
26(3.69%)

2079/80

Vita "A"
Albendazole

Kartik

20 (2.5%)
26(3.1%)

Baishak

26 (106.8%)
36(8.5%)

Annual Health Review

................Rural/Municipality

27 of 53

IMNCI- Classification

0-2 Months

2-59 Months

Annual Health Review

................Rural/Municipality

28 of 53

CB-IMNCI-Incidence of ARI/1000

/1000

Annual Health Review

................Rural/Municipality

29 of 53

Incidence of pneumonia among children under five years (per 1000)

/1000

Annual Health Review

................Rural/Municipality

30 of 53

% of pneumonia cases treated with antibiotics

Annual Health Review

................Rural/Municipality

31 of 53

Incidence of CDD (Per 1000 children of <5yrs)

/1000

Annual Health Review

................Rural/Municipality

32 of 53

% of diarrheal cases treated with Zinc and ORS among children under five years with diarrhea

Annual Health Review

................Rural/Municipality

33 of 53

Safe Motherhood Program Achievement in %

Annual Health Review

................Rural/Municipality

34 of 53

ANC 1^st (any time), 4 ANC & 8 ANC as per protocol in %

Annual Health Review

................Rural/Municipality

35 of 53

% of Institutional deliveries and related

Annual Health Review

................Rural/Municipality

36 of 53

% of postpartum women who received PNC check up

Annual Health Review

................Rural/Municipality

37 of 53

No of women receiving abortion services

Annual Health Review

................Rural/Municipality

38 of 53

New acceptor of FP Methods as % of WRA

Annual Health Review

................Rural/Municipality

39 of 53

Family planning current user in number

Annual Health Review

................Rural/Municipality

40 of 53

% of Mother group meeting held

Annual Health Review

................Rural/Municipality

41 of 53

TB Case Notification Rate�(PBC New , PBC new & relapse form)

/100000

Annual Health Review

................Rural/Municipality

42 of 53

Tuberculosis outcome

Annual Health Review

................Rural/Municipality

43 of 53

Leprosy Registered cases (in Number)

Number

Annual Health Review

................Rural/Municipality

44 of 53

Malaria-Blood Slide Collection

number

Annual Health Review

................Rural/Municipality

45 of 53

HIV AIDS Control Programme

Number of people receiving ART: …. persons (….M+ ….F)

number

Annual Health Review

................Rural/Municipality

46 of 53

PMTCT SERVICES (In number)

number

Annual Health Review

................Rural/Municipality

47 of 53

% new OPD visit among total Population

Annual Health Review

................Rural/Municipality

48 of 53

49 of 53

Outbreak Response

Annual Health Review

................Rural/Municipality

50 of 53

वडाबाट भएका नविनतम् प्रयास

Annual Health Review

................Rural/Municipality

51 of 53

चुनौतीहरु

Annual Health Review

................Rural/Municipality

52 of 53

कार्यक्रमको कार्ययोजना

l;=g+=	;d:of -s]_	sf/0fx? -lsg_	;dfwfgsf pkfofx? -s] ug]{_			slxn]	lhDd]jf/L	s}lkmot
l;=g+=	;d:of -s]_	sf/0fx? -lsg_	:yfgLo :t/	lhNNff :t/	k\|b]z :t/	slxn]	lhDd]jf/L	s}lkmot
1

Annual Health Review

................Rural/Municipality

Rank	Causes of Morbidity	% among total OPD Visits	Total Number	Previous Year Rank
1
2
3
4
5
6
7
8
9
10

1 of 53

2 of 53

3 of 53

4 of 53

5 of 53

6 of 53

7 of 53

8 of 53

9 of 53

10 of 53

11 of 53

12 of 53

13 of 53

14 of 53

15 of 53

16 of 53

17 of 53

18 of 53

19 of 53

20 of 53

21 of 53

22 of 53

23 of 53

24 of 53

25 of 53

26 of 53

27 of 53

28 of 53

29 of 53

30 of 53

31 of 53

32 of 53

33 of 53

34 of 53

35 of 53

36 of 53

37 of 53

38 of 53

39 of 53

40 of 53

41 of 53

42 of 53

43 of 53

44 of 53

45 of 53

46 of 53

47 of 53

48 of 53

49 of 53

50 of 53

51 of 53

52 of 53

53 of 53