Annexure-II Monthly Reporting Format on Delivery Points on key Performance Indicators(KPI) Name of the For the month of- Monthly Avg of (Q1 + Q2) of 2012-13 i.e. April 2012 to Sep, 2012 to be taken for calculation purposes) MOs Name and of Type of the Essen. Facility Number Drugs Mention (MC,DH, Total Total No. of (Y/N) No of DWH, SDH, deliveries in No. of of PW Maternal Fn Anesth. Fn Name of Sl.No CHC-FRU, the reporting detected Deaths in LR Fn OBG, NO. of SNs/ BSU/ BMW the (Delivery CHC- month in the (where with Hb the with OT Pedia. ANMs posted BB (Y/N) District Point) 24x7 level 7 facility in LSAS / at the facility (Y/N) PHC, Other gm and the (Y/N) EmOC/ PHC, SC, below reporting BeMOC Any other month Trained Type of MO and Facility other MO District N 1 7 0 N N N Y MO=8 SN=13 12 0 Hospital CHC N SN=6 2 2 0 0 0 N N N N MO=04 Kamjong ANM=3 Ukhrul PHC N SN=3 3 0 0 0 0 N N N N MO=02 District Somdal ANM=1 CHSRC N Gyne=1 4 30 59 3 0 Y Y N Y SN=8 (private) MO=1 LCH N Gyne=1 14 26 4 0 N Y N Y SN=6 (private) MO=1 Note : Please add more rows as per the no of delivery points and districts Annexure-III
Annexure-II Monthly Reporting Format on Delivery Points on key Performance Indicators(KPI) Name of the For the month of- Monthly Avg of (Q1 + Q2) of 2012-13 i.e. April 2012 to Sep, 2012 to be taken for calculation purposes) Name of the District Sl.No (Delivery Point) Name and Type of the Facility (MC,DH, DWH, SDH, CHC-FRU, CHC- 24x7 PHC, Other PHC, SC, Any other Type of Facility Total deliveries in the reporting month in the No. of (where Total No. of PW detected with Hb level 7 gm and below Number of Maternal Deaths in the facility in the reporting month Fn LR with Fn OT (Y/N) Fn BSU/ BB (Y/N) of Essen. Drugs (Y/N) BMW (Y/N) MOs Mention No of Anesth. OBG, Pedia. LSAS / EmOC/ BeMOC Trained MO and other MO NO. of SNs/ ANMs posted at the facility Ukhrul District 1 District Hospital 12 0 7 0 N N N N Y MO=8 SN=13 2 CHC Kamjong 2 0 0 0 N N N N N MO=04 SN=6 ANM=3 3 PHC Somdal 0 0 0 0 N N N N N MO=02 SN=3 ANM=1 4 CHSRC (private) 30 59 3 0 Y Y N N Y Gyne=1 MO=1 SN=8 LCH (private) 14 26 4 0 N Y N N Y Gyne=1 MO=1 SN=6 Note : Please add more rows as per the no of delivery points and districts Annexure-III
Anexures-MH.docx