SECTOR MEETING REPORTING FORMAT (To be filled up by Sector MO)

Sector___________Population______________ No. Of Sub Centers__________ No. of SCs reported Block______________________ District_____________________________

Month/Year_______________________
Current Action Taken So Cause of Failure in achieving
Expected/ Target for Further Action to
Sl. Status/ Far (Action taken targets
Indicator Data Point Source of Data previous month/ Be Taken to Remarks
No. Achievement for achieving (To be mentioned if current
Norms achieve targets
(in number) targets) status doesn't meet target)
Maternal
1 & child
Health
2 ANC Total ANC Registration RCH Reg/Portal
Total number of Early
3 RCH Reg/Portal
ANC Registration
Total number of PW with
4 RCH Reg/Portal
4 ANC Check-ups
RCH Reg/Portal
Total number of HRP
(For RED card
5 Identified and given RED
refer RED card
card
register)
Stand alone No. of HRP who
Total number of HRP for
report which can have completed 5
6 whom Birth preparedness
be verfied by months of
plan is done
supervisor pregnancy-
PW who are in
Total number of PW SC PMSMA 2nd/3rd trimester
7
scheduled for PMSMA register and not attended
PMSMA
MCP
Total number of PW
8 card/PMSMA
Attendend PMSMA
register
PMSMA card
Total number of PW attached in MCP
9 confirmed as HRP at card/ Message
PMSMA from PMSMA
clinic
Total number of HRP
Referred to higher facility SC PMSMA
10
from PMSMA register
(Out of row 9)
Total number of HRP
SC HRP tracking
11 Follow up after PMSMA
register
(Out of row 9)
PW who are in
Total number of PW 2nd/3rd trimester
MCP card / RCH
12 received atleast 1 USG and not have
register
after 1st trimester undergone
ultrasound
Out of reg. PW total
All PW who have
number of PW received
13 RCH Portal completed 1st
IFA tablets in 2nd and 3rd
trimester
trimester during the month
 Current Action Taken So Cause of Failure in achieving
Expected/ Target for Further Action to
Sl. Status/ Far (Action taken targets
Indicator Data Point Source of Data previous month/ Be Taken to Remarks
No. Achievement for achieving (To be mentioned if current
Norms achieve targets
(in number) targets) status doesn't meet target)
Data to be
Total number of Number
shared by CHO
14 of PW with SCD out of
from Sickel cell
screened
portal
Dtat to be
Total number of PW with
shared by CHO
15 SCD under treatment &
from Sickel cell
counselling
disease portal
Total number of PW
16 diagnosed with HepB out RCH Portal
of screened
Total number of PW
17 RCH Portal
having EDD in next month
Total number of PW with
18 AMLAN
moderate anemia
Total number of PW under
100% PW with
19 treatment for moderate AMLAN
moderate anemia
anemia
Total number of PW with
20 AMLAN
severe anemia
Total number of PW under
100% PW with
21 treatment for severe AMLAN
severe anemia
anemia
Total number of pregnant (Norm-All PW
woman given Antenatal presented with
22 RCH Portal
corticosterioids for preterm labour
preterm labour (24wks to 34 wks)
Stand alone
Total number of area report which can
23 Delivery
Institutional Delivery be verfied by
supervisor
Total number of Home
24 RCH Portal
Delivery
Total number of Live
25 Oucome RCH Portal
births
Total number of Preterm
26 RCH Portal
deliveries
Total number of LBW
27 Babies (Birth weight less RCH Portal
than 2500gm)
Total number of Still
28 births reported in area RCH Portal
delivery
Total number of fresh still
29 RCH Portal
births (Out of above)
Total number of
30 macerated) still births RCH Portal
(Out of above)
 Current Action Taken So Cause of Failure in achieving
Expected/ Target for Further Action to
Sl. Status/ Far (Action taken targets
Indicator Data Point Source of Data previous month/ Be Taken to Remarks
No. Achievement for achieving (To be mentioned if current
Norms achieve targets
(in number) targets) status doesn't meet target)
Total number of Babies
31 with birth defects out of RCH Portal
area delivery
Total number of babies
(Norm-All identified
32 with birth defect referred RCH Portal
cases)
through RBSK MHT
No. of live births received
PNC & (Norm-90% of all live
complete HBNC visits as
33 Child RCH Portal births (100% of high
per guidelines out of area
health risk newborns)
live births
No. of young children (3m-
(Norm-90% of all
15 m) received complete
young children
34 HBYC visits as per RCH Portal
(100% of high risk
guidelines out of total
young children))
HBNC visit
LBW, Preterm,
Home delivery,
birth defects
No. of high risk
NBSU/SNCU/ -
35 newborns/ children
From RCH
identified
Portal NRC
discharge cases-
From area report

Total number of high risk Stand alone (Norm-All high risk

newborns/ children report which can to be followed up by
36
followed up (During be verfied by ASHA through
HBNC, HBYC visit) supervisor HBNC/ HBYC visits)

Total number of mother

Report from
37 who received Nutritional All PW
WCD
supplement (by WCD)
No. of children (0-6
All 0-6 months
38 months) who are RCH Portal
children
exclusively breastfed
Stand alone
report of HW (F)
No. of SAM cases
39 which can be
identified
verfied by
supervisor
Stand alone
report of HW (F)
No. of MAM cases with
40 which can be
complication identified
verfied by
supervisor
No. of SAM & MAM cases
(Norm-100% SAM &
(with medical NRC referral
41 MAM cases with
complications) referred to data with ANM
complicatation)
NRC
 Current Action Taken So Cause of Failure in achieving
Expected/ Target for Further Action to
Sl. Status/ Far (Action taken targets
Indicator Data Point Source of Data previous month/ Be Taken to Remarks
No. Achievement for achieving (To be mentioned if current
Norms achieve targets
(in number) targets) status doesn't meet target)
(Norm-4 facility
Stand alone
No. of NRC discharge follow ups of each
report which can
42 cases followed up as per discharge case
be verfied by
guidelines within 2 months of
supervisor
discharge)
Total number of children
44 UWIN
with Full Immunization
Total number of
45 UWIN
Immunization drop out
Total no. of 6m-59 m
46 AMLAN children beneficiaries AMLAN Report
tested for Hb
Total no. of 5yr-9 yr
AMLAN Report
beneficiaries tested for Hb
Total no. of 10yr-19yr
AMLAN Report
beneficiaries tested for Hb
Total no. of WRA (20-24yr)
AMLAN Report
beneficiaries tested for Hb
Total no. of LM
AMLAN Report
beneficiaries tested for Hb
Total no. of 6m-59 m
47 children identified as AMLAN Report
anameic
Total no. of 5yr to 9yr
children identified as AMLAN Report
anameic
Total no. of 10 yr to 19 yr
children identified as AMLAN Report
anameic
Total no. of WRA (20-24yr)
AMLAN Report
identified as anameic
Total no. ofLactating
women identified as AMLAN Report
anameic
Total no. of identified 6m-
59 m children anaemic
AMLAN Report
cases provided with
therapeutic doses
Total no. of identified 5yr-
9 yr, anaemic cases
AMLAN Report
provided with therapeutic
doses
Total no. of identified 10-
19yr anaemic cases
AMLAN Report
provided with therapeutic
doses
Total no. of identified
WRA (20-24yr) anaemic
AMLAN Report
cases provided with
therapeutic doses
 Current Action Taken So Cause of Failure in achieving
Expected/ Target for Further Action to
Sl. Status/ Far (Action taken targets
Indicator Data Point Source of Data previous month/ Be Taken to Remarks
No. Achievement for achieving (To be mentioned if current
Norms achieve targets
(in number) targets) status doesn't meet target)
Total no. of identified
Lactating Mother anaemic
AMLAN Report
cases provided with
therapeutic doses
No. of all women (15 yr-45 All women death
49 Deaths
yr) deaths reported register
No. of Maternal deaths
50 reported as per guidelines Form-1 of MDR
(in Form 1)
No. of Neontal deaths (0-
51 28 days)reported as per CDR
guidelines (Form 1 & 2)
No. of Infant deaths (29
days to 1yr) reported as
52 CDR
per guidelines (Form 1 &
2)
No. of U5 deaths (1yr- 5yr)
53 reported as per guidelines CDR
(Form 1 & 2)
Total number of SC-AAMs
1 CHO in each SC-
54 Others having CHO postion Sector MO report
AAM
vacant
Total number of SC-AAMs
55 having MPHW (F) position Sector MO report
vacant
Number of VHSND/ VHSND/UHSND (Norm- At least 8 per
56
UHSND sessions planned Micro plan SC per month)
Number of VHSND/ VHSND/UHSND (Norm- At least 8 per
57
UHSND sessions held Report SC per month)
No. of VHSNDs/ UHSNDs (Norm-All essential
sites not having all Supervsior equipment as per
58 functional equipment/ monitoring VHSND/UHSND
kits/logistics as per report report ar to be in
guidelines funtional condition)
No. of PHCs/ UPHCs not
(Norm- All available
having all functional
59 Sector MO report equipment to be in
equipment/ kits/logistics
funtional condition)
as per guidelines
No. of functional
equipment (at Supervsior
60 VHSND/UHSND monitoring
sites/PHCs) needing report
calibration
Total number of GKS
61 HW(F)report
meeting attended
(Norm- 1 JAS
Total number of JAS
SC JAS Report meeting per SC per
meeting condected
month)
 Current Action Taken So Cause of Failure in achieving
Expected/ Target for Further Action to
Sl. Status/ Far (Action taken targets
Indicator Data Point Source of Data previous month/ Be Taken to Remarks
No. Achievement for achieving (To be mentioned if current
Norms achieve targets
(in number) targets) status doesn't meet target)
Issues faced by MPHW
63 (F)/ASHA/AWW during
service provision

64 Any other specific issue