DOH - SPMS Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, ___________________________, of the Provincial DOH Office of ____________________________, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period February - June, 2017

Name of Staff: Date: ________________

Approved By: Date

MTDP
Name of Supervisor / DMO IV
5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
RATING SCALE 2 - Unsatisfactory
1 - Poor
RATING
Success Indicator
Output / Program, Activity & Project
(Target + Measure)
Actual Accomplishment E Q T A Remarks
(1) (2) (3) (4)

I. Support Functions

Percentage of FDS conducted/participated/attended.

Conducted/participated monthly 4P's Family Development
Sessions headed by DSWD.
100 % FDS attended from February-June, 2017

Discussed with: Assessed by: my assessment of the perfomance

I certify that I discussed Final Rating by: Date
with the employee I certify that I discuss my assessment of the performance with the employee.

Municipal Health Officer Development Mgt. Officer IV DMO V / OIC

Legend: 1- Quantity 2 -Quality 3 - Timeliness 4 - Average
DOH - SPMS Form 3
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, ________________, of the Provincial DOH Office of Agusan del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period February - June, 2016

Name of Staff:

Approved By: Date

Name of Supervisor

5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
RATING SCALE 1 - Poor

RATING
Success Indicator
Output / Program, Activity & Project
(Target + Measure)
Actual Accomplishment E Q T A Remarks
(1) (2) (3) (4)

100% implementation of TSEKAP Services to NHTS Families

Conducted TSEKAP services to NHTS Families.
Conducted TSEKAP Services to assigned barangays begining of February-end of
June 2017.

II. MATERNAL SERVICES

To ensure implementation of quality and 100% of pregnant women subjected for prenatal care attended within 30 minutes with no
Perform Prenatal Care to pregnant woman complaints
comprehensive Agency plans for RO XIII

III.NUTRITION AND CHILD CARE SERVICES PROVIDED

Promotion of Exclusive Breastfeeding Strengthened 100% effective in strengthening of exclusive breastfeeding from newborn until six
months of age by begining of February - end of June 2016

Garantisadong Pambata implemented 100% of eligible population from 6mos.-71 mos.old given supplementation efficientlty

IV.DISEASE PREVENTION AND CONTROL SERVICES

TB patient enrolled, started treatment and monitored 9 TB patient enrolled, given treatment and monitored begining of February - end of June
2017

Maintenance of medicine for lifestyle related diseases provided 100% accurate in providing maintenance of medicine to diagnosed hypertensive and
diabetic patients begining of February - end of June 2017

Weekly monitoring Fasting Blood Sugar to clients diagnosed with

diabetis 100% effective implementation of Fasting Blood Sugar to clients diagnosed with diabetis

Advocacy on the promontion of healthy lifestyle diseases and 100% effective implementation on the advocacy for the prevention of Non-Communicable
prevention of Non-Communicable Diseases Diseases and promotion of healthy lifestyle

V.CARRY-OUT OTHER TASKS AS MAYBE ASSIGNED

Discussed With: Assessed by: Final Rating by: Date

I certify that I discussed my assessment of the perfomance I certify that I discuss my assessment of the performance with the employee.
with the employee

Municipal Health Officer Development Mgt. Officer IV DMO V / OIC

Legend: 1- Quantity 2 -Quality 3 - Timeliness 4 - Average

5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor
5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
1 - Poor
DOH - SPMS Form 3
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
I, Katherine A. Baluca,RN, of the Provincial DOH Office of Agusan Del Norte, commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period July -
December 2020

Name of Staff: Katherine A. Baluca,RN

Approved By: Date: December 11, 2020

ENGR. MERIEDETH O. PAGARAN, MPH

Name of Supervisor / DMO V
5 – Outstanding
4 – Very Satisfactory
3 – Satisfactory
2 - Unsatisfactory
NDP 1 - Poor

Expected Output Success Indicator Actual Accomplishment RATING

Remarks
E (1) Q (2) T (3) A (4)

I. HEALTH INFORMATION (Target+Measure)

100 % of( 12) IEC Activities are conducted and 12/6 IEC Activities are conducted and facilitated
5 N/A 5 5.0
facilitated within 45 minutes within 25 minutes
8/6 of BHW meetings & updates on DOH
100% of (8) BHW Meetings & Updates on DOH
programs were conducted & Facilitated within 2 5 N/A 5 5.0
Programs are conducted & facilitated 3 hours
hours

100% of( 1) NTDMIS reports are updated within 5 days 1/1 NTDMIS reports were updated within 4 days 5 N/A 4 4.5
To have ensured timely submission of quality
and comprehensive reports for planning and 100% of (6 )FHSIS reports are consolidated, validated
decision making 6/6 FHSIS report were validated and submitted
and submitted every 5th day of the following month 5 N/A 4 4.5
within 4 days
within 5 days
II. ACCESS TO MEDICINES AND
TECHNOLOGY.

100% of (8 )inventory for essential drugs and logistics 8/6 of inventory for essential drugs and logistics
To have assisted in ensuring accessible & 5 N/A 5 5.0
are initiated & conducted within 5 days were initiated & conducted within 3 days
functional mechanism of distribution of
essential drugs and medical supplies in the
assigned areas 100% of (12 )TSEKAP equipment are checked for 12/6 equipment are checked for availability within
5 N/A 5 5.0
availability and funtionality within 45 minutes 25 minutes

III. HEALTH SERVICE DELIVERY

135/122 patients for consultation were assisted
90% of (135) patients/clients for consultation are given
and given with quality and appropriate health
with quality and appropriate health services in the 3 N/A 5 4.0
services in the assigned area within 13 minutes
assigned area within 20 minutes upon arrival
upon arrival
To have provided quality and accessible 90% of patients/clients with emergency cases are
health care services to all provided with initial interventions prior to referral to
AS NEED ARISES
higher facility within 30 minutes upon arrival to the
assigned facility
90% of (15) priority households with health 15/14 priority household with health problems are
3 N/A 5 4.0
problemsare visited within 45 mintes visited within 25 minutes
IV. MATERNAL HEALTH SERVICES
85% of (6) Pregnant women seen are provided with 6/5 of Pregnant women seen were provided with
quality prenatal care services within 25 minutes upon quality prenatal care services within 17 minutes 4 N/A 5 4.5
arrival upon arrival

90% of (6) target pregnant women due for delivery

To have ensured sustainable and safe NO BHS DELIVERY
from july to December are attended at health facility
Maternal and Reproductive health services to
eligible population 90% of( 7) target Post-partum women are given with 7/6 of target Post-partum women were given with
4 N/A 3 3.5
appropriate care within 1 week appropriate care within 1 week
100% of (72) Family Planning current users are 72/72 of Family Planning current users were
provided with FP commodities and counselling within provided with FP commodities and counselling 3 N/A 5 4.0
20 minutes within 13 minutes
V. NUTRITION AND CHILD CARE SERVICES
PROVIDED
90% of( 7) newborns are effectively referred and 7/6 of newborns were effectively referred and
monitored for newborn screening within 5 days after monitored for newborn screening within 3 days 4 N/A 5 4.5
delivery after delivery
95% of (22) 0-12 months old children are given 22/21 of 0-12 months old children were given
3 N/A 5 4.0
immunization as scheduled within 20 minutes immunization as scheduled within 13 minutes
85% of (17) 6 months old seen are monitored for 17/14 of 6 months old seen were monitored for
4 N/A 5 4.5
exclusive breastfeeding 20 minutes exclusive breastfeeding within 13 minutes
To have attained optimum child health and 85% of (156) eligible children from 6 months - 59 156/133 of eligible children from 6 months - 59
nutrition months old are given Vitamin A supplementation months old were given Vitamin A supplementation 4 N/A 5 4.5
effeciently within 5 days effeciently within 3 days
85% of (145) eligible children from 12 months - 59 145/123 of eligible children from 12 months - 59
months old are given deworming medicine efficiently months old are given deworming medicine 4 N/A 5 4.5
within 3 days efficiently within 2 days
90% of (7) malnourished children are successfully 7/6 of malnourished children were successfully
monitored within 20 minutes 4 N/A 5 4.5
monitored within 13 minutes

VI.COMMUNICABLE DISEASES
To have identified suspected clients of any 3/3 identified TB clients were enrolled, given
90% of (3) identified TB clients are enrolled, given
communicable diseases and referred for treatment and monitored from July to December 3 N/A 3 3.0
treatment and monitored from July to December 2020
appropriate treatment and management 2020

VII. NON COMMUNICABLE DISEASES

85% of (27) diagnosed hypertensive and diabetic 27/23 diagnosed hypertensive and diabetic
patients are provided assessed and referred to CHO patients are provided assessed and referred to
4 N/A 5 4.5
for provision of maintenance medication within 20 CHO for provision of maintenance medication
To have identified clients of Lifestyle related minutes within 13 minutes
diseases referred and monitored for relevant
medical intervention 85% of (14) Clients for FBS are catered effeciently 14/12 of Clients for FBS were catered effeciently 4 N/A 5 4.5
within 20 minutes within 13 minutes
90% of (64) Clients for BP monitoring are catered 64/58 of Clients for BP monitoring were catered 3 N/A 5 4.0
effeciently within 20 minutes effeciently within 13 minutes
VIII. OTHER RELATED TASK

100% of (176) children aged 9- 59 months old are 176/176 of children aged 9- 59 months old were
To have performed other task in relation to given with Measles Rubella vaccination ( Phase 1 ) in given with Measles Rubella vaccination ( Phase
3 N/A 5 4.0
DOH Programs Measles Rubella Supplementation activity within the 1 ) in Measles Rubella Supplementation activity
scheduled timeline within the scheduled timeline

100% of (218) children aged 0- 59 months are given 2 218/218 children aged 0- 59 months are given 2
drops of Bopv during round 2 of Sabayang Patak drops of Bopv during round 2 of Sabayang Patak 3 N/A 5 4.0
Kontra Polio within the prescribed schedule Kontra Polio within the prescribed schedule

100% of (96) PUM/PUQ examined and monitored 96/96of PUM/PUQ examined and monitored
physically in a converted quarantine facility within 5 physically in a converted quarantine facility within 3 N/A 5 4.0
minutes 3 minutes
RATING 93 N/A 114 104
TOTAL OVERALL RATING 104
Divided by 24
FINAL AVERAGE RATING 4.33
ADJECTIVAL RATING Very Satisfactory
Discussed With: Assessed by: Final Rating by:
I certify that I discuss my assessment of the performance with the employee.

Date:
KATHERINE A. BALUCA, RN. JOVETH M. DUARTE, RN ENGR. MERIEDETH O. PAGARAN, MPH JANE YAP LUGO,MD,MPA
NURSE I PHN IV DMO IV DMO V