FHSSP CMRIS DCM FG V1 1 LowRes Oct16

Consolidated Monthly
Return Information
System (CMRIS)
Data Collection Manual
In-service training

Facilitator’s Guide

Prepared for the Ministry of Health and Medical Services, Government of Fiji
by the Fiji Health Sector Support Program

Version 1.1, October 2016

© Commonwealth of Australia, 2016
Copyright protects this publication. Except for purposes permitted by the Australian Copyright Act 1968
and the Fijian Copyright Act, 1999, reproduction, adaptation, electronic storage, and communication to
the public is prohibited without prior written permission. Enquiries should be addressed to
Abt Associates, PO Box 1874, Milton QLD 4064, Australia.

The Ministry of Health and Medical Services, Government of Fiji, has a non‐exclusive, non‐expiring
licence to copy, publish, and adapt this publication.

Any third party material, including images, contained in this publication remains the property of the
specified copyright owner unless otherwise indicated, and is used subject to their licensing conditions.
Version: 1.1
Edition: October 2016
_____________________________________________________________________________________

The Fiji Health Sector Support Program (FHSSP) is an Australian Government initiative, providing support
to the Fiji Ministry of Health and Medical Services to deliver essential health services to the people of
Fiji. The FHSSP supports activities that contribute to improving health outcomes in maternal and child
health, strengthening diabetes and hypertension prevention and management, and revitalising primary
health care and targeted health systems strengthening. FHSSP is implemented by Abt Associates on
behalf of the Australian Government.

Contents Facilitator’s Guide

Contents

Foreword ........................................................................................................................................ iii
Acknowledgements ......................................................................................................................... v
Abbreviations ................................................................................................................................ vii
Glossary of key terms ..................................................................................................................... ix
Section 1 — Introduction and Overview ...................................................................................... 1
1.1 Introduction ......................................................................................................................... 1
Section 2 — PHIS and HMCH ....................................................................................................... 9
2.1 PHIS Monthly Statistical Summary Form, and Hospital Maternal and Child Health Data
Collection Form ........................................................................................................................ 10
2.2 Birth and delivery ............................................................................................................... 10
2.3 Antenatal care .................................................................................................................... 12
2.4 Postnatal care ..................................................................................................................... 12
2.5 Holding beds....................................................................................................................... 13
2.6 Family planning .................................................................................................................. 14
2.7 Non‐communicable diseases ............................................................................................. 16
2.8 Immunisation ..................................................................................................................... 17
2.9 Cervical cancer screening ................................................................................................... 18
2.10 IMCI .................................................................................................................................. 19
2.11 Well child clinic ................................................................................................................. 20
2.12 Medicine stock out ........................................................................................................... 20
2.13 Outpatient services .......................................................................................................... 21
2.14 PHIS statistical summary and HMCH submission and feedback processes ..................... 22
Section 3 — PHIS Monthly Narrative Summary Form ................................................................ 27
3.1 PHIS Monthly Narrative Summary Form ............................................................................ 27
3.2 Submission and feedback of the PHIS Monthly Narrative Summary Form ....................... 28
Section 4 — School Summary Form ........................................................................................... 31
4.1 School Summary Form ....................................................................................................... 31
4.2 Submission and feedback of the School Summary Form ................................................... 32
Section 5 — Nutritional Monthly Report Form .......................................................................... 35

Fiji Health Sector Support Program  i 
CMRIS Data Collection Manual In‐service training

5.1 Nutritional Monthly Report Form ...................................................................................... 35
5.2 Breastfeeding ..................................................................................................................... 36
5.3 National Iron and Micronutrient Supplement (NIMS) ....................................................... 37
5.4 Moderate acute malnutrition ............................................................................................. 38
5.5 Severe acute malnutrition .................................................................................................. 39
5.6 Submission and feedback of the Nutritional Monthly Report Form .................................. 40
Section 6 — Subdivisional Hospital Monthly Return ................................................................. 43
6.1 Subdivisional Hospital Monthly Return .............................................................................. 43
6.2 Admissions, discharges, and deaths ................................................................................... 44
6.3 Maternity services .............................................................................................................. 47
6.4 Outpatient services ............................................................................................................ 48
6.5 Special outpatient services ................................................................................................. 48
6.6 Outreach services ............................................................................................................... 49
6.7 Ambulatory services ........................................................................................................... 50
6.8 Submission and feedback of the Subdivisional Hospital Monthly Return ......................... 50
Section 7 — Tear‐offs ............................................................................................................... 53
7.1 Tear‐offs ............................................................................................................................. 53
References ............................................................................................................................... 55
Annexes ................................................................................................................................... 57
Annex A — Tetanus toxoid schedules .......................................................................................... 58
Annex B — Reporting templates .................................................................................................. 59
Annex C — Participant feedback form ......................................................................................... 64
Annex D — Trainer feedback form ............................................................................................... 65

 ii  V1.1  October 2016
Foreword User Guide

Foreword

The term Health Information Systems refers to any system that captures, stores,
manages or transmits information related to the health of individuals or the activities
of organisations that work within the health sector. Health Information Systems
underpin integrated efforts to collect, process, report and use health information and
knowledge which can be used, in turn, to influence policy and decision‐making,
support program action, monitor individual and public health outcomes, and
contribute towards research.
Sound decision‐making at all levels of a health system requires reliable health statistics
that are disaggregated by sex, age, and socioeconomic characteristics. The
development of the Consolidated Monthly Return Information System provides a
reliable platform to not only capture routine data on a regular monthly basis, but also
produce reports and analysis of the data. This manual provides, in a single easy‐to‐use
manual, guidance on the data collection systems, which include the previous Public
Health Information System and Hospital Maternal and Child Health Data Collection,
and also the new modules of Nutrition Monthly Return and Subdivisional Hospital
Monthly Return.
The Ministry of Health and Medical Services with the support of the Fiji Health Sector
Support Program continues to explore new ways to improve the management of
health information to ensure evidence‐based decision‐making at all levels of the
healthcare system, which promotes better service delivery and improved health
outcomes for our people.
The production of this manual demonstrates our commitment to ensuring better use
of health information at all levels through consolidated data collection systems
throughout the healthcare delivery system.
To the facilitators — this guide was written to assist you in carrying out individual and
group activities and I invite you to read through it and gain a solid understanding of the
activities and the type of facilitation that is necessary for success. I encourage you to
reflect on your strengths in carrying out the facilitator’s role and associated
responsibilities.
To the users of the system — I encourage you to make the best use of this manual to
ensure you have a thorough understanding of the system and enter accurate, timely,
and correct data that are reliable and useful. It is absolutely important to ensure
quality of data is not compromised at any cost. This will enable better and informed

Fiji Health Sector Support Program  iii 

decision‐making at all levels, through the use of different reports that are produced by
the wonderful online reporting tool.
It is our vision that this guide will expand in future to include other monthly data
collections, such as environmental health and dental activity. In that way we will be
able gradually to establish comprehensive and inclusive coverage of public health
information that provides timely, reliable, and accurate information for sound
decision‐making at both operational and strategic levels.

 iv  V1.1  October 2016
Acknowledgements Facilitator’s Guide

Acknowledgements

The 1st edition of the manual for CMRIS data collection, upon which this work was
built, is acknowledged. The number of people involved in the development of the
Consolidated Monthly Return Information System is extensive and their valuable
contributions are gratefully acknowledged.
We would like to thank the following individuals for their support, encouragement,
and decisions on the way forward:
 Mr Philip K. Davies — Permanent Secretary for Health and Medical Services
 Dr Eric Rafai — Deputy Secretary Public Health
 Dr Torika Tamani — National Advisor Family Health
 Dr Isimeli Tukana — National Advisor Non‐Communicable Diseases
 Ms Maca Rokomalani — National Advisor Nutrition
 Ms Kiti Sorovaki — NIMS National Project Officer
 Dr Lisi Tikoduadua — Paediatric Consultant — CWM Hospital
 Dr I. Vereti — Paediatric Consultant — CWM Hospital
 Dr Rigamoto Taito — Paediatric CSN Head/Consultant Lautoka Hospital
 Dr Rosalina Sa’aga‐Banuve — Program Director Fiji Health Sector Support Program.

We would also like to acknowledge the Subdivisions, Divisional Health Officers, and
Divisional Hospitals for the continuous support during the consultation period:
 Divisional Medical Officers  Divisional and Hospital Dieticians
 Divisional Hospital Medical Superintendent  Subdivisional Medical Officers
 Divisional Health Sisters  Subdivisional Health Sisters
 Divisional Hospital Nursing Managers  Subdivisional Hospital Sisters‐in‐
 Divisional In‐service Training Officers Charge and Charge Nurses
 Matron In‐service Training Officers  CWM Hospital Maternity Unit

We would also like to acknowledge the Technical Working Group for collaborating on
consultations from stakeholders in the redevelopment process:
 Dr Devina Nand — Director Epidemiologist
 Ms Varanisese Smith — Senior Statistician
 Ms Ruci Vuadreu — Statistician
 Mr Iliesa Ravuci — National Health Information Officer

Fiji Health Sector Support Program  v 

 Mr Atunaisa Degei — Assistant Statistician — Hospital
 Ms Miriama Rokovutoro — Assistant Statistician — Public Health
 Ms Rosimina Tubuitamana — Statistical Officer PHIS
 Ms Arishma Bali — Statistical Officer Hospital
 Ms Senjalin Shankar — Divisional Health Information Officer CentEast
 Mr Ashnil Kumar — CMRIS Analyst
 Ms Talatoka Tamani — FHSSP
 Mr Amini Mucunabitu — FHSSP

This guide would not have been produced without the expert contribution of Mr Don
Lewis, FHSSP Short‐Term Adviser for HIS. The Technical Working Group’s valuable
contribution and guidance has facilitated the production of this edition of the guide,
with assistance of the staff of the Fiji Health Sector Support Program.

Vinaka Vakalevu.
Mr Shivnay Naidu
Director Health Information, Research and Analysis
Ministry of Health and Medical Services
Suva, Fiji

 vi  V1.1  October 2016
Abbreviations and Glossary of key terms Facilitator’s Guide

Abbreviations

A&E Accident and Emergency
AMO Area Medical Officer
ANC Antenatal clinic
ARF Acute rheumatic fever
BCG Bacillus calmette‐guérin [vaccine]
BMI Body mass index
CBA Child bearing age
CMRIS Consolidated Monthly Return Information System
CWMH Colonial War Memorial Hospital
CYP Couple years protection
DOA Dead on arrival
DTP Diphtheria‐tetanus‐pertussis [vaccine]
ECP Emergency contraceptive pill
FHSSP Fiji Health Sector Support Program
FNU CMNHS Fiji National University College of Medicine, Nursing and Health Sciences
FP Family planning
GOPD General Outpatients Department
HADC Hospital Activity Data Collection
HBV Hepatitis B vaccine
HIU Health Information Unit
HMCH Hospital Maternal and Child Health Data Collection Form
IMCI Integrated Management of Childhood Illness
IST In‐service training
IUCD Intra‐uterine contraceptive device
LGA Large for gestational age
MAM Moderate acute malnutrition
MCDC Medical Cause of Death Certificate
MCH Maternal and child health
MNP Micronutrient powder
MO Medical Officer
MoHMS Ministry of Health and Medical Services
MR Measles‐rubella [vaccine]

Fiji Health Sector Support Program  vii 

NC New case [diabetes]
NCD Non‐communicable disease
NGO Non‐government organisation
NIMS National Iron and Micronutrient Supplement [project]
NP Nurse Practitioner
O&G Obstetrics and gynaecology
OPV Oral polio vaccine
ORS Oral rehydration solution
PHIS Public Health Information System
PNC Postnatal care
RHD Rheumatic heart disease
SAM Severe acute malnutrition
SD Standard deviation
SDD Subdivisional Dietician
SDHS Subdivisional Health Sister
SDMO Subdivisional Medical Officer
SIC Sister‐In‐Charge
SNAP Smoking, nutrition, alcohol, and physical activity
SOPD Specialist Outpatients Department
STI Sexually transmitted infection
Td Tetanus and diphtheria [vaccine]
TR Total registered
TT Tetanus toxoid [vaccine]
TWG Technical Working Group
VCCT Voluntary counselling and confidential testing
VIA Visual inspection using ascetic acid
YP Years of protection

 viii  V1.1  October 2016

Glossary of key terms

The following glossary provides definitions of key terms as they are used in the context
of this Guide and the associated training.
Anaemia in pregnancy Blood haemoglobin level of ≤11 g/dl, usually caused by dietary

iron deficiency.
Antepartum stillbirth A stillbirth where the baby died before the onset of labour (≥28
weeks gestation or, in the absence of a reliable gestational age,
those with a birth weight of ≥1000 g).
At risk pregnancy A pregnancy at increased possibility of harm to mother or baby
because of medical or social conditions that pre‐exist or arise
during the antenatal period.
Baby born before arrival Live births (at any gestation) and stillbirths (at ≥28 weeks) born
before arrival to the reporting hospital, where the reporting
hospital is the first health facility where the baby has been
seen. Does not include babies born at home, Nursing Stations,
or Health Centres.
Bed day An occupied bed in a 24‐hour period where there is a patient
physically in the bed or the bed is being retained for the
patient.
Bed occupancy rate The percentage of beds occupied by hospital inpatients for a
given period of time. For a bed to be included in the count it
must be set‐up, staffed, equipped, and available for patient
care.
Boarder People who are not under the hospital’s care, but may be
getting food or accommodation from the hospital. For example,
when a sick child is admitted to hospital and the mother stays
with the child, the mother is considered to be a boarder.
Breech vaginal delivery The delivery of a baby that exits the mother's pelvis with
buttocks or feet first and is delivered through the vagina.
Community birth Any birth occurring outside of the hospital.
Community death Any death occurring outside of the hospital.
Daily bed state The number of beds that are averagely occupied on a daily
basis in a period of time.
Day case Patient admitted for a medical procedure or surgery in the
morning and released before the evening.
Death on arrival Indicates that a person was found to be already clinically dead
before the arrival of professional medical assistance.

Fiji Health Sector Support Program  ix 

Early booking When pregnant women attend their first ANC visit early in their

pregnancy.
Elderly primiparous A woman who is pregnant for the first time at age 35 or over.
Also known as elderly primip or elderly primigravida.
Elective caesarean Surgical procedure to deliver a baby by making a surgical cut
section into the abdomen and womb, which has been planned in
advance.
Emergency caesarean Surgical procedure to deliver a baby by making a surgical cut
section into the abdomen and womb, which is done at short notice.
This is usually after labour has commenced, but when fetal or
maternal complications have developed.
Fetal death Any baby expelled from the mother's body at ≥22 weeks
gestation, but before 28 weeks gestation, who shows no signs
of life. (In the absence of a reliable gestational age, include
those with a birth weight between 500–999 g.)
First antenatal visit The first pregnancy‐related visit with healthcare professionals
by a pregnant woman at any antenatal clinic.
First trimester Up to and including 13 weeks of pregnancy.
Forceps delivery The assisted delivery of a baby by the application of forceps to
the baby's head to aid extraction through the birth canal.
Hypertension Blood pressure >140 mmHg systolic and/or >90 mmHg
diastolic, confirmed by repeat readings whatever the cause.
Intrapartum stillbirths A stillbirth where the baby died after the onset of labour or
during delivery (≥28 weeks gestation or, in absence of a reliable
gestational age, those with a birth weight of ≥1000 g).
Live birth ‘Live birth refers to the complete expulsion or extraction from
its mother of a product of conception, irrespective of the
duration of the pregnancy, which, after such separation,
breathes or shows any other evidence of life — e.g. beating of
the heart, pulsation of the umbilical cord or definite movement
of voluntary muscles — whether or not the umbilical cord has
been cut or the placenta is attached. Each product of such a
birth is considered live born’ (World Health Organization
[WHO], 2014).
Low birth weight baby A live born baby born weighing less than 2500 g, regardless of
gestational age.
Multiple pregnancy A pregnancy in which there are two or more developing fetuses
at any gestation.

 x  V1.1  October 2016

Normal pregnancy A pregnancy with no apparent risks identified outside of the

normal range, from either pre‐existing or new conditions
during the antenatal period. This does not include deviations
from the norm during labour, delivery, or the postpartum
period.
Normal vaginal delivery The delivery of a baby in a head down position through the
vagina without the need for forceps, vacuum, or any other
instrumentation. This does not mean that every part of the
birth was without medical care or intervention (such as
episiotomy).
Obesity The condition of being grossly overweight. This can be
determined either by a body mass index (BMI) of ≥30 kg/m2, or
applying clinical judgement where a person's build means that
the traditional BMI categories are not applicable.
Obstructed labour Labour is considered obstructed when the presenting part of
the fetus cannot progress into the birth canal, despite strong
uterine contractions.
Performance indicator Measures taken from the collection of data and information
that tell us whether performance is achieving its goal.
Second trimester 14 to 27 weeks of pregnancy.
Skin-to-skin To ‘place babies in skin‐to‐skin contact with their mothers
immediately following birth for at least an hour’ (UNICEF &
WHO, 2009, p.11).
Third trimester 28+ weeks of pregnancy.
Underweight The condition of being below a normal weight. This can be
determined either by a body mass index (BMI) of ≤18 kg/m2 or
by applying clinical judgement where a person's build means
that the traditional BMI categories are not applicable.
VCCT (Voluntary Confidential dialogue between a client and a care provider
confidential counselling aimed at enabling the client to make personal decisions related
and testing) to HIV/AIDS and other STI testing to reach an understanding of
what they can and should do if the results are positive.
Ventouse delivery The assisted delivery of a baby by the fixation of a vacuum
device onto the baby's head to aid extraction through the birth
canal.

Fiji Health Sector Support Program  xi 

 xii  V1.1  October 2016
Section 1 —Introduction and Overview Facilitator’s Guide

Section 1 — Introduction and

Overview

1.1 Introduction
Welcome to your Facilitator’s Guide to support you in delivering training to update
health workers about the Consolidated Monthly Return Information System (CMRIS).
Read through this Facilitator’s Guide prior to starting the training to make sure you are
familiar and comfortable with the material, the scenarios and questions, and any
suggested activities. It is also useful to help you prepare any other resources you may
need.
Check that all participants have a copy of the Consolidated Monthly Return Information
System (CMRIS) Data Collection Manual User Guide. The primary aim of this training is
to build on health workers’ understanding and to reinforce the correct use of the
CMRIS for data collection.
Evidence-based training
Explain that evidence or competency‐based training means using evidence provided by
the participants to show they are building their ability or competence to use the data
collection forms for the Consolidated Monthly Return Information System (CMRIS) to
support effective health service delivery and better health outcomes.
This also means that participants in the training will demonstrate their ability and
knowledge at the facilitated training sessions, and/or in the clinical setting, to provide
‘evidence of competence’ to complete the statistical data collection forms accurately.
CMRIS Data Collection Manual User Guide

The CMRIS Data Collection Manual User Guide provided to participants is designed to
be used as an ongoing reference in the workplace, to assist health workers and their
colleagues. The CMRIS data collection system consists of the following components:
 PHIS Monthly Statistical Summary Form
 Hospital Maternal and Child Health Data Collection Form
 PHIS Monthly Narrative Summary Form
 School Summary Form

Fiji Health Sector Support Program  1 

 Nutritional Monthly Report Form
 Subdivisional Hospital Monthly Return
 Tear‐offs.

Role of facilitator
To deliver the training you must have a copy of both this Facilitator’s Guide and the
User Guide. Before you commence any training sessions, please read all of the
chapters.
Some features that you will notice as you read the chapters are discussed below.
Symbols for facilities

The data for the CMRIS forms is collected at different service delivery points. The User
Guide and this Facilitator’s Guide use symbols to show the type of facilities where the
data is collected, as shown below. The following symbols represent the type of
facilities named below them. These icons are used in each section discussing the
reporting forms.
Health Centre Subdivisional Divisional

Nursing Station Hospital Hospital

Health Centre/ Subdivisional Hospital Divisional Hospital

Nursing Station

It is important to explain this in the training, because the symbols also signify the type
of facilities that must provide particular reports.
Counting rules
For each section of the forms, counting rules state the criteria and the type of data to
be reported.
As a facilitator, it is important that these counting rules are reinforced to participants,
so that each section of the form is accurately completed.
Glossary
Participants should familiarise themselves with the definitions given in the Glossary, as
it will enable them to fully understand the requirements of the reporting system. It
also provides reassurance about practice at the service delivery points.

 2  V1.1  October 2016

Prepare other resources

Aside from a general resource kit (outlined further in this section), please read this
guide and identify other resources you may need to be ready for every session of
training.
Competency for CMRIS data collection training

Participants will gain the following knowledge and skills from this training to show
their competence as effective health workers, when collecting, recording, and
reporting on the CMRIS data collection forms. Discuss these with the training group.
A simplified version of this information is given in Section 1 of the User Guide, and the
full table is provided for participants’ reference in Annex A of their User Guide.

Unit of Competency

Competency Use the data collection forms for

A critical area of knowledge and skills required the Consolidated Monthly Return
to perform the job role of participants
Information System (CMRIS) to
support effective health service
delivery and better health
outcomes.
Training elements Demonstrated evidence
The specific knowledge and skills that The measurable evidence that participants must be able to
participants will gain by the end of this training demonstrate to prove their competence for each training element
1. Become familiar with the purpose 1.1 Describe the purpose and types of information

and structure of the CMRIS collected in each of the CMRIS forms.
forms.
2. Enter accurate data using the 2.1 Explain the process and standards for entering
CMRIS forms. data on the CMRIS forms.
2.2 Demonstrate the expected standard of
accuracy and consistency when entering and
updating data on the CMRIS forms.
3. Submit the CMRIS forms for 3.1 Demonstrate consistent process and
collation and reporting purposes. knowledge of factors affecting data quality, to
submit the CMRIS forms at the end of each
month.


3.2 Explain the data flow processes at your health
facility for submitting the CMRIS forms.
4. Interpret data and use CMRIS 4.1 Explain how to interpret indicators calculated
data reports to assist from the CMRIS data.
subdivisional and divisional 4.2 Describe how to advise and encourage
managers to monitor and subdivisional and divisional managers to
improve health service delivery analyse data reports and identify strategies to
and the performance of health improve service delivery and staff performance.
workers.

Statement of Attendance
Inform participants that when they attend all sessions and participate fully in all
activities and group work to complete this training program, then they will be provided
with a Statement of Attendance. This statement is also a useful document to
demonstrate a commitment to ongoing professional development.
Important contact
Advise participants that they can contact the Health Information Unit for further
information:
Name Senior Statistical Officer
Address Health Information Unit, Ministry of Health and Medical Services
Level 2, Dinem House
Amy Street, Toorak, Suva
Telephone 321 5176
Fax 331 8227

Using this Facilitator’s Guide

This guide will assist you to plan the delivery of each session by providing:
 Topics
 Suggested activities
 A list of resources and materials required
 Elements of competency and demonstrated evidence.

Mode of delivery
It is recommended that you aim to deliver the training face‐to‐face in a group setting
with a group of no more than 20 participants over two consecutive days of training.

 4  V1.1  October 2016

Training space
Aim to provide training in a central space in the district areas, close to where people
work. This is a useful way for colleagues to get to know those workers from their
region and help to build a network of contacts.
Training tips and preparation

The following tips provide suggestions and strategies to support effective delivery of
this training. Before delivering this training, take some time to familiarise yourself with
the following documents:
 CMRIS Data Collection Manual User Guide
 CMRIS Data Collection Manual Facilitator’s Guide
 CMRIS Reporting Forms:
 PHIS Monthly Statistical Summary Form
 Hospital Maternal and Child Health Data Collection Form
 PHIS Monthly Narrative Summary Form
 School Summary Form
 Nutritional Monthly Report Form
 Subdivisional Hospital Monthly Return
 Tear‐offs.

You might also wish to review the following training suggestions to assist you to
prepare for a successful training program.
Training suggestions
Training delivery
It is suggested that:
 Sessions are delivered in the order they appear. However, some sessions may be
appropriately grouped together for practical purposes.
 Allow sufficient time for questions, reflection, and review.
 Each activity has an estimated time to complete.
 After each activity aim to have feedback from participants and general group discussion to
confirm everyone has understood the information and the activity and feels confident to
progress.


Create a comfortable and encouraging learning environment

To create an environment where participants are comfortable with you as the facilitator and
encouraged to share their ideas, consider the following steps:
 Welcome participants and acknowledge them as colleagues who have experience. Explain
that this training is an important upgrade, and part of their professional development.
 Introduce yourself (more than your name and role — provide a brief overview of your
professional experience).
 Indicate your pleasure to be there and your gratitude for the participants’ attendance.
 Tell participants that the training is a place and time to learn and share knowledge and
experiences. Everyone is there to learn, including you as the facilitator.
 Establish that all questions are encouraged (reinforce that all questions are welcome and
you are keen to answer what you can or help the participants to find answers).
 Create some guidelines with the group about how to achieve the best learning place. For
example, participants may disagree and should be encouraged to say what they think.
However, the aim is to encourage and role model constructive criticism or disagreement
with the points being discussed, not the person making the comment.
 Make positive comments such as: ‘Thank you for that question. I am sure others wanted to
know the answer to that also’.

When working with the training participants, their responses may be varied, as with any group.
Some may interact freely in a group setting of training. Others may be more withdrawn, quiet,
and minimally responsive. Catering your training delivery to suit a range of learning styles
(even in the same group) is more effective, particularly with minimally responsive individuals,
and can include strategies such as:
 Discussing third party stories or case studies from elsewhere as examples to reinforce
training, then inviting local experience. For example, ‘How does this compare with what
you see here?’, ‘Can you tell me what happens in your clinic in this scenario?’
 Asking for responses from the group rather than calling on selected individuals. For
example, ‘You all have experience as health workers. What do you think are some of the
problems/solutions/issues?’
 Providing alternative opportunities for sharing of local experiences. For example, invite
participants who are very quiet to write about what is happening for couples, families,
mothers and children in communities near their clinics, perhaps working together in the
group to do this, and then sharing this information with the class and you as a group. This
is particularly effective if you provide materials for participants to use, such as butcher’s
paper, art supplies, magazines, and health information.
 Encouraging sitting around in the training as a group (not behind desks). The facilitator
should also be a part of this group.
 Providing audio‐visual and written information, including accessing samples where
relevant.

Activities such as these can help you to establish an appropriate comfort level. They may assist
you to find an appropriate icebreaker to start the session, so that you and the participants
start to feel comfortable with each other.

 6  V1.1  October 2016

Consider different ways of learning

Adults learn in a number of different ways:
 Visual learning (use pictures, videos, and diagrams)
 Auditory learning (use lectures, group discussions)
 Kinaesthetic learning (use models, role‐plays, demonstrations, and on‐the‐job activities).

Brainstorming — some tips for brainstorming are:

 Capture all ideas.
 Encourage different ideas and other ways of doing things.
 Encourage everyone to offer their ideas (either by writing or drawing alone or in groups,
and then presenting their ideas in the group).
 Build on other people’s ideas.
 Use words and pictures.
 Keep going until everyone agrees they can’t think of anything else.
 When the group is finished, share some case studies or examples of ideas, strategies,
resources, projects, or methods other people have used (choose these carefully to be as
similar to the characteristics or situation as the one you are training the group about).

Other tips to support participants

It is important to recognise that participants completing this training will be diverse and at
varying levels of capacity, experience, and education.
 Gain as much information as possible about the characteristics and circumstances of the
participants and the community.
 Establish and maintain a high level of communication and sharing to encourage participant
involvement and interest.
 Discuss having a common purpose with participants to support them to build their skills
and knowledge as health workers to collect, report, and respond to accurate health data to
affect health outcomes in Fiji.
 Develop an oral and written feedback system, so that participants can genuinely
contribute their ideas, experiences, and suggestions about the training.

Training toolbox
Your ‘training toolbox’ is the set of general resources that you bring to every session and
should include:
 coloured markers
 whiteboard markers
 labels for name badges
 pens for writing
 butcher’s paper and tape
 coloured pencils
 relevant documents (including the User Guide and Facilitator’s Guide for this training)
 topic‐relevant materials, such as case studies, photos, relevant equipment and models,
and posters.


 8  V1.1  October 2016
Section 2 — PHIS and HMCH Facilitator’s Guide

Section 2 — PHIS and HMCH

Session plan
Session 1 PHIS and HMCH
Topics to be covered  Sections of the PHIS Monthly Statistical Summary Form and

Hospital Maternal and Child Health Data Collection Form:
 Birth and delivery.
 Antenatal care.
 Postnatal care.
 Holding beds.
 Family planning.
 Non‐communicable diseases.
 Immunisation.
 Cervical cancer screening.
 IMCI.
 Well child clinic.
 Medicine stock out.
 Outpatient services.
 Submission and feedback of the PHIS Monthly Statistical
Summary Form.
 Submission and feedback of the Hospital Maternal and Child
Health Data Collection Form.
Mode of delivery  Face‐to‐face in group setting.
Activities  Practical activities.
 Discussions.
 Scenarios.
Elements of For each data collection form in the CMRIS, consider all of the
competency Elements of Training and the Demonstrated Evidence outlined in
the Unit of Competency.
Resources/materials  Check each participant has their own copy of the:
 User Guide.
 PHIS Monthly Statistical Summary Form.
 Hospital Maternal and Child Health Data Collection Form.
 Pens and paper.


 Digital projector and PowerPoint presentation (print a master
copy of the PowerPoint slides as a back‐up).
Preparation  Read this guide and the User Guide.

2.1 PHIS Monthly Statistical Summary Form, and Hospital

Maternal and Child Health Data Collection Form
Confirm that participants each have a copy of the updated PHIS Monthly Statistical
Summary Form and the Hospital Maternal and Child Health Data Collection Form.
Explain that the two collection forms contain tables for data to be collected. For PHIS,
this data will be reported from Nursing Stations and Health Centres, and for Hospital
Maternity and Child Health (HMCH) this will be reported from Subdivisional and
Divisional Hospitals. The data is a count of the number of services that are provided in
each facility under various programs. At the end of each calendar month, the person
responsible compiles the data from registers and records it carefully and accurately
into these forms. The forms must then be submitted and received within 7 days at the
subdivisional level.

Practical activity
Ask participants to review the two forms and then discuss them with the

person next to them to identify the similarities and differences in the
two forms.
Invite responses and then discuss the similarities and the differences
that were identified.

Subdivisional Divisional
2.2 Birth and delivery

Hospital Hospital
Explain that the birth and delivery section is only reported from Subdivisional and
Divisional Hospitals. Discuss the two main sections of this reporting, which are:
 Birth details — which mainly consist of the baby’s details.
 Delivering mother’s details — which consist of the mother’s details.

Discuss the fields in this section and the rules that determine the data that is required
to be reported in the HMCH data collection form.

 10  V1.1  October 2016

Key points
 Note that spontaneous abortions (<22 weeks gestation) are not
reported on this form.
 Total Number of Stillbirths = Intrapartum Stillbirths + Antepartum
Stillbirths.
 Total Births = Total Number of Stillbirths + Live Births.
 In cases of intrapartum transfers, deliveries are to be reported by the
hospital of delivery, not the hospital of referral.
 Total Number of Deliveries is all modes of delivery added together.
 Include unknown types of deliveries under the Other field.
 The Emergency Caesarean Section and the Elective Caesarean
Section fields will usually be zero for Subdivisional Hospitals, unless
there has been a surgical delivery performed by a flying squad from
the Divisional Hospital.

Counting rules
Read and discuss each of the points in the counting rules with participants. Reinforce
these counting rules for correctly entering data in the birth and delivery sections of the
HMCH.

Discussion
Ask participants to discuss with the person next to them the key data

they will gather from the birth and delivery sections.

Scenarios
Ask participants to read the scenarios in the User Guide and discuss how

each would be reported on the form.

Indicators
Discuss what the birth and delivery data tells us.


2.3 Antenatal care

Explain that the antenatal care section is reported from all health facilities (i.e. Nursing
Stations, Health Centres, Subdivisional Hospitals, and Divisional Hospitals). Discuss the
two main sections of this reporting, which are:
 ANC booking visit — which reports on the first ANC visit only.
 All other ANC visits — which reports on all of the other ANC visits. In hospital
settings (HMCH) this section does not have an Out of Area field, whereas this field
is in the PHIS Monthly Statistical Summary Form.

Key point
The total number of visits seen in all other ANC visits in the month is the

total number of normal and at risk pregnancy visits.

Counting rules
the counting rules for correctly entering data in the ANC sections of the forms.

Discussion

they will gather from these sections.

Indicators
Discuss what the antenatal care data tells us.

2.4 Postnatal care

Discuss that the postnatal care section is reported from all health facilities (i.e. Nursing
Stations, Health Centres, Subdivisional Hospitals, and Divisional Hospitals) and the only
difference is that hospitals will not be reporting on Outside Area.

 12  V1.1  October 2016

Practical activity
Ask participants to take about 10 minutes to work as a group to

brainstorm examples they have experienced of:
 complications or concerns a woman suffered in the postnatal period
 responses that were needed to support the woman’s complication or
concern.

Invite answers and write these on the board or butcher’s paper.

Now ask participants to identify whether any of the concerns were
commonly‐seen problems.
Encourage a discussion about how any information gained about a
problem like this can be used to identify a range of responses to help
resolve these issues.

Counting rules
the counting rules for correctly entering data in the PNC section of the forms.

Scenario
Ask participants to read the scenario in their User Guide and discuss

their answers.

Indicators
Discuss with participants the key data they will gather from the PNC section.

Health Centre
2.5 Holding beds

Nursing Station
Explain that the holding beds section is only reported from Nursing Stations and Health
Centres.
Explain that this section records the number and use of the holding beds in the facility.
These holding beds are used for:


 stabilising patients who may need referral to hospital
 observation after treatment and before discharge home
 emergency delivery.

Confirm with participants that patients should not be held for more than 12 hours
before referral or discharge.
Counting rules
the counting rules for correctly entering data in the holding beds section.
Indicators
Discuss with participants the key data they will gather from the holding beds section.

Key points
 You should count couches and similar arrangements as beds here, as
long as these are staffed and used regularly by patients.
 The bed occupancy rate is calculated as:

Total number of inpatient days
x 100
No. of beds x No. of days in the month

2.6 Family planning

Explain that the family planning section is reported from all health facilities (i.e.
Nursing Stations, Health Centres, Subdivisional Hospitals, and Divisional Hospitals).
The differences between the forms are:
 Only the hospitals (HMCH) will be reporting on Vasectomy and Tubal Ligation.
 In the PHIS form it is a requirement for the CBA population to be reported every
month, but this is not a requirement for HMCH.

Discussion
Ask participants to identify the purpose of the family planning program.

Share responses and review the following information.

 14  V1.1  October 2016

The family planning program aims to:
 Encourage the mother/parents to space their children, to ensure wellness for both
mother and child.
 Provide information to the mother/parents on the safety and effectiveness of
various family planning methods.
 Help the mother/parents prevent sexually transmitted infections (STIs).

Explain that in this section participants must record the family planning activity that
happened in the past month and only that activity. Reinforce that participants should
not record the number of women in their catchment who are protected, but the
number of women who attended the clinic and received one of the family planning
methods during the month.
Note that at the top of the PHIS Monthly Statistical Summary Form, the health worker
is to record the number of women of child bearing age (CBA) in their catchment this
year. If they don’t know the breakdown by ethnicity, then they just record the total
number of women of CBA in their catchment.
Counting rules
the counting rules for correctly entering data in the FP section of the forms.
Indicators
Discuss with participants the key data they will gather from the FP section.

Key point
It is not possible to calculate the contraceptive coverage from

distribution data of health facilities. CMRIS Online calculates the Years of
Protection distributed for each contraceptive method. If calculated over
the whole year, the Years Protection from all contraceptive methods is
roughly equal to the number of women who had contraceptive
protection coverage for the year. Remember that this only includes the
contraceptive protection distributed by your facility. This is also
dependent on the reporting of contraceptive distribution of each facility.


Health Centre
2.7 Non-communicable diseases

Nursing Station
Explain that the NCD section is only reported from Nursing Stations and Health
Centres. Discuss with participants that there are five conditions reported in the non‐
communicable diseases section of the PHIS Monthly Statistical Summary Form. These
are:
 Diabetes
 Hypertension
 Dual (diabetes and hypertension)
 Rheumatic heart disease
 Foot care.

Explain that this section records information about all patients who have been
diagnosed with any of the five non‐communicable diseases, and who are within the
participants’ catchment areas. The data recorded in this section comes from the
national screening program, which aims to screen 20% of adults over 30 years of age in
each catchment each year.
Counting rules
the counting rules for correctly entering data in the NCD section of the form.
Indicators
Discuss with participants the key data they will gather from the NCD section.

Key point
Example: If a person is already recorded with hypertension in the

register and this month is diagnosed with diabetes, then this month the
person should be recorded as a new diabetes case (NC) and an existing
hypertension case in the TR column. In the next reporting months the
person should be recorded as an existing (TR) dual case on the register.
If a new case is diagnosed with diabetes and hypertension at the same
time, then record them as a new case in the Dual column. Do not also
record them in the individual diabetes and hypertension columns. Only
record these in the Dual column (NC).

 16  V1.1  October 2016

2.8 Immunisation

Explain that the immunisation section is reported from all health facilities (i.e. Nursing
Stations, Health Centres, Subdivisional Hospitals, and Divisional Hospitals), and the
only difference is that hospitals will not be reporting on Out of Area and the Target
Population.
Highlight to participants that the provision of immunisation services is an important
part of public healthcare delivery. Explain that the monitoring of coverage rates is also
an essential part of preventing disease outbreaks and for the evaluation of
immunisation programs at a national level. Conscientious and deliberate efforts are
required to control vaccine‐preventable disease, and accurate information about the
number of immunisations, populations, and defaulters is an essential part of this
process.
Reinforce that the aim of immunisation activity is to reduce the incidence of vaccine‐
preventable diseases.

Practical activity
Ask participants to work with a partner for approximately 5 minutes to:

 Identify the benefits of immunisation to the community.
 Identify the impact of poorly maintained immunisation programs (on
the community, and health service).

Invite responses, and discuss the impacts and how participants
addressed these issues in their team.

Read the following points and discuss:
 In the top line record the immunisation Target Population for the year. This is only
reported in the PHIS Monthly Statistical Summary Form and not in the Hospital
Maternal and Child Health Data Collection Form.
 The Target Population is the number of children under 1 year of age in your
catchment area.
 This Target Population should be calculated each year from the number of births in
the previous year and used in local coverage monitoring graphs.


Counting rules
the counting rules for correctly entering data in the immunisation section of the forms.

Discussion

they will gather from this section.

Key point
The Immunised row should record all immunisations given, including

Out of Area. The Out of Area count is included as part of this row, but
also reported separately in the line underneath.

Indicators
Discuss what the immunisation data tells us.

2.9 Cervical cancer screening

Explain that the cervical cancer screening section is reported from all health facilities
(i.e. Nursing Stations, Health Centres, Subdivisional Hospitals, and Divisional Hospitals).

Practical activity
Ask participants to brainstorm which maternal services points can screen

for cervical cancer.
Some responses that would be expected are:
 Antenatal clinic
 Family planning clinic
 Outreach
 Postnatal clinic.

Invite answers and write them on the whiteboard or butcher’s paper.

 18  V1.1  October 2016

Counting rules
the counting rules for correctly entering data in this section of the forms.

Discussion


Indicators
Discuss what the cervical cancer screening data tells us.

2.10 IMCI

Explain that the IMCI section is reported from all health facilities (i.e. Nursing Stations,
Health Centres, Subdivisional Hospitals, and Divisional Hospitals).
Explain that all IMCI data obtained at clinics is to be reported in that reporting month.
This is divided into two sections according to the age of the baby, as noted below:
 2 months to 5 years — to capture data from 2 months of age up to <5 years of age.
 Birth to 2 months — to capture data from birth up to <2 months of age.

Key point
Please note that IMCI data can only be completed by nursing staff who

have received IMCI training (FNU CMNHS or MoHMS in‐service). All
other staff should record under GOPD in the Outpatient Services section
of the PHIS Monthly Statistical Summary Form.

Counting rules
the counting rules for correctly entering data in this section of the forms.


Discussion

they will gather from these sections.

Indicators
Discuss what the IMCI data tells us.

Health Centre
2.11 Well child clinic

Nursing Station
Explain that the well child section is reported from Nursing Stations and Health Centres
only. Explain to the group that this is because well children are only seen in these
facilities and not in hospital settings.
Elaborate that a well child clinic is the normal child health clinic that occurs in a weekly
to a monthly clinic.
Counting rules
the counting rules for correctly entering data in this section of the PHIS Monthly
Statistical Summary Form.
Indicators
Discuss what the well child clinic data tells us.

Health Centre
2.12 Medicine stock out

Nursing Station
Explain that the medicine stock out section is reported from Nursing Stations and
Health Centres only.
Explain to the group that reporting on stocks such as medicines is vital to build an
understanding of the availability of resources.
This question records any medicines or drugs that were out‐of‐stock at your facility for
1 week or more over the past month.

 20  V1.1  October 2016

Key point
This information is used for statistical reporting only. You should order

any out‐of‐stock medicines using the usual order forms and processes.

Practical activity
Ask participants to work with a partner for approximately 15 minutes to

identify:
 Key issues they face with drug stocks, ordering, and storage.
 The benefits of identifying medicine stock outs on the PHIS form.

Invite responses and draw out the key issues. Reinforce the benefits of
collecting and recording data on medicine stock outs in the PHIS
Monthly Statistical Summary Form.

Counting rules
Indicators
Discuss what the medicine stock out data tells us.

Health Centre
2.13 Outpatient services

Nursing Station
Explain that the outpatient services section is reported from Nursing Stations and
Health Centres only.
Discuss with the group that capturing data about outpatient operations at health
facilities is another excellent quality and performance indicator.
Read and discuss the following points:
This section aims to monitor and ensure the provision of quality health care to all
outpatients through:
 Implementation of health assessments.


 Implementation of prescribed treatment/orders.
 Rapid assistance in emergency cases.
 Appropriate referrals and providing continuity of care through planning,
coordinating, and exchanging information.

Further explain that the outpatient services reported in this section vary from initial
illness presentation and follow‐up/routine medical checks, to emergency cases and
also referral.
These can be reported from four different levels of services, which are GOPD, SOPD,
shift clinics, and home visits.
Counting rules
Indicators
Discuss what the outpatient data tells us.

2.14 PHIS statistical summary and HMCH submission and

feedback processes
Discuss that submitting relevant, accurate, and timely data is crucial in any activity,
because this enables decision‐makers to base their decision on relevancy and
evidence.
Health Centre
Submission and feedback of PHIS statistical summary data

Nursing Station
Refer to the flow chart about the submission and feedback process for the PHIS
Monthly Statistical Summary Form in the User Guide. Using this flow chart, explain the
three main stages of the data to information flow of this reporting form. These are:
 data collection
 data analysis
 feedback.

 22  V1.1  October 2016

Figure 2.1: Data flow of the PHIS Monthly Statistical Summary Form

(FHSSP, 2016)

Subdivisional Divisional
Submission and feedback of HMCH data

Hospital Hospital
Refer to the flow charts about submission and feedback processes for the HMCH in the
User Guide. Using these flow charts, explain the three main stages of the data to
information flow of this reporting form at Subdivisional and Divisional Hospitals. These
are:
 data collection
 data analysis
 feedback.


Subdivisional Hospital submission and feedback process

Figure 2.2: Data flow of the HMCH at Subdivisional Hospitals

(FHSSP, 2016)

 24  V1.1  October 2016

Divisional Hospital submission and feedback process

Figure 2.3: Data flow of the HMCH at Divisional Hospitals

(FHSSP, 2016)


 26  V1.1  October 2016
Section 3 — PHIS Monthly Narrative Summary Form Facilitator’s Guide

Section 3 — PHIS Monthly Narrative

Summary Form

Session plan
Session 2 PHIS Monthly Narrative Summary Form
Topics to be covered  PHIS Monthly Narrative Summary Form.

 Submission and feedback of the PHIS Monthly Narrative
Summary Form.
Activities  Practical activity.
 User Guide.
 PHIS Monthly Narrative Summary Form.
 Pens and paper.

Health Centre
3.1 PHIS Monthly Narrative Summary Form

Nursing Station
Explain that the PHIS Monthly Narrative Summary Form is used to record issues that
have affected the recording and reporting of PHIS data. These issues might include:
 Natural disasters — where registers are damaged.
 Improper handover.
 Out of registers.
 Lack of training.


Practical activity
Ask participants to think about any of the issues listed. Invite them to

share examples, as well as the impacts these situations or issues have
had on the health information and health services.

Ask participants to brainstorm answers to the following questions:
 Why is it important to acknowledge and identify these issues?
 What strategies have participants used in the past to overcome any
of these issues and resume reporting their PHIS data?

Write responses on the board and discuss. Identify any key strategies
that were useful and successful.

Key point
Be sure to write the month at the top of the PHIS Monthly Narrative

Summary Form.

Health Centre
3.2 Submission and feedback of the PHIS Monthly

Narrative Summary Form Nursing Station

Refer to the flow chart about the submission and feedback process for the PHIS
Monthly Narrative Summary Form in the User Guide. Using this flow chart, explain the
three main stages of the data to information flow of this reporting form. These are:
 data collection
 data analysis
 feedback.

 28  V1.1  October 2016
Section 3 — PHIS Monthly Narrative Summary Form Facilitator’s Guide

Figure 3.1: Data flow of the PHIS Monthly Narrative Summary Form

(FHSSP, 2016)

Remind participants of the following key points, and discuss and clarify them to resolve
any confusion.

Key points
 Make sure you send in a birth notification for each community birth
recorded on the PHIS Monthly Narrative Summary Form.
 The MO must submit a Death Certificate for each community death.


 30  V1.1  October 2016
Section 4 — School Summary Form Facilitator’s Guide

Section 4 — School Summary Form

Session plan
Session 3 School Summary Form
Topics to be covered  School Summary Form.

 Submission and feedback of the School Summary Form.
 Discussion.
 User Guide.
 School Summary Form.
 Pens and paper.

Health Centre
4.1 School Summary Form

Nursing Station
Explain and discuss that the School Summary Form should be completed whenever the
primary school is visited to:
 screen children
 give immunisations.

Remind participants that the School Summary Form should be sent to the SDHS at the
end of the month.


Practical activity
Ask participants to discuss the following questions in the larger group:

 What screening activities do they complete when attending a
school? (What are they screening for?)
 What immunisations are given to school‐aged children?
 What is the benefit of collecting, recording, and reporting data from
primary schools?

Invite participants to share their responses. Put these on the board and
highlight the key points and purpose of the School Summary Form.

Key point
Remember that the target population for HPV vaccinations is grade 8

girls, but girls who are repeating the year and were vaccinated the
previous year should not be vaccinated again or included in this column.

Counting rules
Read and discuss the counting rules with the participants. Reinforce the counting rules
for correctly entering data in the School Summary Form.

Discussion
Invite questions from participants and discuss identified issues.

Health Centre
4.2 Submission and feedback of the School Summary

Form Nursing Station

Refer to the flow chart about the submission and feedback process for the School
Summary Form in the User Guide. Using this flow chart, explain the three main stages
of the data to information flow of this reporting form. These are:
 data collection
 data analysis
 feedback.

 32  V1.1  October 2016
Section 4 — School Summary Form Facilitator’s Guide

Figure 4.1: Data flow of the School Summary Form

(FHSSP, 2016)

The flow chart shows the flow of data from School Health, Zone, and District Nurses
when collating the School Summary Forms every month. A copy is submitted to SDHS,
one is to be retained by the School Health Sister and Zone and District Nurses, and a
copy is also submitted to the Medical Area for management, but not for reporting.


 34  V1.1  October 2016
Section 5 — Nutritional Monthly Report Form Facilitator’s Guide

Section 5 — Nutritional Monthly

Report Form

Session plan
Session 4 Nutritional Monthly Report Form
Topics to be covered  Sections of the Nutritional Monthly Report Form:

 Breastfeeding.
 National Iron and Micronutrient Supplement (NIMS).
 Moderate acute malnutrition.
 Severe acute malnutrition.
 Submission and feedback of the Nutritional Monthly Report
Form.
Activities  Practical activities.
 Discussion.
 Scenario.
 User Guide.
 Nutritional Monthly Report Form.
 Pens and paper.

Health Centre
5.1 Nutritional Monthly Report Form

Nursing Station
Confirm that participants each have a copy of the Nutritional Monthly Report Form.
Explain that the Nutritional Monthly Report Form consists of tables that are completed
by Nurses and Dieticians.


Practical activity
Ask participants to review the Nutritional Monthly Report Form. Then

ask them to discuss the form with the person next to them to identify all
of the changes they noticed on the revised form.
Invite responses and discuss the new sections that are the main changes
to the form.

Health Centre
5.2 Breastfeeding
Nursing Station
Explain that this report is only submitted from Nursing Stations and Health Centres.

Discussion
Encourage a general discussion to start the topic on nutrition.

Ask participants to identify issues and preventable outcomes they have
seen that were caused by poor breastfeeding.

Reinforce that a focus on the role of breastfeeding is an essential part in assessing the
health potential of all clients, and that reporting data on nutrition is important.
Explain that they will only report data from specific visits. These are:
 the first MCH visit
 when the baby is at or near 6 months of age
 when the baby is at or near 2 years of age.

Counting rules
the counting rules for correctly entering data in this section of the form.

Key points
 Record every child once and only once at each of the three visits.
Doing this is essential for the accurate calculation of indicators and
national statistics.

 36  V1.1  October 2016

 Exclusive breastfeeding refers to those babies who are breastfed
from birth to close to 6 months of age.
 For the 6 month Exclusive Breastfeeding field, collect/capture only
those babies exclusively breastfed at 6 months of age. This refers to
the capture of information at a cross‐sectional point in time — the
time being near to 6 months of age.
 It is essential that each baby be recorded at each of the time points
that are applicable to them. These time points refer to three cross‐
sectional time points: the first MCH visit, when the baby is at or near
6 months of age, and when the baby is at or near 2 years of age.
 Exclusive breastfeeding means that the infant receives only breast
milk. No other liquids or solids are given — not even water — with
the exception of oral rehydration solution, or drops/syrups of
vitamins, minerals, or medicines. WHO recommends that infants
should be exclusively breastfed for the first six months of life to
achieve optimal growth, development, and health. Thereafter,
infants should receive nutritionally adequate and safe
complementary foods, while continuing to breastfeed for up to
2 years or more.

Indicators
Discuss what the breastfeeding data tells us.

Health Centre
5.3 National Iron and Micronutrient Supplement

(NIMS) Nursing Station

Explain that the Nutritional Monthly Report Form collects NIMS data for children under
five years of age only.

Practical activity
Ask participants to turn to the person next to them and provide a brief

explanation of the purpose of NIMS. After 5 minutes, ask the person
who received the explanation to share that response with the group.


Explain that it is important to understand the benefit of NIMS in relation
to anaemia and micronutrient deficiencies, as well as the ability to
reduce the impact of preventable disease and illness for children.
Counting rules
the counting rules for correctly entering data in this section of the form.

Scenarios
Ask participants to read the scenarios in their User Guide and discuss

their answers.

Indicators
Discuss what the NIMS data tells us.

Health Centre
5.4 Moderate acute malnutrition

Nursing Station
Discuss that moderate acute malnutrition (MAM) is normally observed in well children
who usually do not present with any complications. In classifying children in this
category, health workers are required to use the weight‐for‐length scale.
Explain that for children to be classified as having moderate acute malnutrition under
the weight‐for‐length scale, they must be between –2 standard deviations to –3
standard deviations. Explain that the weight‐for‐length scale is divided by sex in the
respective age categories, which are birth to 2 years, and 2 years to 5 years.

Practical activity
Ask participants to look at examples 1 and 2 in their User Guide.

Invite participants to come up with other examples and confirm the
category of malnutrition.

 38  V1.1  October 2016

Key points
 Children reported in this section are those who were detected at
well child clinics (which are MCH clinics), GOPD, or A&E, and were
treated by non‐IMCI‐trained Nurses and Dieticians.
 Those children who are seen at the IMCI clinic will be reported under
the IMCI section of the PHIS Monthly Statistical Summary Form.
 Only the facility that initiates first treatment should report this, to
avoid double reporting.

Counting rules
the counting rules for correctly entering data in this section of this reporting tool.
Indicator
Discuss what the MAM data tells us.

Health Centre
5.5 Severe acute malnutrition

Nursing Station
Explain that for children to be classified as having severe acute malnutrition (SAM)
under the weight‐for‐length scale, they must be below –3 standard deviations. Explain
that the weight‐for‐length scale is divided by sex in the respective age categories,
which are birth to 2 years, and 2 years to 5 years.

Practical activity
Ask participants to look at the example in their User Guide.

Invite participants to come up with other examples and confirm the
category of malnutrition.

Key points
 Children reported in this section are those who were detected at
well child clinics, which are MCH clinics, and were treated by non‐
IMCI‐trained Nurses and Dieticians.


 Those children who are seen at IMCI clinics will be reported under
the IMCI section of the PHIS Monthly Statistical Summary Form.
 Only the facility that initiates first treatment should report this, to
avoid double reporting.

Counting rules
the counting rules for correctly entering data in this section of this reporting tool.
Indicators
Discuss what the SAM data tells us.

Health Centre
5.6 Submission and feedback of the Nutritional

Monthly Report Form Nursing Station

Explain that the process for submitting the Nutritional Monthly Report Form is similar
to submitting the PHIS Monthly Statistical Summary Form. Confirm that this will
require Nurses and Dieticians to work collaboratively, depending on the settings they
are present in. The collation will be completed by the Area Medical Officers or Nurse
Practitioners.
Refer to the flow chart about the submission and feedback process for the Nutritional
Monthly Report Form in the User Guide. Using this flow chart, explain the three main
stages of the data to information flow of this reporting form. These are:
 data collection
 data analysis
 feedback.

 40  V1.1  October 2016

Figure 5.1: Data flow of the Nutritional Monthly Report Form

(FHSSP, 2016)


 42  V1.1  October 2016
Section 6 — Subdivisional Hospital Monthly Return Facilitator’s Guide

Section 6 — Subdivisional Hospital

Monthly Return

Session plan
Session 5 Subdivisional Hospital Monthly Return
Topics to be covered  Sections of the Subdivisional Hospital Monthly Return:

 Admissions, discharges, and deaths.
 Maternity services.
 Outpatient services.
 Special outpatient services.
 Outreach services.
 Ambulatory services.
 Submission and feedback of the Subdivisional Hospital
Monthly Return.
 Scenarios.
 Discussions.
 User Guide.
 Subdivisional Hospital Monthly Return.
 Pens and paper.

Subdivisional
6.1 Subdivisional Hospital Monthly Return

Hospital
Confirm that participants each have a copy of the Subdivisional Hospital Monthly
Return form.


Explain that the Subdivisional Hospital Monthly Return contains tables for data to be
collected and reported. The data counts the number of services that are provided in
Subdivisional Hospitals. At the end of each calendar month, the person responsible
compiles the data from the registers and records it carefully and accurately into the
Subdivisional Hospital Monthly Return. This form must then be submitted and received
within 7 days by the Sister‐In‐Charge/Charge Nurse.

Practical activity
Ask participants to review the Subdivisional Hospital Monthly Return.

Then ask them to discuss the form with the person next to them to
identify all of the changes they noticed on the revised form.
Invite responses and then discuss the improvements. These sections are
GOPD, SOPD, outreach services, and ambulatory services.

Subdivisional
6.2 Admissions, discharges, and deaths

Hospital
Discuss each section of this part of the form with participants. Note that admissions
and discharges are categorised by wards, and deaths are categorised by age.
Admissions
Explain that this section counts the number of patients who were admitted in each of
the wards in the Subdivisional Hospital.

Key points
 Admissions do not include:
 Boarder cases, unless they are admitted. Boarders are people
who are not under the hospital’s care, but may be getting food or
accommodation from the hospital. For example, when a sick child
is admitted to hospital and the mother stays with the child, the
mother is considered to be a boarder.
 Well babies born in hospital.
 Note that a patient doesn’t have to stay overnight to be counted as
an admission. If the initial intent was to admit the patient, this will
be counted as an admission, regardless of the time period (even if it
is less than a day).

 44  V1.1  October 2016

Indicators
Discuss what the admissions data tells us.

Discharges
Explain that discharges from Subdivisional Hospitals include those who have been
discharged back to the community and/or those who have been transferred out of the
hospital for a higher level of care to Divisional Hospitals, the National Referral Hospital
(CWMH), or Specialised Hospitals (Twomey Hospital, Tamavua Rehabilitation Hospital,
and St Giles Hospital).

Key point
The total number of discharges and number of in‐hospital deaths in the

month should be equal to the total number of tear‐offs received in that
reporting month. Therefore, the submission of this report should include
the corresponding tear‐offs (see Section 7 for more information about
tear‐offs).

Scenarios

their answers.

Discussion


Indicators
Discuss what the discharges data tells us.

Unplanned re-admissions (less than 28 days)

Explain that unplanned re‐admission is an event in which a patient is re‐admitted for
the same condition within a specified period of time, which is less than 28 days. Clarify
that a person discharged with diabetes and then admitted with a broken leg is not an
unplanned re‐admission.


Scenarios

their answers.
Indicators
Discuss what the re‐admissions data tells us.

Deaths
Explain that there are two types of deaths reported:
 Deaths in hospital — Deaths that occur in the hospital, either in the ward or in
A&E.
 Deaths on arrival — Deaths that are received by the hospital. That is, when a
person is found to be clinically dead before the arrival of professional medical
assistance.

Key point
The total number of deaths in the month should be equal to the number

of MCDCs issued, unless a post‐mortem is required. In this case the
MCDC will be sent later.

Scenarios

their answers.

Indicators
Discuss what the deaths data tells us.

Bed days
Explain that this section reports on bed days, which determine the bed occupancy of
the hospital in a certain period. Note that a bed day is defined as an occupied bed in a
24‐hour period where there is a patient physically in the bed or the bed is being

 46  V1.1  October 2016

retained for the patient. The bed occupancy rate, then, is the percentage of beds
occupied by hospital inpatients for a given period of time.

Scenarios
Ask participants to read the scenarios in their User Guide.

Explain each of the calculations and discuss the answers.

Indicator
Discuss what the bed occupancy data tells us.

Subdivisional
6.3 Maternity services

Hospital
Explain to the participants that this section reports on the activities that are
undertaken in the Maternity Unit in Subdivisional Hospitals.
Elaborate that this section covers other areas of maternity services, apart from those
reported in the Hospital Maternal and Child Health Data Collection Form. Sections
covered in this area are:
 ANC lab tests — This reports on the number of lab test results that were received
this month.
 At risk supplements — This section reports on the supplements given to babies
after birth.
 Conditions at birth — This section collects data on complications during delivery.

Discussion


Indicators
Discuss what the maternity data tells us.


Subdivisional
6.4 Outpatient services

Hospital
Explain to participants that this section looks into the number of general outpatients
that present at GOPD and A&E. These are normally walk‐ins and return visits. Injuries
are reported in more detail by looking at the cause(s) of the injury.
Confirm that this section is divided into two major areas, which are:
 GOPD and A&E — According to the categories, clients are recorded from either the
GOPD or A&E area of the Subdivisional Hospital.
 GOPD and A&E injuries — These are injuries that presented at A&E and GOPD.

Discussion

Indicators
Discuss what the outpatient services data tells us.

Subdivisional
6.5 Special outpatient services

Hospital
Explain to participants that this involves those cases that are booked in for special
clinics. These are mostly for chronic cases that are detected, treated, and monitored at
the Subdivisional Hospital level.
Confirm that this section is divided into two major sections, which are:
 SOPD new cases — Reports on the new cases of special outpatients that were
detected in multiple entry points in Subdivisional Hospitals.
 SOPD clinics — Reports on cases that are normally the registered chronic cases that
come in for clinic to monitor compliance or to improve compliance in patients.

Discuss with participants how their subdivision operates with regard to SOPD cases.

 48  V1.1  October 2016

Key point
For Diabetes, the number of new diabetic patients reported should be

accompanied by individual Diabetes Notification Forms that are received
by HIU.

Scenario
Ask participants to read the scenarios in their User Guide and discuss the

answers.

Discussion


Indicators
Discuss what the special outpatient data tells us.

Subdivisional
6.6 Outreach services

Hospital
Explain to participants that this section reports only on the number of outreach
services that are conducted by MoHMS (e.g. Divisional/Specialised Hospitals) or civil
society organisations.

Discussion
Discuss with the participants the categories of services included in

outreach services. Invite participants to discuss the types of outreach
that their subdivisions have received in the past year.

Scenario
Ask participants to read the scenario in their User Guide.

Discuss how the data will be reported.


Discussion


Indicators
Discuss what the outreach services data tells us.

Subdivisional
6.7 Ambulatory services

Hospital
Explain that ambulatory services report on the transfer of patients from Subdivisional
Hospitals to higher levels of care in Divisional Hospitals or Specialised Hospitals. This
report is divided by mode of transport and clinical disciplines.

Discussion


Indicators
Discuss what the ambulatory services data tells us.

Subdivisional
6.8 Submission and feedback of the Subdivisional

Hospital Monthly Return Hospital

Explain to participants that the Sister‐In‐Charge/Charge Nurse is responsible for
submitting the Subdivisional Hospital Monthly Return.
Refer to the flow chart about the submission and feedback process for the
Subdivisional Hospital Monthly Return in the User Guide. Using this flow chart, explain
the three main stages of the data to information flow of this reporting form. These are:
 data collection
 data analysis
 feedback.

 50  V1.1  October 2016

Figure 6.1: Data flow of the Subdivisional Hospital Monthly Return

(FHSSP, 2016)


 52  V1.1  October 2016
Section 7 — Tear‐offs Facilitator’s Guide

Section 7 — Tear-offs

Session plan
Session 6 Tear-offs
Topics to be covered  Tear‐offs.

 User Guide.
 Tear‐offs.
 Pens and paper.

Subdivisional
7.1 Tear-offs
Hospital
Confirm that participants each have a copy of the tear‐offs.
Explain that the tear‐offs give a summary of the admissions to the Subdivisional
Hospital.
Explain that the total number of tear‐offs in a month should be equal to the total
number of discharges and total number of in‐hospital deaths, which are reported in
the Subdivisional Hospital Monthly Return.
Tear‐offs are a duplicate copy of the inpatient folder, which is summarised in a page. It
is important to complete each section of the tear‐offs, because this will allow decision‐
makers to plan resources with regard to health for the future.


Key points
 Tear‐offs will be submitted monthly with the Subdivisional Hospital
Monthly Return.
 The total number of tear‐offs should be equal to the number of in‐
hospital deaths and discharges for the reporting month.

Discuss with participants the descriptions of the fields in the tear‐offs, which are in a
table in their User Guide.

 54  V1.1  October 2016
References Facilitator’s Guide

References

Fiji Government Ministry of Health National FPAN Advisory Committee. (July 2010).
The Fiji plan of action for nutrition (FPAN) 2010–2014. Suva: Fiji Government
Ministry of Health.
Fiji Health Sector Support Program. (June 2015). Expanded program on immunisation:
Practice manual. Suva: FHSSP & MoHMS.
Malul, Y. (2010). File: weight vs gestational age.jpg. Wikimedia commons. Retrieved
20 October 2016, from <https://commons.wikimedia.org/wiki/File:Weight_vs_
gestational_Age.jpg#filelinks>.
UNICEF & World Health Organization. (2009). Section 4: Hospital self‐appraisal and
monitoring. Baby‐friendly hospital initiative. Geneva: Author.
World Health Organization. (2013). Pocket book of hospital care for children:
Guidelines for the management of common childhood illnesses (2nd ed.). Geneva:
Author.
World Health Organization. (2014). Maternal mortality ratio (per 100 000 live births).
Programmes: Health statistics and information systems. Retrieved 20 June 2014,
from <http://www.who.int/healthinfo/statistics/indmaternalmortality/en>.


 56  V1.1  October 2016
Annexes Facilitator’s Guide

Annexes

Annex A Tetanus Toxoid Schedules

Annex B Reporting templates
Annex C Participant feedback form
Annex D Trainer feedback form


Annex A — Tetanus toxoid schedules

Immunisation Schedule D for women of child-bearing age 15–49 years old
Dose When to give Level of protection

Td1 At first contact or as early as possible in pregnancy None
Td2 At least 4 weeks after Td1 1–3 years
Td3 At least 6 months after Td2 5 years
Td4 At least 1 year after Td3 or during subsequent 10 years
pregnancy
Td5 At least 1 year after Td4 or during subsequent All child‐bearing years
pregnancy

Second or subsequent pregnancy or women who have been previously

immunised with 3 doses of Td vaccine
Timing Vaccine Dose Route Site

At first contact Td4 0.5 mL Intramuscular Upper arm
One year later or during Td5 0.5 mL Intramuscular Upper arm
subsequent pregnancies

Women who have been previously immunised with 4 doses of Td vaccine

At first contact Td5 0.5 mL Intramuscular Upper arm

Women who have been previously immunised with 5 doses of Td vaccine

 Presentation to Td6 0.5 mL Intramuscular Upper arm
antenatal clinic with
first pregnancy
 20 years after previous Td7 and
dose subsequent
doses
Booster doses of Td are required every 20 years during child‐bearing years

(FHSSP, 2015)

 58  V1.1  October 2016

Annex B — Reporting templates

PHIS Monthly Statistical Summary Form


Hospital Maternal and Child Health Data Collection Form

 60  V1.1  October 2016

PHIS Monthly Narrative Summary Form

School Summary Form


Nutritional Monthly Report Form

Month Year Division Medical Area Zone/District (if applicable)
Subdivision Facility Reporting Officer
MCH Clinic Breast-feeding
First MCH visit Six month Two years
Exclusive breast‐ Partial breast‐
Number Out of Number Exclusive breast‐feeding Number
feeding Default feeding
area
F M F M F M F M F M F M
IT
FI
O
National Iron & Micronutrients Supplements - NIMS

6 – 11months 12-23months 24 - 59months
M NP Vitamin A Dewo rmed Vitamin A M NP Dewo rmed Vitamin A M NP
IT
FI
O
Moderate Acute Malnutrition (MAM) Severe Acute Malnutrition (SAM)

0- 11months 12-23months 24-60months 0-11months 12-23months 24-60months
M F M F M F M F M F M F
IT IT
FI FI
O O
T T

 62  V1.1  October 2016

Subdivisional Hospital Monthly Return


Annex C — Participant feedback form

CMRIS Data Collection Manual

Date: Location:

We value your feedback about the training you have just received, and appreciate any
comments that will assist us to improve the training in the future.
Please indicate how useful you Very useful Somewhat Not useful
found the: useful
Training overall
Topics/information covered
Training manual/other materials
Practical activities

Please indicate how effective Very effective Effective Not effective

you found the:
Method and format of the training
Style and expertise of the
facilitator(s)

What were the most relevant aspects of the training for you?

What changes can you suggest to make this training more relevant or useful for
you?

How confident are you about applying this training to your own work and sharing
the knowledge and skills with others in your team?

Comments

Was the venue suitable? Yes No

Why? Why?

 64  V1.1  October 2016

Annex D — Trainer feedback form

CMRIS Data Collection Manual

Date Where/who you will

today: be training:

As you participate in this training, take a moment to consider how you might deliver the
training to your audiences. Note some ways the training delivery and materials could be
improved to make them more effective for when you are using them to train your audiences.
Part of Specific details Your feedback

training Describe briefly what content  Suggested information or activity that would
or aspect you are providing help deliver this part of the training
feedback about  Change or addition to materials that would help
to deliver this part of the training
Introducing
training
Section 1

Section 2

Section 3

Section 4

Section 5

Section 6

Section 7

Concluding
training
Any other
aspect of
training


 66  V1.1  October 2016

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Version 1.1, October 2016

Glossary of key terms

Anaemia in pregnancy Blood haemoglobin level of ≤11 g/dl, usually caused by dietary

Early booking When pregnant women attend their first ANC visit early in their

Normal pregnancy A pregnancy with no apparent risks identified outside of the

Section 1 — Introduction and

CMRIS Data Collection Manual User Guide

Symbols for facilities

Health Centre/ Subdivisional Hospital Divisional Hospital

Prepare other resources

Competency for CMRIS data collection training

Competency Use the data collection forms for

1. Become familiar with the purpose 1.1 Describe the purpose and types of information

Using this Facilitator’s Guide

Training tips and preparation

Create a comfortable and encouraging learning environment

Consider different ways of learning

Brainstorming — some tips for brainstorming are:

Other tips to support participants

Section 2 — PHIS and HMCH

Session 1 PHIS and HMCH

Topics to be covered  Sections of the PHIS Monthly Statistical Summary Form and

2.1 PHIS Monthly Statistical Summary Form, and Hospital

2.2 Birth and delivery

Health Centre Subdivisional Divisional

2.3 Antenatal care

2.4 Postnatal care

2.5 Holding beds

2.6 Family planning

2.7 Non-communicable diseases

Health Centre Subdivisional Divisional

2.9 Cervical cancer screening

2.11 Well child clinic

2.12 Medicine stock out

2.13 Outpatient services

2.14 PHIS statistical summary and HMCH submission and

Submission and feedback of PHIS statistical summary data

Submission and feedback of HMCH data

Subdivisional Hospital submission and feedback process

Figure 2.2: Data flow of the HMCH at Subdivisional Hospitals

Divisional Hospital submission and feedback process

Figure 2.3: Data flow of the HMCH at Divisional Hospitals

Section 3 — PHIS Monthly Narrative

Session 2 PHIS Monthly Narrative Summary Form

Topics to be covered  PHIS Monthly Narrative Summary Form.

3.1 PHIS Monthly Narrative Summary Form

3.2 Submission and feedback of the PHIS Monthly

Section 4 — School Summary Form

Session 3 School Summary Form

Topics to be covered  School Summary Form.

4.1 School Summary Form

4.2 Submission and feedback of the School Summary

Figure 4.1: Data flow of the School Summary Form

Section 5 — Nutritional Monthly

Session 4 Nutritional Monthly Report Form

Topics to be covered  Sections of the Nutritional Monthly Report Form:

5.1 Nutritional Monthly Report Form

5.3 National Iron and Micronutrient Supplement

5.4 Moderate acute malnutrition

5.5 Severe acute malnutrition

5.6 Submission and feedback of the Nutritional

Figure 5.1: Data flow of the Nutritional Monthly Report Form

Section 6 — Subdivisional Hospital