DOH - SPMS Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, RICHARD A. CORTEZ assigned in PARACALE, CAMARINES 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 TO DECEMBER 2016

Name of Employee: RICHARD A. CORTEZ Date: 12/30/2016

Approved By: Date

VIRGINIA B. MAZO,MD,MPH DECEEMBER 30, 2016

Name of Supervisor
5 - ≥ 130% of the target 5 - Outstanding
4 - 115-129% of the target 4 - Very Satisfactory
3 - 100-114% of the target 3 - Satisfactory
2 - 51-99% of the target 2 - Unsatisfactory
1 - ≤ 50% of the target 1 - Poor

OUTPUT ACCOMPLISHMENT
(Programs / Projects / Activities) SUCCESS INDICATOR Target Actual Number Rating
Total Percentage
JUL. AUG. SEP. OCT. NOV. DEC.
1. GOVERNANCE (Local Health System)
1.1 Ensure functionality of Barangay Health Board
a. Regular Barangay Health Board meeting • No of Barangay Health Board
meetings attended 3 1 0 2 1 0 0 4 133 5

b. Presence of Barangay Health Plan • No. of local health committee assited

on formulation of Barangay Health 3 0 1 1 0 1 1 4 133 5
Plan

SERVICE DELIVERY (assist in the implementation of various health programs of the LGU in accordance with program goals of the DOH)

2.1 Family Planning Program

2.

a. Provision of services to address unmet need • No of women of reproductive age

for Modern Family Planning (MFP) method (WRA) mapped/reached and identified 15 5 4 3 4 2 3 21 140 5
with unmet need for MFP.
• No. of women with unmet need for
MFP who are referred for appropriate 15 3 4 5 3 3 2 20 133 5
MFP services.
• No of WRA with unmet need for MFP
provided with counselling and MFP
services thru (a) Facility-based
services (b) Outreach Medical 15 5 2 1 4 4 4 20 133 5
Missions (c) Post-partum FP
counselling and services (d) Usapan
Series Session.

• No of (WRA) with unmet need for

MFP who accepted MFP method 15 2 5 4 1 4 4 20 133 5
assisted/provided.

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 OUTPUT ACCOMPLISHMENT
(Programs / Projects / Activities) SUCCESS INDICATOR Target Actual Number Rating
Total Percentage
JUL. AUG. SEP. OCT. NOV. DEC.
2.2 Maternal Care
a. Tracking and assisting new pregnant mother in • No. of new pregnant tracked and
30 7 7 5 6 8 7 40 133 5
the formulation of birth plan assisted in formulating birth plan
b. Pregnant tracking and provision of prenatal • No of pregnant tracked and provided 110 28 27 26 20 22 20 143 130 5
services of post partum care to mother and
c. Provision •with
No.prenatal services
of postpartum mothers and
25 4 5 7 5 5 7 33 132 5
newborn newborns provided postnatal care
2.3 Child Care

a. Provision of routine immunization to age- • No of age appropriate children

appropriate children provided/assited with routine 100 21 22 16 17 17 17 110 110 3
immunization
b. Provision of other nutrition-related intervention • No of children provided with nutrition
related intervention (micronutrient
supplementation/MNP/RUTF/supplem 230 48 45 34 47 48 50 272 118 4
entary feeding, etc.)

c. Deworming services • No of children (age group based on

FHSIS) provided with deworming 220 56 45 45 54 65 44 309 140 5
drugs
c. Management of sick infant and children • No. of sick infant and children
assessed, provided treatment and/or 4 0 1 1 2 2 0 6 150 5
referred
d. Management of sick infant and children • No. of sik infant and children
assessed, provided treatment and/or 3 1 0 1 1 1 0 4 133 5
referred
2.4 Non-Communicable Disease Prevention and Control Services

a. Risk assess, treat and refer individuals (20 • No. of individuals 20 years old and
years old & above) above risk assessed 600 154 179 133 175 149 96 886 148 5

• No. of individuals 20 years old and

above provided with Health Lifestyle 230 53 45 46 47 36 42 269 117 4
Modification counselling (HLMC)
• No. of individuals 20 years old and
above provided with drugs for 189 43 50 37 50 31 33 244 129 4
hypertension and diabetes mellitus
2.5 Communicable Disease Prevention and Control • No. of presumptive TB cases
assisted/referred for treatment 3 0 1 1 1 1 0 4 133 5

2.6 Environmental Health and Sanitation • No. of household assessed using the
ZOD verification form
1 1 1 0 1 0 0 3 300 5

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 OUTPUT ACCOMPLISHMENT
(Programs / Projects / Activities) SUCCESS INDICATOR Target Actual Number Rating
Total Percentage
JUL. AUG. SEP. OCT. NOV. DEC.
2.7 Community profiling and assessment • No. of household profile
conducted/updated
906 344 102 221 108 234 298 1307 144 5

2.8 Conducts regular visits to priority households • No. of households/families visited

847 234 109 210 201 233 140 1127 133 5

• No. of households/families visited

with health problems assisted. 110 32 27 21 26 23 25 154 140 5

TECHNICAL ASSISTANCE
3.1 Training / Capability Building
3.
a. Training/orientation/supervision of BHWs and • No. of capability building
other auxiliary health workers activity/updates conducted/assisted.
2 1 1 0 0 0 1 3 150 5

• No. of BHW/BNS oriented/trained on

health and nutrition related 8 4 3 5 5 3 4 24 300 5
course/topic
3.2 Advocacy/Information dissemination • No. of health related advocacy /IEC
30 3 6 5 3 8 8 33 110 3
activity conducted/ assisted
3.3 Assist community mobilization on health related • No. of community mobilization
activity such as mass blood donation, search and assisted/conducted 5 1 2 1 1 2 1 8 160 5
destroy, community health assembly, etc.
3.4 Assist/Facilitate hypertensive and diabetic clubs. • No. of hypertensive and diabetic
clubs meeting facilitated/ convened. 2 0 1 1 0 0 1 3 150 5

3.5 Disease Surveillance and Monitoring

a. Disease Surveillance (for all notifiable/ • No of disease surveillance conducted

reportable diseases) 20 3 5 4 5 5 4 26 130 5

b. Mortality review, data collection and validation • No. of deaths where data collected,
(for all deaths in the community) review and validated 6 5 4 6 3 2 1 21 350 5

3.6 Health programs/projects/implementation • No of program implementation review

1 0 1 1 0 1 0 3 300 5
monitoring and evaluation assisted/conducted

HEALTH INFORMATION SYSTEM

4.1 Submission of reports • No. of reports submitted on time

4.

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 OUTPUT ACCOMPLISHMENT
(Programs / Projects / Activities) SUCCESS INDICATOR Target Actual Number Rating
Total Percentage
JUL. AUG. SEP. OCT. NOV. DEC.
• FHSIS monthly report (M1)
5 1 2 1 1 2 0 7 140 5

• Notifiable Diseases (M2) 5 0 0 2 0 1 1 4 80 2

• Monthly accomplishment 5 1 0 1 1 1 1 5 100 3
report (MAR).
RATING
Total Overall Rating 148.000
Final Average Rating 4.625
Very
Adjectival Rating Satisfactory
Comments and Recommendation for Development Purposes
Discussed with: Assessed by: Date Final Rating by: Date
I certify that I discussed my assessment of
the performance with the employee

12/30/2016 12/29/2016
RICHARD A. CORTEZ VIRGINIA B. MAZO,MD,MPH ALMA V. PERALTA
Employee Municipal Health Officer PUBLIC HEALTH NURSE

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