Ipcr Evaluation For HRH 2024

DOH-SPMS Form 4 Document Code: DOH-CHD-CAR-QSOP-127 Form 3
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 1

Effectivity: January 1, 2023
I,______NAME OF EMPLOYEE________________, ___POSITION__________ of the CITY/PROVINCIAL DOH OFFICE- PROVINCE commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period,
January 11, 2024 to December 31, 2024.
(Name of HRH & Signature) Date:
Approved By: Date:
Name of Supervisor
Remarks/ Justification of Unmet
RATING Targets
Output Success Indicator (Targets + Measure) Actual Accomplishment Q (1) E (2) T (3) A (4) (use separate sheet if needed)
Core Functions
Average Rating (Core Functions)

Strategic Functions
Average Rating (Strategic Functions)

Support Functions
Average Rating (Support Functions)

RATING
Function Percentage Distribution* Average Rating per Function Final Average Rating Adjectival Rating Remarks
Core Functions 50%
Support Functions 10%
Strategic Functions 40%
Comments and Recommendations for Development Purposes:
Discussed With: Assessed by: Date Final Rating by: Date
I certify that I discussed my assessment of the perfomance with the employee
Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average; *In the event that there is no strategic output, the percentage distribution is as follows: Core output- 80% and Support output-20%
THIS IS THE FINAL IPCR TEMPLATE. PLEASE DO NOT EDIT. PRINT IPCR IN LONG BOND PAPER. FORMAT: TIMES NEW ROMAN 11
Approved By: Date: day of approval
Name of Supervisor
Output Success Indicator (Targets + Measure) RATING Targets
Actual Accomplishment Q (1) E (2) T (3) A (4) (use separate sheet if needed)
Core Functions
To ensure access to effective, safe and quality health care 1.1.1 100% (Actual) of pregnant women tracked within the rating period N/A N/A
service 1.1.2 100% of pregnant women tracked given appropriate prenatal services N/A N/A
1.1.3 100% of pregnant women tracked assisted in completing/ updating the birth
plan
N/A N/A
1.1.4 100% (__) postpartum women provided with postpartum services within 7
days after
N/A
1.1.5 100%delivery
(___) post partum women given complete Vit. A supplementation after
delivery and(___)
within
N/A
1.2.1 100% of1targeted
month 6 to 11 months children given Vitamin A
1.2 No. of Child Health services provided
supplementation
N/A N/A
1.2.2 100% of targeted 0 to 1 year and 29 days children Fully Immunized N/A
1.2.3 100% (___) of targeted 0 to 24 months children monitored growth monthly N/A N/A
1.2.4 100% (Actual) of Moderately Acute Malnourished (MAM) children
monitored
N/A N/A
1.2.5 100%and and referred
(Actual) for appropriate
of Severely intervention
Acute Malnourished (SAM) children monitored
and referred to WRA
appropriate health facility
N/A N/A
1.3.1 100% of (Women of Reproductive Age) provided with appropriate
1.3 No. of Men and women's health services provided
services
N/A N/A
1.3.2100% (2) Men's Involvement on Reproductive Health activities conducted N/A
1.4.1 100% (____) of adolescents given comprehensive assessment and provided
1.4 No. of Adolescent health services provided
appropriate
N/A N/A
1.5 No. of Infectious Disease prevention and control services 1.5.1 100% health
(____)care servicesassessed for TB, given proper information and
of patients
provided appropriate
N/A N/A
1.6 No. of Non-communicable disease prevention and control 1.6.1 100% intervention according
(_____) of clients to TB
assessed andguidelines
screened for risk factors for NCDs, and
services provided provided with
N/A N/A
1.7 No. of Environmental and occupational health services 1.7.1 100% (2)appropriate
of targettedhealth education
activities and intervention
on provision of adequate information and
provided education on Basic Safe Water Supply and Basic Sanitation Facilities
N/A
1.8 No. of National voluntary blood services provided 1.8.1 100% (Actual) of bloodletting activities assisted N/A
1.8.2 100% (2) clients successfully engaged as blood donors N/A N/A
1.9 No. of health services provided to support the functionality 1.9.1 100% of clients needing further intervention and/or specialized care were
of the referral system referred to the RHU or higher health facilities
N/A
Strategic Functions
2.1 No. of activities conducted to support the conduct of 2.1.1 100% of targeted activities to support implementation of community playbook
community
2.2. playbookstoand/or
No. of activities health
assist in promotion
capacitating activities
Barangay Health people focused activities are conducted in the barangay as per timeline
Workers as activities
on the ground HPOs
2.2.1 100% of capacity building activities for barangay health workers assisted N/A
2.3. No. of assisted to implement the healthy settings 2.3.1 100% of targeted activities to support implementation of healthy settings
program activities are conducted in the municipality/ barangay
N/A N/A
2.4 No. of activities to assist in the conduct, monitoring and 2.4.1 100% (Actual) of notifiable disease and health events assisted N/A
verification of notifiable diseases and health events in the 2.4.2 100% (Actual)notifiable disease/health events monitored and reported using
municipality/barangay as necessary appropriately filled out forms/tools
N/A
2.5 No. of activities to assist in the institutionalization of 2.5.1 100% of Health Emergency Commodities inventory report is up to date N/A
DRRMH System in the LGU 2.5.2 100% (actual) reportable incidents/events monitored and reported using
appropriately
2.5.3 filled-out
100% (actual) forms/ tools
of incidents based on occurence or events based on request
assisted
N/A N/A
2.6.1 100% of household visited and with updated family profile with complete
2.6 No. of households profiled and number of individuals
households
N/A
registered to a Primary Care Provider 2.6.2 100% information within the prescribed
of targeted unregistered timeline
individuals registered to a primary care facility
within the rating period
N/A N/A
Support Functions
3.1.1 100% (19) of correct and complete documents as required by P/CDOHO
3.1 Ensures timely submission of correct and complete reports
submitted on or earlier than the set deadlines (DTR, MAR, MIT, IPCR)
3.2.1 100% (2) Attendance to Learning Development Interventions from January -
June 2024
N/A N/A
3.2 Attends Functional Career and Development Program
3.2.2 100% (3) Attendance to UHC Sirib Series N/A N/A
RATING
Core Functions 50%


6
Approved By: Date:
Name of Supervisor
Output RATING Targets
Success Indicator (Targets + Measure) Actual Accomplishment Q (1) E (2) T (3) A (4) (use separate sheet if needed)
Core Functions
1.1 No. of Maternal health services provided 1.1.1 100% (Actual) of pregnant women tracked within the rating period N/A N/A
1.1.2 100% of pregnant women tracked given appropriate prenatal services N/A N/A
1.1.3 100% of pregnant women tracked assisted in completing/ updating the birth
plan
N/A N/A
1.1.4 100% of deliveries assisted/attended consistent with BEmONC standards N/A
1.1.5 100% (__) postpartum women provided with postpartum services within 7
days after
N/A
1.1.6 100%delivery
(___) post partum women given complete Vit. A supplementation after
1.2.1 100%
delivery andofwithin
WRA1(Women
month of Reproductive Age) provided with appropriate
N/A
1.2. No. of Men and women's health services provided services N/A N/A
1.2.3 100% (2) Men's Involvement on Reproductive Health activities conducted N/A
1.3.1 100% (___) of targeted 6 to 11 months children given Vitamin A
1.3 No. of Child Health services provided
supplementation
N/A N/A
1.3.2 100% of targeted 0 to 1 year and 29 days children Fully Immunized N/A
1.3.3 100% (___) of targeted 0 to 24 months children monitored growth monthly N/A N/A
1.3.4 100% (Actual) of Moderately Acute Malnourished (MAM) children
monitored
N/A N/A
1.3.5 100%and and referred
(Actual) for appropriate
of Severely intervention
Acute Malnourished (SAM) children monitored
1.4.1 100% (____)
and referred of adolescents
to appropriate given comprehensive assessment and provided
health facility
N/A N/A
1.4 No. of Adolescent health services provided appropriate
1.5.1 100% health
(____)care servicesassessed for TB, given proper information and
of patients N/A N/A
1.5 No. of Infectious Disease prevention and control services
provided
appropriate
1.6.1 100% intervention according
(_____) of clients to TB
assessed andguidelines
screened for risk factors for NCDs, and N/A N/A
1.6 No. of Non-communicable disease prevention and control
services provided
provided
1.7.1 100%with
(2)appropriate
of targettedhealth education
activities and intervention
on provision of adequate information and N/A N/A
1.7 No. of Environmental and occupational health services
provided
education on Basic Safe Water Supply and Basic Sanitation Facilities N/A
1.8 No. of National voluntary blood services provided
1.8.1 100% (Actual) of bloodletting activities assisted N/A
1.8.2 100% (2) clients successfully engaged as blood donors N/A N/A
1.9 No. of health services provided to support the functionality
of the referral system
1.9.1 100% of clients needing further intervention and/or specialized care were N/A
referred to the RHU or higher Average
health facilities
Rating (Core Functions)
Strategic Functions
2.1 No. of activities conducted to support the conduct of 2.1.1 100% of targeted activities to support implementation of community playbook
community
2.2 playbooks
No. of activities to and/or health
assist in promotion
the conduct, activitiesand
monitoring people focused activities are conducted in the barangay as per timeline
2.2.1 100% (Actual) of notifiable disease and health events assisted N/A
verification of notifiable diseases and health events in the 2.2.2 100% (Actual)notifiable disease/health events monitored and reported using
municipality/barangay as necessary N/A
appropriately filled out forms/tools
2.3 No. of activities to assist in the institutionalization of 2.3.1 100% of Health Emergency Commodities inventory report is up to date N/A
DRRMH System in the LGU 2.3.2 100% (actual) reportable incidents/events monitored and reported using
appropriately
2.3.3 filled-out
100% (actual) forms/ tools
of incidents based on occurence or events based on request
N/A N/A
assisted
2.4.1 100% of household visited and with updated family profile with complete
2.4 No. of households profiled and number of individuals N/A
households
2.4.2 100% information within the prescribed
of targeted unregistered timeline
individuals registered to a primary care facility
registered to a Primary Care Provider N/A N/A
Support Functions
3.1 Ensures timely submission of correct and complete reports
submitted
3.2.1 100%on(2)
orAttendance
earlier thanto
theLearning
set deadlines (DTR, MAR,
Development MIT, IPCR)
Interventions from January -
June 2024
N/A N/A
3.2 Attends Functional Career and Development Program
RATING
Core Functions 50%


Approved By: Date:
Name of Supervisor
RATING Targets
Core Functions or after rehabilitation.
Service target-20% of age specific eligible population
100% of the service targets for the following age groups provided with
BOHC
0-11 as scheduled
months
1-4 years old
5-9 years old
Provision of Basic Oral Health Care (BOHC) services to the
eligible population for indicators and targets set on FHSIS
10-14 years old
15-19 years old
20-59 years old
60 years old and above
Pregnant Women
for cases not with in the scope and capability of the 100% (2/2) oral health care campaign activities and other oral health
PHO/RHU/C/MHSO activities conducted
100% of cases as planned
not within by the
the scope andpublic healthofdentist
capability PHO/RHU/C/MHSO
are referred to appropriate facilities with follow-up from other Oral Health
100% timely submission of required program reports to RHU
Support Functions 100% (Actual) of requested Oral Health Program (OHP) activities area
Assistance to other partner stakeholders. attended/provided.
3.1.1 100% (19) of correct and complete documents as required by N/A N/A
Ensures timely submission of correct and complete reports P/CDOHO submitted on or earlier than the set deadlines (DTR, MAR, MIT,
3.1.3
IPCR)100% (2) Attendance to Learning Development Interventions from N/A N/A
January - June 2024
Attends Functional Career and Development Program
RATING
Core Functions 80%

THIS IS THE FINAL IPCR TEMPLATE. PLEASE DO NOT EDIT. PRINT IPCR IN LONG BOND PAPER.
Approved By: Date:
Name of Supervisor
RATING Targets
Core Functions MOV: AAR, PSCM Monitoring
Provides technical asistance to MLGUs and other health partners a. 100% of health facilities monitored with relevant technical input (2) tool and CSS / / /
MOV: AAR, Monitoring tool and target: No. of AOR x 6 months.. Post marketing surveilance included to ensure safety and efficacy of
b.100% of monitoring activities conducted in the health faclities through inventory N/A / /
CSS medicines. (monthly monitoring)
and/or post-marketing
c.100% of stakeholdersdrug surveillance
assisted ( )
in the Pharmacovigilance Information System MOV: SAE Form, CSS N/A / / proper completion of Serious Adverse Event Reporting Form (as needed)
(PViMS)
d. 100% of technical assistance provided to stakeholders in support of the post MOV: AAR / / N/A in coordination with FDA.
marketing
e. 100% ofsurveillance (actual)
Health facilities assisted in the transfer of stocks to other health facilities MOV: stock transfer form N/A / N/A
(actual) All commodities within the inventory reports are encoded. Target: No. of AOR*6 months..timeline: every the
f. 100% of validated inventory reports are encoded in the Pharmaceutical MOV: generated report frPMIS N/A / / 10th day Formulary
of the following
National (PNF)month
program in all health facilities such as, but
Cascade policies to LGUs and other health partners through Management
a. Information
100% of policies System
cascaded (PMIS)
to LGUs andwithin the precribed
other health partnerstimeline ( ) MOV: AAR, new policies N/A / N/A not limited to: 1. Newly Approved PNF medicines; 2. Deleted PNF medicines; and,3. National Antibiotic Guidelines (NAG).
outlets to Electric Drug Price Monitoring System (EDPMS) in
dissemination campaigns/activities b. 100% o f programs with dissemination campaigns cascaded to LGUs and other MOV: AAR N/A / N/A collaboration with the RDPMOs
No. of patients received medicines with counselling upon receipt health
100% ofpartners
of patients received medicines with counselling upon receipt of MOV: filled prescription/logbook / / N/A
of prescription prescription Average Rating (Core Functions)
Strategic Functions
Provision of Technical Assistance to support the implementation 100% of Pharmacy and Therapeutics Committee (PTC) meetings/activities attended the PNF, DPRI); (applicable for PDOHO based PHPs.. To check the PTC activities of PHO as basis for
of the PTC in the P/CWHS with relevant technical inputs ( ) MOV: After Activity Report; CSS / / N/A targets)
Support Functions
Submits validated reports 100% of Program quarterly Reports consolidated and submitted within the
prescribed
a. Quarterlytimeline
No stock out indicator report tracer commodities
b. Quarterly Supply Chain Management Report AAR monitoring tool
c. Consolidated Quarterly Inventory Report MOV; report generated fr PMIS generated report
RATING
Core Functions 50%


Approved By: Date:
Name of Supervisor
RATING Targets
Core Functions
Conduct of regular visit to catchment municipalities to provide 100% of targeted LGUs/municipalities visited to provide preventive and
preventiveholistic
Provides and rehabilatative
managementservices responsive
of patient, to the needs of
from reviewing rehabilitative
100 services
% of patients at least
(Actual) _________
visited withinholistic
and provided the rating period. 1 care.
management
medical history,
Prepares reports referral, or handled,
of patients notes from attending physicians
interventions conducted, 100% (Actual) of progress reports of patients handled submitted to the Municipal
progress ofhealth
Conducts patients, and referrals
education, madeand training on
advocacies Health(6/6)
100% Office.
of targeted Health Education activities on rehabilitation and preventive
preventive and
Participates rehabilitative
in the care of health programs of DOH
implementation care conducted
100% (Actual) ofthrough the following
DOH and LGU Health modes:
programs participated in its implementation
and LGU in the
Participation community
in other activities as required or requested 100% (Actual) of Involvement during emergency/disasters as part of the HERT.
Support Functions
Ensures timely submission of correct and complete reports
submitted
N/A N/A
3.1.3 100%on(2)
orAttendance
earlier thanto
theLearning
set deadlines (DTR, MAR,
Development MIT, IPCR)
Interventions from January -
Attends Functional Career and Development Program June 2024
RATING
Core Functions 80%

Approved By: Date:
Name of Supervisor
RATING Targets
Core Functions
To ensure that relevant policies, guidelines and programs are 100% of received policies / programs with dissemination campaigns are cascaded to N/A
cascaded toAssistance
Technical LGUs andtoother
LGUspartners
and other health partners LGUSsofand
100% otherhealth
(target) healthfacilities
partners provided
by June 30,
with2024 with 100%
technical clientonsatisfaction
assistance the N/A
toweards the achivement of UHC is provided. establishment
100% of Outpatient
of (target) Therapeutic
health facilities providedCare
with(OTC)
technical assistance on the N/A
establishment
100% of LGUsofandInpatient Therapeutic
other health Care
partners (ITC) with technical assistance on
provided N/A
capability
100% building
of (target) activities
LGUs and advocacies
provided assistance inonthe
nutrition by June 30,of2024.
timely validation Operation
Timbang
100% PLus reports
of (target) healthusing the Electronic
and non-health OPT provided
facilities Tool withwith
100% client satisfaction
technical assistance N/A
in the establishment
100% of Lactation
(actual) of planned technicalStations
assistance activity on appropriate recording and N/A
reporting
100% of nutrition
of LGUs indicators
monitored in the TCL
and evaluated conducted
using the MELLPI Tool N/A N/A
100% of (target) LGUs assisted on verification/calibration of weighing scales N/A N/A
100% of target LGUs assisted in the collection and testing of salt samples for the N/A N/A
monitoring
100% (1/1)ofofiodized
nutritionsalt
month advocacy activity/s conducted as planned
Provision of assistance to Local Nutrition Committes and Local 100% of LNC request/s for on-site technical assistance on LNAP provided (Actual) N/A
Nutrition Action Planning 100% of (target) non-functional, substantially functional and partially functional N/A
local nutrition committees provided withRating
Average technical assistance
(Core to improve
Functions)
Strategic Functions
No. of activities conducted to support the conduct of 100% of LGUs with Playbook PA1 Karinderya provided with technical assistance
community playbooks and/or health promotion activities (if applicable)

Support Functions
Ensures timely submission of correct and complete reports 100% of (target) LGUs with updated inventory of nutrition commodities properly
accomplished
100% of LGUsand submitted
provided within in
assistance thethe
prescribed timelines of OPT PLus Report
timely submission N/A
using the
100% updated
of LGUs version
assisted in of
theE-OPT PLusofTool
preparation documents for MELLPI
100% (19) of correct and complete documents as required by P/CDOHO submitted
on or earlier
100% than the set
(2) Attendance deadlinesDevelopment
to Learning (DTR, MAR,Interventions
MIT, IPCR) from January - June
2024
N/A N/A
100% (3) Attendance to UHC Sirib Series N/A N/A
RATING
Core Functions 50%

Approved By: Date:
Name of Supervisor
RATING Targets
Core Functions
100%
100% of clientsof
(Actual) referred for available
laboratory procedures
examinations are attended
are performed to within
accurately andset timelines.
conforms NA
No. of clients served/attended to and given the requested to standards.
100% (Actual) of Results are made available within prescribed timelines with no NA
laboratory services errors.
100% of laboratory facilities, equipment and supplies are maintained monthly.
100%
100% (2)
(2) of bloodletting
clients activities
successfully assisted.
engaged as blood donors as Donor Recruitment NA NA
Number of NVBSP activities assisted Officer. NA
1.5 No. of activities to assist in the institutionalization of
100% (actual) of incidents based on occurence or events based on request assisted. N/A N/A
DRRMH System in the LGU
Strategic Functions
No. of activities assisted to implement the healthy settings 100% of targeted activities to support implementation of healthy settings activities
To assist in the conduct, monitoring and verification of N/A N/A
program are conducted in the municipality/ barangay
notifiable diseases and health events in the 100% (Actual) of notifiable disease and health events assisted N/A
municipality/barangay as necessary 100% (Actual)notifiable disease/health events monitored and reported using
N/A
appropriately filled out forms/tools
Support Functions
Laboratory application for LTO assisted. 100% (1) laboratory provided assistance on licensing requirements
Ensures timely submission of correct and complete reports 100% (19) of correct and complete documents as required by P/CDOHO submitted
on or earlier
100% than the set
(2) Attendance deadlinesDevelopment
to Learning (DTR, MAR,Interventions
MIT, IPCR) from January - June
2024
N/A N/A
100% (3) Attendance to UHC Sirib Series N/A N/A
RATING
Core Functions 50%

AGREEMENT
IPCR TARGETS Operational definition QUALITY EFFICIENCY
RETAIN MODIFY DELETE
STRATEGIC
1.1 Support for FUNCTIONS
the conduct of community playbooks and/or
health promotion activities in the barangay Community playbook people focues activities refer to the
monthly health events (Playbook 1).
5 = 96%-100% Average Rating
1.1.1 100% of targeted activities to support implementation of 4 = 91%-95% Average Rating
Target: 1 health event per month (counting is per event not 5 =100% of target conducted
community playbook people focused activities are conducted Yes 3 = 85%-90% Average Rating
per activity) 2 = below 100%
in the barangay as per timeline 2 = 80%-84% Average Rating
1 = <79% Average Rating
MOV: After Activity Report
1.2 To assist in capacitating Barangay Health Workers as on
the ground HPOs
Capacity buidling activities refer to activities conducted by
the HRH to capacitate BHWs as on the ground HPOs. These
5 = 96%-100% Average Rating 5 = ≥130% of the target
activities can be trainings, orientations, seminars, coaching
4 = 91%-95% Average Rating 4 = 115-129% of the target
1.2.1 100% of capacity building activities for barangay health and mentoring and others.
Yes 3 = 85%-90% Average Rating 3 = 100-114% of the target
workers assisted
2 = 80%-84% Average Rating 2 = 51-99% of the target
Target: 2 (1 per quarter)
1 = <79% Average Rating 1 = ≤50% of the target
1.3 To assist in the implementation of activities to implement
the healthy settings program
Activities refer to any activity conducted to implement the
healthy settings program: Healthy Communities, Healthy
Schools, Healthy Workplaces 5 = ≥130% of the target
1.3.1 100% of targeted activities to support implementation of 4 = 115-129% of the target
healthy settings activities are conducted in the municipality/ Yes All Provinces: Community and workplace NA 3 = 100-114% of the target
barangay Benguet, Kalinga, Mt. Province: Healthy Schools 2 = 51-99% of the target
1 = ≤50% of the target
Target: to be set per P/CDOHO
1.4 To assist in the conduct, monitoring and verification of
notifiable diseases and health events in the Any health event that causes public concern
5- 100%
1.4.1 100% notifiable
of notifiable
municipality/barangay
1.4.2 100% asdisease and events
necessary
disease/health health events assisted
monitored and Yes NA 5-
Yes Target: Actual
Target: Actual number
number or
or events/
events/ notifiable
notifiable diseases
diseases NA 2- 100%
below 100%
reported usinginappropriately
1.5 To100%
assist supplychain filled-out
chainmanagement
management forms/ tools
in the barangay 2- below 100%
1.5.1 of supply reports validated and monitored
1.6 To assist in the prepositioning of Health Emergency Yes To be captured
MOV: by pharmacists
CIF or ESR
submitted within prescribed timeline
Commodities in the barangay
Refers to the conduct of monthly inventory of Health
emergency Commodities using the appropriate inventory
1.6.1 100% of Health Emergency Commodities inventory tool, submitted as scheduled 5 = 100% 6 reports
Yes NA
report is up to date 2 = 99% and below (<6)
Target: 6 (monthly)
MOV: HEC inventory report
1.7 To assist in the registration of families to a Primary Care
Provider
Refers to the percentage of households visited and with
updated family profile using the FHSIS profiling form until
April 30, 2024
1.7.1 100% of household visited and with updated family profile with 5 = 100%
complete households information within the prescribed timeline
Yes NA
Target: # of HH to be set at LGU level (c/o PDOHO), due 2 = below 100%
on April 30, 2024
MOV: Household profile form
Refers to the percentage of individuals registered (encoded)
to the Primary Care Facility, mode of registration can be
iClinicSys or Konsulta Registration
1.7.2 100% of targeted unregistered individuals registered to a 5 =100% of target
NA
primary care facility within the rating period 2 = 99% or below target
Target: # of HH to be set at LGU level (c/o PDOHO)
MOV: database of registration (in the PCF), registration
number (outside municipality)
CORE
1. MATERNAL CARE
1.1. PRENATAL CARE
Refers to the percentage of new and old pregnant women
100% (Actual) of pregnant women tracked within the rating tracked
Yes NA 3 = 100% of target
period MOV: pregnancy tracking form
Refers to the percentage of pregnant women tracked

provided with any appropriate prenatal services in the 5 = 100%
facility or through HH visits 4 = 95.01%-99.99%
100% of pregnant women tracked given appropriate prenatal
Yes NA 3 = 80%-95%
services
Target: number of pregnant women tracked (based on 2 = 50%-79.99%
pregnancy tracking tool) 1 = <50%
MOV: TCL
Refers to the number of pregnant women tracked assisted in

completing or updating the birth plan. Birth plan refers to
the Mother and Child Book, Family Health Diary of any 5 = 100%
localized birth planning tool Denominator- based on 4 = 95.01%-99.99%
100% of pregnant women tracked assisted in completing/
Yes pregnancy tracking tool NA 3 = 80%-95%
updating the birth plan
2 = 50%-79.99%
Target: number of pregnant women tracked (based on 1 = <50%
pregnancy tracking tool)
MOV: TCL, Birth Plan
Refers to the number of post partum women provided with 5 = 100%
1.2. POST PARTUM women
CARE provided with postpartum postpartum services within 7 days after delivery 4 = 95.01%-99.99%
100% (__) postpartum
Yes NA 3 = 80%-95%
services within 7 days after delivery
Target: Based on delivery 2 = 50%-79.99%
FSHIS
MOV: Indicator:
Validated Vitamin
M1, TCLA supplementation Refers to 15 = = <50%
100%
200,000 I.U. of Vitamin A capsule given to PP women
100% (___) post partum women given complete Vit. A 4 = 95.01%-99.99%
within 1 month after delivery
supplementation after delivery and within 1 month NA 3 = 80%-95%
2 = 50%-79.99%
Target: based on pregnancy tracking, TCL, delivery
1 = <50%
MOV: TCL
Refers to the percentage of targeted 6-11 months children 5 = 100%
2. CHILD Refers to the percentage
given Vitamin of targeted 0 to 1 year and 29 days
A supplementation 54 = 100% 95.01%-99.99%
100% (___)CARE
of targeted 6 to 11 months children given Refers
childentofully
targeted 0-24 months children monitored growth
immunized 543 = 100% 95.01%-99.99%
100% of A targeted 0 to 1 year and 29 days children Fully Yes NA 80%-95%
Vitamin supplementation Refers
100% (___)
Immunized of targeted 0 to 24Acute
months children monitored Yes Target:tobased
monthly the percentage
on TCL of MAM children monitored and NA 5432 = = 100%
95.01%-99.99%
80%-95%
50%-79.99%
100% (Actual) of Moderately Malnourished (MAM) Yes Refers
MOV: to
referred
Target: theappropriate
for
based
TCL percentage of SAM children monitored and
on TCL intervention NA 54321 = = 100%
95.01%-99.99%
80%-95%
50%-79.99%
<50%
growth monthly referred for appropriate
children monitored
100% (Actual) and andAcute
of Severely referred for appropriate
Malnourished (SAM) Yes Target:
MOV: TCL Based
Comprehensive on TCL intervention
assessment uses the HEEADSSS tool, NA 4321 = = 95.01%-99.99%
80%-95%
50%-79.99%
<50%
intervention Yes Target:
MOV: to
Refers Based
TCL on with
patients TCL coughall
forservices
2 weeks, collected NA 5321 = = 100%
80%-95%
50%-79.99%
<50%
children monitored and referred to appropriate health facility Appropriate health services- provided to with
the
3. ADOLESCENT HEALTH Target: Based 421 = = 95.01%-99.99%
100% (____) of adolescents given comprehensive assessment MOV: TCL
sputum
adolescents inclon
specimen TCL
for Genexpert
referral for highertesting and monitored for
interventions 531 =
50%-79.99%
<50%
and provided appropriate health care services
Yes MOV: TCL
treatment compliance NA = 100%
80%-95%
<50%
4. INFECTIOUS DISEASE 42 = 95.01%-99.99%
100% of patients assessed forPREVENTION
TB, given properAND CONTROL
information Target: Based on TCL 531 =
50%-79.99%
and appropriate intervention according to TB guidelines
Yes Using
Target: PhilPen
TB presumptive masterlist
NA = 100%
80%-95%
<50%
100% (____) of clients assessed
5. NON-COMMUNICABLE DISEASE PREVENTIONand screened for risk factorsA MOV: HEADSSS Tool and TCL (Count Presumptive TB 42 = 95.01%-99.99%
50%-79.99%
for NCDs, Yes Patients from the previous year plus 10%) NA
100% (___)and provided
of clients with
with appropriate
NCDs provided health
with education
appropriateand
Target:
MOV:years
15-49 TBD by P/CDOHO
TB presumptive
old, provided masterlist,
with any TB Case Registry,
FP services (counseling,
31 = 80%-95%
52 =
<50%
intervention
health education and intervention
Yes
Target: = 100%
50%-79.99%
MOV:
Men 20NCD
Individual
years Masterlist/
Treatment TCL
old and Card,
above MAR
provided with any advocacy 5 = 96%-100% Average Rating 541 =
6. FAMILY
100% of WRA PLANNING
(Women of Reproductive Age) provided with
commodities, referral)
MOV: for FP/RH (counseling, commodities, referral) = ≥130%
<50% of the target
95.01%-99.99%
Yes activities 4NA= 91%-95% Average Rating 43 = 115-129%
80%-95% of the target
100%
appropriate(2) MIRH (Men's Involvement in Reproductive
services
100% (___) adolescent Yes Target: TCL 3 = 85%-90% Average Rating 32 = 100-114%
50%-79.99%of the target
Health) activities conductedboys (10-19 y/o) provided Yes
information of Reproductive Health Target:
MOV: TCL
Target: 2 activities for men 2 = 80%-84% Average Rating 21 = 51-99%
<50% of the target
7. ENVIRONMENT AND OCCUPATIONAL HEALTH MOV:
MOV: AAR 1 = <79% Average Rating 1 = ≤50% of the target
5 = 96%-100% Average Rating 5 = ≥130% of the target
Activities conducted for EOH
100% (2) of targeted activities on provision of adequate 4 = 91%-95% Average Rating 4 = 115-129% of the target
information and education on Basic Safe Water Supply and Yes 3 = 85%-90% Average Rating 3 = 100-114% of the target
Target: 2
Basic Sanitation Facilities conducted 2 = 80%-84% Average Rating 2 = 51-99% of the target
MOV: AAR
Barangay events- HRH; Municipal events- PHN, not for 1 = <79% Average Rating 1 = ≤50% of the target
8. DISASTER RISK REDUCTION AND 5- Completely filled-out form with 5 = 100%
OPCEN duty
100% (actual) reportable
MANAGEMENT incidents/events monitored and
IN HEALTH correct data 5-
4 =all events reported
95.01%-99.99%
100% of using
incidents based on occurrence or events based on Yes
reported appropriately filled-out forms/ tools Yes 2- Incomplete data and with
NA 32-=not all events reported
80%-95%
request assisted Target: Based
Target: Actualon request
9. NATIONAL VOLUNTARY BLOOD SERVICE PROG correction 255-== 50%-79.99%
≥130% of the target
MOV: AAR
MOV: HEARS Form all activities assisted
100% (____) of bloodletting activities assisted Yes NA 41 =
= 115-129%
<50% of the target
100% (2) clients successfully engaged as blood donors Yes Target: Number
Referral of Bloodletting
means navigating activities
the patient to the appropriate NACompletely filled-out form or 2-
3 =not all activities
100-114% of theassisted
target
Target: 2
MOV:facility
AAR 5-
100% of clients needing
10. REFERRAL SYSTEM further intervention and/or health 2 =all
51-99%
MOV: AAR 5- no mistakes
logbook with correct data 5- patientsofreferred
the target
specialized care were referred to the RHU or higher health Yes 4- 1 =not
≤50% of the target
100%
SUPPORT (19) of correct and complete documents as required by 2- 1Incomplete
or 2 minordata
errors
and with 2-
5- 100% all of
patients
target referred
documents
facilities Target:
For new Number
physicians,of patients
nurses andneeding further intervention
midwives 3- more than 2 minor errors/
P/CDOHO Yes correction 5- with Certificate/ portal
100% of thesubmitted on orfor
requirements earlier thanCare
Primary the set deadlines
Workers' MOV:
Target:Referral
19 logbook/ form minor/partial revision needed
accomplished
(DTR, MAR,complied
MIT, IPCR) Yes NA submission
2- below 100%
Certification by June 30, 2024 Target: Submission
MOV: Submitted to the portal
documents 2- major revision needed 2- incomplete/ no cert or submission
MOV:
Any LDIPCW cert/toportal
related submission
their cadre (exceptSSSirib series). Self- 1- needs total revision 5 = ≥130% of the target
initiated. 4 = 115-129% of the target
100% (2) Attendance to Learning Development Interventions
NA 3 = 100-114% of the target
Target: 2 2 = 51-99% of the target
MOV: Certificate 1 = ≤50% of the target
5 = ≥130% of the target

UHC Sirib Series
4 = 115-129% of the target
100% (3) Attendance to UHC Sirib Series NA 3 = 100-114% of the target
Target: 3
MOV- Certificate
Note: If IPCR target was not achieved, please put reason for non-attainment in Remarks column
TIMELINESS
5 = conducted as scheduled
2 = conducted not within the schedule
NA
NA
5- within 24 hours
5-
2- within 24 hours
more than 24 hours
2- more than 24 hours
5 = submitted within schedule

2 = submitted after schedule
5 = 2 weeks before the deadline

4 = 1 week before the deadline
3 = During the deadline
2 = 1 week after the deadline
1 = 2 weeks or more after the deadline
0 = no submission
NA
NA
NA
NA
5 = within timeline (7 days)

2 = more than 7 days
5 = within timeline (1 month)

2 = more than 1 month
NA
5 = within period
2
NA= more than 1 year 29 days
NA
NA
NA
NA
NA
NA
NA
NA
5- report submitted within 24 hours of the

event
2- report submitted more than 24 hours of
NA
the event
NA
NA
NA
5- submitted on time
5-
2- submitted on time
late submission
2- late/no submission
NA
NA
AGREEMENT Operational
QUALITY EFFICIENCY TIMELINESS
IPCR TARGETS RETAIN MODIFY DELETE definition
CORE
IMPLEMENTATION OF HEALTH PROGRAMS
1. MATERNAL CARE BSM- no need for
1.1. PRENATAL CARE Harmonized BEmONC
training
No of pregnant Any CSS Tool in the
100% (Actual) ofwomen tracked
pregnant women given appropriate prenatal services as
LGU
scheduled
Target:Actual number of
100% of pregnant women assisted in completing the birth plan deliveries in the
1.2. DURING DELIVERY catchment facility 4 = 91%-95% Average Rating 5- all
100% of deliveries assisted/ attended consistent with BEmONC MOV: CSS, TCL 3 = 85%-90% Average Rating 2- not all NA
standards
1.3. POST PARTUM CARE 2 = 80%-84% Average Rating
100% (Actual) postpartum women provided with at least 2 postpartum 1 = <79% Average Rating
services 7 dayspostpartum
100% (Actual) after delivery
women initiated breastfeeding after delivery
100% (Actual) postpartum women given complete iron folate
supplementation
100% post partum (90 tabs) given complete Vit. A supplementation after
women
delivery
2. CHILD
100% orCARE
within
(Actual) 1 month thoroughly assessed and appropriately
of children
managed
100% (___)forofcommon childhood
6 to 11 months illnesses
children utilizing
given IMCI
Vitamin manual
A supplementation
as scheduled
95%
100%of(___)
0 to 1ofyear
12 toand
59 29 days children
months children given
Fully Immunized
micronutrient
supplementation
100% (___) of 12-59and/or Vitamin
months A in October
children 2022
given deworming tablets in July
2022
100% (___) of 0 to 23 months children monitored growth monthly
100% (Actual) of Moderately Acute Malnourished (MAM) children
monitored
100% and of
(Actual) provided
Severelyappropriate intervention(SAM) children
Acute Malnourished
monitored
3. FAMILYand referred to appropriate health facility
PLANNING
100% (___) of Women of Reproductive Age (WRA) assessed for unmet
needs for Modern
100% (___) Family
of clients Planning
provided with Famiy Planning Counseling
of clients
100% (___) menprovided withbeyond)
(20 y/o and appropriate services
provided information on Male
Involvement
100% on RPRH boys (10-19 y/o) provided information of
(___) adolescent
Reproductive Health
4. HEALTH
100% (actual)EMERGENCY AND DISASTER
reportable incidents/events monitored and reported using
appropriately filled-out forms/ tools
100% of incidents/events assisted
5. REFERRAL
100% of clientsSYSTEM
needing further intervention and/or specialized care
were referred to the RHU or higher health facilities
STRATEGIC
SUPPORT
100% ( ) of correct and complete documents as required by P/CDOHO
submitted
100% on orofearlier
(Actual) thanand
application
meetings the set deadlines
for other
leave (DTR,
accomplished
activities MAR,workshops,
IPCR)
properly
(seminars, and
submitted within promotion
trainings, health the prescribed timelines
activities) attended/ conducted with after
activity
100% ofreport/s
the requirements for Primary Care Workers' Certification
complied
100% (2) by December
Attendance to15, 2022 Development Interventions from
Learning
January - June 2023
Note: If IPCR target was not achieved, please put reason for non-attainment in Remarks column
Output
CORE FUNCTIONS
To ensure that relevant policies,
guidelines and programs
Technical Assistance are and
to LGUs
other health partners toweards
the achivement of UHC is
provided.
Provision of assistance to Local

Nutrition Committes and Local
Nutrition Action Planning
STRATEGIC FUNCTIONS
SUPPORT FUNCTIONS
To ensure timely submission of
correct and complete reports
To strengthen coordination,
Collaboration and partnership
with other agencies and private
To increase capacity of DOH-HRH
in order to improve workplace
performance
Success indicator
(Target + Measure) MOV
100% of received policies / programs with dissemination campaigns are AAR

cascaded to LGUSs
100% of (target) andfacilities
Health other health partners
provided withby June 30,assistance
technical 2024 withon100%
the AAR
establishment of Outpatient Therapeutic Care (OTC)
100% of (target) Health facilities provided with technical assistance on the AAR
establishment
100% of LGUs and of Inpatient Therapeutic
other health partners Care (ITC)with technical assistance
provided AAR
on capability
100% building
of (target) LGUs activities
provided and advocacies
assistance in theontimely
nutrition by June
validation of30, AAR; OPT
Operation
100% of (target) health and non-health facilities provided technical 100%
Timbang PLus reports using the Electronic OPT Tool with Report
AAR;
assistance in the
100% (actual) establishment
of planned of assistance
technical Lactation Stations
activity on appropriate accomplished
AAR
recording and reporting of nutrition indicators
100% of LGUs monitored and evaluated using the in MELLPI
the TCL Tool
conducted AAR;
100% of (target) LGUs assisted on verification of weighing scales accomplished
AAR
100% of LNC request/s for on-site technical assistance on LNAP provided AAR
(Actual)
100% of (target) non-functional and partially functional local nutrition AAR;
committees provided with technical assistance to improve functionality Functionality
S
100% (19) of correct and complete documents as required by P/CDOHO
submitted on of
100% (Actual) or application
earlier thanfor
theleave
set deadlines (DTR,properly
accomplished MAR, MIT andIPCR)
submitted
within the prescribed timelines
100% of (target) LGUs with updated inventory of nutrition commodities accomplished
properly accomplished
100% of LGUs and submitted
provided assistance in thewithin
timelythe prescribed
submission oftimelines
OPT PLus inventory
copy of form
Report using the updated version of E-OPT PLus Tool
100% of LGUs assisted in the preparation of documents for MELLPI transmittal
100% (Actual) of meetings and other activities (seminars, workshops,
trainings,
100% of thehealth promotion
requirements foractivities) attended/
Primary Care conducted
Workers' with after
Certification complied
by December 15, 2022
100% (2) Attendance to Learning Development Interventions from January -
June 2024
RATING
Q (1) E (2) T (3) A (4)
N/A N/A
N/A
N/A
Remarks
Include LGU targets

Success indicator
Output (Target + Measure) Actual Accomplis
CORE FUNCTIONS
Technical Assistance
Conduct of regular visit to 100 % of patienst (Actual) visited and provided preventive Target to be set by C/PDOHO
catchment municipalities
Provides holistic to
management and
100% rehabilitative
(Actual) of services.
patients provided holistic management,
of patient,reports
Prepares from reviewing
of patients reviewed
100% medical
(Actual) history, referral
of progress reports or
of notes from
patients the
handled MOV: Patient Chart & Progress
handled, interventions
Conducts health education, submitted to the Municipal Health Office.
100% (6/6) of targeted Health Education activities on
advocacies
Participatesand training on
in the rehabilitation
100% (Actual)and preventive
of DOH care Health
and LGU conducted through the
programs
implementation of health participated in its implementation
programs of DOH and LGU in
the community
Participation in other activities 100% (Actual) of Involvement during emergency/disasters

as required or requested as part of the HERT.
SUPPORT FUNCTIONS
To ensure timely submission 100% (19) of correct and complete documents as required by
of correct and complete reports P/CDOHO submitted
100% (Actual) on or earlier
of application than accomplished
for leave the set deadlines
To strengthen coordination, properly and submitted
100% (Actual) within
of meetings andthe prescribed
other timelines
activities (seminars,
Collaboration and partnership workshops, trainings, health promotion activities)
To increase capacity of DOH- 100% of the requirements for Primary Care Workers' attended/
HRH in order to improve Certification
100% compliedtobyLearning
(2) Attendance December 15, 2023
Development
workplace performance Interventions from January - June 2023
RATING
Actual Accomplishment Q (1) E (2) T (3) A (4)
et to be set by C/PDOHO / / /
/ / N/A
V: Patient Chart & Progress Report c/o HRH PT / / N/A
/ / N/A
N/A / N/A
ü ü ü
ü ü ü
N/A ü N/A
N/A ü ü
N/A ü ü
Remarks
OPERATIONAL DEFINITION
patient's progress and counseled

Include LGU targets family members of patient handled
and
recommendations
Participation means
DOH - SPMS Form 4
INDIVIDUAL PERFORMANCE COMMITMENT AND R
I, _____________________, _____________of the PROVINCIAL DEPARTMENT OF HEALTH OFFICE-_

indicated measures for the period ______________________
___________________________
Name of Employee:
Approved By:
______________________________
DMO IV
Output
STRATEGIC FUNCTIONS
1.1 No. of activities assisted to implement

the healthy settings program
verification of notifiable diseases and health

events in the municipality/barangay as
CORE FUNCTIONS
No. of clients served/attended to and given
the requested laboratory services
Number of NVBSP activities assisted

1.5 No. of activities to assist in the
institutionalization of DRRMH System in the
LGU
SUPPORT FUNCTIONS
Laboratory application for LTO assisted.

RATING
Function
Core Function
Support Function
Strategic Function
Comments and Recommendation for Development Purposes:
Discussed With:
NURSE II
Legend: 1- Quality 2- Efficiency 3- Timeliness 4- Average * In the event that there is no strategic output, the per
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)
___________of the PROVINCIAL DEPARTMENT OF HEALTH OFFICE-_____________, commit to deliver and agr
od ______________________
___________________________
Name of Employee:
______________________________
DMO IV
Success indicator
(Target + Measure)
1.3.1 100% of targeted activities to support implementation of

healthy settings activities are conducted in the municipality/
barangay
1.4.1 100% (Actual) of notifiable disease and health events

assisted
1.4.2 100% (Actual)notifiable disease/health events monitored

and reported using appropriately filled out forms/tools
100% of clients referred for available procedures are
attended to within set timelines
100% (Actual) of laboratory examinations are performed

accurately and conforms to standards
100% (Actual) of Results are made available within prescribed

timelines with no errors
100% of laboratory facility equipment and supplies are

maintained monthly
100% (2) of bloodletting activities assisted
100% (2) clients successfully engaged as blood donors as

Donor Recruitment Officer
1.5.3 100% (actual) of incidents based on occurence or events
based on request assisted
3.1.1 100% (19) of correct and complete documents as

required by P/CDOHO submitted on or earlier than the set
deadlines (DTR, MAR, MIT, IPCR)
3.1.2 100% of the requirements for Primary Care Workers'

Certification complied by June 30, 2024
3.1.3 100% (2) Attendance to Learning Development

Interventions from January - June 2024
3.1.4 100% (3) Attendance to UHC Sirib Series
100% (1) laboratory provided assistance on licensing

requirements
Percentage Distribution
50%
10%
40%
for Development Purposes:
Assessed by:
I certify that I discussed my assessment of the performance
with the employee
DMO IV
Timeliness 4- Average * In the event that there is no strategic output, the percentage distribution is as follows: Core Outp
Document Code:
TMENT AND REVIEW (IPCR) Revision No.:
Effectivity:
ALTH OFFICE-_____________, commit to deliver and agree to be rated on the attainment of the following targets in a
__________ Date:
oyee:
Date
___________
RATING
Actual Accomplishment Q E T A
(1) (2) (3) (4)
Activities refer to any activity conducted to implement
the healthy settings program: Healthy Communities,
Healthy Schools, Healthy Workplaces All Provinces:
Community and workplace
Benguet, Kalinga, Mt. Province: Healthy Schools
N/A 1 N/A
N/A 1 TRUE
N/A 1 TRUE
NA 1 TRUE
1 1 NA
1 1 TRUE
1 TRUE
NA 1 NA
1 NA
N/A 1 N/A
1 TRUE
1 TRUE
1 FALSE
1 FALSE
NA 1 TRUE
Average Rating:
Average Rating per Function Final Average Rating
Date Final Rating by:
DMO V
output, the percentage distribution is as follows: Core Output - 80% and Support Output - 20%
Annex D
Document Code:
Revision No.:
Effectivity:
of the following targets in accordance with the
Date:
Date

Target Operational Definition
Activities refer to any activity conducted to

implement the healthy settings program:
Healthy Communities, Healthy Schools,
Healthy Workplaces
All Provinces: Community and workplace
Benguet, Kalinga, Mt. Province: Healthy
Schools
Any health event that causes public concern

Target: Actual number or events/ notifiable
diseases monitored
MOV: CIF or ESR
Target: actual number clients attended for
referred laboratory procedures
MOV: lab result logbook
Target: actual number of laboratory

examinations performed
MOV: lab result logbook, Quality Control
Logbook/NQAS
Target: actual number of lab. results released

within prescribed timelines
MOV: releasing logbook
Target: To be set by the Med. Tech. (no. of

equipment in the facility needing preventive
maintenance)
MOV: Preventive Maintenance Logbook,
Inventory of equipment and supplies
Target: Number of Bloodletting activities

MOV: AAR
Target: 2
MOV: AAR
Target: Based on request
MOV: AAR
Target: 19
MOV: Submitted documents
For new physicians, nurses and midwives

Target: Submission to the portal
MOV: PCW cert/ portal submission SS
Any LDI related to their cadre (except Sirib

series). Self-initiated.
Target: 2
MOV: Certificate
UHC Sirib Series

Target: 3
MOV- Certificate
Adjectival Rating Remarks
Date
DMO V
Quality efficiency timeliness

NA 3 = 100-114% of the target NA
NA
5- 100% 5- within 24 hours
2- below 100% 2- more than 24 hours
NA 5- 100% 5- within 24 hours

2- below 100% 2- more than 24 hours
5- no mistakes 5 = ≥130% of the target

4- 1 or 2 minor errors 4 = 115-129% of the target
3- more than 2 minor errors/ 3 = 100-114% of the target
minor/partial revision needed 2 = 51-99% of the target
2- major revision needed 1 = ≤50% of the target
1- needs total revision
5- no mistakes
4- 1 or 2 minor errors 5 = ≥130% of the target
3- more than 2 minor errors/ 4 = 115-129% of the target
minor/partial revision needed 3 = 100-114% of the target
2- major revision needed 2 = 51-99% of the target
1- needs total revision 1 = ≤50% of the target

3 = 100-114% of the target 5- submitted on time
2 = 51-99% of the target 2- late submission
NA 5- all activities assisted

2- not all activities assisted NA

5 = 100%
4 = 95.01%-99.99%
NA 3 = 80%-95% NA
2 = 50%-79.99%
1 = <50%
5- no mistakes
4- 1 or 2 minor errors
5- 100% of target documents
3- more than 2 minor errors/ 5- submitted on time
minor/partial revision needed accomplished 2- late submission
2- major revision needed 2- below 100%
1- needs total revision
5- with Certificate/ portal

NA submission 5- submitted on time
2- incomplete/ no cert or 2- late/no submission
submission



NA 3 = 100-114% of the target 5- submitted on time
2 = 51-99% of the target 2- late submission
Core Functions
A. General Health Sevices
Number of clients provided access to effective, safe

and quality health care service
B. Family Planning Services

C. Maternal Care and Services

D. Child Care and Services
E. Disease Prevention and Control Services
Number of clients provided timely and appropriate TB
management
number of animal bite cases provided first aid,
treatment and management appropriately
Number of Active case finding and surveillance
conducted
F. Non-communicable disease prevention and control services
Number of clients provided timely and appropriate

management
G. National Voluntary Blood Services Program

Number of voluntary blood donation conduscted/
assisted
H. Adolescent Services
Number of Adolescents given comprehensive
assessment and provided appropriate health services
I. Environment
Number and Occupational
of application Health Services
for health certificate and
sanitary permits acted uppon/assisted within ARTA
timelines
J. Health Emergency and Disaster Response
K. Health Governance
number of Local Health Board and Rhu Staff Meeting

conducted to solve raised health issues and concerns
number of Local Health Board and Rhu Staff Meeting
conducted to solve raised health issues and concerns
L. Health Promotion and Education

Number of relevant policies, guidelines and programs
cascaded
M. Reports
Number of correct and complete reports submitted
Strategic Functions
Active case finding and surveillance

Support Functions
Number of correct and complete reports submitted

timely
NUmber of coordination, Collaboration and partnership
activities conducted/ attended
RATING
Function
Core Functions
Support Functions
Strategic Functions
Discussed With:
Employee/DTTB
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average; *In the event that there is no strategic output, the percentage distrib
Success Indicator (Targets + Measure)
AGREEMEN
RETAIN MODIFY
100% of patients who consulted at the RHU/BHS were provided with

comprehensive and appropriate health services
100% of clients needing further intervention and/or specialized care
were referred to higher health facilities following guidelines, protocol
100% of medico legal referrals attended to and given result within
and manuals.
prescribe timeline in the manual.
100% (Actual) of patients provided with Family Planning Services
100% of pregnant women referred for complete blood count and

screened for syphilis,
100% (Actual) HbSag
of patients and HIV
provided testing
with complete post-partum care
within puerperium
100% of sick children seen, examined and given appropriate care.

100% of childern <5 y.o with complete immunization under the NIP (1
dose of BCG, 3 doses of OPV, 3 Doses of DPT-Hib-HepB, 2 doses of
measles vaccine by 12 months)
100% of TB patients prescribed appropriate treatment regimen.
100% of Animal bite cases given first aid, treated and managed
appropriately
100% (Actual) of number of disease surveillance done
nd control services
100% of number of clients are assessed and screened with Philpen Risk
Assessment Tool and given health education,intervention and referred
according to protocol
100% of hypertensive and/or diabetic patients seen and examined
100% of examined and registered patients are given monthly medication
am
100% (input target) of voluntary blood donation conducted/assisted
100% (actual) of adolescents given comprehensive assessment and

provided appropriate health care services
vices
100% of applications for health certificates and sanitary permits
evaluated and acted upon/assisted within ARTA timelines.
100% (actual) reportable incidents/events monitored and reported using
appropriately filled-out forms/ tools
100% of incidents/events are responded/ assisted
100% (input target) of Local Health Board Meeting conducted/ attended

100% (input target) of RHU staff meeting conducted/ attended
100% (input target from Jan.-June) of comprehensive health education

and promotion activities conducted based on schedules
100% (Actual) of complete and accurate plans, reports and other

required documents by LGUs ( LIPH, AOP) and DOH (FHSIS,HEARS)
Averagesystematically prepared and submitted on time
Rating (Core Functions)
100% of community playbook (Volume 1) people-focused activities

100% (2/2) of quarterly
implemented target
as planned fortargeted
in the plannedLGU.
major health events under the
Health Promotion Framework Strategy Campaign, Primary Care Provider
Campaign, or of
100% (Actual) HPB Public of
number Engagement Gridinvestigation
epidemiologic for 2023 implemented.
conducted
Submission of application for the primary care workers certification on

or before August
Submission 31,2023. for the PHIC as KONSULTA provider on or
of application
100% (July-December)
before October 31,2023. of correct and complete documents as required
by P/CDOHO submitted on or earlier than the set deadlines (DTR, MAR,
100% (Actual) of inter-agency meetings (ex: MADAC, MNC, MIT, MPOC,
MIT IPCR)
MDRRM) attended/ conducted with after activity report/s
Percentage Distribution*
50%
10%
40%
lopment Purposes:
Assessed by:
I certify that I discussed my assessment of the perfomance with the
employee
Supervisor/DMO V
- Average; *In the event that there is no strategic output, the percentage distribution
AGREEMENT
Operational definition
DELETE
100% of the 50% of total clients served

rated using the PCES Tool
note: how to include HIV

for new HRH
for the non-Konsulta
CORE FUNCTIONS IPCR TARGETS
Core Functions Service target-20% of age specific eligible
population
100% of the service targets for the following age
groups provided with BOHC as scheduled
0-11 months
1-4 years old
5-9 years old
Provides Basic Oral Health Care

(BOHC) to the eligible population for
indicators and targets set on FHSIS
10-14 years old

15-19 years old
20-59 years old

60 years old and above
with in the scope and capability of Pregnant Women
the PHO/RHU/C/MHSO 100%
100% of cases
timely not withinofthe
submission scope and
required capability
program
of PHO/RHU/C/MHSO
reports. are referred to appropriate
activities and other oral health health activities
conducted as planned.
SUPPORT FUNCTIONS 100% (Actual) of requested Oral Health Program
(OHP) activities
3.1.1 100% (19) ofarea attended/provided.
correct and complete documents
Ensures timely submission of correct as
3.1.3 100% (2) Attendancesubmitted
required by P/CDOHO on or earlier
to Learning
andAttends
complete reports
Functional Career and than the set deadlines (DTR, MAR,
Development Interventions from JanuaryMIT, IPCR)
- June
Development Program 2024
3.1.4 100% (3) Attendance to UHC Sirib Series
OPERATIONAL DEFINITION MOVs
(1) caries free / carious teeth filled with either temporary or

permanent filling materials
(2) with healthy gums
Same as above AND topical fluoride application (at 9-11
mos.) (unlessRestorative
- Atraumatic contraindicated)
Treatment (ART)
- Oral prophylaxis/scaling
Refers to the provision of the following:

Oral examination
AND
(2) Supervised Toothbrushing
AND
(3) Oral Health Education
AND (if necessary)
- Pits and Fissure Sealant
- Temporary filling
- Permanent filling
(2) Education and counselling on good oral hygiene, diet and
adverse effects of tobacco/smoking and alcohol
and sweetened beverages & food
AND (if necessary)
- Pit and fissure sealant application
- Temporary filling
- Permanent filling
- Oral prophylaxis/scaling
-- Oral Urgentfilling
Permanent Treatment (OUT)
-unsavable
Atraumatic Restorative
teeth Treatment
and referral (ART) cases to higher
of complicated
level
- Temporary filling
- Permanent filling
Referral Forms
FHSIS Reports
After Activity Reports
After Activity Reports

Submitted Documents
Certificate of
Attendance/Completion
Certificate of
Attendance/Completion
target
4 = 3.5- 3.99 average N/A score 15-=100%
≤50%ofoftarget
the target
documents N/A
3 == 33.5-
4 - 3.49
3.99average
averagescore
score accomplished
5- 100% of target documents N/A
324 === 233.5-
-- 2.99
3.49 average
average score
score
3.99 average score 2-
5- below
100% of100%
accomplishedtarget documents
23 == 23 -- 2.99
3.49 average
average score
score 2- below 100%
accomplished
2 = 2 - 2.99 average score 2- below 100%
5 = 4 average score
4 = 3.5- 3.99 average score 5- 100% of target documents
3 = 3 - 3.49 average score accomplished
1 = 1 - 1.99 average score

5 = 4 average score
34 == 33.5- - 3.49
3.99average
averagescore
accomplished
score
5- 100% of target documents
23 == 23 -- 2.99
3.49 average
average score
2-
score below 100%
accomplished
23 == 23 -- 2.99
3.49 average
average score
2-
score below 100%
accomplished
2 = 2 - 2.99 average
N/A score
2- below 5- all
100%patients referred
5- 100%
3- more than 2 minor errors/
of target
2- not documents
all patients referred after theN/A
deadline
4 = 91%-95% Average accomplished 0 = no submission
minor/partial revisionRating
needed
52-=100%
belowof target conducted
100% scheduled
2 = 80%-84% Average Rating 2 = below 100% 2 = conducted not
5 =100% of requests
2 = below
5- 100% of target 100%
documents 5- submitted on
3- more than 2 minor errors/ accomplished time
minor/partial revision needed 42-
= 115-129% of the target
NA 34 ==below 100%
100-114%
115-129% ofof the
the target
target 2- late submission
NA
NA 2 = 51-99% of the target
3 = 100-114% of the target NA
4- 1 day before the deadline
3- During the deadline
4 = 3.5- 3.99 average score
▪ 1 = ≤50% of the target
Rating Scale for 100%
Guide Questions Yes No Partial Remarks/Observations
1 Did the Ratee use the correct template?
2 Were all the required blanks signed by Ratee and Rater?
Were the Rater the Supervisor who signed the IPCR the proper ones, as defined
3
in SPMS Guidelines?
Was the next higher supervisor who signed the proper official?
4 Immediate Supervisor: DMO IV
Next Higher Supervisor: DMO V
Review the Quality (Q) Ratings. Were the “Q” scores computed correctly, based
5
on OPCR Metadata?
6 Were the “Q” scores computed correctly, if based on SPMS Rating Scale?
Review the Efficiency (E) Ratings.
7
Were the “E” scores computed correctly based on OPCR Metadata?
8 Were the “E” scores computed correctly, if based on SPMS Rating Scale?
Review the Timeliness Ratings. Were the “T” scores computed correctly, based
9 on OPCR Metadata?
10 Were the “T” scores computed correctly, if based on SPMS Rating Scale?
Was the Final Average Rating computed correctly, based on SPMS Guideline?
(Core = 50%,
11
Support = 10%, Strategic = 40% or if no strategic output, Core = 80%, Support =
20%)
12 Was the Adjectival Rating correct, based on the SPMS Guidelines?
13 Was the signatory of the Final Rating the proper official?

Did the rater provided comments and recommendations for the improvement of
14
the ratee?

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DOH-SPMS Form 4 Document Code: DOH-CHD-CAR-QSOP-127 Form 3

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) Revision No.: 1

(Name of HRH & Signature) Date:

Approved By: Date:

Average Rating (Core Functions)

Average Rating (Strategic Functions)

Average Rating (Support Functions)

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date: day of approval

Discussed With: Assessed by: Date Final Rating by: Date

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date:

Discussed With: Assessed by: Date Final Rating by: Date

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date:

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date:

Discussed With: Assessed by: Date Final Rating by: Date

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date:

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date:

Average Rating (Strategic Functions)

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

(Name of HRH & Signature) Date:

Approved By: Date:

Employee/HRH Supervisor/DMO IV Next Higher Supervisor/DMO V

Refers to the percentage of pregnant women tracked

Refers to the number of pregnant women tracked assisted in

5 = ≥130% of the target

5 = submitted within schedule

5 = 2 weeks before the deadline

5 = within timeline (7 days)

5 = within timeline (1 month)

5- report submitted within 24 hours of the

Provision of assistance to Local

100% of received policies / programs with dissemination campaigns are AAR

Include LGU targets

Participation in other activities 100% (Actual) of Involvement during emergency/disasters

patient's progress and counseled

I, _____________________, _____________of the PROVINCIAL DEPARTMENT OF HEALTH OFFICE-_

1.1 No. of activities assisted to implement

verification of notifiable diseases and health

Number of NVBSP activities assisted

Laboratory application for LTO assisted.

1.3.1 100% of targeted activities to support implementation of

1.4.1 100% (Actual) of notifiable disease and health events

1.4.2 100% (Actual)notifiable disease/health events monitored

100% (Actual) of laboratory examinations are performed

100% (Actual) of Results are made available within prescribed

100% of laboratory facility equipment and supplies are

100% (2) of bloodletting activities assisted

I, _________, _of the PROVINCIAL DEPARTMENT OF HEALTH OFFICE-_