M2

FHSIS REPORT for the MONTHLY YEAR:

Name of Municipality/City:
Name of Province:

RHU
Projected Population of the Year:
For submission to PHO/CHO
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total for WRA 15-49 y/o Interpretation Recommendation / Action Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5)
10-14 y/o 15-19 y/o 20-49 y/o
1. Proportion of WRA with unmet need for modern FP
(No.1.1/No.1.2 X 100)
1.1 Number of WRA with unmet need for MFP - Total
1.2 Total No. of Estimated WRA
(Eligible Population )
A2. Use of FP Method Current Users Acceptors Drop-outs Current Users New Acceptors CPR Interpretation Recommenda
(Beginning of Qtr) New (end of Qtr) Other (end of Qtr) (Present Quarter) (End of Quarter) (Last Month of Col. 6/TP x 25.854% tions/Actions
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) to be Taken
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total (Col. 9) (Col. 10)
a. BTL -Total
b. NSV - Total
c. Condom - Total
d. Pills - Total
d.1 Pills-POP - Total
d.2 Pills-COC - Total
e. Injectables (DMPA/POI) -
f. Implant - Total
g. IUD (IUD-I and IUD-PP) - Total
g.1 IUD-I- Total
g.2 IUD-PP - Total
h. NFP-LAM - Total
i. NFP-BBT - Total
j. NFP-CMM - Total
k. NFP-STM - Total
l. NFP-SDM - Total
m. Total Current Users
1
 Section B. Maternal Care and Services
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
(Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) (Col. 5)
B1. Prenatal Care
1. No. of pregnant women w/ at least 4 prenatal check-ups - Total
2. No. of pregnant women assessed of their nutritional status during the 1st
trimester - Total
a. Number of pregnant women seen in the first trimester who have
normal
b. No. of pregnant women seen in the first trimester who have low BMI-
c. No. of pregnant women seen in the first trimester who have high BMI-
3. No. of pregnant women for the first time given at least 2 doses of Td
vaccination - Total
4. No. of pregnant women for the 2nd or more times given at least 3 doses
of Td vaccination (Td2 Plus) - Total
5. No. of pregnant women who completed the dose of iron with folic acid
supplementation - Total
6. No. of pregnant women who completed doses of calcium carbonate
supplementation - Total
7. No. of pregnant women given iodine capsules – Total
8. No. of pregnant women given one dose of deworming tablet - Total
9. No. of pregnant women screened for syphilis - Total
10. No. of pregnant women tested positive for syphilis - Total
11. No. of pregnant women screened for Hepatitis B - Total
12. No. of pregnant women tested positive for Hepatitis B - Total
13. No. of pregnant women screened for HIV - Total
14. No. of pregnant women tested for CBC or Hgb&Hct count - Total
15. No. of pregnant women tested for CBC or Hgb&Hct count diagnosed
with
16. No. of pregnant women screened for gestational diabetes – Total
17. No. of pregnant women tested positive for gestational diabetes – Total
2
 Section I. Natality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken
(Col. 1)
(Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1. Livebirths - Total
a. Livebirths among 10-14 y/o women - Total
a. Livebirths among 15-19 y/o women - Total
a. Livebirths among 20-49 y/o women - Total
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
(Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) (Col. 5)
B2. Intrapartum Care and Delivery Outcome
18. No. of deliveries – Total
19. No. of live births – Total
a. No. of live births with normal birth weight - Total
b. No. of live births with low birth weight - Total
c. No. of live births with unknown birth weight - Total
20. No. of deliveries attended by skilled health professionals - Total
a. No. of deliveries attended by a doctor - Total
b. No. of deliveries attended by a nurse – Total
c. No. of deliveries attended by midwives - Total
21. No. of health facility-based deliveries - Total
a. No. of deliveries in public health facility - Total
b. No. of deliveries in private health facility - Total
22. No. of non-facility-based deliveries - Total
23a. No. of vaginal deliveries – Total
23b. No. of deliveries by cesarean section – Total
24a. No. of full-term births – Total
24b. No. of pre-term births – Total
24c. No. of fetal deaths - Total
24d. No. of abortion/miscarriage - Total
3
B3. Postpartum and Newborn Care
25. No. of postpartum women together with their newborn who completed
at
26. No. of postpartum women who completed iron with folic acid
supplementation - Total
27. No. of postpartum women with Vitamin A supplementation – Total
Section C. Child Care and Services
Indicators Eligible Population Counts % Interpretation Recommendations /
(Col.5/E.Po Actions to be Taken
Male Female Total
p x 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total
2. BCG - Total
3. HepB, within 24 hours. - Total
4. DPT-HiB-HepB 1 - Total
5. DPT-HiB-HepB 2 - Total
6. DPT-HiB-HepB 3 - Total
7. OPV 1 - Total
8. OPV 2 - Total
9. OPV 3 - Total
10a. IPV1 - Total
10b. IPV2 - Total
11. PCV 1 - Total
12. PCV 2 - Total
13. PCV 3 - Total
14. MCV 1 - Total
15. MCV 2 - Total
16. FIC - Total
17. CIC - Total
4
 Indicators Eligible Population Counts % Interpretation Recommendations /
(Col.5/E.Po Actions to be Taken
Male Female Total
p x 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
18. Td, Grade 1 (November) - Total
19. MR, Grade 1 (November) - Total
20. Td, Grade 7 (November) - Total
21. MR, Grade 7 (November) - Total
C2. Nutrition Services for Infants and Children
22. Newborns initiated on breastfeeding immediately after birth lasting to 90
mins - Total
23. Preterm/LBW infants given iron supplementation - Total
infants 5 mos and 29 day old Seen
24.1 Infants exclusively breastfed until 6th month - Total
25. Infants 6 mos. old initiated to comp, feeding w/ continued breastfeeding - Total
26. Infants 6 mos. old initiated to complementary feeding but no longer or
never
infant 6-11 Seen
27. Infants 6-11 mos. given 1 dose of Vit. A 100,000 I.U. - Total
children 12-59 mos old Seen
28. Children 12-59 mos. old given 2 doses of Vit. A 200,000 I.U. - Total
29. Infant 6-11 months old who completed MNP supplementation - Total
Infants 12-23 months old seen
30. Children 12-23 mos. who completed MNP supplementation - Total
5
31. Nutritional Status 0-59 mons
31.1. Stunted - Total
31.2. Wasted - Total
31.2.a. MAM - Total
31.2.a.1.MAM-admit ed in SFT-Total
31.2.a.2MAM-cured in SFP-Total
31.2.a.3MAM-defaulted in SFP-Total
31.2.a.4MAM died in SFP-Total
31.2.b. SAM - Total
31. 2.b.1 SAM- admit ed to OTC-Total
31.2.b.2SAM - cured in OTC-Total
31.2.b.2SAM-defaulted in OTC-Total
31.2.b.2SAM- died in OTC-Total
31.3. Overweight and Obese - Total
31.4. Normal - Total
C3. Deworming Services for Infants, Children and Adolescents
31. 1-19 y/o given 2 doses of deworming drug - Total
a. PSAC, 1-4 y.o. dewormed (2 doses) - Total
b. SAC, 5-9 y.o. dewormed (2 doses) - Total
c. Adolescents, 10-19 y.o. dewormed (2 doses) - Total
6
 C4. Management of Sick InfantsIndicators
and Children Eligible Population Counts Interpretation Recommendations /
32. Sick Infants 6-11 mos. old seen - Total 10-14 y/o 15-19 y/o 20-49 y/o Total % Actions to be Taken
33. Sick Infants 6-11 mos. old received Vitamin A - Total (Col.6/ E.Pop x 100)

34. Sick Children 12-59 mos. old (Col.

seen1)- Total (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8) (Col. 9)
9. Pregnant women who received BOHC - Total
35. Sick Children 12-59 mos. old received Vitamin A - Total
36. Diarrhea cases 0-59 months old seen - Total Section E. Infectious Disease Prevention and Control Services
Indicators Denominator Counts % Interpretation Recommendations /
37. Diarrhea cases 0-59 months old received ORS - Total (Col.5/E.Po
Male Female Total Actions to be Taken
38. Diarrhea cases 0-59 mos. received ORS w/ zinc - Total p x 100)
39. Pneumonia cases 0-59 mos. old (Col.seen
1) - Total (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
E1. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
40. Pneumonia cases 0-59 mos. old completed treatment - Total
1. No. of WRA, 20-49 years old, who completed 2 doses of deworming
tablet -
Section D. Oral Health Care and Services
E2. HIV-AIDS/STI Prevention andIndicators Control (reflected under Maternal Care) Eligible Population Counts % Interpretation Recommendations /
E3. Tuberculosis Prevention and Control (Col.5/E.Po Actions to be Taken
Male Female Total
1. Number of notified TB cases, all forms - Total p x 100)
2. Number of registered bacteriologically (Col. 1)confirmed drug resistant TB (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1.(RR/MDR-TB
Orally fit children
Cases)12-59- Total
months old upon oral examination plus orally fit
3.after
Number of TB, all forms that are cured and completely treated - Total
4.2.Number
Clients 5ofyears
registered
old andbacteriology
above withconfirmed drug resistant
cases of DMFT - Total TB Cases
3.(RR/MDR-TB) cured and
Infants 0-11 months old whocompleted
receivedtreatment
BOHC --Total
Total
E4. Malaria Prevention and Control
4. Children 1-4 years old (12-59 mos.) who received BOHC - Total
1. No. of patients with probable/clinically diagnosed Malaria and confirmed
5.case
Children 5-9 years old who received BOHC - Total
- Total
6. •Adolescents
< 5 y/o - Totalwho received BOHC - Total
•a.≥Adolescents
5 y/o - Total 10-14 years old who received BOHC - Total
2. No.b. Adolescents
of lab-confirmed 15-19Malaria
yearsdeaths
old who- Total
received BOHC - Total
7. •Adults
< 5 y/o20-59 years old who received BOHC - Total
- Total
8. •Senior
≥ 5 y/ocitizens
- Total60 years old and above who received BOHC - Total
8
7
E5. Leprosy Prevention and Control Section G. Environmental Health and Sanitation Services
1. No. of Leprosy cases on treatmentIndicators during reporting period - Total Target/Denominator Total % Interpretation Recommendations /
2. No. of newly detected cases during reporting period - Total (Col.5/Target x 100) Actions to be Taken
E6. Rabies Prevention and Control (Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6)
1. No. of animalHHs withbites
access
- Totalto basic safe water supply - Total
2. No.a. No. of HHs due
of deaths with toLevel
Rabies I - Total
- Total
b. No. of HHs with Level II - Total
Section F. Non-Communicable Disease Prevention and Control Services
c. No. of HHs with Level III - Total
Indicators Eligible Population/Denominator Counts % Interpretation Recommendations /
2. No. of HHs using safely managed drinking-water services - Total
(Col.5/E.Po Actions to be Taken
3. No of HHs with basic sanitation facility - Total Male Female Total
p x 100)
a. No. of HH with pour/flush toilet connected to septic tank - Total
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
b. No. of HHs with pour/flush toilet connected to community sewer/sewerage
1. No. of adults risk-assessed using PhilPEN - Total
system or any other approved treatment system - Total
2.c. No.
Current smokers
of HHs - Total improved pit latrine (VIP) - Total
with ventilated
4. No.3. Alcohol
of HHs binge
using drinkers
safely managed- Total sanitation services - Total
5. No.4. Overweight/Obese-Total
of industrial establishments issued with sanitary permit - Total 105138
6.5. No. of adult womendeclared
barangays screenedZODfor- Cervical
Total Cancer using VIA/Pap Smear -
Total Section H. Mortality
6. No. of adult women found positive/suspect Indicatorsfor Cervical Cancer using Denominator Counts % Interpretation Recommendations /
VIA/Pap Smear- Total Male Female Total Actions to be Taken
7. No. of adult women screened for breast (Col. 1)mass - Total (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1.8. Total
No. ofDeaths
adult women with suspicious breast mass - Total
2.9. Maternal
No. of newly-identified
Deaths - Total hypertensive adults - Total
3.10.Under-five
No. of newly-identified
Deaths - Totaladults with Type 2 DM - Total
4.11.Infant
No. ofDeaths
senior- Total
citizens screened for visual acuity - Total
5.12.Neonatal
No. of senior
Deathscitizens
- Totalscreened for eye problems - Total
6.13.Fetal
No. ofDeaths
senior- Total
citizens diagnosed with eye disease/s - Total
7.14.Early
No. ofNeonatal
senior citizens
Deaths -whoTotalreceived one (1) dose of PPV - Total
8.15.Perinatal Deathscitizens
No. of senior - Total who received one (1) dose of influenza vaccine -
10
9