Ministry of Health and Family Welfare

(Monitoring and Evaluation Division)

Monthly Service Delivery Reporting Format for Sub-Centre And Equivalent Institutions
Health Management Information System(HMIS)

Name of Sub-Centre : Chanmari West Sub Centre

Reporting Month ; April 2023

Indicato
r Indicator Name Numbers
Number
Part A REPRODUCTIVE CHILD HEALTH
M1 Anti Natal Care (ANC) Services
1.1 Total number of Pregnant Women registered for ANC 8
1.1.1 Out of the total ANC women registered,number registered within 1st Trimester (within
12weeks) 8
1.2 ANC Services
1.2.1 Number of PW given TT1/Td1 3
1.2.2 Number of PW given TT2/Td2 3
1.2.3 Number of PW given TT/Td Booster 2
1.2.4 Number of PW provided Full Course 180 Iron Folic Acid (IFA) tablets 7
1.2.5 Number of PW provided Full Course 360 Calcium tablets 0
1.2.6 Number of PW given one Albendazole tablet after 2nd Trimester 6
1.2.7 Number of PW received 4 or more ANC check ups 7
1.2.8 Number of PW given ANC Corticosteroids in Pre Term Labour 0
1.3 Pregnant Women (PW) with Hypertension (BP> 140/90) 0
1.3.1 New Cases of PW with Hypertension Detected 0
1.3.1(a) Out of the New Cases fo PW with Hypertension detected, cases managed at institution 0
1.4 Pregnant Women (PW) with Anaemia
1.4.1 Number of PW tested for Haemoglobin(Hb) 4 or more than 4 timedfor respective ANC's 7
1.4.2 Number of PW having Hb level < 11 (out of total tested cases) (7.1 to 10.9) 0
1.4.3 Number of PW having Hb level <7 (out of total tested cases) 0
1.5 Pregnant Women (PW) with Syphillis 0
1.5.1 Point of Care (POC) tests conducted for Syphillis 0
1.5.1.a Number of PW tested using POC test for Syphillis 5
1.5.1.b Out of above, number of PW found sero positive for Syphillis 0
M2 Deliveries
2.1 Deliveries conducted at Home 0
2.1.1 Number of Home Deliveries attended by 0
Number of Home Deliveries attended by Skill Birth Attendant (SBA)
2.1.1.a (Doctor/Nurse/ANM/Midwife) 0
Number of Home Deliveries attended by Non-SBA (Trained Birth Attendant (TBA) /
2.1.1.b Relatives/etc) 0
2.1.2 Number of PW given Tablet Misoprostol during home delivery 0
2.1.3 Number of newborns received 7 Home Based Newborn Care (HBNC) visits in case of Home
Delivery 0

1
 2.2.1 Out of total institutional deliveries number of women discharge within 48 hrs of delivery
0
2.2.2 Number of newborns received 6 HBNC visits after Institutional Delivery 7
M3 Pregnancy Outcome & details of new-born
3.1 Pregnancy Outcome (in number) 0
3.1.1 Live Birth 0
3.1.1.a Live Birth - Male 0
3.1.1.b Live Birth - Female 0
3.1.2 Number of Pre term newborns (<37weeks of Pregnancy) 0
3.1.3 Still Birth 0
3.2 Abortion (Spontaneous) 0
3.3 Details of New Born Children 0
3.3.1 Number of New Borns weigh at Birth 0
3.3.2 Number of New Borns having weight less than 2.5kgs 0
3.3.3 Number of New Borns Breast fed within 1 hour of Birth 0
M4 Post Natal Care (PNC) 0
4.1 Women receiving 1st Post Partum check ups within 48hrs of Home Delivery 0
4.2 Women receiving 1st Post Partum check ups between 48hrs and 14days of Home Delivery 0
4.3 Number of mother provided full course of 180 IFA Tablets after Delivery 0
4.4 Number of mother provided full course of 360 Calcium tablets after Delivery 0
M5 Family Planning 0
5.1 Number of Interval IUCD Insertions (excluding PPIUCD and PAIUCD) 0
5.2 Number of Postpartum (within 48hrs of Delivery ) IUCD Insertions 0
5.3 Number of IUCD Removals 0
5.4 Number of Complication Following IUCD Insertions 0
5.5 Injectable Contraceptive - Antara Programme - First Dose 0
5.6 Injectable Contraceptive - Antara Programme - Second Dose 0
5.7 Injectable Contraceptive - Antara Programme - Third Dose 0
5.8 Injectable Contraceptive - Antara Programme - Fourth or more than Fourth 0
5.9 Number of Combined Oral Pills Cycles Distributed 4cycle
5.1 Number of Condom Pieces distributed 45pieces
5.11 Number of Centchroman (weekly) pills strips distributed 0
5.12 Number of Emergency Contraceptive Pills (ECP) given 0
5.13 Number of Pregnancy Test Kit (PTK) used 0
5.14 Quality in Sterilization Services 0
5.14.1 Complications following Male Sterilization 0
5.14.2 Complications following Female Sterilization 0
M6 CHILD IMMUNISATION
6.1 Number of Infants 0-11months old who received : 0
6.1.1 Child Immunisation - Vitamin K (Birth Dose) 0+1
6.1.2 Child Immunisation - BCG 1+2
6.1.3 Child Immunisation - DPT1 0
6.1.4 Child Immunisation - DPT2 0
6.1.5 Child Immunisation - DPT3 0
6.1.6 Child Immunisation - Pentavalent1 3+4
6.1.7 Child Immunisation - Pentavalent2 2+3
6.1.8 Child Immunisation - Pentavalent3 4+3
6.1.9 Child Immunisation - OPV (Birth Dose) 0+1
2

6.1.10 Child Immunisation - OPV1 3+4

6.1.11 Child Immunisation - OPV2 2+3
6.1.12 Child Immunisation - OPV3 4+3
6.1.13 Child Immunisation - Hepatitis - B0 (Birth Dose) 0+1
6.1.14 Child Immunisation - Hepatitis - B1 0
6.1.15 Child Immunisation - Hepatitis B2 0
6.1.16 Child Immunisation - Hepatitis B3 0
6.1.17 Child Immunisation - Inactivated Injectable Polio Vaccine 1 (IPV 1) 3+4
6.1.18 Child Immunisation - Inactivated Injectable Polio Vaccine 2 (IPV 2) 4+3
6.1.19 Child Immunisation - Rotavirus 1 3+4
6.1.20 Child Immunisation - Rotavirus 2 2+3
6.1.21 Child Immunisation - Rotavirus 3 4+3
6.1.22 Child Immunisation - PCV 1 3+4
6.1.23 Child Immunisation - PCV 2 4+3
6.1.24 Child Immunisation - PCV Booster 1+3
6.2 Number of Children 9-11 months who received :
6.2.1 Child Immunisation (9-11months) - Measles &Rubella (MR) / Measles containing Vaccine
(MCV) - 1st Dose 1+3
6.2.2 Child Immunisation (9-11months) - Measles 1st Dose 0
6.2.3 Child Immunisation (9-11months) - JE 1st Dose 0
Number of Children aged between 9-11 months fully immunized {OPV 0+BCG 0+HepB
6.2.4 0+OPV123+Rotavirus123 (applicable)+Pentavalent123+1dose of IPV (selected states)
+Measles/MR-1st Dose,JE 1st Dose(where applicable) 0
6.2.4.a Children aged between 9 and 11 months fully Immunized -Male 1
6.2.4.b Children aged between 9 and 11 months fully Immunized -Female 3
6.3 Children given following vaccination after 12months 0
6.3.1 Child Immunisation (after 12months) - Measles & Rubella (MR)/Measles 0
6.3.2 Child Immunisation (after 12months) - Measles 1st Dose 0
6.3.3 Child Immunisation (after 12months) - JE 1st Dose 0
6.4 Number of Children - more than 12months who received :
6.4.1 Child Immunisation - Measles & Rubella (MR)/ 2nd Dose (16-24 months) 13+17
6.4.2 Child Immunisation - Measles 2nd Dose (more than 16 months) 0
6.4.3 Child Immunisation - DPT 1st Booster 13+17
6.4.4 Child Immunisation - OPV Booster 13+17
6.4.5 Child Immunisation - Measles, Mumps, Rubella (MMR) Vaccine 0
Number of Children more than 16 months of age who received Japanese Encephalitis (JE)
6.4.6 Vaccine 0
6.5 Number of Children more than 23 months who received:
6.5.1 Child Immunisation - Typhoid 0
6.5.2 Children more than 5 years who received DPT5 (2nd Booster) 1+2
6.5.3 Children more than 10 years received TT10/Td10 2+2
6.5.4 Children more than 16 years received TT16/Td16 0
6.6 Adverse Effect Following Immunisation (AEFI)
 6.6.1 Number of cases of AEFI - Abscess 0
6.6.2 Number of cases of AEFI - Death 0
6.6.3 Number of cases of AEFI - Others 8
6.7 Number of Immunisation Sessions

6.7.1 Immunisation Session Planned 1

6.7.2 Immunisation Held 1
6.7.3 Number of Immnisation Sessions where ASHA's were prensent 1
6.8 Children received Vitamin A doses between 9months and 5years
6.8.1 Child Immunisation - Vitamin A dose - 1 1+3
6.8.2 Child Immunisation - Vitamin A dose - 5 0+0
6.8.3 Child Immunisation - Vitamin A dose - 9 1+2
6.9 Number of Children (6-59 months) provided 8-10doses (1ml) of IFA Syrup (Bi Wekly) 0
6.1 Number
Number of
of Children (12-59 months)
severely underweight provided
children Albendazole
provided Health Check up (0- 0
6.11 5years) 0
M7 Number of cases of Childhood Disease (0-5years) 0
7.1 Childhood Diseases - Tuberculosis (TB) 0
7.2 Childhood Diseases - Acute Flaccid Paralysis (AFP) 0
7.3 Childhood Diseases - Measles 0
7.4 Childhood Diseases - Malaria 0
7.5 Childhood Diseases - Diarrhoea 0
M8 National Vector Borne Diseases Control Programme (NVBDCP) 0
8.1 Malaria 0
8.1.1 Rapid Diagnostic Test (RDT) 0
8.1.1.a RDT conducted for Malaria 0
8.1.1.b Malaria (RDT) - Plasmodium Vivax test positive 0
8.1.1.c Malaria (RDT) - Plasmodium Falciparum test positive 0
Part B Health Facility Services
M9 Patient Services
9.1 OUT Patient Department (Out Patients) by disease / health Condition
9.1.1 OUT Patient - Diabetes 19
9.1.2 OUT Patient - Hypertension 19
9.1.3 OUT Patient - Stroke (Paralysis) 0
9.1.4 OUT Patient - Acute Heart Disease 0
9.1.5 OUT Patient - Mental illness 0
9.1.6 OUT Patient - Epilepsy 0
9.1.7 OUT Patient - Opthalmic Related 0
9.1.8 OUT Patient - Dental 0
9.2 OUT Patient Attendance (All)
9.2.1 Allopathic Outpatient Attendance
9.2.2 Ayush - Outpatient Attendance 0
Number of Anganwadi Centres / UPHC's reported to have conducted Village Health &
9.3 Nutrition Day (VHND's) / Urban Health & Nutrition Day (UHND's) / Outreach / Special 2
Outreach
M10 Laboratory Testing
10.1 Hb Test Conducted 0
 10.1.1 Number of Hb Tests Conducted 15
10.1.2 Out of the total number of Hb Test done , number having Hb < 7mg 0
10.2 (Human Immuno-Deficiency Virus) HIV Test Conducted 0
10.2.1 Pregnant Women Screened for HIV 0
10.2.1.a Number of Pregnant Women Screened for HIV (bu finger prick test) 0
10.2.1.b Out of the above, number screened positive 0

Stock Related Data

11.1 Drugs
11.1.1 Last Date of Supply of Essential Drugs (DD/MM/YYYY) 2/9/2023
11.1.2 Items
11.1.2.a IFA Tablets Adequate
11.1.1.k IFA Tablets (Blue) Inadequate
11.1.2.b IFA Syrup with Dispencer Inadequate
11.1.2.c Vit A Syrup Inadequate
11.1.2.d ORS Packets "
11.1.1.e Zinc Packets "
11.1.1.f Inj Magnesium Sulphate Inadequate
11.1.1.g Inj Oxytoxin "
11.1.1.h Misoprostol Tablets "
11.1.1.i Antibiotics "
11.1.1.j Drugs for Hypertension, Diabetis, Common Ailments e.g; PCM, Anti Allergic Drugs etc. "
11.1.1.l Tab Albendazole Adequate
11.2 Contraceptives
11.2.1 Last Date of Supply of Essential Contraceptives (DD/MM/YYYY) 21.4.23
11.2.2 Items
11.2.2.a IUCD Adequate
11.2.2.B Combined Oral Pills (In Cycles) Adequate
11.2.2.C Condom (in Pieces) "
11.2.2.d Injectable Contraceptive MPA (Vials) Inadequate
Part C Mortality Details
M12 Details of Deaths reported with probable causes :
12.1 Infant Deaths within 24hours (1-23hours) of birth 0
12.2 Infant Deaths upto 4 weeks (1-28days) due to 0
12.2.1 Infants Deaths upto 4 weeks due to Sepsis 0
12.2.2 Infants Deaths upto 4 weeks due to Asphyxia 0
12.2.3 Infants Deaths upto 4 weeks due to Other Causes 0
12.3 Infant Deaths between 1month (more than 28days) and less than 12 months due to
12.3.1 Number of Infant Deaths (1-12months) due to Pneumonia 0
12.3.2 Number of Infant Deaths (1-12months) due to Diarrhoea 0
12.3.3 Number of Infant Deaths (1-12months) due to Fever Related 0
12.3.4 Number of Infant Deaths (1-12months) due to Measles 0
12.3.5 Number of Infant Deaths (1-12months) due to Others 0
12.4 Childs Death between 1 year and less than 5 years due to 0
12.4.1 Number of Child Deaths 1-5 years) due to Pneumonia 0
 12.4.2 Number of Child Deaths 1-5 years) due to Diarrhoea 0
12.4.3 Number of Child Deaths 1-5 years) due toFever related 0
12.4.4 Number of Child Deaths 1-5 years) due to Measles 0
12.4.5 Number of Child Deaths 1-5 years) due to Others 0
12.5 Maternal Deaths (15-49 years) due to 0
12.5.1 Number of Maternal Deaths (15-49 years) due to Bleeding 0
12.5.2 Number of Maternal Deaths (15-49 years) due to High Fever 0
12.5.3 Number of Maternal Deaths (15-49 years) due to Abortion 0

12.5.4 Number of Maternal Deaths due to Obstructed/Prolonged Labour 0

12.5.5 Number of Maternal Deaths due to Severe Hypertension/Fits 0
12.5.6 Number of Maternal Deaths due to Other Causes(including causes not known 0
12.6 Other Deaths (except Infant, Child & Maternal Deaths) 5years and above due to 0
12.6.1 Number of Adolescent / Adult Deaths due to Diarrhoel Disease 0
12.6.2 Number of Adolescent / Adult Deaths due to Tuberculosis 0
12.6.3 Number of Adolescent / Adult Deaths due to Respiratory disease including infections
(other than TB) 0
12.6.4 Number of Adolescent / Adult Deaths due to Other Fever Related 0
12.6.5 Number of Adolescent / Adult Deaths due to HIV/AIDS 0
12.6.6 Number of Adolescent / Adult Deaths due to Heart Disease /Hypertension Related 0
12.6.7 Number of Adolescent / Adult Deaths due to Cancer 0
12.6.8 Number of Adolescent / Adult Deaths due to Neurogical Disease including Strokes 0
12.6.9 Number of Adolescent / Adult Deaths due to Accidents/Burns Cases 0
12.6.10 Number of Adolescent / Adult Deaths due to Suicide 0
12.6.11 Number of Adolescent / Adult Deaths due to Animal Bites & stings 0
12.6.12 Number of Adolescent / Adult Deaths due to Known Acute Disease 0
12.6.13 Number of Adolescent / Adult Deaths due to Known Chronic Disease 0
12.6.14 Number of Adolescent / Adult Deaths due to Causes not known 0
12.7 Deaths Due to Vector Borne Diseases (all age groups) 0
12.7.1 Number of Deaths due to Malaria - Plasmodium Vivax 0
12.7.2 Number of Deaths due to Malaria - Plasmodium Falciparum 0
Additional : Sub Centre in a bial chhung bika piang leh thi report na tur Reporting Cumulative
Month
1 Sub-Centre bial chhunga Naupiang awm zawng zawng zat 3+3 3+3=6

2 Sub-Centre bial chhunga Nausen kum 1 hnuailam thi awm zawng zawng 0 3
zat
3 Sub-Centre bial chhunga NU naupai thi(Maternal Death) awm zat 0 0
3 Sub-Centre bial chhunga Mithi awm zawng zawng zat 0+1 0+1=1