DOH - SPMS Form 1

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, _____________________________________, MEDICAL OFFICER IV of the Provincial DOH Office -Isabela of Cagayan Valley - Center for Health Development, 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-December 31, 2019.

. Name: __________________________ Date: July 01, 2019

Approved by: Date:

__________________________________
Development Management Officer IV
OFFICE OBJECTIVE:
SECTION/ UNIT OBJECTIVE:
Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment REMARKS
Q E T A
STRATEGIC FUNCTIONS
1 Assisted LGUs in the operationalization of Health Service >LGUs assisted.
Providers Network.
AVERAGE RATING
CORE FUNCTIONS
1 Provided primary health care services. >100% of clients seen provided with basic health services.
2 Prepared/ assisted in the development Annual Operational Plan >2021 AOP developed before the end of 3rd Quarter.
(AOP) 2021.
3 Conducted health education campaign. >100% of health education campaign conducted with
feedback report submitted 7 days after.

4 Maintined the operationalization of health facility in accordance
to regulatory standards
5 Conducted meeting with RHU staff.
SUPPORT FUNCTIONS
1 Acted as resource speaker/ facilitator for trainings and other HR-
related activities
2 Attended inter-agency meetings/ trainings/ orientations/
workshops.
3 Submitted DTR / Accomplishment.
>Health facility's license/ accredition renewed 15 days
before the year ends.
>100% of RHU staff meetings conducted monthly.
AVERAGE RATING
>100% of HR-related activities responded/ facilitated with
satisfactory feedback.
>100% of inter-agency meeting/ trainings/ workshops/
orientations attended/ participated.
>DTR, accomplishment report, and claims submitted within
1st 10 working days of the succeeding month with minimal
errors/ revisions.

AVERAGE RATING
RATING
 Average Rating
Function Percentage Distribution Final Rating per Function Remarks
per Function
Strategic Functions 0.30
Core Functions 0.50
Support Functions 0.20
Final Average Rating:
Adjectival Rating: Satisfactory
Prepared by: Date: Validated and Approved by: Date:

____________________________ _________________________________
Nurse II Development Management Officer V
Assessed by: Date: Final Rating by: Date:
________________________________
Development Management Officer IV
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
 DOH - SPMS Form 1
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) - Medtech

I, _____________________________________, Medical Technologist II of the Provincial DOH Office -Isabela of Cagayan Valley - Center for Health Development, 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-December 31, 2019.

. Name: __________________________ Date: July 01, 2019

Approved by: Date:

__________________________________
Development Management Officer IV
OFFICE OBJECTIVE:

SECTION/ UNIT OBJECTIVE:

Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment REMARKS
Q E T A
STRATEGIC FUNCTIONS
1 Assists the RHU in maintaining the license of the clinical laboratory RHU Clinical Laboratory with License To Operate issued a COC
in accordance to regulatory standards upon submission of compliance report within 30 working days from Issuance of COC
monitoring

Prepare requirements for the licensing of the RHU Clinical 100% of requirements prepared and submitted for the application of
Laboratory License To Operate Receipt of Application

AVERAGE RATING

CORE FUNCTIONS
1 Performs laboratory examinations 100% of routine laboratory requests with available reagents
performed upon request all lab request perfomed

2 Ensures accurate and timely release of laboratory results 100% of routine laboratory results with available reagents released
within 4 hrs upon request lab results released

100% of DSSM results released within 2 days upon receipt of 2 DSSM result released w/in 2
specimens days
100% of laboratory results recorded in its proper logbook before
releasing of results (or after performing the procedure) lab results recorded

3 Maintains laboratory facility, equipment and supplies 100% of laboratory equipment and facility properly maintained and
documented in the preventive and corrective maintenance logbooks
(daily/weekly/monthly) preventive and corrective
maintenance done

Inventory of supplies are recorded in the inventory logbook monthly

monhtly inventory done

4 Observes and promotes infection control and proper disposal of Existing Infection control policy properly implemented with presence of Infection
biological and chemical substances documentation at all times Control policy
100% laboratory waste properly segregated and disposed documented waste
(daily/weekly) segregation and disposal
 5 Prepares, analyzes and submits reports required by DOH Central 100% of reports (prepared, analyzed and) submitted with at least 1-2
and CHD errors on the first week of the following month

6 Assists in the implementation of and provision of technical 100% assistance given in the implementation and promotion of
assistance in health promotion programs health programs as needed

7 Assists in the conduct of advocacy and health campaign 100% advocacy to local officials and key stakeholders to support 100% of advocacy/meetings/ orientations activities
implementation of national health programs and services conducted conducted as scheduled with at least 80% very
as scheduled satisfactory feedback from stakeholders Attendance/minutes of the
meeting

8 Paticipates in data gathering and response during health 100% participation in the preparation of health emergency report
emergencies and disaster submitted upon declaration of code alert/occurrence of event:

a) Rapid Health Assesstment (within 24 hours after impact)

accomplished RHA form
b) Health Emergency Alert Reporting Sytem (3pm daily if no
declaration of code/normal days; 3pm and 11pm daily if with accomplished HEARS
declaration of code/with event) reports

c) Surveillance in Post Extreme Emergencies and Disasters (daily

SMS or paper-based report
once activated)
AVERAGE RATING

SUPPORT FUNCTIONS
1 Attend RHU staff meeting. 100% RHU staff and DOH HRH meeting attended as scheduled 100% of meetings attended as scheduled with issues
(with issues resolved) resolved Attendance/minutes of the
meeting

2 Submit DTR and accomplishment report. 100% of administrative reports ( DTRs/ARs/ Vacation leave forms) 100% of reports submitted on or before deadline
submitted every first week of the following month, and upon receipt of DTRs/ ARs/leave
assumption to duty for Sick leave forms

3 Submit itinerary of travel for the succeeding month. 100% Itinerary of Travel submitted within the 3rd week of the 100% of IT submitted within 3rd week of the month
preceeding month receipt of IT

AVERAGE RATING
RATING
Average Rating Final Rating per
Function Percentage Distribution Remarks
per Function Function
Strategic Functions 30% #REF! #REF!
Core Functions 50% #REF! #REF!
Support Functions 20% #REF! #REF!
Final Average Rating: #REF!
Adjectival Rating: Satisfactory
Prepared by: Date: Validated and Approved by: Date:

____________________________ _________________________________
Nurse II Development Management Officer V
Assessed by: Date: Final Rating by: Date:
________________________________
Development Management Officer IV
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
 DOH - SPMS Form 1
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, _____________________________________, Dentist II of the Provincial DOH Office -Isabela of Cagayan Valley - Center for Health Development, 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-December 31, 2019.

. Name: __________________________ Date: July 01, 2019

Approved by: Date:

__________________________________
Development Management Officer IV
OFFICE OBJECTIVE:
SECTION/ UNIT OBJECTIVE:
Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment REMARKS
Q E T A
STRATEGIC FUNCTIONS
1 Assist LGUs in the establishment/ operationalization of two-way >100% of LGUs assisted.
referral and follow-up systems with other stakeholders.

AVERAGE RATING

CORE FUNCTIONS
1 Implement basic oral health services. >100% of clients seen provided with basic oral health
services.
2 Conducts community dental surveys and diagnosis on oral health.

3 Prepare annual area-based oral health plan. >100% of assigned LGUs with area-based oral health plan.

4 Assist in the implementation and supervision of oral care >100% of assigned LGUs assisted in the implementation/
activities in the community initiated by LGU. supervision of community initiated oral care activities.

5 Conducts education campaign. >100% of activites conducted with 1-2 complaints.

6 Maintains facilities and dental equipment in good working >Monthly maintenance of facilities' cleanliness and
conditon monitoring dental equipment's working condition using
standard checklist.

7 Assist in the mangement of logistics. >100% of assigned LGUs assisted in the inventory of
logistics.
 8 Integrates oral health program activities with the overall >100% of oral health program activities integrated with all
framework of the RHU in the delivery of health services health programs.

9 Assist in data gathering and response during health emergencies >100% of assigned LGUs assisted in data gathering and
and disasters response during health emergencies and disasters with 1-2
errors.

AVERAGE RATING

SUPPORT FUNCTIONS
1 Act as resource speaker/ facilitator for trainings and other HR- >100% of HR-related activities responded/ facilitated with
related activities satisfactory feedback.
2 Attend RHU staff meeting. >100% of RHU staff meetings attended/ participated per
invitation.
3 Attend inter-agency meetings/ trainings/ orientations/ workshops. >100% of inter-agency meeting/ trainings/ workshops/
orientations attended/ participated.
4 Submit DTR and accomplishment report. >DTR, accomplishment report, and claims submitted within
1st 10 working days of the succeeding month with minimal
errors/ revisions.

5 Submit itinerary of travel for the succeeding month. >Itinerary of travels submitted third week of the preceding
month with minimal errors/revisions.

AVERAGE RATING

RATING

Average Rating
Function Percentage Distribution Final Rating per Function Remarks
per Function
Strategic Functions 30% #REF! #REF!
Core Functions 50% #REF! #REF!
Support Functions 20% #REF! #REF!
Final Average Rating: #REF!
Adjectival Rating: Satisfactory
Prepared by: Date: Validated and Approved by: Date:

____________________________ _________________________________
Nurse II Development Management Officer V
Assessed by: Date: Final Rating by: Date:
________________________________
Development Management Officer IV
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
 DOH - SPMS Form 1
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, FREMMA V. TAMANG, Pharmacist II of the Provincial DOH Office -Isabela of Cagayan Valley - Center for Health Development, 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-December 31, 2019.

. Name: __________________________ Date: July 01, 2019

Approved by: Date:

__________________________________
Development Management Officer IV
OFFICE OBJECTIVE:

SECTION/ UNIT OBJECTIVE:

Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment REMARKS
Q E T A
STRATEGIC FUNCTIONS
AVERAGE RATING
CORE FUNCTIONS
1 Monitored Supply Chain Management (SCM) of LGUs. >100% (7/7) LGUs of monitored quarterly with report submitted
within 7 days after the conduct. TO, IT, AR

2 Conducted inventory DOH-procured medicines. >85% (6/7) of LGUs conducted inventory monthly with report
submitted within 10 days of the succeeding month.
3 Disseminated Phil National Formulary / Anti microbial resistance updates. >100 % of related policies / updates disseminated within one month
upon receipt/ downloading. AR, Attendance

4 Provided technical assistatnt to SCM officer. >100% of LGUs' SCM officer provided technical assistance with 0-
1 complaint. AR, Attendance

5 Participated in response during health emergencies / disasters >100% of health emergencies / disasters participated without
complaints.

AVERAGE RATING
SUPPORT FUNCTIONS
5 Submit DTR and accomplishment report. 100% of administrative reports ( DTRs/Ars/ Vacation leave forms)
submitted first week of the following month while for Sick leave receipt of DTRs/
upon assumption to duty Ars/leave forms

6 Submit itinerary of travel for the succeeding month. 100% Itinerary of Travel submitted within 3rd week of the
preceeding month receipt of IT

AVERAGE RATING
RATING
Average Rating Final Rating per
Function Percentage Distribution Remarks
per Function Function
Strategic Functions
Core Functions 80% 0.00 0.00
Support Functions 20% 0.00 0.00
Final Average Rating: 0.00
Adjectival Rating: Satisfactory
Prepared by: Date: Validated and Approved by: Date:

____________________________ _________________________________
Nurse II Development Management Officer V
Assessed by: Date: Final Rating by: Date:
________________________________
Development Management Officer IV
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
 INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) -MIDWIFE
Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment REMARKS
Q E T A
STRATEGIC FUNCTIONS
1 Monitor RHU/BHSs capacities and implementation of referral system 100% of BHS monitored on HCP and referral system functionality with feedback report feedback report/SDN
based on HCPN policy submitted first week of the following month logbook/referral forms

AVERAGE RATING
CORE FUNCTIONS
1 Conducts home visit to households for monitoring of pregnant and post- 100% pregnant and postpartum mothers visited monthly with monitoring reports submitted HH profiling/monitoring
partum mothers first week of the following month forms
2 Assist the health facility in the identification of clients with unmet 100% of targeted clients with modern FP unmet need identified with reports submitted first
FP unmet masterlist
Modern Family Planning needs week of the following month
3 Assist in Family Planning Program services 100% of clients with MFP unmet need provided with MFP services within one week of visit ITR, FP form I. TCL, Referral
form. SDN logbook
Provide direct Maternal and Child care services 100% of barangays with status report on health services delivered under Maternal and ITR,TCL. Referral forms,
Child care SDN logbook
4 Assist in the monitoring and evaluation of health program 100% of barangays monitored and evaluated re health program implementation with brgy LGU
implementation report submitted first week of the following month scorecard/monitoring tool
5 Act as resource speaker/ facilitator for trainings and other HR-related 100% of health workers (BHW/BNS) provided with education and training/updates
activities quarterly with activity report submitted within one week of activity actvity report, minutes of the
meeting

6 Validate and facilitate LGU submission of required health data 100% of program reports submitted first week of the following month with minimal errors
FHSIS report
(1-2)
7 100% of notifiable diseases(Cat 1 & 2 ) investigated with reports submitted not later than
Friday 4pm of the week of occurrence case investigation report

8 100% AEFIs investigated with reports submitted not later than Friday 4pm of the week of
occurrence AEFI report

t 100% of barangay health emergency report submitted upon declaration of code

alert/occurrence of even

a) Rapid Health Assesstment (within 24 hours after impact) RHA form

b) Health Emergency Alert Reporting Sytem (3pm daily if no declaration of code/normal
days; 3pm and 11pm daily if with declaration of code/with event) HEARS reports

c) Surveillance in Post Extreme Emergencies and Disasters (daily once activated)

SMS or paper-based report

AVERAGE RATING
SUPPORT FUNCTIONS
1 Facilitate in the conduct of PIR 100% barangay PIR facilitated with issues identified and interventions identified submitted PIR action plan/minutes of
within one week of activity the meeting

2 Participate/ attend BLHB and other local meetings 100% barangay health boards facilitated with issues raised and resolved, submmitted minutes of the
within one week of activity meeting/resolution

3 Advocate to local officials and key stakeholders to support 100% identifed National/Regional/Provincial policies lobbied for adaption
implementation of national health programs and services. C/resolution

4 Attend RHU staff meeting. 100% of scheduled RHU staff and DOH HRH meeting attended, with issues raised and Attendance/minutes of the
resolved meeting

5 Submit DTR and accomplishment report. 100% od admin reports ( DTRs/Ars/leave forms) submitted first week of the following receipt of DTRs/ Ars/leave
month forms

6 Submit itinerary of travel for the succeeding month. 100% Its submitted within 3rd week of the preceeding month receipt of IT
AVERAGE RATING
 DOH - SPMS Form 1
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR) -NURSE 2

Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment REMARKS
Q E T A
STRATEGIC FUNCTIONS
1 Monitor RHU/BHSs capacities and implementation of referral system 100% of BHS monitored on health care provider and referral system functionality with feedback report/SDN
based on HCPN policy feedback report submitted first week of the following month logbook/referral forms

AVERAGE RATING
CORE FUNCTIONS
1 Conduct regular visits to priority households with health problems 100% identified households with health problems visited monthly with monitoring HH profiling/monitoring forms
reports submitted first week of the following month

2 Provide appropriate intervention on identified health concerns of 100% of identified individuals /families/households provided with appropriate health ITR, referral forms, SDN logbook
families/households intervention/s within the week of visit

3 Prepare health status report of households/families visited 100% of visited HH with health status report submitted first week of the following HH/individual profiling/monitoring
month form

4 Assist in the implementation of health services 100% of health services delivered based on needs AR

5 Assist in the monitoring and evaluation of health program 100% of barangays monitored and evaluated re health program implementation with brgy LGU scorecard/monitoring tool
implementation report submitted first week of the following month

90% of targeted pregnant women given ante-natal care (1-1-2) before delivery

90% of targeted post-partum women given care within 24 hrs and 1 week after
delivery

100% of targeted WRA with unmet need given health education and referred to
health facility

60% of targeted WRA with unmet need converted as new acceptor

95% targeted of children below 1 year old fully immunized before reaching their first
birthday

90 % of targeted presumptive TB cases referred and managed by RHU

100% of cases initiated to treatment monitored with zero defaulter (0)

____% of targeted population screened using PHILPEN protocol

 _____-% of PHILPEN screened referred and managed in the health facility

____% of targeted health promotion activities implemented with satisfactory

feedback

6 Act as resource speaker/ facilitator for trainings and other HR-related 100% of health workers (BHW/BNS) provided with education and training/updates actvity report, minutes of the
activities quarterly with activity report submitted within one week of activity meeting

7 Validate and facilitate LGU submission of required health data 100% of program reports submitted first week of the following month with minimal FHSIS report
errors (1-2)

100% of notifiable diseases(Cat 1 & 2 ) investigated with reports submitted not later case investigation report
than Friday 4pm of the week of occurrence

100% AEFIs investigated with reports submitted not later than Friday 4pm of the AEFI report
week of occurrence

100% of barangay health emergency report submitted upon declaration of code

alert/occurrence of event:

a) Rapid Health Assesstment (within 24 hours after impact) accomplished RHA form

b) Health Emergency Alert Reporting Sytem (3pm daily if no declaration of accomplished HEARS reports
code/normal days; 3pm and 11pm daily if with declaration of code/with event)

c) Surveillance in Post Extreme Emergencies and Disasters (daily once activated) SMS or paper-based report

AVERAGE RATING
SUPPORT FUNCTIONS
1 Facilitate in the conduct of PIR 100% barangay PIR facilitated with issues identified and interventions identified PIR action plan/minutes of the
submitted within one week of activity meeting

2 Participate/ attend BLHB and other local meetings 100% barangay health boards facilitated with issues raised and resolved, submmitted
within one week of activity minutes of the meeting/resolution

3 Advocate to local officials and key stakeholders to support 100% identifed National/Regional/Provincial policies lobbied for barangay adaption
implementation of national health programs and services. C/resolution

4 Attend RHU staff meeting. 100% of scheduled RHU staff and DOH HRH meeting attended, with issues raised
and resolved Attendance/minutes of the meeting

5 Submit DTR and accomplishment report. 100% of administrative reports ( DTRs/Ars/ Vacation leave forms) submitted first
week of the following month while for Sick leave upon assumption to duty
receipt of DTRs/ Ars/leave forms

6 Submit itinerary of travel for the succeeding month. 100% Itinerary of Travel submitted within 3rd week of the preceeding month
receipt of IT
 DOH - SPMS Form 1
INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, _______________________, Nurse II of the Provincial DOH Office -Isabela of Cagayan Valley - Center for Health Development, 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-December 31, 2019.

. Name: __________________________ Date: July 01, 2019

Approved by: Date:

__________________________________
Development Management Officer IV
OFFICE OBJECTIVE:

SECTION/ UNIT OBJECTIVE:

Rating
OUTPUT Success Indicators and Semi - Annual Targets Accomplishment
Q E T A
STRATEGIC FUNCTIONS
1 Monitor RHU/BHSs capacities and implementation of 100% of BHS monitored on health care provider
referral system based on HCPN policy and referral system functionality with feedback
report submitted first week of the following
month

AVERAGE RATING
CORE FUNCTIONS
1 Conduct regular visits to priority households with 100% identified households with health problems
health problems visited monthly with monitoring reports
submitted first week of the following month

2 Provide appropriate intervention on identified health 100% of identified individuals

concerns of families/households /families/households provided with appropriate
health intervention/s within the week of visit
3 Prepare health status report of households/families
visited 100% of visited HH with health status report submitted
first week of the following month

4 Assist in the implementation of health services

100% of health services delivered based on needs

5 Assist in the monitoring and evaluation of health 100% of barangays monitored and evaluated re
program implementation health program implementation with report
submitted first week of the following month

90% of targeted pregnant women given ante-

natal care (1-1-2) before delivery
90% of targeted post-partum women given care
within 24 hrs and 1 week after delivery
100% of targeted WRA with unmet need given
health education and referred to health facility
60% of targeted WRA with unmet need
converted as new acceptor
95% targeted of children below 1 year old fully
immunized before reaching their first birthday
90 % of targeted presumptive TB cases referred
and managed by RHU
100% of cases initiated to treatment monitored
with zero defaulter (0)
____% of targeted population screened using
PHILPEN protocol
_____-% of PHILPEN screened referred and
managed in the health facility

____% of targeted health promotion activities

implemented with satisfactory feedback
6 Act as resource speaker/ facilitator for trainings and 100% of health workers (BHW/BNS) provided
other HR-related activities with education and training/updates quarterly
with activity report submitted within one week of
activity

7 Validate and facilitate LGU submission of required 100% of program reports submitted first week of
health data the following month with minimal errors (1-2)

100% of notifiable diseases(Cat 1 & 2 )

investigated with reports submitted not later than
Friday 4pm of the week of occurrence

100% AEFIs investigated with reports submitted

not later than Friday 4pm of the week of
occurrence

100% of barangay health emergency report

submitted upon declaration of code
alert/occurrence of event:

a) Rapid Health Assesstment (within 24 hours

after impact)
b) Health Emergency Alert Reporting Sytem
(3pm daily if no declaration of code/normal days;
3pm and 11pm daily if with declaration of
code/with event)

c) Surveillance in Post Extreme Emergencies

and Disasters (daily once activated)

AVERAGE RATING
SUPPORT FUNCTIONS
1 Facilitate in the conduct of PIR 100% barangay PIR facilitated with issues
identified and interventions identified submitted
within one week of activity

2 Participate/ attend BLHB and other local meetings 100% barangay health boards facilitated with
issues raised and resolved, submmitted within one
week of activity

3 Advocate to local officials and key stakeholders to 100% identifed National/Regional/Provincial

support implementation of national health programs policies lobbied for barangay adaption
and services.

4 Attend RHU staff meeting. 100% of scheduled RHU staff and DOH HRH
meeting attended, with issues raised and resolved

5 Submit DTR and accomplishment report. 100% of administrative reports ( DTRs/Ars/

Vacation leave forms) submitted first week of the
following month while for Sick leave upon
assumption to duty

6 Submit itinerary of travel for the succeeding month. 100% Itinerary of Travel submitted within 3rd
week of the preceeding month

AVERAGE
RATING
RATING
Average Rating Final Rating per
Function Percentage Distribution Remarks
per Function Function
Strategic Functions 30% #REF! #REF!
Core Functions 50% 0.00 0.00
Support Functions 20% 0.00 0.00
Final Average Rating: #REF!
Adjectival Rating: Satisfactory
Prepared by: Date: Validated and Approved by:
____________________________ _________________________________
Nurse II Development Management Officer V
Assessed by: Date: Final Rating by:
________________________________
Development Management Officer IV
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
 DOH - SPMS Form 1

ment of the following targets in

July 01, 2019

Date:

REMARKS

feedback report/SDN
logbook/referral forms

HH
profiling/monitoring
forms

ITR, referral forms,

SDN logbook
 HH/individual
profiling/monitoring
form

AR

brgy LGU
scorecard/monitoring
tool
actvity report, minutes
of the meeting

FHSIS report

case investigation
report

AEFI report

accomplished RHA
form

accomplished HEARS
reports

SMS or paper-based
report
PIR action
plan/minutes of the
meeting

minutes of the
meeting/resolution

C/resolution

Attendance/minutes of
the meeting

receipt of DTRs/
Ars/leave forms

receipt of IT

Date:

Date:
 INDIVIDUAL PERFORMANCE COMMITMENT AND RE

I, _________________, Development Management Officer IV of the Provincial DOH Office -Isabela of Cagayan Valley - Center f
the following targets in accordance with the indicated measures for the period July-December 31, 2019.

Approved by:
_________________________________
Name of Supervisor
OFFICE OBJECTIVE:

SECTION/ UNIT OBJECTIVE:

OUTPUT Success Indicators and Semi - Annual Targets

STRATEGIC FUNCTIONS
1 Monitor RHU/BHSs capacities and implementation of 100% of BHS monitored on HCP and referral
referral system based on HCPN policy system functionality with feedback report
submitted first week of the following month

CORE FUNCTIONS
1 Conducts home visit to households for monitoring of 100% pregnant and postpartum mothers visited
pregnant and post-partum mothers monthly with monitoring reports submitted first
week of the following month
2 Assist the health facility in the identification of 100% of targeted clients with modern FP unmet
clients with unmet Modern Family Planning needs need identified with reports submitted first week
of the following month
3 Assist in Family Planning Program services 100% of clients with MFP unmet need provided
with MFP services within one week of visit

Provide direct Maternal and Child care services

100% of barangays with status report on health
services delivered under Maternal and Child care

4 Assist in the monitoring and evaluation of health
program implementation
5 Act as resource speaker/ facilitator for trainings and
other HR-related activities
100% of barangays monitored and evaluated re
health program implementation with report
submitted first week of the following month
100% of health workers (BHW/BNS) provided
with education and training/updates quarterly
with activity report submitted within one week of
activity

6 Validate and facilitate LGU submission of required 100% of program reports submitted first week of
health data the following month with minimal errors (1-2)
7 100% of notifiable diseases(Cat 1 & 2 )
investigated with reports submitted not later than
Friday 4pm of the week of occurrence
8 100% AEFIs investigated with reports submitted
not later than Friday 4pm of the week of
occurrence
100% of barangay health emergency report
submitted upon declaration of code
alert/occurrence of even
a) Rapid Health Assesstment (within 24 hours
after impact)

b) Health Emergency Alert Reporting Sytem

(3pm daily if no declaration of code/normal days;
3pm and 11pm daily if with declaration of
code/with event)
c) Surveillance in Post Extreme Emergencies
and Disasters (daily once activated)

SUPPORT FUNCTIONS
1 Facilitate in the conduct of PIR 100% barangay PIR facilitated with issues
identified and interventions identified submitted
within one week of activity

2 Participate/ attend BLHB and other local meetings 100% barangay health boards facilitated with
issues raised and resolved, submmitted within one
week of activity

3 Advocate to local officials and key stakeholders to 100% identifed National/Regional/Provincial

support implementation of national health programs policies lobbied for adaption
and services.
4 Attend RHU staff meeting. 100% of scheduled RHU staff and DOH HRH
meeting attended, with issues raised and resolved

5 Submit DTR and accomplishment report. 100% od admin reports ( DTRs/Ars/leave forms)
submitted first week of the following month

6 Submit itinerary of travel for the succeeding month. 100% Its submitted within 3rd week of the
preceeding month

RATING
Average Rating
Function Percentage Distribution
per Function
Strategic Functions 30% #REF!
Core Functions 50% 0.00
Support Functions 20% 0.00
Final Average Rating:
Adjectival Rating:
Prepared by: Date:
_________________________________
 RHMPP
Assessed by: Date:
__________________________________
Development Management Officer IV
Legend: 1- Quality 2 -Efficiency 3 - Timeliness 4 - Average
 DOH - SPMS Form 1
E COMMITMENT AND REVIEW (IPCR)

of Cagayan Valley - Center for Health Development, commit to deliver and agree to be rated on the attainment of

Name: ___________________________ Date: July 01, 2019

Date:
_____

Rating
Accomplishment REMARKS
Q E T A

feedback
report/SDN
logbook/referral
forms
AVERAGE RATING

HH
profiling/monitori
ng forms

FP unmet
masterlist

ITR, FP form I.
TCL, Referral
form. SDN
logbook

ITR,TCL.
Referral forms,
SDN logbook

brgy LGU
scorecard/monitor
ing tool

actvity report,
minutes of the
meeting

FHSIS report
 case investigation
report

AEFI report

RHA form

HEARS reports

SMS or paper-
based report

AVERAGE RATING

PIR action
plan/minutes of
the meeting

minutes of the
meeting/resolutio
n

C/resolution

Attendance/minut
es of the meeting

receipt of DTRs/
Ars/leave forms

receipt of IT

AVERAGE
RATING

Final Rating per

Remarks
Function
#REF!
0.00
0.00
#REF!
Satisfactory
Validated and Approved by: Date:
__________________________________
 Development Management Officer V
Final Rating by: Date: