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Reporting tool for Community Engagement activities

Link to MS Word can be found here

Name of Clinic: _________

Month: ____/ 2020

Monthly utilization Sheet

  • How to Guide

o # of times Community mapping exercise / Update carried out

o # of Community dialogue on Primary Health Care conducted

o # of Meetings held with Local Governance Structures

o # of times Planning for Community Engagement and PHC services carried out

o # of Home visits done

o # of At-Risk child, youth and women identified.

o # of Basic Counselling Sessions conducted

o # of Outreach visits conducted

o # of Community demonstrations done

o # Local Campaign and Community Events carried out

o # of Referrals done to other services in the Community

  • Tally

  • Total end Month

  • Monthly key event (s)

Reported by (PH Nurse): _______

1st Review MAs: _____ Date: __ / ___ / ___

2nd Review DPNO: _______ Date: __ / ___ / ___

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