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
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Tally
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Total end Month
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Monthly key event (s)
Reported by (PH Nurse): _______
1st Review MAs: _____ Date: __ / ___ / ___
2nd Review DPNO: _______ Date: __ / ___ / ___