Revised HMIS Indicators - Tools Training PPT - Final

Revised HMIS Indicators and Tools
Training
February 2022
Addis Ababa
Self Introduction
• Name
• Region/Directorate
• Profession
• Service year and Experience related with HMIS
• Expectation
2
Training sessions
SN Sessions Topic
1 Session one Health System, HIS and HMIS Overview
2 Session two Individual Medical Records & Procedures
3 Session Registers and Tally sheets
three
4 Session four RMNCH HMIS tools
5 Session five Disease prevention and control
6 Session six Medical Services and ESV-ICD 11
7 Session Hygiene and Sanitation and HEP/PHC
seven
8 Session Health System Strengthening 3
eight
Objectives of the training
• To familiarize health managers and health care providers on the revised HMIS_2021 data
recording procedures, reportable data elements, and indicators with a focus on
o Basic concepts of a health system and HIS
o Rationale for HMIS Indicators revision
o HMIS tools, recording and reporting procedures with a focus on revised sections
o ESV-ICD 11 overview
4
Session One: Health System, HIS and HMIS
1Hr Overview
• Objectives • Rational for HMIS revision
• HIS and HMIS • Revised Indicators

overview
Health System, HIS and HMIS Overview
Objectives
• At the end of this session, participants will be able to:
• Explain health system and its functions
• Describe HIS and its components
• Describe the routine HMIS as part of the bigger HIS
• Understand rationale of HMIS revision
6
1. Health System overview
• What is a health system?
• Why health systems matter?
7
1.1 Health system or health care system
• It refers to the organization, institutions, people & resources involved in delivering
health care to individuals. Its primary purpose is to improve health
• Three major objectives

o Improving the health of the population
o Responding to people’s expectations (Responsiveness)
o Providing financial protection against the costs of ill-health (Risk Protection)
8
WHO’s Health System Building Blocks
9
1.2 Health information system (HIS)
• It refers to a system that captures, stores, manages or transmits information related

to the health of individuals or the activities of organizations, which improves health
care management decisions at all levels of the health system
• Information is crucial to inform on the performance of the health system and about
health challenges
• Heath Information system is required for timely intelligence on the other building
blocks of the health system:
10
Components of HIS
Legislative, regulatory, & planning

Making readily framework, personnel, financing, logistics
accessible to decision support, ICT, coordinating mechanisms
makers, ensure
information use
Measures, usually core set
of indicators
(determinants, inputs,
Data translated outputs, outcomes &
to information health status)
1. Population-based sources
(censuses, civil registration,
surveys)
Covers all aspects of data handling, 2. Institution based data (individual,
collection, storage, quality- service & resource records)
assurance, flow, processing, 3. Others: Occasional surveys,
compilation & analysis, research, & information, CBOs, 11
What are HIS Data sources?
Data Sources components
Institution based Individual records, service records, supplies, resource records, administrative
sources reports
Routine HMIS, supportive supervision, review meetings, inspection, surveillance
Facility-based surveys: SARA, SPA+,
Population-based Census, civil registration, population based surveillance,

sources population surveys (DHS, MIS, MICS, etc) and other program specific surveys and
researches
Data sources by level:

Community, Facility (HCs, Hosp. Private Facilities), Woreda, Zonal and Regional levels, and National level
12
1.3 HMIS …
• Health Management Information System (HMIS) is the routine collection, aggregation,
analysis, presentation and utilization of health and health related data for evidence
based decisions for health workers, managers, policy makers and others
• Purposes of HMIS
• Availing accurate, timely and complete data to support decision making at each
level of the health system
• Strengthening the use of locally generated data for evidence based decision
making
13
1.3 HMIS …
Components of HMIS
1. Information management
• Data collection: Recording of health data using individual and family folder,
registers, tally and reporting formats
• Data processing: is a process of cleaning, entering and aggregation of data.
• Data analysis and presentation: is a process of interpretation and comparison of
generated information in the form of sentence, tables and graphs.
14
1.3 HMIS …
2. Using information for management purposes
• Problem identification: identifying problems using key indicators
• Prioritizing problems and decision making : Problems identified should be

prioritized and decide what types of actions need to be taken.
• Action taking: Implementing the agreed action.
• Result monitoring: Assessing the desired result has been achieved.
15
HMIS Indicator Revision (2021)
RATIONALE
▪ Indicator revision has been happening about every 3-4 years so far
▪ The most recent revision was conducted in 2017 following start of HSTP I
▪ HSTP II launched recently and will span 2020-2025
▪ HSTP II comes with additional new programs and initiatives
▪ Some activities of HSTP-I are matured, others are evolved that need to amend the existing
indicators
▪ Need for integration program indicators (eg. KPIs, and other quality indicators)
▪ Therefore, the monitoring and evaluation of HSTP II demands the revision of HMIS
indicators
16
Trends of Indicator Revision
17
Final revised HMIS indicators
2017_HMIS 2021_HMIS
Total Indicator:131 Total indicators:177
Continued: Dropped:
103 Modified: 3 New:71
25
18
Revised Indicators (2021)
Number of indicators by category (2017 versus 2021)
SN Indicator Category 2017 2021
SN Indicator Category 2017 2021
1 Reproductive and Maternal 14 15 11 Neglected Tropical Diseases (NTD) 2 8
health
12 Non-communicable diseases (NCD) 3 10
2 PMTCT 7 6 & mental Health
3 EPI 13 12 13 HEP and Primary Health care 3 4
4 Child health 8 10 14 Leadership and governance 4 4
5 Nutrition 8 8 15 Health Financing 3 4
6 Hygiene & environmental 2 10 16 Pharmaceutical supply and services 4 7
Health
17 Evidence based decision making 3 6
7 Medical service 12 21
18 Health Infrastructure 4 2
8 HIV/AIDS/Hepatitis viruses 10 15
19 Human Resource Development & 4 3
9 Tuberculosis/TB/ & 22 22 mgt
Leprosy
20 Regulatory system 1 2
10 Malaria 5 8
Total 131 177
19
REVISED REGISTERS AND TALLY SHEETS
S. No Type of Tools Maintained Modified New Total
1 Registers 13 26 18 57
2 Tally Sheets 5 9 7 21
There are changes in data elements (some modified and others added) and
3 Report forms
NTD, TB & Leprosy quarterly changed to monthly
Registers: for HCs/Hosp= 42 For Hosp only =13 For HC only= 1

Geographic Areas specific= 2 Special center=1
NB: Health Post level tools are not included 20
Session Two: Individual Medical Records and
2Hrs 30 minutes Procedures
Session Objective
 Understand Individual Medical Records

 Describe medical recording procedures
22
2.1 Individual Medical Records
• What is individual medical record
• What are the components of an individual medical records?
• What are the purposes of medical record?
23
• Individual Medical record is an important compilation of facts about a patient’s life
and health.
• It includes documented data on past and present illnesses and treatment written by
health care professionals caring for the patient.
24
25 Characteristics: Purposes:
• Medical records are lifetime records. • To document the course of the
• Kept by healthcare organizations. patient's illness and treatment
• Record - property of the Facility. • To communicate between attending
• Data - property of the Client. healthcare providers

• Providing continual care for the
patient
• For collection of health statistics and
research
2.3 Individual patient Medical Records
26
• Common components: components:……
1. Individual Folder 6. Patient Card/form
2, Individual Summary Sheet 7. RH/ANC card
3. Tracer card 8. Woman’s Card
4. Service ID Card 9. Appointment card
5. Master Patient Index 10. Others
NB: No. 1-5 are components

which are provided for all
clients
Individual folder
27Individual folder: The basic patient
identification should be written on the
demographic sheet paper in each medical
folder. Contents include:
o Medical record number (unique)
o Date of registration
o Full name of the client (in Capital

Letter), sex, and address
o Emergency contact
Medical Record Number (MRN)
28Features:
• A patient should have only ONE MRN Purpose:
• Sequential number • To easily find patient’s record
• Characters of MRN: • To link a patient’s previous admission or
o Unique – identify only one individual out patient attendance to the current
o Focused – maintained solely for admission.
healthcare delivery.
• To identify the correct medical record of
o Longevity – It should not contain patients when there is more than one
limitations. patient with the same name
o Permanent – never be reassigned to
another person.
Medical Record Number (MRN)…
• Health facilities should follow the following MRN issuance,
o Hospitals: Use 6 digits (XXXXXX). For example, the first client can be issued 000001
and the 253rd client be given 000253.
o Health centers: Use 5 digits (XXXXX). For example, the first client can be issued
00001 and the hundredth client be given 00100, then the twenty five thousand
client be given 25000.
29
Summary sheet
• Summary Sheet: Summarizes date, identification,

final diagnosis (NCoD), and cost in each visit. It is
completed by the clinical staff offering the service
30
Master Patient Index
31 • Key to locating the medical record.
• Could be Manual/ Computerized.
• Contains no medical data.
• Contents:
o Medical Record Number
o Registration date
o The client's full name
o Date of birth and Age
o Sex
o The patient's full address
Service ID card
• Issued to each new patient registered.
32
• A pocket-sized card used as an ID Card.
• Contents:
o Name of the Facility
o Date of Registration
o Name of client
o Age
o Sex
o Client’s address
• What is an appointment card ?
Appointment Card
• Issued to a client who has an
appointment
• A pocket-sized card used as reminder
of appointment date
Contents:
o Name of the Facility
o Name of client
o Appointment date
o Appointment with service
33
Tracer Card
34• Enable MRs not filed to be TRACED
• Same size or slightly smaller than Individual folder
• Contents:
o Facility Name
o Medical Record Number.
o Client Name
o Where the MR is going (department/responsible
healthcare provider)
o The date the record was removed from file and
Remark/signature
• Filled inside a Folder when in the MR Unit
Patient form/Patient card
• It contains sign and Symptoms, care provider’s clinical observations, notes, diagnosis,
and NCoD Diagnosis
• Patient card is a free form and has three sections:

o Section to write chief complaint and detailed clinical notes
o Section to write the main diagnosis and other diagnosis (if any).
o Section to write Diagnosis in NCoD (National Classification of Disease)
• It is kept in integrated individual folder
35
Integrated RH and women's card
Integrated RH card
• Used to document ANC, Delivery, PNC and PMTCT care services of a single individual
• Kept in integrated individual folder
Woman’s card
• Used to document family planning, Tetanus diphtheria (Td) vaccination and abortion
care services of a single individual
• Kept in integrated individual folder
36
Other different forms/cards(1)
Name of Forms Purpose
MDR-TB Its use to record MDR-TB patient’s personnel information, Rx supporter, drug
Treatment card sensitivity test (DST), x-ray, smear and culture result, medical diagnosis other than TB,
contact investigation, treatment and treatment outcome, during treatment and drug
administration monitoring. Kept in integrated individual folder
Leprosy patient A record of leprosy patients on personnel information, history, medical condition (skin,
record nerve, eye, muscle), level of disability and review at completion of treatment. kept in
an integrated medical folder
A record of leprosy patients on medical condition (skin, nerve, eye, muscle) every
VMT/ST card month for monitoring of nerve function. kept in an integrated medical folder.
37
Other different forms/cards (2)
Clinical Progress Notes It is a blank sheet used to review and document the progress of an
already examined patient
Clinical Procedures Used to document different clinical procedures done in different

service unit
Follow up cards Used when an individual's health status is documented on a periodic

basis for a follow up of a certain chronic illness. E.g. HIV/AIDS
Consent Forms This is a form signed by the patient or a relative when authorization is
needed to carry out a certain clinical task.
38
Other different forms/Cards (3)
Operation Notes A sheet of paper used to document detailed procedure notes by the
clinician who has carried out the operation.
Admission Card lists services that will be offered for the patient and also terms of
agreements for service utilization set by the facility on admission
Discharge Summary Summary of all records documented when an admitted patient is sent out
from the healthcare institution
Follow-up Chart It is usually part of the record of an admitted patient where certain
elements of hourly/daily progress are documented
Medication chart It is used to record the daily medication given to a patient after admission
39
Medical Record Unit Standards and procedures
40 General Rules:
• All clients who appear seeking health care should pass through the MRU for
registration and/or update their medical record
• In all cases the patient should present himself/herself to the record room, unless the
patient is unable to do so (e.g. if they are severely ill) and VCT cases
Medical Record Unit Standards and procedures…
• Patient who comes to health facility on emergency basis
o Has the right to see a health professional first.
o In such cases, relatives can provide the required information instead of the
patient himself.
• Patient with a health record at another health facility

o Should have a new folder in the new facility visited.
41
MR Procedures and Standards
42 1. Recording Procedure
2. Indexing Procedure
3. Retrieving Procedure
4. Filing Procedure
5. Admission/Discharge Procedure
6. Completion Procedure
7. Maintenance Procedure
8. Culling Procedure
1. Recording Procedure
43 • Make sure there are no patients who claim emergency
• Find out if a patient holds a Service card or not
• Collect Service cards from those who have it.
• Else, identify which scenario the patient belongs to: New ; Repeat (has Service
Card/has no Service Card); Emergency
Or Has Duplicate Records
• If has service card: Retrieve the record from the shelves and update
1. Recording Procedure…
• If Service card is lost: Locate Master Patient Index card
• If new: he/she should be registered, given an MRN, entered in the MPI, and given a
service ID
• If the client has the duplicate records, cancel the number and combine the medical
records under the first number (folder).
o The number in the MPI should not be canceled; rather a cross reference should be
made linking the duplicated numbers.
• All clients should be registered on central register

44
2. Indexing Procedure
45 • All MPI cards must be filled immediately after the patient’s demographic information is
recorded on the folder
• The information needed for the completion of the MPI card could be retrieved from
the folder.
• The MPI should be completed by the same person who recorded the information on
the folder.
• MPI cards should be filed in a card drawer in strict alphabetical order.
• Each drawer should contain guides/Tabs
• If there is a computer Indexing system (EMR-MRU), use both indexing system
3. Retrieving Procedure
• Collect the Service cards and/or
46
• Access patient’s profile from the MPI box or • Complete the Tracer card
Computer.
• Replace MR by its TRACER Card
• Locate the MR using info. from MPI.
• Pick the medical record from shelf • Purpose of this procedure ?
4. Filing Procedure
• Filling Systems:
o Straight numeric filing (recommended and currently in use)
o Terminal digit filing.
o Alphabetical filing (not at all recommended),
Storage and Filing
47• space is available for to setup
shelves.
• Specification (Minimum standard):
o Hospital = 60 (sq.m)
o Health Center = 24 (sq.m)
o Lockable
265 cm
• Shelves available for filing MR
• Specification:
o Space Efficient
o Adequate lightening
o Spine Shelving
Standard shelve
cm
25
35cms
2 .75m
50 cm
Column
2m
48
Standard MPI Box
1.5ms
49
Standard MPI…
1.5ms
2ms
50
5. Admission/Discharge Procedure
If the patient is admitted:
• The nurse adds data relating to nursing care plan and doctors record their notes on a
patient's: past medical history, family medical history, history of present illness, physical
examination, plan for treatment and requests for laboratory/X‑ray tests.
• The doctor and nurses continues to record, on a daily basis, writing notes on the
patient's progress, medical findings, treatment, test results, and the general conditions
• Nurses record all observations, medications administered, treatment and other

services, and other professionals
51
5. Admission/Discharge Procedure…
At discharge: the doctor records
• The condition of the patient at discharge, the prognosis, treatment and whether the
patient has to return for follow up.
• write a discharge summary, the main diagnosis, other diagnoses and operative
procedures performed, and sign to indicate responsibility for the information
recorded under his signature
52
6. Completion Procedure
53 • Regardless of where MRs are, there must be a sign-out & sign-in
process.
• Procedure:
o Collection/receipt of the MRs.
o Check each MR if all forms are in the record.
o Check if Summary sheet is complete
o Sort the forms order – chronological.
7. Maintenance Procedure
54 • All MRs protected from an unauthorized access.
• MRs must be placed in a separate locked room.
• Storage area should be accessed by selected staff.
• Records should be secured from moisture/rodents
• Storage must be organized to facilitate retrieval.
• Old MR Folders should be replaced by new.
• Loose forms should be re-attached firmly.
8. Culling Procedure
• This is the removal of medical records, which have not been used for a specified
number of years, from the active record filing room.
• The facility should define a specific retention policy for different types of records
based on national law and professional practice standards.
• The aim of culling is to remove INACTIVE medical records from file to make more
filing space.
• The culled records can then be stored in secondary storage or destroyed based on
the culling policy of the country. Culling should be done every year.
• If no regulation for culling, records are retained in active storage for 5 years and
then kept in inactive storage for 10 years after last visit.
How to handle Medico-Legal Requests? 55

MEDICO-LEGAL ISSUES
Medico-legal issues and procedure
• Medical records are important legal documents.
• It is essential that they are complete, accurate and available when needed.
• Notes of the patient’s condition on admission and complete findings upon physical
examination should be recorded along with the progress of the patent while in health
care facility.
• MR clerks must be familiar with the legal requirements regarding medical records.
• Clerks must be able to distinguish between legitimate and illegitimate requests for
information.
56
MEDICO-LEGAL ISSUES…
Privacy and confidentiality
• The information contained in the medical record belongs to the patient and is a
confidential communication between the doctor or other health professional and
the patient.
• Medical records should be safeguarded against unauthorized use.
• Medical records should in a secure area, and there should be detailed policies
regarding confidentiality and the release of patient information.
57
Medico-legal issues and policies Cont’d…
Release of patient information
• The medical record is a confidential document and the Patient’s right to privacy
must be considered at all times.
• No unauthorized person may take any or part of a medical record out of file, or
read, copy, or erase the content.
• The administrator in charge of the MRU should develop a policy for approval by
the healthcare facility for the release of patient information.
• All staff, including those in other sections of the healthcare facility should aware of
the policy.
58
Medico-legal issues and policies Cont’d…
• There are four methods of releasing information:
1. Direct access to the medical record
2. Supply of an abstract giving details requested
3. Verbal release
4. Photocopying
59
Session Three: Registers and tally sheets:
30 Minutes Introduction
Session Objectives
By the end of this session, participants will:

• Understand types and features of registers
• Describe tally sheet and its purposes
61
62 3. Registers and Tally
sheets
Register: is a form/tool that is used
to record the abstract information
from each service/ department
3. Registers and tally sheets…
63 Common features:
• Every register has columns & rows
• Each row contains information for one patient
• The column contains information about that patient, and one piece of information per
column is available
• Contains reportable and non-reportable data elements
• Are data sources for computation of HMIS indicators
• Most registers have tally sheet , those registers which don’t have tally sheet have a box
for computation of reportable data elements
3. Registers and tally sheets …
64
Two types of registers
 Serial (Case) Registers:
Each subsequent visit is registered as a new entry. E.g. OPD, VCT, Abortion
registers...
 Longitudinal Registers:
Each client is stayed in the register so long as s/he is in the service. E.g. EPI,
ANC, FP, ART , TB...
Common data Elements of Registers
65 • Identification:
o Registration Number: sequential number.
o Medical Record Number (MRN): Card number
o Name: clients’ full name (except VCT, OPD, IPD, Abortion …)
o Age: age in years/ in months
o Sex: M for Male and F for Female
• Address:
• Region, Woreda, Kebele, and Gott and House number
• Date: All dates are written in the EC as Date/Month/Year (DD/MM/YY)
Tally Sheet
• It is a piece of paper/pad that is used to mark the number of clients that use specific
services
• In tallying, each stroke represents a single unit to be counted in service;

client/patient, dose and others.
• Service given should be tallied immediately after the service provided
• Its main purpose is to simplify reporting. It is also used in data quality check as
triangulation with other recording tools.
66
Number of Register and Tally by program area
Program area Number of Register Number of Tally

Reproductive and Maternal health 7 6
Child and EPI 6 1
Nutrition 8 2
HIV/AIDS & Hepatitis 10 4
TB/Leprosy 6
Malaria 1
NCD & Mental health 3 1
NTD 2
Medical Service 11 7
HSS 3
Total 57 21
67
Reproductive, Maternal, Neonatal,
Session Four: child, Adolescent and Nutrition
6 Hrs 30 Minutes program
Session Objective
69
By the end of this session, participants will:
 Understand the data recording procedure of RMNCH-N program HMIS tools
 Identify reportable data elements from each registers
 Understand the indicators computed under each program

RMNCY-N Program registers (#21)
Reproductive Health
Adolescent and Nutrition Program
• Family Planning Register
• Long-acting FP Removal Register • Pregnant and Lactating Women (PLW) Nutrition
• Comprehensive Abortion care Register Screening register
Maternal Health • Therapeutic Food Program (TFP) Register
• ANC Register • GMP and Us Nutrition Screening (CINuS)
• Delivery register register
• PNC Register • VAS and Deworming Register
• PMTCT Register
• MAM treatment for 6–59-month Register
Child Health and Immunization • MAM treatment for PLW Register
• Adolescent Nutrition Register
•Tetanus diphtheria (Td) Register
•Human Papilloma Virus (HPV) immunization Register • Integrated AYH Register
•Infant Immunization & growth Monitoring
•IMNCI register (0-2 months)
•IMNCI (from 2 month to 5 year) Register Black: Maintained;
•Neonatal and Intensive Care Unit (NICU) Register Purple: Modified;
Green: New
RMNCY-N Program Tally Sheets (#9)
71
• Family Planning Service Tally • Abortion Tally
• Family Planning Methods Dispensed • Immunization tally
Count Tally • Comprehensive and Integrated
• ANC Tally Nutrition Service (CINuS) Tally

• PMTCT tally • Adolescent Nutrition service
• Pregnancy testing tally tally
Black: Maintained
Purple: Modified
Green: New
Family Planning Register
 A longitudinal register used to record FP information for one year for a single client
 After the fiscal year is completed, the client is registered again in the same registration book
 kept in the FP Room
 The information required to complete the FP register is obtained from woman’s card
Tallies used for Family planning service: both kept F/P room
1. Family planning service tally
 Count the total number of new & repeat client, disaggregated by age and type of method, and
reported monthly
2. Family Planning Methods Dispensed count tally sheet
 Collect the total amount of contraceptives distributed, by type of method and reported annually
Show & demonstrate FP register and Tallies: Use soft copy

72
Family Planning….cont
New acceptors
 A client who has not received a contraceptive from a recognized FP program
previously at the time of registration
Repeat acceptors
 A client who has received a contraceptive method from a recognized FP program
in previous year (EFY).
Note 1: A client is counted only once as new or repeat in one fiscal year (reporting year)
Note 2: A client who used long acting contraceptive should visit the health facility every
year, registered and reported as repeat till the contraceptive removed. If she does
not appear in subsequent years for follow up, she will not be reported
73
Long-Acting FP (LAFP) removal register
74
• LAFP register is used to document the number of long-acting family planning methods
removed
• It is used for women who came for removal of Long-Acting Family Planning methods
• The LAFP methods are disaggregated by method and period of removal since insertion
(< 6 months and >= 6 months)

Show & demonstrate the register
Family planning Services… Data elements
S.No. Reportable data element Disaggregation
75 1 Number of new acceptors Age & Method
2 Number of repeat acceptors Age & Method
3 Number of clients tested for HIV Age & Sex
4 Clients testing positive for HIV (at HTS) Age & Sex
5 Number of Family planning methods issued/dispensed Method
6 Total number of premature removal of LAFP within 6- Method: Implants,
month insertion IUCD, others
7 Total LAFP removal in the reporting period
NB: All data elements are monthly reportable except F/P methods dispensed
Antenatal Care
• Service provision modality is changed
• At least 8 contacts
Contacts Gestational age of contact in weeks Appointment schedule

First Trimester
1st Up to 12 After 8 weeks
Second trimester
2nd 20 After 6 weeks
3rd 26 After 4 weeks
Third trimester
4th 30 After 4 weeks
8th 40
76
Antenatal Care register
• It is a longitudinal register
• Used to record antenatal care provided to a client during a single pregnancy
• Enables to follow the expectant mother throughout her pregnancy
• Follows the protocol of antenatal care for eight contacts and more during the current
pregnancy.
• Additionally, HIV assessment and follow up, partner test and different counseling
including care for child development are recorded.
• The information required to complete this register is from integrated RH card

Show & demonstrate ANC register and Integrated RH card
77
Antenatal Care..
ANC tally sheet
•Used for collecting:
o 1st ANC contact disaggregated by age of the mother and gestational age
o 4th ANC contacts disaggregated by the mother and gestational age
o ANC eight Contacts

Show & demonstrate ANC
78
Antenatal Care Services… Data elements
S.N Reportable data element Disaggregation

1 No. of pregnant women that received ANC first visit Age & GA
2 No. of pregnant women that received four ANC visits Age and GA
3 No. of pregnant women that received Eight ANC visits None
4 No. of pregnant women tested for syphilis Test result
5 No. of reactive pregnant women treated for syphilis None
6 No. of pregnant women tested for hepatitis Test result
7 No. of reactive pregnant mother treated for hepatitis None
8 No. of pregnant women who received Iron folate at least 90+ Age
9 No. of pregnant women tested for HIV and know their result during pregnancy None
10 No. of new Positive women's during ANC, L&D and Postpartum None
11 No. of partners of pregnant, laboring and lactating women tested and know None
their results
12 Number of dewormed pregnant mothers in the reporting period None
NB: All are monthly reportable data elements

Delivery Register
 It is a case (serial) register
 lists all clients who gave birth at the facility
 The information required to complete this register is found on the clients’

integrated RH card
 Placed in the delivery room
Show & demonstrate delivery register
80
Delivery con't…
S.N Reportable data element Disaggregation Frequenc Level of Tally

o y Reporting
1 No. of births attended by skilled Health personnel None
2 No. of deliveries by cesarean section None

3 No. of women who received uterotonics with in one Oxytocin, Monthly HC, clinic,
minute after delivery, Mesoprostol, Hospital
Ergometrin, others
4 No. of institutional maternal deaths None
None
5 Number of live births None
6 Number of still births None
7 Total number of newborns weighed None
8 No. of newborns whose weight is less than 2500gms None HP, HC,
Monthly clinic,
9 No. of newborns whose weight is less than 2000gms None Hospital
10 Number of newborns who received Chlorhexidine None
11 Number of newborn with sepsis/VSD None 81
Delivery con't…
S.N Reportable data element Disaggreg Frequency Level of Reporting Tally
ation
12 Number of early neonatal deaths None

13 Number of women who received HIV test Age
Monthly HP, HC, clinic, Hospital
14 No. of women who tested HIV positive Age
None
15 Total IPPFP acceptors Age &
Method
Monthly HC, clinic, Hospital
16 Total number of neonates resuscitated
17 Number of neonates treated for birth None
asphyxia & survived
18 None Monthly HP, HC, clinic, Hospital

Number of birth notified
82
Postnatal (PNC) Register
 Lists all clients receiving postnatal services at the health facility
 Each row has 5 sub rows; each sub row is used for one visit
 Information for this register is collected from the integrated RH card
Show & demonstrate PNC register
83
Postnatal (PNC) cont.…
S.N Reportable data element Disaggregatio Frequency Level of Type of
n Reporting tally used
1 Number of postnatal visits within 7 days Period Monthly HP, HC, clinic, None
of delivery Hospital
2 Number of institutional maternal death None
3 Number of women with PPH Place of

complication Delivery(hom
e/Facility)
HC, clinic,
Monthly Hospital None
4 Number of pregnant women who were None
tested for HIV and who know their
results during post-partum period
5 Number of women tested positive for None
HIV
6 Number of neonatal deaths in the first By period Monthly HP, HC, clinic, None
24 hrs of life/institutional/ Hospital
84
Postnatal (PNC) con't…
S.N Reportable data element Disaggregation Frequency Level of Reporting

7 Number of sick young infants 0-2 By disease type:- Very sever
months treated for Critical illness Disease, Local bacterial
infection ( LBI) Pneumonia
Monthly HC, clinic Hospital
8 Total IPPFP acceptors Age
Method
9 Number of Newborn weighing None
<2000gm and premature
newborns for which KMC initiated
10 Number of neonates treated for None HP, HC, clinic,

birth asphyxia & survived Monthly Hospital
11 Number of births notified None
85
Comprehensive Abortion Care Register
• It is a case (serial) register
• Used to document Post abortion and Safe abortion care services
• Completed by service providers
• Kept in a room where abortion care service is provided
Abortion tally
• Abortion tally is used to tally data elements related to abortion care services
• Abortion tally simplify reporting of the disaggregated data elements
Show & demonstrate abortion register and tally
86
Abortion register con't…
S.N Reportable data element Disaggrega Frequency Level of tally used
tion Reporting
1 Number of safe abortions care provided age
2 Number of post abortions care provided age
3 Number of women receiving comprehensive Trimester

abortion care
4 Number of women who were tested for HIV Age Monthly HC, clinic & Abortion Tally
Hospital sheet
5 Number of Positive HIV tests Age
6 Number of maternal deaths (institutional) None
7 Number of new and repeat family planning Age,

acceptors Method 87
Reproductive and Maternal Health Indicators
S.No Indicator Remarks
1 Contraceptive Acceptance Rate (CAR) Existing
2 Immediate postpartum contraceptive acceptance rate (IPPCAR) Existing
3 Antenatal Care (ANC) coverage – First contact Existing
4 Antenatal Care (ANC) coverage – Four contacts Existing
5 Antenatal Care (ANC) coverage – Eight or more contacts New
6 Proportion of pregnant women tested for syphilis Existing
7 Skilled delivery attendance Existing
8 Stillbirth Rate Existing
9 Early Postnatal care (PNC) coverage Existing
10 Caesarean Section (C/S) Rate Existing
11 Women receiving comprehensive abortion care services Existing
12 Institutional maternal deaths Existing
13 Number of maternal deaths in the community Existing
14 Women who developed Post-partum Hemorrhage (PPH) New
15 Delivered women who received Uterotonics New
88
PMTCT
Register PMTCT Tally

 A longitudinal register. • This is used to capture
 Used to follow HIV positive pregnant and reportable data elements

lactating women and the newborn
 The register is kept in PMTCT service room.
 The register is completed by the PMTCT care

provider
Show & demonstrate PMTCT register&

Tally 89
Reportable data elements from PMTCT register
S.N Reportable data element Disagg. Frequency Level of Tally
Reporting
1 No. of HIV positive pregnant women who received ART none
during ANC for the first time
2 No. of HIV positive Pregnant women who received ART none
during L&D for the first time
3 No. of HIV positive Pregnant women who received ART none
during PNC for the first time
HC, Clinic & PMTCT
4 No. of HIV-positive women who get pregnant while on none Monthly Tally
Hospital
ART and linked to ANC
5 No. of HIV exposed infants who received Virological HIV Test Result
test 0- 2 months of birth
6 No. of HIV exposed infants who received an Virological Test Result

HIV test 2-12 months of birth
90
PMTCT register cont….
S.No, Reportable data element Disagg. Freq. Level of tally
Reporting used
7 No. of infants born to HIV positive women started on none

co-trimoxazole prophylaxis within two months of birth
8 No. of HIV exposed infants who received ARV None

prophylaxis
Monthly HC, Clinic & PMTCT

9 No. of HIV exposed infants receiving HIV confirmatory Test Hospital Tally
(antibody test) by 18 months Result
10 No. of partners of pregnant, laboring and lactating HIV

women tested and know their results positive
91
S.N Reportable data element Disaggregation Frequency Level of Tally
Reporting
11 Number of adults who are currently on ART Age , regimen type
12 Number of PLHIV on ART documented as Lost/lost none

to follow up during the reporting period.
13 Number of adults and children with HIV infection Age,

newly started on ART Pregnancy, Status, Monthly HC, Clinic & PMTCT
Hospital Tally
14 Number of adults and children who are still on Age,

treatment at 12 months after initiating ART Pregnancy,
Status,
92
S.N Reportable data element Disagg. Freq. Level of Tally
Reporting
15 Number of persons on ART in the original cohort Age,
including those transferred in, minus those transferred Pregnancy,
out (net current cohort). Status,
16 Total number of adult and pediatric ART patients with Age,

an undetectable viral load <1000copies/ml in the Pregnancy
reporting period status
HC, Clinic & PMTCT
17 Number of adult and pediatric ART patients with a Age, Monthly Hospital Tally
viral load test in the reporting period. Pregnancy
status
18 Number of PLHIV who were assessed/screened for Age,

malnutrition Pregnancy
status
93
S.N Reportable data element Disagg. Freq. Level of Reporting tally
used
19 Number of PLHIV that were nutritionally Age, Pregnancy,

assessed and found to be clinically nutritional status
undernourished
20 Number of clients who were on ART and Age,

screened for TB during the reporting Pregnancy PMTCT
period status Monthly HC, Clinic & Hospital Tally
21 Number of PLHIV women who are using Age,

modern family planning Method
94
PMTCT Indicators
Indicators Remarks
1 Percentage of pregnant, laboring and lactating women who were tested for HIV and Existing
who know their results
2 Percentage of HIV-positive pregnant women who received ART to reduce the risk of Existing
mother-to child-transmission during pregnancy, labor & delivery (L&D) and postpartum
3 Proportion of HIV exposed infants with virological test Existing

4 Percentage of exposed infants born to HIV-infected women who were started on co- Existing
trimoxazole prophylaxis within two months of birth
5 Percentage of infants born to HIV-infected women receiving antiretroviral (ARV) Existing
prophylaxis for prevention of mother-to-child transmission (PMTCT)
6 Percentage of HIV exposed infants receiving HIV confirmatory (antibody test) test by 18 Existing
months
95
Infant Immunization Register
Infant Immunization Register EPI Immunization tally

 A longitudinal register  Collects all infant vaccination and Td
 Each row is used to document all the vaccine to women
required immunization services data of one  Immunization tally is filled at the end of
child each service
 completed by the service provider at time of

service
 kept in the immunization room
Show & demonstrate EPI register & tally sheet 96

Reportable data elements Immunization register
S.N Reportable data element Disagg. S.No Reportable data element Disagg.on
1 BCG None 10 Protected at birth(PAB)

2 Hepatitis Birth Dose By period
3 OPV 1 & 3
11 Vaccine wastage rate Type of vaccines
4 Pentavalent vaccine 1 & 3
Developmental milestone By Status:
5 PCV vaccine 1 & 3 12 classification (ND, SD, DD Normal,
for U5 (0-23) and (24-59) Suspected
6 Rota vaccine 1-2 None developmental,
Developmental Delay
7 IPV Bye Age :0-23
:24-59
8 Measles vaccine 1-2
9
Fully immunized
97
Human Papilloma Virus (HPV) immunization Register
 A longitudinal register
 Each row is used to document HPV vaccine for 14 years old girl
 completed by the service provider at time of service
Show & demonstrate HPV Register
98
Reportable data elements (HPV register)
S.No Reportable data element Disagg. Frequency Level of Reporting
.
1
Number of girls 14 year of age who have received first
dose of human papilloma virus vaccine
2
Number of girls 14 year of age who have received None HP, HC, clinics &
Monthly
second dose of human papilloma virus vaccine in 6 Hospital
months interval from the first dose
3
HPV doses given /opened/damaged/expired
99
Tetanus diphtheria (Td) vaccination Register
 A longitudinal register
 each row is used to document all 5 doses of Td vaccine provided for pregnant
and non-pregnant
 completed by the service provider at time of service

Show & demonstrate Td Register
100
Reportable data elements (TT Immunization register)
S. Reportable data element Disaggreg. Frequency Level of Tally d

No Reporting
1 Td1
2 Td2
3 Td3 HP, HC,
Immunization
4 Td4 None Monthly clinic &
Tally
5 Hospital
Td5
6 Td doses given /
opened/damaged/expired
101
EPI Indicators
Indicators Remarks
1 Hepatitis -Birth dose(BD) immunization coverage Existing

2 DPT3-HepB3-Hib3 (Pentavalent third dose) immunization coverage (< 1 year) Existing
3 OPV 3 (Oral Polio Vaccine third dose) Immunization Coverage (< 1 year) Existing
4 Pneumococcal conjugated vaccine (PCV3) immunization coverage (< 1 year) Existing
5 Rotavirus vaccine 2nd dose (Rota2) immunization coverage (< 1 year) Existing
6 IPV (Inactivated Polio Vaccine) Immunization Coverage (< 1 year) Existing
7 Measles (MCV1) immunization coverage (< 1year) Existing
8 Measles second dose (MCV2) immunization coverage (15-24 months) Existing
9 Full immunization coverage (< 1 year) Existing
10 Proportion of infants protected at birth against neonatal tetanus Existing
11 HPV 2 (Human Papilloma Virus vaccine (2nd dose) Immunization coverage (14 years Modified
old girls)
12 Vaccine wastage rate Existing 102
Neonatal Intensive Care Unit (NICU) Register
• It is a Case (serial) register where each row is used only for one visit
• It is used to record information about neonates who have been treated in the
NICU
• It should be completed by service providers after the service is provided
103
Reportable data elements from NICU register
S. Reportable data element Disagg Frequen Level of Tally
N cy Reporting
1 Number of Newborn weighing <2000gm and None

premature newborns for which KMC initiated
2 Number of Newborn weighing <2000gm and or None
premature Monthly HC, No
Hospital tally
3 Number of neonates resuscitated and survived None
4 Total number of neonates resuscitated None

5 Total neonates admitted to NICU None
6 Number of sick young infants 0-2 months treated By disease type:- Very sever
for Critical illness Disease, Local bacterial
infection ( LBI) Pneumonia
7 Number of neonate deaths By age: within 24 hrs, 1-7
days,
7-28 days
8 Total neonates discharged during the reporting Treatment outcome
period
104
IMNCI register
• A case (serial) register
• Is used to record clinical signs and symptoms, assessment (Diagnosis based on

National classification of diseases), and treatment given or referral status of sick
children of age 0-2 months and 2 month -5 Years
105
Reportable data elements from IMNCI register
S.N Reportable data element Disagg Frequency of Level of
reporting Reporting
1 Diagnosis/diseases By Disease types
2 Number of sick young infants 0-2 By disease type:- Very sever

months treated for Critical illness Disease, Local bacterial infection
( LBI), Pneumonia
3 Number of under 5 years children
treated for pneumonia
Monthly HC & Hosp
4 Children treated with Zinc and ORS Rx type: ORS &Zinc
for diarrhea ORS Only
Age 0-2 Month and 2 Month 5 Yr
5 Children aged 0 to 59 months Age: 0-23months, and 24-59 moths

assessed for developmental
milestone
106
Child health Indicators
Indicators Remarks
1 Institutional Neonatal Death Rate Existing
2 Number of Neonatal death at community Existing
3 Proportion of under-five children with pneumonia received antibiotic treatment Existing
4 Proportion of Sick Young infant treated for Newborn infection Existing
5 Proportion of children with diarrhea who are treated by both ORS and Zinc at Modified
community and facility level
6 Proportion of low birth weight or premature newborns for whom Kangaroo Mother Existing
Care (KMC) was initiated after delivery
7 Proportion of asphyxiated neonates who were resuscitated (with bag & mask) Existing
8 Treatment outcome of neonates admitted to NICU Existing
9 Proportion of newborns that received at least one dose of Chlorhexidine Digluconate New
(CHX) to the cord on the first day after birth
10 Proportion of under-five children monitored for child development New
107
Integrated Adolescent or Youth Health Service Register
• It is a Case (serial) register where each row is used only for one visit
• It is used to capture data on service given to adolescents or youths which include HIV
testing, F/planning service, pregnancy test, abortion service, assessment and
treatment of STI, substance abuse, Psychiatric problems, Sexual GBV survivor, and
screening for non-communicable diseases, and counseling on menstrual hygiene.
• It should be completed by service providers after the service is provided
108
Reportable data elements from AYH service register
S.N Reportable data element Disagg Frequency of Level of

reporting Reporting
1 Number of clients “referred” from By HF type: youth center,

school, internal referral,
and Other Facility
2 Number of clients accepted HIV test
3 Number of clients tested by status
4 Number of new acceptors Age, method Monthly HC, Hospital

5 Number of new acceptors Age, method
6 Number of safe abortions performed Age

7 Number of safe abortion/emergency care Age
performed
109
Nutrition Program
GMP and <5 Nutrition Screening Services (CINuS) Register
CINuS Register CINuS Tally
• It is a longitudinal register, where each row can be • It is used to simplify reporting of CINuS
used for one child for two years in repeated visits.
related reportable data elements
• It is used to record the following services:
o Growth monitoring for children under 2 years • The tally is used to tally GMP,
of age
o Nutritional screening for children under 5 nutritional screening and Vitamin A &
years of age de-worming services, disaggregated by
o To screen developmental milestones
age and nutritional status category.
• It is kept at a department where the service is
provided.
Show & demonstrate register and CINuS

111
Reportable data elements from CINuS register
S.N Reportable data element Disaggregation Frequenc Level of Tally

y Reporting
1 Total number of children less than 2 Age and

years weighted during GMP session nutritional status
2 Total Number of children < 5 years Age and

screened for acute malnutrition nutritional status
3 Developmental milestone classification By Status:

(ND, SDD, DD for U5 (0-23) and (24-59): Normal, HP, HC, CINuS
Monthly Hospital tally
Suspected, or
ND: Normal Development Delay
SDD: Suspected Developmental Delay development
DD: Delay Development Bye Age :0-23
:24-59
112
Vitamin A Supplementation and Deworming Register
• It is a longitudinal register, where each row can be used for one child for five years in repeated
visits.
• It is used to record the following services:
o Vitamin A supplementation and De-worming
o A child should take two doses of Vitamin A and anti-helminthiasis per year
• It is kept at a department where the service is provided.
S.N Reportable
Reportable data
data element
elements Disaggregation Frequency Reporting Tally
level
1 Number of children who were provided Age and dose
with vitamin A supplementation
Monthly HP, HC, CINuS tally
2 Number of children aged 24-59 months Dose Hospital
de-wormed
113
Therapeutic Food Program (TFP)Register for under 5 years children
• It is kept at a department where the service is provided
• It is used to record therapeutic feeding that is provided for Children < 5 years of age
with Severe Acute Malnutrition (SAM)
• The information is completed by service provider after delivering the service.
• Data related to admission and treatment outcome of children who have been
admitted to TFP centers will be recorded in this register
Show and demonstrate TFP register
114
Reportable data elements from TFU register
Reporting
1 Total number of SAM at the beginning None
2 Total number of children with SAM None

admitted to TFP (OTP &SC) during the
reporting period
Monthly HP, HC, No
Hospital Tally
3 Total number of children who exit from outcome
severe acute malnutrition treatment
115
Moderate acute malnutrition treatment (MAM) register for 6–59-
month Register
• A longitudinal register for clients who developed Moderate acute malnutrition

of children 6-59 months.
• It is used to capture information about admission and discharge of children

admitted with Moderate acute Malnutrition.
• This recording follows the nutritional screening protocol of child health care
visits.
116
Reportable data elements from MAM U5 register
of reporting Reporting used
1 Total number of MAM at the None

beginning
2 Total number of children with None

MAM admitted during the
reporting period No
Monthly HP, HC, Hospital Tally
3 Total number of children who exit outcome

from MAM treatment
117
Pregnant and Lactating women (PLW) Nutrition screening
register
• It is a longitudinal register
• It is used to record information regarding screening of pregnant and lactating women for
acute malnutrition
• It is kept at a department where the service is provided
• Completed by the service provider at time of service Show & demonstrate PLW
Screening register
Reportable data elements
S.N Reportable data element Disagg. Frequency of Level of Reporting
reporting
1 Total number of PLW screened for acute Maternal Monthly HP/HC/clinic,
malnutrition status & Hosp
MUAC 118
Moderate acute malnutrition treatment for PLW Rx Register
• A Longitudinal register for pregnant and lactating women (PLW) who developed
Moderate acute malnutrition.
• It is used to record information about admission (status and entry information) and
discharge (exit information) of moderately acute malnourished PLW.
• This record follows the nutritional screening protocol of maternal health care visits
119
Reportable data elements from PLW Rx register
S.N Reportable data element Disagg. Frequency of Level of Tally
reporting Reporting used
1 Total number of PLW with MAM None

at the beginning
2 Total number of PLW with None

MAM admitted during the
reporting period No
Monthly HP, HC, Hospital
Tally
3 Total number of PLW who exit outcome
from MAM treatment
120
Nutrition Indicators
Indicators Remarks
1 Percentage of live births that weigh less than 2,500gm out of the total live births Existing
weighed
2 Proportion of children under two years who participated in Growth Monitoring and Existing
Promotion
3 Proportion of children aged 6–59 months who received two doses of vitamin A Existing
supplement
4 Proportion of children 24-59 months de-wormed Existing
5 Proportion of pregnant women received IFA 90 plus Existing
6 Proportion of Pregnant and lactating women screened for malnutrition Existing
7 Proportion of children under five years screened for malnutrition Existing

8 Treatment outcomes for management of complicated severe acute malnutrition in Existing
children 0-59 months 121
Session Five: Disease Prevention and Control
6Hrs 30 Minutes (DPC)
HIV/AIDS
TB and Leprosy
Malaria
NCD and Mental Health
NTD
HIV/AIDS and Hepatitis
123
HIV registers (8) & Hepatitis (2)
Registers
HIV tally sheets (5):
1) PEP (post exposure prophylaxis) FU
register 1. HIV Testing Services (HTS)
2) HIV Testing Services (HTS) Register Tally
3) ART register
4) DSD Register 2. HIV clinical care tally
5) Pre-exposure prophylaxis Register 3. Currently on ART by regimen
6) HIV Self-testing (HIVST) Register type and DSD tally sheets
7) Index Case Testing (ICT) Register
8) HIV positive client tracking register 4. ICT Tally sheet
9) Hepatitis B Treatment Register
10)Hepatitis C Treatment Register
Black: Maintained
Green: New
124
Purple: Modified
HIV Testing Services (HTS)
HTS Register
• It is a case(serial) register
• Each row is used for one client only
• The register is kept in HTS service room
• HTS service provider (counselor) completes the register
HTS Tally Sheet

• It is used to capture reportable data element from HTS service areas
• Help to tally information about all patients/ clients who are tested for HIV
• It should be available to all Service outlets where HIV testing service is given
• The required information is tallied from HTS, OPD, IPD, FP, ANC, Delivery, PNC , safe abortion care,
and TB registers …..
Show & demonstrate both HTS
• The tally is completed by the care provider register and Tally Sheet
125
Reportable data elements from HTS register and Tally Sheet
12
6 Data element Disaggregation Frequency of Level of
the report report
Clients receiving HIV test results Age group:

(at PITC) Sex:
HIV result
Population group
HC,
Monthly Clinic
Number of STI cases tested for Sex Hospital
HIV in the reporting period HIV test result:
Index Case Testing (ICT) Register
• It is longitudinal record of HIV positive client’s demographic information and service
provided;
• Used to record contact of index client (i.e., a person known to be HIV positive)
demographic information and provided service such as HIV testing and result, linkage
to care and treatment and information related with PrEP service for eligible HIV
negative contact.
• It is kept at ART and PMTCT room
ICT Tally sheet
• Help to simplify compiling reportable data elements regarding ICT service cascade
offered, accepted, elicited, new positive and known positive by sex and age category
Show & demonstrate register and ICT Tally Sheet

127
12
8 Data element Disaggregation Frequency of Level of report
the report
Number of index cases offered
Number of contact elicited

HC,
Age group and sex Monthly Clinic Hospital
Number of contact tested and test
result
HIV Self-testing (HIVST) Register
• The register is a serial register
• Used to record information about self-testing on HIV, HIV test kit distribution, linkage to
care & treatment
• Data is recorded while the client is receiving the kit by

• It is kept at secondary distribution for sexual partners of Index cases (ART room), and Key
and priority population center (KPP)
Reportable date element
- Number of Individual HIV self-test KIT distributed directly assisted disaggregated by age group
and sex
- Number of individual HIV self-test KIT distributed unassisted disaggregated by sex
Show & demonstrate HIVST register

129
Pre exposure to HIV prophylaxis (PrEP) register
• A longitudinal record of client’s follow up on pre exposure to HIV where the targets
are female sex worker and discordant couples
• It is kept at ART room for sero-discordant couples and KPP clinic (FSW)
Reportable Data elements
● PrEP_current disaggregated by age group, Sex (M/F) and clients’ Category

(Female sex workers (FSW) or Discordant Couples)
● Number of new PrEP cases disaggregated by age group, Sex (M/F) and client
Category (Female sex workers (FSW) or discordant Couples)
130
Post exposure to HIV prophylaxis (PEP) follow up
register
• It is a serial register
• used to record the client’s information of demographic data, exposure status, baseline HIV status, PEP
provision, exposed person follow up.
Reportable data element

● Records counted monthly from the PEP register.
● The sum of each data element counted at every page.
● The data elements are the number of persons provided with post-exposure prophylaxis (PEP) for risk of
HIV infection by exposure type.
o Occupational
o non-occupational and
o Sexual violence for the eligible clients. 131
HIV positive client tracking register (NEW)
• Used to record HIV positive clients information on demographic data,

• date of HIV tested positive, entry point,
• date of linked to care and treatment,
• date of start on ART,
• initiation date and outcome of the client.
o Number of newly identified positive adults and children linked to care and treatment
by linkage outcome (Linked to care and treatment, Known on ART, Lost to follow up,
Referred to other facility, Died and other)
132
ART registers & Tally Sheets
ART Register
• ART register is a longitudinal register.
• It is used to follow PLWHIV who are on ART.
• The register is kept in ART service room and is completed by the ART care
provider/ART data clerks
• The data is abstracted from ART follow up card
Show & demonstrate ART register
133
ART registers & Tally Sheets …
HIV clinical care tally
• It is used to simplify reporting of number of ART patients screened: for TB, initiated on TPT,
completed TPT, screened for cervical cancer and managed for cervical lesion, screened for
nutritional status and supplementation with food support for malnourished client
Currently on ART by regimen type and DSD tally sheets
• This tally sheet is used to simplify reporting of number of ART client by regimen category (as
1st, 2nd and 3rd), number of viral load tested and result and number on specific regimen type
Show & demonstrate ART Tally Sheets

134
Reportable data elements from ART Register
Sr # Data element Disaggregation Frequency of Level of Tally sheet
the report report
131 Number of adults and children who are currently on Age, Monthly HC Currently on
5 ART Sex clinics ART by
Regimen Hosp regimen &
DSD tally
2 Number of adults and children with HIV infection Age, Sex Monthly HC
newly started on ART Pregnancy clinic Clinical care
Status Hosp tally sheet
3 Number of adults and children who are still on Age
treatment at 12 months after initiating ART Sex
pregnancy
status
HC,
4 Number of persons on ART in the original cohort Age, Sex Clinic,
including those transferred in, minus those pregnancy Monthly Hospita
transferred out (net current cohort). status l
5 Number of ART clients restarted ARV treatment Age, Sex
Sr # Data element Disaggregation Frequenc Level of Tally sheet
y report
13
66 Number of adult and pediatric ART patients Age Monthly HC Currently
with a viral load test in the reporting period Sex Pregnancy clinic on ART &
status Hosp regimen
tally
7 Total number of adult and pediatric ART Age Monthly HC
patients with an undetectable viral load Sex clinic
<1000copies/ml in the reporting period pregnancy Hosp
status
8 Number of PLHIV who were Age Monthly HC,
assessed/screened for malnutrition Sex Hospital
Pregnancy
status
9 Number of PLHIV that were nutritionally Age, Sex
assessed and found to be clinically Pregnancy
undernourished status
Nutritional
status
Sr # Data element Disaggregation Frequency of Level of Tally
the report report sheet
13
7 10 Clinically undernourished PLHIV who received Age, Sex Monthly HC/Hos
therapeutic or supplementary food Pregnancy status
Nutritional status
Currently on ART & regimen tally

11 Number of newly enrolled ART clients who were Age
screened for TB during the reporting period Sex
Pregnancy status
12 Number of previously enrolled ART clients who Age

were screened for TB during the reporting period Sex
Pregnancy status HC
Monthly clinic
13 Number of ART patients who started on TPT in the Age, sex, and Hospital
reporting period regimen type
14 Number of ART patients who were initiated on Age, sex, and
any course of TPT 12 months before the reporting regimen type
period
13 Sr # Data element Disaggregation Frequency Level of Tally
8 of the report sheet
report
15 Number of ART patients who started TPT 12 Age, sex, and

months prior to the reporting period that regimen type
completed a full course of therapy
16 Number of ART clients interrupted treatment by Sex

outcome Age
HC
Monthly clinic
17 Number of Women living with HIV aged 15-49 Age Hospital
using any method of modern family planning Method
18 Number of ART clients that received Age, Sex

cervical cancer screening Screening result
& Treatment type

Differentiated Service Delivery (DSD) register
• It is a longitudinal record of client’s,
• It helps to record information on differentiated models for PLHIV, ARV regimen

and follow-up.
- Total number of clients on ASM disaggregated by age group and sex

- Total number of clients on FTAR disaggregated by age group and sex
- Total number of clients on CAG disaggregated by age group and sex
- Total number of PCAD disaggregated by age group and sex
- Total number of Advanced HIV disease (AHD) disaggregated by age group and
sex
139
Hepatitis B Treatment Register
• It is a longitudinal register used to record hepatitis B infected individuals’

demographic, baseline status and follow up status information.
Reportable data elements are;

o Total number of individuals treated for Hepatitis B by sex and age.
Show & demonstrate Hepatitis B register

140
Hepatitis C Treatment Register
• It is a longitudinal register used to record hepatitis C infected individuals’

demographic, baseline status and follow up status information.
Reportable data elements are;

o Total number of individuals treated for Hepatitis C by sex and age.
Show & demonstrate Hepatitis C register

141
HIV and Hepatitis Indicators
Sr # List of Indicators Remarks
1 Percentage of people living with HIV who know their status Existing
2 Number of people living with HIV currently receiving ART Existing
3 Number of adults and children with HIV infection newly started on ART Existing
4 ART retention rate Existing
5 Number of ART Clients that interrupted Treatment New
6 Viral load Suppression Modified
7 Number of individuals receiving Pre-Exposure Prophylaxis New
8 Number of persons provided with Post-Exposure prophylaxis Existing
9 Proportion of clinically undernourished People Living with HIV (PLHIV) who Existing
received therapeutic or supplementary food
142
HIV and Hepatitis Indicators
Sr # List of Indicators Remar
ks
10 Proportion of STI cases tested for HIV Existing
11 Percentage of non-pregnant women in the reproductive age living with HIV Existing
on ART using a modern family planning method
12 Proportion of patients enrolled in HIV care who were screened for TB Existing
13 Proportion of HIV positive women (15+) on ART screened for Cervical Ca New
14 Number of individuals tested for Hepatitis New
15 Proportion of diagnosed Hepatitis B and C patients who received treatment New
143
TB and Leprosy HMIS Tools
1. Unit TB register
2. TB Contact Register
3. DR TB Register
4. MDR TB follow up Register
5. Leprosy Register
6. Leprosy register for care after completion of treatment
144
Unit TB register
• It is a longitudinal register where patients are followed for the whole period of
treatment once they are registered
• Used to record data for patients who are on TB treatment
• Completed by the health service provider and kept at TB treatment room
Show & demonstrate Unit TB Register
145
Reportable data elements from Unit TB Register
Sr # Data elements Disaggregatio Frequenc Level of
14 n y report
61 Number of bacteriologically confirmed New Pulmonary TB Age and sex
cases detected and enrolled in the reporting period
2 Number of clinically diagnosed New pulmonary TB cases Age and sex
detected and enrolled in the reporting period
3 Number of clinically diagnosed new EPTB cases detected Age and sex
and enrolled in the reporting period
HC,
4 Number of RELAPSE (bacteriological confirmed and Age and sex Monthly clinics,
clinically diagnosed) TB cases in the reporting period Hosp
5 Number of notified TB cases from key affected population None

group
6 Total number of new bacteriologically confirmed TB cases None
(PTB+) enrolled in cohort in same month of previous EFY
Reportable data elements from Unit TB Register…
Sr # Data element Disaggregatio Frequency Level of
14 n report
7
7 Treatment outcome of new bacteriologically confirmed TB cases Type of Rx
(PTB+) outcome
8 Total number of new clinically diagnosed pulmonary TB cases None
enrolled in the cohort in same month of previous EFY
9 Treatment outcome of new clinically diagnosed pulmonary TB Type of Rx
cases (P/Neg) outcome
10 Total number of clinically diagnosed EPTB cases enrolled in the None HC,
cohort (EPTB) in same month of previous EFY Monthly clinics,
Hospital
11 Treatment outcome of clinically diagnosed EPTB cases (EPTB) Type of Rx
outcome
12 Total number of RELAPSE TB cases enrolled in the cohort in the
same month of previous EFY
13 Treatment outcome of RELAPSE TB cases Type of Rx
outcome
Sr # Data element Disaggregati Frequenc Level of
on y report
14 Number of all forms TB cases detected and registered on unit TB None

register who are initially referred by the community
15 Treatment success of TB patients who received community-based None

treatment support
16 Number of notified bacteriologically confirmed TB cases evaluated Registration

for drug susceptibility testing group HC,
Monthly clinics,
Hospital
17 Number of TB cases with drug susceptibility testing result for at Registration
least rifampicin during the reporting period group
18 Number of TB cases (all forms) notified in public health facilities None

with initial referral by PPM sites for TB diagnosis or initiation of TB
treatment
148
Sr # Data element Disaggregatio Frequency Level of
14 n report
9
19 Number of test with rapid diagnostic tests (Xpert and others) at Age, Sex
the time of diagnosis(initial diagnosis)
20 Total number of new and relapse TB patients registered during Age, Sex
the reporting period having a documented HIV test result
21 Total number of HIV-positive new and relapse TB patients Age, Sex

started on TB treatment during the reporting month who are HC, clinic,
Monthly Hospital
already on ART
22 Total number of newly tested HIV positive TB patients who Age, Sex
began ART during the reporting month
23 Number of notified all forms of TB cases screened for Screening

malnutrition result
TB Contact Register
15
0
• It is a longitudinal register and the main purpose is to record information about
TB contact screening, diagnosis and referral.
• It is kept in TB treatment room and filled by health workers providing the service
Show & demonstrate TB Contact Register

Reportable data elements from TB Contact Register
Sr # Data element Disaggregati Frequency Level of
on report
15
1
1 Total number of contacts with index of drug susceptible Age
bacteriologically confirmed pulmonary TB cases
2 Total number of contacts with index of bacteriologically confirmed Age
DR-TB cases
3 The number of contacts with index cases screened for TB Age
4 Number of contacts with index of bacteriologically confirmed TB Age
cases screened negative for TB HC,
5 Number of contacts screened negative for TB and others eligible Age Monthly clinic,
and put on TPT in the reporting period Hospital
6 Number of cohort of individuals started TPT 12 months prior to Age &

the reporting period regimen
7 Number of cohort of individuals who had completed TPT in the Age &
reporting period regimen
DR TB Register
• It is a longitudinal register where patients are followed for the whole period of
treatment once they are registered
• It is used to record data for patients who are on DR TB treatment.

• It is used for facilities which started drug resistant tuberculosis treatment.
Show & demonstrate DR TB Register
152
Reportable data elements from DR TB Register
Sr # Data element Disaggregation Frequency Level of report
151 Number of DR TB cases detected Age, Sex Monthly HC, Clinic, Hosp
3 Resistance type
2 Drug Susceptibility Test (DST) coverage for DR-TB Regiment type Monthly Treatment
patients initiating center
3 DR TB treatment interim result for cohort of patient Regimen type,
registered 9 -12 month earlier culture result &Rx
outcome
4 Total number of cohort DR-TB cases started on short Rx out come

term second-line anti-TB treatment regimen 24 months
earlier HC, Clinic,
Monthly Hospital
5 Total number of cohort DR-TB cases started on long Rx out come
term second-line anti-TB treatment regimen 36 months
earlier.
6 Number of DR- TB cases enrolled to second line drugs Screening result

screened for Malnutrition during the reporting period
DR TB follow up Register
15
4
• It is a longitudinal register where DR TB patients are followed for the whole period of
treatment once they are registered.
• It is used at MDR treatment initiating center and MDR treatment follow up center
• The Register includes information for clinical monitoring for the health facility.
Show & demonstrate MDR TB follow up register

Leprosy Register
 A longitudinal register where a confirmed leprosy patient is registered and

followed until the end of the treatment period.
 The register is kept in leprosy treatment room and is completed by the leprosy
care provider
• The required data elements are abstracted from the Leprosy patient record card
to the register.
Show & demonstrate Leprosy register
155
Reportable data elements from LP Register
Sr # Data element Disaggregatio Frequency Level of report
15 n of the
6 report
1 Number of new Leprosy cases detected Age, Sex and

type of LP
2 Number of household contacts of leprosy cases registered None

3 Number of household contacts of leprosy patients that None
are screened for Leprosy
Monthly HC, Clinics,

4 Number of household contacts diagnosed with Leprosy None Hospital
cases
5 Number of new leprosy cases with Grade II disability Age & Sex
(MB+PB)
6 Result of new leprosy cohort cases registered during 16- Rx outcome

18 months prior to the reporting period
Leprosy referral and transfer form
15
7
This form used for leprosy cases
• Which is referred to your health facility for registration and starting Leprosy
treatment:
• Which is transferred out to your health facility to continue and complete Leprosy
treatment
• To refer the cases for further investigation and managements with other health
facility.
Leprosy register for care after completion of
treatment
• Used to follow leprosy patients after completion of treatment for any disability or
medical care
• It is used at the leprosy treatment room of the facilities.

• There is no reportable data elements from this register
Show & demonstrate Hepatitis B register

158
TB and Leprosy Program Indicators
Sr # Indicators Remarks
1 TB Treatment coverage Existing
2 Tuberculosis Re-treatment Rate Existing
3 Cure Rate for bacteriologically confirmed Pulmonary TB cases Existing
4 TB Treatment Success rate (TSR) among all forms of TB cases Existing
5 Unsuccessful treatment outcome among all forms of TB New
6 Proportion of all forms of TB cases notified and treated from community Existing
referral
7 Community based TB Treatment success rate Existing
8 Proportion of notified TB cases (all forms) contributed by other governmental New
and private facilities
9 Contact investigation coverage New
10 TB Preventive Therapy (TPT) Coverage New
11 TPT Completion Rate New
159
TB and Leprosy Program Indicators
12 Percentage of new and relapse TB patients tested using a WHO recommended rapid New
tests at the time of diagnosis
13 Drug Susceptibility testing (DST) coverage for TB patients Existing
14 Drug Resistant (DR) TB case detection rate Existing
15 DR TB treatment coverage New
16 Final Outcome of DR-TB Cases Existing
17 Proportion of all forms of TB and DR-TB patients with malnutrition New
18 Proportion of registered new and relapse TB patients with documented HIV status Existing
19 Proportion of HIV-positive new and relapse TB patients on ART during TB treatment Existing
20 Leprosy notification per 10,000 population Existing
21 Grade II disability rate among new cases of leprosy Existing
22 Leprosy treatment completion rate Existing
160
Malaria Prevention and Control
Malaria Screening and Treatment Registration Register
• The main purpose is to document malaria case management in targeted elimination
Woreda.
• The register is a serial record of travel history, fever history, diagnosis, and treatment
for malaria cases, index cases classification, notification and investigation of foci.
• It also help to documents the presence of other cases around the index case and helps
to identify focus with ongoing transmission and inform interventions.
Show & demonstrate Malaria register

162
Malaria….
● Index case: A case of which the epidemiological characteristics trigger additional active
case or infection detection.
o An index case is eligible for investigation when the case's local address can be
ascertained and for visitors if they have stayed 21 days or more in the area.
● Focus: A defined and circumscribed area situated in a currently or formerly malarious
area that contains the epidemiological and ecological factors necessary for malaria
transmission
163
Sr Data element Disaggreg Frequency Level of
# ation of the report
report
1 Number of malaria cases with travel history None
2 Number of index cases investigated and None

classified
Monthly HP & HC
3 Number of secondary cases None
4 Number of foci investigated and classified None
164
Malaria Program Indicators
1 Morbidity attributed to malaria Existing
2 Facility based death attributed to malaria Existing
3 Malaria positivity rate Existing
4 Proportion of confirmed malaria cases fully investigated and classified New
5 Proportion of foci fully investigated and classified New
6 Annual parasite incidence New
7 Proportion of unit structures covered by Indoor residual spraying Existing
8 Proportion of health facilities covered by External Quality Assurance New

(EQA) for malaria diagnosis
165
NCD prevention and Control, and Mental
Health
Registers:
1. Cervical cancer register
2. Diabetes and Hypertension Treatment Register
3. Mental Neurological and Substance Use register
Tally Sheet:
1. Hypertension and Diabetes Screening Tally Sheet
Hypertension and Diabetes Screening Tally Sheet
• This tally sheet is standalone (i.e it is not attached with register) and
used to record number of individual screened for hypertension and
diabetes mellitus disaggregated by sex and age
• It should be available at facility triage, OPD, EOPD, ART clinic, TB

clinic etc.
• It is also used at health post
167
Sr Data element Disaggreg Frequency Level of
# ation of the report
report
1 Number of adults screened for Sex
hypertension Age
Result
HP, HC
2 Number of individuals screened for Sex Monthly Clinic &
diabetes mellitus Age Hospital
Result
168
Diabetes and Hypertension Treatment Register
• It is a longitudinal register,
• Used to register and follow up clients who are confirmed to have

hypertension (HTN) and/or diabetes mellitus (DM).
• It is kept at NCD chronic care unit
• The reportable data elements are directly compiled from the register by
the end of each reporting period.
Show & demonstrate the register

169
Reportable data elements from HTN-DM Register
Sr # Data element Disaggregation Frequency Level of
17 report
0 1 Number of confirmed hypertensive patient enrolled to
care
Age, sex
Type of Rx
Timing of enrollment
2 Total number of cohort of hypertensive patients None
registered six months prior to the reporting period
3 Treatment outcome of patient on hypertensive care at six Type of outcome

month
HC,
4 Number of confirmed diabetic patient enrolled to care Age, Sex Monthly Clinics,
Type of DM Hospital
Type of Rx
5 Total number of cohort of diabetic patients registered six None
months prior to the reporting period
6 Treatment outcome of patient on diabetic care at six Type of outcome
month of care
7 Number of individuals in high CVD risk category Risk category
Cervical cancer register
• It is a serial register that is used to capture basic personal and service
related information of eligible women who received cervical Cancer
Screening and Treatment.
• It also helps to follow clients with suspicious cervical cancer treatment.

• Each row of the register is used for one client.
Show & demonstrate Cervical Cancer register

171
Reportable data elements from Cervical Ca. Register
Sr # Data element Disaggregation Frequency Level of
17 report
2 1 Total number of women age 30–49 years who have been Screening type
screened for cervical cancer
2 Number women aged 30 – 49 yr screened with HPV DNA for Screening result
cervical cancer
3 Number women aged 30 – 49 yr screened with VIA for Screening result HC, Clinic,
cervical cancer Monthly Hospital
4 Number of women aged 30-49 yr with precancerous Rx type
cervical lesion received treatment
5 Number of women screened 1 year after treatment follow Screening result

up
Mental Neurological and Substance Use register
• It is a longitudinal register used to register and follow up

clients who are confirmed to have mental, neurological, and
substance use disorders.
• It is kept at the mental health unit or OPD
• The data is abstracted from a patient form found in an
integrated patient folder
• There is no reportable data elements from this register
Show & demonstrate the register 173

NCD and Mental Health indicators
1 Cataract surgical rate (CSR) Existing

2 Number of hypertensive patients enrolled to care New
3 Six-monthly control of blood pressure among people treated for hypertension New
4 Proportion of patients with high CVD risk who received treatment New
5 Number of diabetic patients enrolled to care New
6 Six-monthly control of diabetes among individuals treated for diabetes New
7 Proportion of women aged 30–49 years screened for cervical Ca Existing

8 Proportion of eligible women who received treatment for cervical lesion New
Mental Health
9 Proportion of individuals treated for priority mental health disorders New
10 Proportion of children (<18) diagnosed and treated for childhood developmental New
and behavioral disorders 174
NTD Prevention and control
Registers:
o Trachomatous Trichiasis (TT) Surgery Register
o Leishmaniasis Register
Trachomatous Trichiasis (TT) Surgery Register
• It is a serial register used to record data for patients whom Trachomatous Trichiasis
corrective surgery is done.
• It should be placed in a room where TT surgery is performed/optometry

department/minor OR.
• If the TT surgery is performed at an outreach place, the register should be taken to

the outreach site.
• Number of people with TT who received corrective TT surgery by age group (<15yrs
and +15 yrs) and by sex (M/F) Show & demonstrate TT register
176
Leishmaniasis Register
• This register used to capture data about basic personal and services related with
leishmaniasis treatment and follow up.
• its use is limited at specific health facilities that provide leishmania treatment and
follow up.
Show & demonstrate Leishmaniasis register
177
Reportable data elements from Leishmania Register
Sr Data element Disaggregation Frequency Level of
17# report
8
1 Number of visceral leishmaniosis (VL) patients Age, Sex, VL
treated type, HIV status
2 Number of VL patients treated and Rx outcome Rx outcome
HC,
3 Number of cutaneous leishmaniasis (CL) treated Age, Sex, CL Monthly Clinics,
type Hospital
4 Number of VL patients treated and Rx outcome Rx outcome

NTD Program Indicators
1 Proportion of individuals who swallowed drug for soil transmitted helminthiasis New
(STH))
2 Proportion of individuals who swallowed drug for lymphatic filariasis(LF) New
3 Proportion of individuals who swallowed drug for onchocerciasis New

4 Proportion of individuals who swallowed drug for trachoma New
5 Proportion of individuals who swallowed drug for Schistosomiasis New
6 Number of visceral Leishmaniasis (VL) cases treated Existing
7 Number of cutaneous Leishmaniasis (CL) cases treated New
8 Proportion of Trachomatous Trichiasis (TT) cases who received corrective TT surgery New
179
Medical Service Tools
and
Session Six: ESV-ICD 11
6 Hrs 30 minutes
Ethiopian Simplified Version of ICD 11 (ESV-ICD 11)
(NCOD)
Outline
Background, NCoD Gap Assessment
Introduction
Findings, Rationale
Purpose & ICD 11 Purpose, brief description of ICD 11
ESV-ICD 11 Content Chapters, Blocks, Categories, Editions
ESV-ICD 11 Rules & General , Morbidity and Mortality Rules, Conventions

Conventions
Tools & Workflow Reporting & Reporting Tools, Workflow, Mal practices
Roles and
responsibilities
Clinician, Nurse Assistant, HIT, Admin Level
182
Introduction
Background
▪ Understanding why people get sick and die in specific geographical areas is very critical to
plan interventions.
▪ Routine disease recording and reporting is one of the four technical areas of HMIS.
▪ Earlier to 2008/9 G.C, the ICD 6 –WHO 1948 was used for disease coding in Ethiopia.
▪ HMIS disease coding and classification with +126 diagnosis, mapped on ICD 10 chapters
deployed from 2009/10 to 2016.
183
Introduction
Background
▪ Since 2017, MOH designed and developed a new disease list (NCoD).
▪ NCoD has 2,054 diagnoses with three main editions & Health post version
(1869,617,45).
▪ Piloted to some health facilities in few health facilities such As Zewditu Memorial
Hospitals and Arada HC.
▪ However, no substantial changes have been observed in the quality of disease data.
184
Introduction…
NCoD Gap Assessment Findings
Implementation related gaps

▪ Inadequate availability of disease recording and reporting tools (registers and tally
sheets, booklets)
▪ In appropriate use of NCoD editions : Referral Hospitals using Mini edition
▪ Inadequate training, no cascaded training to the grassroots level
▪ No adequate mentorship provided
▪ Poor disease data quality and use
185
Introduction…
NCoD Gap Assessment Findings
▪ Inadequate knowledge of basic concepts such as main diagnosis, new vs. repeat episode of
an illness
▪ Lack of implementation guide and SOP
Design/Content related gaps

▪ Erroneous use of parentheses e.g. Kaposi sarcoma (Malignant neoplasm of breast)
▪ Presence of redundant terms for the same disease concept(Typhoid, Typhoid unspecified)
▪ Missing diagnosis and different codes for the same disease in different editions
186
Introduction…
Rationale-
Why revising the national disease list?
▪ NCoD Gap assessment Results
▪ Advent of ICD 11 with synonyms
▪ HSTP 2
▪ Emerging diseases such as COVID 19
187
Purpose of Having ESV-ICD11
Purpose
▪ To identify leading causes of morbidity and mortality.
▪ To estimate incidence & prevalence of diseases/injuries.
▪ To monitor effects of interventions such as vaccines for Measles, Poliomyelitis.
▪ International Reporting (communicable, non-communicable diseases and injuries).
▪ To strengthen other systems such as CRVS & Insurance.
188
Revision …
Disease Rating
▪ Several health professionals are participated in the current revision. Diseases or
injuries from GBD and PHCCG taken as mandatory
• Final Outputs
o New ESV-11 Disease List
o ESV-ICD 11 Editions
o ESV- ICD 11 Implementation Guide
o ESV- ICD 11 SOP & Job Aid
189
ESV-ICD 11 Content
Chapters & Blocks
▪ NTF adopted all the chapters (26) of ICD 11
▪ Supplementary chapter for traditional medicine (chapter 26) and Extension Codes
(chapter X) as the initial dataset not considered
▪ Each chapter has blocks and range of block codes
▪ ESV-ICD 11 chapters are categorized into two groups:
o Body systems chapters
o Special group chapters

190
ESV-ICD 11 Content
Special group
▪ Conditions originating in perinatal period
▪ Infectious & parasitic disorders
▪ Developmental anomalies
▪ Neoplasm
▪ Injury, poisoning & other conditions due
▪ Disease of blood or blood forming organs to external causes are chapters of
▪ Disease of the Immune system special group category
▪ Pregnancy, Childbirth or Puerperium
191
Code Block Name
BlockL1- - Gastroenteritis or colitis of infectious origin

1A0
BlockL1- - Predominantly sexually transmitted infections
1A6
BlockL1- - Mycobacterial diseases
1B1
BlockL1- - Certain zoonotic bacterial diseases
1B9
BlockL1- - Other bacterial diseases
1C1
BlockL1- - Human immunodeficiency virus disease
1C6
BlockL1- - Dengue
1D2
BlockL1- - Certain arthropod-borne viral fevers
1D4
BlockL1- - Certain zoonotic viral diseases
1D6
BlockL1- - Certain other viral diseases
1D8
ESV-ICD 11 Content…
Categories
▪ Disease /injuries are category type in ICD 11( concepts represented with distinct
code)
▪ Each category can have depth up to three levels in hierarchical relationship.
▪ The parent /child relationship of disease/ injury categories are helpful to produce
summary report on similar disease.
Editions
SN Edition Name # Diseases/Injuries
1 Completed Edition 2,437
2 Compact Edition 1,756
3 Mini Edition Primary Hospital 935
4 Mini Edition Health Center 595
5 Health post edition 94
ESV-ICD 11 Content…
Global Burden of Diseases and Primary Healthcare Clinical Guide
194
ESV-ICD 11 Rules , Conventions, Synonymous
Conventions/Concepts
▪ The main condition is defined as the condition, diagnosed at the end of the episode of
health care, primarily responsible for the patient’s need for treatment or investigation.
▪ If there is more than one such condition, the one held most responsible for the
greatest use of resources should be selected.
▪ ‘Not elsewhere classified’ : Serves as a warning that certain specified variants of the
clinical concept may appear in other parts of classification
195
ESV-ICD 11 Rules , Conventions, Synonymous
Conventions/Concepts
▪ ‘……Unspecified’ implying the source documentation used for classifying did not provide
more detail beyond the term. Unable to further classify the disease. E.g. Syphilis, Unspecified.
▪ ‘Other specified….’ implying the source document /clinician able to specify the diagnosis but
not included in the list.
▪ If no diagnosis was made, the main symptom, abnormal finding or problem should be
selected as the main condition.
▪ Underlying cause of death: is the disease which has initiated the series of illnesses leading
directly to death, or the circumstances connected with an accident or an act of violence
which caused the injury or poisoning leading to death.
196
ESV-ICD 11 Rules…
▪ The concept of the ‘Underlying Cause of Death’ (UCOD) is central to mortality
recording and reporting.
▪ immediate cause of death: It refers to the disease, failure of injury whose symptoms
cause the person to die.
▪ Intermediate cause of death: refers to the condition which leads from the underlying
cause of death to the immediate cause of death.
197
ESV-ICD 11 Rules…
Episode of illness as New
When an individual visits a health facility for an illness due to new exposure, the
episode of illness can be labeled as ‘New’ case.
Episode of illness as Repeat
The individual can also visit a health facility for illness of the same exposure some time
earlier for follow up or recurrence of the disease as recurrent or old cases.
198
ESV-ICD 11 Rules…
General Rules
Rule 1:
• A disease or a condition recorded as cause of morbidity or mortality on the patient
chart at the final stage of the episode of care by the treating clinician shall be
considered as the main diagnosis of the patient.
Rule 2:
A disease or a condition shall be labeled as either “New” or “Repeat” episode of illness by
the treating clinician
Rule 3:
• Name and code of a specific diagnosis or condition shall be written on the abstract
register (all service units where diagnosis is made) at the end of the episode of care.
199
ESV-ICD 11 Rules…
Rule 4:
• Only a single condition or diagnosis shall be recorded and reported as cause of
morbidity or mortality on the abstract register for an individual diagnosed to have one
or more diagnoses or conditions at the end of the episode of care.
Rule 5:
The name of a disease or a condition shall not be written in abbreviations form on the
abstract register. ]
Rule 6:
• Treating clinician shall put the main diagnosis with clear handwriting and in expanded
form on the patient chart to avoid errors of interpretation during mapping onto ESV-
ICD 11 and recording on IPD/OPD registers.
200
ESV-ICD 11 Rules…
Rule 7:
• Only ESV-ICD 11 diagnosis or condition is allowed to be written on the abstract register
as the cause of morbidity or mortality by the treating clinician or the Nurse Assistant
with transcription/mapping role.
Rule 8:
• If the main diagnosis or condition to be mapped onto ESV-ICD 11 can’t be found in the
list, search for its parent category in the hierarchy to write its name and code on the
register. If you can’t get the immediate parent category, consider the next higher level
category.
Rule 9:
• During a diagnosis or a condition mapping, if you can’t get it in the edition
recommended to the level of the health facility you are working for, use editions meant
to higher level before you look for the parent category.
201
ESV-ICD 11 Rules…
Rule 10:
• The ICD has historically used body systems as an organizing principle. Traditional
divisions of body systems facilitate the creation of meaningful subsets for coding and
analysis. If you can’t get the corresponding diagnosis or condition in the chapter
categorized based on anatomic site, try to search it in the relevant special group
chapters before you opt to the parent category. e.g Polycythaemia
Rule 11:
• Working diagnosis or condition we want to rule out or under question mark shouldn't be
recorded or reported as a cause of morbidity or immortality if the treating clinician
couldn’t reach a definitive diagnosis at the end of the episode of care. Rather record and
report the Clinical finding or Investigation result for which you have been treating the
patient as the main diagnosis or condition. 202
ESV-ICD 11 Rules…
Rule 12:
• ESV-ICD 11 contains some services for which clients can visit a health facility other than
for diseases or injuries. During analysis of morbidity and mortality data, such as
producing top causes of morbidity or mortality, one should exclude service data from the
list before analysis.
Morbidity Specific Rules

Rule 1:
Only the treating clinician can determine the ‘main condition’ or ‘primary diagnoses of the
episode of care on the patients’ card to be transcribed .
203
ESV-ICD 11 Rules…
Rule 2:
If there are more than one main diagnoses or conditions identified at the end of the episode
of care, the one that takes the facility’s resources more will be recorded and reported as ‘main
diagnosis’. To determine the resource consumed during the care of the patient the clinician
can consider the severity of the illness.
Rule 3:
The type of episode of an illness as ‘New’ or ‘Repeat’ can only be determined by the
treating clinician’, and expected to mark the main diagnosis or the condition as ‘New’ or
‘Repeat’ on the patient chart.
NB: When a patient with chronic illness such as Diabetes Mellitus visits a health facility for a new
complication, a treating clinician can mark and report the new condition as ‘main diagnosis’ and ‘New’
episode of illness. E.G: A known Diabetic Type 1 case with acute complication of Diabetic Ketoacidosis
(DKA), the case can be reported as New case of DKA rather than Diabetic Mellitus Type 1 repeat case.
204
ESV-ICD 11 Rules…
Rule 4:
For an admitted or a referred case, the patient’s main condition shall not be written on
the outpatient abstract register. Instead, the ‘Admitted’ or ‘Referred” will be filled as
status (according to HMIS recording and reporting standards). However, the diagnosis of
cases who are referred to other facilities shall be written on the Liaison Referral In and
Out Register.
205
ESV-ICD 11 Rules…
Mortality Specific Rules
Rule 1:
• The clinician who is well informed about the medical history of the patient and who has
carefully carried out the examination of the deceased shall write the causes of death
(immediate, intermediate and underlying cause of death) on the medical certificate
(Death notification form) and the underlying causes of death on the discharge diagnosis
column of the IPD abstract register.
Rule 2:
• The treating clinician must indicate or mark the ‘underlying’ cause of death so that it
will be recorded on the IPD register under the column labeled as ‘Discharge Diagnosis’.
206
ESV-ICD 11 Rules…
Mortality Specific Rules
Rule 3:
• In case of death due to injury or poisoning, the external cause of the injury such as
‘road traffic accident with dimension ’ should be reported as the underlying cause of
death. However, if the treatment outcome is not death, the actual body damage or
injury shall be reported as cause of morbidity.
Rule 4:
• The mode of death such as cardiac arrest or respiratory failure should not be
reported as immediate cause of death.
N.B When filling the Death notification form all the three causes of death (immediate,
intermediate and underlying causes of death should be recorded)
207
Tools & Workflow …
Tools ( Patient charts, Registers, Tally Sheet)
o Registers,
o Tally sheet- Age group, Sex and Outcome (Morbidity and mortality)
o ESV- ICD 11 implementation Guide
o ESV –ICD 11 SOP & Job Aid
o Death Certificate
208
Tools & Workflow …
Malpractices of disease recording & reporting
▪ Using a smaller list for certain service unit

▪ Recording ‘abbreviation’
▪ Unmarking the main diagnosis
▪ Unable to identify the main diagnosis as new or repeat
▪ Writing the clinician’s textbook diagnosis on the register (no transcription)
▪ No communication and feedback among participating actors (Clinicians, HIT and
Nurse Assistants)
Procedure of morbidity/injury recording and reporting
1. Recording
•Done by a clinician on the patient card/form

o Write a chief complaint and detailed clinical notes
o Free/open diagnosis: As many diagnosis as possible based on terminologies from

medical/health science education , clinical experience or common medical science
sources for the purpose of managing the patient
210
•‘Main Diagnosis”: Based on ESV-ICD 11 naming/coding convention for reporting to the next to next
level.
o Use CAPITAL LETTER/UPPER Case to highlight/single out the ‘main diagnoses in the patient
form/card.
o A disease or a condition recorded as a cause of morbidity on the patient’s chart at the final stage
of the episode of care by the treating clinician; no working diagnosis should be put as a ‘main
diagnosis’.
o Single condition reporting: Only a single condition or diagnosis and its code are recorded as the
cause of morbidity ( main diagnosis) at the end of the episode of healthcare
o New versus Repeat: In addition, the ‘main diagnosis’ has to be labeled ‘new’ and ‘repeat’ after a
full stop of the main diagnosis ’ based on the definition in the ‘ESV-ICD implementation guideline’
211
2. Transcription to registers
● Once all the above basic recordings are made by clinicians and only by clinicians on
the patient form/card, the next step is to transcribe into the registers stated above
depending on the units the patient is diagnosed and treated.
● Transcription should by word for word/verbatim
● Transcribe ‘New’ and ‘Repeat ” status on ‘New’ and ‘Repeat’ or ‘Remark’
columns of the corresponding registers
● The transcription is done by the below cadres depending on circumstances.
○ Nurse assistant: Tertiary and general hospitals ,as well as and also primary
hospitals and health centers, depending on availability.
○ Clinicians: Mostly at primary hospitals and health centers in situations
where nurse assistants are not available.
212
3. Summering the data into tally sheet
● Once the ‘Main diagnosis (New/repeat) is transcribed into the different registers, the
next step is to tally into the ‘ESV-ICD 11 tally sheets’.
● Tally only ‘New episodes’ from the registers to the tally sheet
● Again, this can be done optionally depending on circumstances by the below
professionals.
○ Nurse assistant: Tertiary and general hospitals as well as and also primary hospitals and health
centers, depending on availability.
○ OPD/IPD coordinators: Tertiary and general hospitals as well as and also primary hospitals and health
centers, depending on availability.
○ Clinicians: Mostly at primary hospitals and health centers in situations where nurse assistants or
OPD/IPD coordinators are not available 213
4. Entry into DHIS2/eCHIS

● In general, this is expected to be done by HITs unless absence/shortage
prompts other options.
● Entry into eCHIS can be done by Health extension workers upon design in the
future
214
Procedure of mortality recording and reporting
1. Recording
● Done by a clinician on the patient card/form
○ Write a chief complaint and detailed clinical notes
○ Free/open diagnosis: As many diagnosis as possible based on terminologies from
medical/health science education , clinical experience or common medical science sources
for the purpose of managing the patient
○ Cause of death: In the event of a death, the health care provider who attends the death is
expected to document/ record cause of death in three levels based on the definition in the
ESV-ICD 11 implementation guide: Immediate/direct; Intermediate and Underlying
○ A disease or a condition recorded as a cause of mortality on the patient’s chart at the final
stage of the episode of care by the treating clinician; no working diagnosis should be put as a
‘main diagnosis’.
○ All the three levels have to be copied to the ‘death notification form’ and for
communication to the nearby civil status or vital registration office as part of the
implementation of Civil Registration and Vital Statistics (CRVS)
215
1. Recording
•Health facility death is mostly expected from IPD, emergency and Intensive Care Units
•Patients who died at arrival before admission/at emergency should not be counted as
deaths from OPD, emergency, IPD, ICU and NICU
•Such deaths should be recorded as ‘Death on Arrival’ in health facilities which use patient
form/card and in pastoralist health post under the ‘remark ‘ section of ‘curative care
register
•’Death on arrival’ cases should generally follow Verbal autopsy procedures depending the
type/level of health facilities
● As a guideline which is expected to define who should do a verbal autposy is
underway, in general it can potentially be done the health facility at which death
on arrival happense, by the next /upper level health facilities or the respective
Immigration, Nationality Vital Events Agency offices
216
2. Transcription to registers
● Once all the above basic recordings are made by clinicians and only by clinicians
on the patient form/card, the next step is to transcribe into the registers stated
above depending on the units the patient is diagnosed and treated.
● Transcription should by word for word/verbatim
● For HMIS/DHIS2 reporting purposes, it is the ‘underlying cause of death’ that has
to be transcribed to registers, tally sheets and eventually to DHIS2.
● Deaths on arrival should not be transcribed to registers
● The transcription is done by the below cadres depending on circumstances.
○ Nurse assistant: Tertiary and general hospitals ,as well as and also primary
○ Clinicians: Mostly at primary hospitals and health centers in situations where
nurse assistants are not available.
217
3. Summering the data into tally sheet
● Once the ‘underlying cause of death’ is transcribed into the different registers, the
next step is to tally into the ‘ESV-ICD 11 tally sheets’.
● Again, this can be done optionally depending on circumstances by the below
professionals.
● Nurse assistant: Tertiary and general hospitals as well as and also primary
● OPD/IPD coordinators: Tertiary and general hospitals as well as and also primary
● Clinicians: Mostly at primary hospitals and health centers in situations where
nurse assistants or OPD/IPD coordinators are not available
218
4. Entry into DHIS2/eCHIS
• Only ‘underlying cause of death entered into DHIS2/eCHIS

• In general, this is expected to be done by HITs unless absence/shortage prompts
other options.
• Entry into eCHIS can be done by comprehensive health posts upon implementation
the Health extension roadmap and design of ESV-ICD 11 in eCHIS in the future
219
Workflow & Tools…
Death Certificate
220
Roles and Responsibilities
Actors : Clinicians
• Make a diagnosis
• Write patient diagnosis/diagnoses on patient’s chart with legible handwriting and
avoiding use of abbreviations.
• Mark the patient’s ‘Main diagnosis’
• Support and guide a Nurse Assistant in case the following situations occur:
• illegible handwriting
• Unindicated Main diagnosis
• Main diagnosis not marked as New (N) or Repeat(R)
• Main Diagnosis written in abbreviated form (by mistake)
• At time of difficulties to map the main diagnosis on the ESV-ICD 11
• Support HIT or HMIS focal person in analysis and interpretation of disease data as
cause of morbidity and mortality.
221
Roles and Responsibilities…
Actor: Nurse Assistant
▪ Map transcribe the main diagnosis on register accurately.
▪ Communicate with the clinician if there is any issue/concern.
▪ Communicate with the head nurse /supervisor if the clinician is not following rules.
▪ Cross-check daily card numbers with total number of registrations in order to

minimize unregistered patient files.
▪ Make sure that all patient cards are registered unless waiting for definitive diagnosis.
222
Actor: HIT
▪ Verification of collected tally sheet before data encoding
▪ Data entry to DHIS2
▪ Produce monthly and ad hoc disease reports and share with all stakeholders
▪ Provide tally sheets regularly per HMIS standard
▪ Frequent communication with department heads if any discrepancy or concern
▪ Provide short term disease recording & reporting on job trainings for nurse heads,
nurses & clinicians
223
Actor: Admin Level
▪ Organize trainings & experience sharing platforms
▪ Cascade training, guides or any developments that originate from the federal level.
▪ Secure partners that can support the implementation
▪ Ensure ESV-ICD 11 related capacity building within their jurisdiction: Cascading of

training, mentorship and supervision
▪ Coordinate partners for better quality disease data
▪ Ensure adequate availability of ESV-ICD 11 related tools for health facilities within
224
their catchment
Medical Service: Clinical, Quality and Emergency (EICC)
Registers, Tally sheets, data elements and

indicators
MSD: registers(11)
SN Registers
1 Central register 8 AT register
2 OPD register 9 Liaison referral in-out register
3 IPD register
10 Surgical waiting list register
4 ICU register
11 Ambulance service register
5 OR register
6 Surgery ward register
7 Emergency register Black: Maintained
Green: New
Purple: Modified
Summary of tools: tally sheets (6)
SN Tallies
1 Patient/Client Attendance tally sheet
2 ICU tally
3 AT tally
4 Essential drug list tally sheet
5 IPD tally sheets
6 Surgical Waiting Tally sheet
Black: Maintained
Green: New
Purple: Modified
Summary of tools: forms
SN Forms Status
1 Referral slip New
2 Referral feedback New
3 Trauma form New
4 Patient form Maintained
228
Concepts, common features of MS tools
New visit:
• is when a patient or client visits an OPD for a new episode of illness
Repeat visit
• A patient who visits the health facility for the same episode of illness and or for
follow up etc
229
Concepts, common features of MS tools…
• Common data elements from MSD tools
o Identification & address
o Diagnosis based on Ethiopian Simplified Version-ICD 11 (ESV-ICD11)
o Malaria travel history
o PICT service provision
o Length of stay at a health facility
o Screening for TB
o Road traffic accident (RTA)
o Death (before or after 24 hours, notification)
o Finance (Charged, paid, V. number) 230
Central register
• It is a serial register, which captures data on demography, insurance
membership, disability
• Kept in the card room
• Completed by card room workers
S.№ Reportable Data element Disagg. Frequency Level of reporting
1 Number of OPD visits Age, sex
2 Total number of CBHI member visits None Monthly HC, hospital
3 Total number of fee waiver beneficiaries’ None
4 Number of people with disabilities who None
visited health facility
5 Number of health insurance beneficiaries None
that visited HF in the reporting period
231
Show and demonstrate Central register
OPD abstract register
• It lists all patients who received outpatient services at the facility.
• It is used for outpatient patients 5 years & older.
• Under five year children will be recorded in the IMNCI register.
• Data will be abstracted from the patient form
• The patient form and register are both completed by the service provider at the
time of OPD service.
• The register is kept at all out patient department
Show and demonstrate OPD Abstract register
232
Reportable data elements from OPD register
SN Reportable data element Disaggregation Frequen Level of
cy reporting
1 ESV-ICD11 Disease type by age & sex
2 HIV Testing Services age, sex, HIV result, pop.
HP, HC, Clinic Hospital

category
3 Road traffic accidents Category (pedestrian,
Monthly
motorcycle, Veh. occupant
4 Deaths age, sex,
5 Malaria Cases with travel none
history
6 Deaths notified None
233
IPD admission-discharge register
IPD Register
Tally sheets used in IPD;
• It is a case register and is used to abstract
• IPD Service tally sheet completed at the time
data from the inpatient departments
of discharge of admitted patients
• Each row is used for one admitted
• PITC tally:
patient.
• ESV-ICD 11 summary sheet
• The same row is completed by the
** Help to capture morbidity and mortality cases
service provider on admission and upon
at time of admission
discharge.
and discharge.
Show and demonstrate IPD register and Tally 234

SN Reportable data element Disaggregation Frequen Level of
cy reporting
1 ESV-ICD11 Disease, age & sex
2 # of admission None
HC, Clinic, Hosp

3 # of Discharge None
Monthly
4 Length of Stay None
5 Inpatient Death None
6 HIV Testing Services Age ,sex, HIV result,
(HTS) category
7 Deaths notified none
235
ICU register
• A case register covering each row for a single client
• It is used to record information about patients who are treated in the

Intensive Care Unit (ICU).
• The Register should be placed in the intensive care unit room
• It is filled by service providers after service is provided
Show and demonstrate ICU register

236
ICU register: Reportable data elements
SN Reportable Data element Disaggregation Frequency Reporting Talley
of report level Sheet
1 Total Death in ICU Type
2 Total discharge from ICU None
3 Number of deaths with MV, without MV, with

24hrs, beyond 24 hrs
IPD
Monthly Hospital
Tally
4 Deaths notified none
5 VAP cases none
6 Clients with MV None
237
Emergency Register
• A case register that is prepared for use in the emergency department
• lists all clients who arrive with emergency case at facility using each row covers for a
single client
• It is kept in the emergency unit/department
• It filled by service providers immediately after service is provided
• Captures data on mode of arrival, patient handover, source of referral, diagnosis on

arrival, types of accident (if any), HIV testing, diagnosis at disposition from ED,
disposition time, length of stay, and outcome at disposition.
Show and demonstrate Emergency register 238

Emergency register: reportable data elements
S. Reportable Data element Disaggregation Frequency Level of Talley
№ of report reporting Sheet
1 Total death in the emergency Age, Sex
unit <24hrs, >24 hours
2 Number of emergency unit Stayed for <24hrs, >24 hours

attendance
3 Emergency referrals Pre, between facilities Monthly HC, Hospital None
4 No. of deaths notified None
5 Number of road traffic injury Accident type

cases
239
Liaison referral in-and-out register
• It is used to document patients who are referred to or referred in
• The referral out can be to higher health facilities (for better care) or to lower health
facilities for continuity of care.
• The Referral in can be from other health facilities or from the community
• This register is kept at Liaison department for Hospital and Outpatient Department for HC
• The information required to complete this register is found on the clients’ referral paper
Show and demonstrate Referral register

240
Liaison referral in-and-out register: reportable data elements
S.№ Reportable Data Disaggregation Frequency Level of Talley sheet
element of report reporting
1 Number of people Referral Type

referred-in
2 Number of people Referral Type

referred-out
Monthly HC, Hospital None
4 Referral with ambulance none
241
Ambulance service register
• It is used to record information about community ambulance request and service
provided.
• Register is to be placed in ambulance dispatch center (WoHO, Hopital, and in some cases
HC)
S.№ Reportable Data element Disaggregation Frequency of Level of Talley sheet
report reporting
1 Number of calls None

2 Number of ambulance None
dispatches HC, clinic,
Monthly None
Hospital
3 Number of ambulance With EMT, nurse or
dispatches with health health worker, not
worker accompanied
242
Surgical Waiting List Register
• A serial register
• Placed in the liaison office
• Used to capture clients in the waiting list for elective surgical service, which is
meant to quantify the backlog for elective surgical service
• Completed by liaison officer
• Number of clients in the waiting list

• Delay for elective surgical admission (in days)
Show and demonstrate Surgical Waiting List register

243
Surgery register
• The Register is a serial register
• used to record and register data required from the surgical ward which include
information about admission, post operation, PICT, TB Screening, discharge and others

S.№ Reportable Data element Disagg. Frequency Level
1 Number of admissions for surgical services None
2 Number of the pre-operative length of stay Surgery type
HC/Hospital
3 Number of major surgeries by type
Monthly
4 Length of stay for clients admitted for surgical
services in days
5 Surgical ward post-operative deaths None
6 Number of deaths notified
244
Assistive technology service register
• Placed in the rehabilitation centers
• Meant to capture the data on AT service provided
• Mainly purposed to show inclusiveness of the health sector and
estimation of the resource required

• Number of clients received AT services by categories (physical, mobility, hearing, visual,
& others impairments)
Show and demonstrate AT register 245

Operation room register
• The Register is a serial register

• Used to record data from patients who have had an operation (major or minor
surgery) in the facility.
• Number of Cataract surgeries performed (the report is the sum total of cataract
surgeries listed under column 8)
Show and demonstrate OR register
246
MS Indicators
S Clinical Service Indicators
Remarks
N
1 Outpatient Attendance Per-capita Existing
2 Bed occupancy rate Existing
3 Average Length of stay Existing
4 Hospital Bed Density New
5 Assistive Technology service coverage New
6 Essential laboratory test availability New
7 Referral-out Rate Existing
8 Ambulance service utilization for referral service New
9 Ambulance service response rate Existing
10 Facility emergency department mortality rate Existing
Emergency room attendances with length of stay > 24 New
11 247
hours
MS Indicators…
SN Clinical Service Indicators Remarks
12 Percentage of ventilator associated pneumonia New
13 Mortality rate in Intensive Care Unit Existing
14 Perioperative mortality rate New
15 ICU length of stay New
16 Mean duration of in-hospital pre-elective operative stay New
Number of clients in the waiting list for elective surgical New
17
service
18 Delay for elective surgical admission New
19 Inpatient mortality rate Existing
20 Top 10 causes of morbidity Existing
21 Top ten causes of institutional mortality Existing
248
Session Seven: Hygiene and environmental Health
1hrs and HEP/PHCU
Hygiene and Sanitation
HEP
PHCU
Hygiene & environmental Health …
Some facts:
 There are 10 indicators under this section
 There are no registers at HC and Hospital levels.
 Requires revision during CHIS
Assumption:
 HEWs visits every household in their kebele in each quarter
250
Operational definitions:
 *Liquid wastes at household level: Seepage pit, septic tanks, connected to sewer
lines & latrines.
 *Safe solid waste disposal at HH level includes burial, composting, providing

household wastes to authorized collectors, disposing in municipal containers by
households
 *Healthy Housing: it should fulfill at least Separate kitchen, Smokeless stove and
separate animal house.
251
• *Hand washing facility: may be fixed or mobile, and include sinks with tap water,
buckets with taps, tippy-taps, and jugs or basins designated for hand washing.
o Soap includes bar soap, liquid soap, powder detergent, and soapy water but does
not include ash, soil, sand or other traditional hand washing agents.
o Basic hand washing service: availability of a hand washing facility on premises with soap
and water.
o Limited hand washing service: availability of hand washing facility on premises but
without soap or water.
252
 Sanitation facilities:
A. *Basic sanitation Facilities: Use of improved sanitation facilities that are not shared with
other households.
B. *Limited sanitation Facilities: Use of improved sanitation facilities shared between two or
more households.
Improved sanitation facilities are Sanitation facilities that are designed to hygienically
separate human excreta from human contact. These include:
- Wet sanitation technologies such as flush and pour flush toilets connected to sewers,
septic tanks or pit latrines,
- Dry sanitation technologies such as dry pit latrines with slabs and composting
toilets.
C. *Unimproved sanitation Facilities: Do not hygienically separate human excreta from human
contact. (Dry pit latrines without slabs, hanging latrines, bucket latrines, and flush and pour
flush toilets discharging to an open drain.) 253
Operational definitions…
Health facility with water service
 Basic water service: The water source is within the premises of the health facility.
 Limited water services: The water source is outside of the health facility but within
500meters
o Water Source: Piped water, boreholes or tube wells, protected dug wells,
protected springs, rainwater, and packaged or delivered water
 No water services: Water is taken from unprotected dug wells or springs, or

surface water sources; or an improved source that is more than 500 meters from
the premises; or there is no water source.
254
Health facility with sanitation facilities
• Basic sanitation service: (flush and pour flush toilets connecting to sewers, septic tanks
or pit latrines, dry pit latrines with slabs, and composting toilets) designed to hygienically
separate human excreta from human contact, with at least one toilet dedicated for staff,
at least one sex-separated toilet with menstrual hygiene facilities, and at least one toilet
accessible for people with limited mobility.
• Limited sanitation services: At least one (wet sanitation technologies – such as flush and
pour flush toilets connecting to sewers, septic tanks or pit latrines – and dry sanitation
technologies – such as dry pit latrines with slabs, and composting toilets) is available, but
not all requirements for basic service are met.
• No sanitation services: Toilet facilities are unimproved (e.g. pit latrines without a slab or
platform, hanging latrines, bucket latrines) or there are no toilets.
255
Health facilities with healthcare waste management services
 Basic waste management service: Waste is safely segregated into at least three
categories: bins, sharps and infectious wastes, and are treated and disposed safely.
 Limited waste management services: There is limited separation and/or treatment

and disposal of sharps and infectious waste, but not all requirements for basic service
are met.
 No waste management services: There are no separate bins for sharps or infectious
waste, and sharps and/or infectious waste are not treated/disposed of safely.
256
Hygiene & environmental Health … Data Elements
Frequency
Sr Level of
Data element Disaggregation of the
# report report
Number of Households with Liquid waste
1 management area None
Number of Households with safe Solid waste

2 None
management
Health Post
Basic, Limited,
Quarterly
3 Number of households with sanitation facilities unimproved
Number of households having hand washing

4 facilities at the premises Basic, Limited
Number of households with healthy housing Separate kitchen,
Smokeless stove,
5 separate animal
house
257
Frequency of Level of
Sr # Data element Disaggregation
the report report
6 Number of kebeles that have been declared open

defecation free
New, Existing. Drop Quarterly PHCU
Number of health facilities with healthcare waste

7 None
HP, HC, Hosp

management services
Quarterly
8 Number of health facility with water service Basic, Limited,
None
Basic, Limited,
9 Number of health facility with sanitation facilities
None
10 Number of water schemes for which water quality test Microbiological test
conducted result (P/N)
Quarterly
Woreda Health Offices with functional Water quality
WoHO
11 test kits (Enter 1 if yes ,otherwise enter,0) None
12 Number of functional sanitation marketing centers None
258
Hygiene & environmental H Indicators and tools
Hygiene & environmental has (10 indicators)
S.No Indicators Remarks
1 Proportion of HHs with liquid waste management New
2 Proportion of HHs with safe solid waste management New
3 Proportion of kebeles declared ODF Existing
4 Proportion of HHs having sanitation facilities Modified
5 Proportion of HHs having hand washing facilities at the premises New
6 Proportion of HHs with healthy housing New
7 Proportion of water schemes for which water quality test conducted New
8 Proportion of HFs with water service New
9 Proportion of HFs with sanitation facilities New
10 Proportion of HFs with healthcare waste management services New
259
Health extension and primary Health care
HEP and PHC
Some facts:
 There are 4 indicators under this section
 There is no register
 Only three data elements: Most of the indicators are computed from
a standardized assessment checklist.
261
HEP and PHC …
Operational definition
1. Model Households
*Households that put at least 75% of the HEP packages into practice are considered as Model.
*Currently Model Households = (Previously model and sustained + New models).
2. High performing PHCUs

Number of high performing PHCUs/ Total number of PHCUs
*A PHCU will be considered as high performing if it scored an average weight of more >85%.
- Model kebeles (>80%): …………………………………………… 30%
- Health care financing
- EHCRIG (81 items Yes/No) ((>80%): : ……………………………… 35% - Information use score
- Motivated, competent and
- KPI:18 indicators (All weighted – out of 100) (>85%): ……………… 35%
motivated
- Leadership/governance
262
HEP and PHC …
3. Proportion of health posts providing comprehensive health services
Number of health posts providing comprehensive health services/ Total Number of health
posts
*During HSTP-II: 10% of current health posts are expected to be changed to comprehensive
health post.
• The HEP optimization roadmap categorizes health posts in to three, namely: comprehensive
health post, basic health post and integrated health post based on different criteria.
4. Model Kebele
Number of graduated Model Kebeles/ Total number of kebeles
*Model kebele= 85% or above out of 100%
- Proportion of model households (25%) .
- Proportion of SBA (25%)
- Proportion of HHs with Improved latrine access (25%)
- Model school status (25%)
263
HEP and PHC …
HEP and Primary health care has (4 indicators)
S.N Indicators Remarks
1 Model Households Existing
2 Proportion of high performing PHCUs New
3 Proportion of health posts providing comprehensive health services New
4 Model Kebele Existing
264
Session Eight: Health System Inputs
1 Hr
Health System tools and indicators
 Health system strengthening operationally encompasses
Category # of indicators
Improve access to pharmaceuticals & medical devices & their rational & proper use 7
Improve regulatory systems 2
Improve human resource development and management 3
Enhance informed decision making and innovations 6
Improve health financing 4
Strengthen governance and leadership 4
Improve health infrastructure 2
Total 27
 There are 2 registers and one tally sheet (Drug Dispensing & Gender Based Violence
Register)
 One Log book
266
Pharmaceuticals and medical devices
Sr Level of
Data element Disaggregation Frequency
# report
1 Number of line items delivered in full

By category (Program HC,
and RDF) and Supplier Quarterly
(PFSA and Other) Hospital
2 Total line items requested during the reporting period
None HP,
3 Available tracer drugs
Monthly HC,
Hospital
4 Total Tracer drugs
None
5 Number of encounter with one or more antibiotics
6 Total number of encounters HC,

Monthly Hospital
None
7 Number of clients who received 100% of prescribed drugs
8 Total number of clients who received prescriptions

267
Pharmaceuticals and medical devices
Sr Disaggregati Frequency of Level of
Data element
# on the report report
None
9 Total number of medicines prescribed from Health facility medicine list
HC,
Monthly
Hospital
10 Total number of medicine prescribed
11 Unusable stock of products during a quarter in terms of monetary value

By category
HC,
(Program and Quarterly
Hospital
Beginning stock plus quantity received of products during the quarter in RDF)
12 terms of monetary value during the reporting period
None
13 Number of functional medical equipment in the health facility
HP, HC,
Annually Hospital
Total number of available medical equipment (From the facility's updated
14 medical equipment inventory list)
268
Pharmaceuticals and medical devices …
1. Supplier fill rate:
Number of line item delivered at least 80% of the requested amount/ Total number of line item
requested
*This indicator measures supplier’s ability to fill orders completely in terms of items and quantity
during a definite period of time.
2. Essential Drugs Availability:

Σ (tracer drugs x months available)/ Σ tracer drugs x Σ total number of months in time period
*Any month in which a drug unavailability is experienced, even for only 1 day, is reported as a month in
which the drug was unavailable when needed
*There are few changes to the drug list from the previous
269
Tally sheet:
- Has to be filled daily
- 1 if available and 0 if
not available
270
3. Percentage of encounters with an antibiotic prescribed:
Total number of encounter with one or more antibiotics/Total number of encounter
*Encounter refers to every patient’s or client’s visit to the health facility. Whether a patient is given one
or more prescription papers per visit, all is considered as one encounter.
4. Percentage of client with 100% prescribed drug filled:

Total number of client who received all prescribed drug /Total number of client who received
prescription
*It is expected that all clients should get all the prescribed drugs (100%) from the health facility
dispensary.
5. Percentage of medicines prescribed from the facility’s medicines list:

Total number of medicines prescribed from Health facility medicine list /Total number of medicine
prescribed
271
 Serial Register
 Kept at Pharmacy
 Column 1-6: demographic
characteristics of the patient
 The following reportable data
elements from this register:
1. Column 4: Total number of encounter and total
number of clients with prescription
2. Column 9: Total number of medicines
prescribed
3. Column 10: Total number of medicines
prescribed from Health facility medicine list
4. Column 11: Total number of client who received
all prescribed drug
5. Column 12: Total number of encounter with one
or more antibiotics
272
6. Pharmaceuticals wastage rate:
Unusable stock of products during a period in monetary value/ Beginning stock+
received stock during the same period in monetary value
*Existing indicator with no change

7. Functionality of medical equipment:
Number of functional medical equipment in the health facility / Total number of
available medical equipment in the health facility from updated medical equipment
inventory list
*Functional medical equipment are instruments which are giving the expected
services.
*Health facility should update the inventory of medical equipment annually.
*Medical equipment refers to a capital medical device
273
Improve access to pharmaceuticals and medical devices and their rational
and proper use (7 indicators)
1 Supplier fill rate Existing

2 Essential Drugs Availability Existing
3 Percentage of encounters with an antibiotic prescribed Existing
4 Percentage of client with 100% prescribed drug filled Existing
5 Percentage of medicines prescribed from the facility’s New

medicines list
6 Pharmaceuticals wastage rate New
7 Functionality of medical equipment New
274
Regulatory System & HRH
Level of
Sr # Data element Disaggregation report Frequency
1 Number of health facilities that met Ethiopian health facility Private, Public
requirements
WoHO
Number of food and drinking service establishments that met
2
Ethiopian hygiene and environmental health requirements None
3 All food and drinking service establishments
4 Health professionals at the beginning of the year SEX: HP,
TYPE: Physicians, HC, HOSP
5 Health professionals at the end of the year Nurses, Midwives, ANNUAL
6 Health professionals leaving during the year ESOs, LEVEL IV
HEWs
7 Health professionals facility standard
8 Health professionals with an active License
HP,
9 Is the health facility staffed as per the standard? HC, HOSP
275
Regulatory systems
1. Proportion of health facilities that met Ethiopian health facility requirements
Number of health facilities that met Ethiopian health facility requirements at least 75% (Green
Level) / Total number of health facilities
2. Proportion of food and drinking service establishments that met Ethiopian hygiene
and environmental health requirements
Number of food and drinking service establishments that met Ethiopian hygiene and environmental
health requirements / All food and drinking service establishments
276
Human resource development & management
1. Health care worker to Population ration by Category
1: [Total Population / Total number of health care workers at the end of the year (by category)]
*Disaggregation: Physician (Specialist, sub-specialists and all types of Doctors), Health officers, all types of
nurses, Midwives, ESO and Level IV health extension worker) and by sex
2. Proportion health Facility staffed as per the standard

Number of health facilities meeting staffing standard for particular category / Total number of health
facilities
*It is based on the Ethiopian facility staffing standard.
3. Percentage of health professionals with an active professional license

Number of health professionals that have active/renewed professional license in each professional category
/ Total number of health professionals in each category (at the end of the year)
*An active license is defined as a professional license within the range of the allowed period/time of
practice (i.e not expired). 277
Regulatory System & HRH
Regulatory system (2) and Human Resource for Health (3 indicators)
S.N Indicators
Regulatory system
1 Proportion of health facilities that met Ethiopian health facility requirements
2 Proportion of food and drinking service establishments that met Ethiopian hygiene
and environmental health requirements
Human Resource for Health
1 Health care worker to Population ration by Category
2 Proportion health Facility staffed as per the standard
3 Percentage of health professionals with an active professional license
278
Evidence Informed Decision Making
Frequency
Sr Level of
# Data element Disaggregation of the
report
report
1 Does the facility/woreda conduct HIS asseement NONE
2 HIS resources and score

HP/HC/
HOSP/
3 Data quality score ANNUALLY
NONE WoHO
4 Data use score
5 Total HIS score

6 Has the health facility conducted LQAS for the month?
Service reports
7 LQAS score IPD
OPD HP/HC/
Monthly
HOSP
8 Number of Births notified
9 Number of Deaths notified

279
Enhance informed decision making
1. Reporting Completeness
Total number of reports received during a given time period / The number of reports expected
*Measures representative completeness. At all levels calculating content completeness should be done
2. Reporting Timeliness
Number of reports received according to schedule/ The number of reports expected
*For both indicators: Disaggregation by report type is necessary
3. Proportion of health facilities that conduct reporting consistency check using LQAS
Number of health facilities that conducted LQAS / Total number of health facilities
*Ask participants to explain how LQAS is done
280
Enhance informed decision making
4. Proportion of live births notified by the health facility
Total number of births notified / Expected live births in that specific period
5. Proportion of deaths notified by the health facility

Total number of deaths notified / Expected number of deaths in that specific period
*The health sector is mandated to notify births and deaths that happen in the facility and in the
community
6. Information use score

(Data use score*100%)/40%*Further analysis by first LQAS score can also be done
*This is the average score of information use as measured by the information use parameters of the IR
model woredas assessment measurement tool.
281
Explain the PMT logbook at a glance
282
Evidence Informed Decision Making
Evidence Informed Decision Making (6 indicators)
1 Reporting Completeness Existing
2 Reporting Timeliness Existing
3 Proportion of health facilities that conduct reporting consistency check Existing
using LQAS
4 Proportion of live births notified by the health facility New
5 Proportion of deaths notified by the health facility New
6 Information use scores New
283
Health care financing
Sr #Data element Disaggregation Frequency Level of
report
Total amount of fees reimbursed (public facilities only, in Fee waved
1
birr) Exempted fee Quarter HC/HOSP
Insurance
2 Total amount of fees requested (public facilities only, in 3rd party
birr)
3 Member enrolled to CBHI Indigent, Paying Quarter WoHO
GOV treasury, AID
Total health budget allocated to the woreda health office, Appropriated Internal
4 zone health department, region health bureau in the fiscal revenue
year All levels
GOV treasury Annual
5 Total health budget utilized in the fiscal year Internal revenue, AID
6 Internal revenue collected

Fee waived:
Insurance: Exempted HC/HOSP
7 Number of beneficiaries health services: 3rd party Quarter
payment: 284
1. Proportion of government health budget allocated to the health sector in the fiscal year
Total government budget allocated to health / Total Government budget
This indicator shows the relative share of health sector budget to the total budget. It
illustrates the commitment of the government to the health sector.
Moreover, the data from this indicator can be analyzed to see the share of health sector
budget as a proportion of total government budget disaggregated by Domestic sources
(Government treasury, internal revenue) and external sources (AID) in the fiscal year.
Note: Internal revenue is the total amount of resource mobilized locally at health facility
from clinical and non-clinical services and appropriated by respective legal framework).
285
2. Health budget Utilization
Total Health budget Utilized / Total health budget allocated (appropriated)
3. Proportion of reimbursed amount from the total spent

Total reimbursed amount of money to health facilities/ Total amount of money spent
Disaggregation:
o Fee waived beneficiaries:
o Insurance beneficiaries:
o Exempted health services:
o 3rd party payment:
4. Membership Enrollment Rate for CBHI

Number of HHs enrolled in CBHI woreda / Total number of eligible households for CBHI
membership in the woreda
286
Health Care Financing
Health Care Financing

1 Proportion of health budget allocated to the health sector in the fiscal years Existing
2 Health budget Utilization Existing

3 Proportion of reimbursed amount from the total spent Existing

4 Membership Enrollment Rate for CBHI Existing

287
Leadership and Governance
Sr # Data element Disaggregation Frequen Level of
cy report
1 Average Community Scorecard
2 Caring, respectful compassionate service (100%)
3 Waiting time for service (100%) Quarterl HC
Availability of drugs, diagnostic services and supplies y
4 (100%)
NONE
5 Infrastructure of facility (100%)
6 Availability and management of ambulances (100%)
7 Cleanness and safety of facilities (100%) Bi-
Annual Hosp
8 Average Good governance score
Type: Sexual, Physical,
9 Number of Gender based violence (GBV) survivors who Psychological & mixed; Monthly
received health care services HC,
Sex: M/ F Hosp
Number of leadership positions held by women at None Annual HC,
10 health facility level Hosp
11 Total number of leadership positions in health facilities
288
1. Proportion of Primary health Care facilities implementing Community Scorecard (CSC)
Number of Primary health Care facilities with a community Score Card (CSC) of >=80%/ Total number of
primary health care facilities
Note: Primary health care facilities that did not report their community score card score or that did not
conduct the assessment will be considered as having a CSC value of less than 80%.
2. Proportion of hospitals with Good Governance Index (GGI) of >=80%
Number of hospitals with a Good Governance Index (GGI) of >=80%/ Total number of hospitals
289
Leadership and Governance …
1 Proportion of Primary health Care facilities implementing Community New

Scorecard (CSC)
2 Proportion of hospitals with Good Governance Index (GGI) of >=80% New

3 Proportion of leadership positions in health facilities that are held by New
females
4 Number of Gender based violence (GBV) survivors (Physical and sexual) New
who received health care services
290
GBV Register
• It is used to record data for GBV survivors
• There is only one reportable data element with its disaggregation:
 Number of GBV survivors (Sexual, Physical, Psychological, Mixed)
Show & demonstrate GBV register
291
3. Proportion of leadership positions in health facilities that are held by females
#of leadership positions held by women at health facility level/ Total #of leadership positions in health
facilities
Note: Leadership position at health facility level is operationally defined as the Head/ Vice head/
Department heads.
4. Number of Gender based violence (GBV) survivors who received health care services
The number of GBV survivors who received health care services
This indicator includes individuals (Both male and female) who survive any form of gender based violence
(sexual, physical, psychological or mixed)
Disaggregation: by Physical, psychological, sexual and mixed and by sex
292
Health Infrastructure
Health Infrastructure (2 indicators)
Health Infrastructure
1 Functional health facility to population ratio Existing
2 Proportion health facilities with functional infrastructure Existing
293
Health infrastructure
1. Functional health facility to population ratio
1: Total Population/ Total number of functional public facilities by type
Disaggregation: Facility Type: health post (Basic and Comprehensive), health center, primary
hospital, general hospital and specialized hospital
2. Proportion health facilities with functional infrastructure
# of health facilities with electricity *100

Total number of health facilities
# of health facilities with full functional Network infrastructure *100

Total number of health facilities
294
Session Nine: Reporting tools and Procedure
1 Hr
Reporting Procedures
1 2 3
Each service delivery Summarized report from Each department
unit is responsible to each service delivery should conduct data
prepare the summary of unit compiled at quality check and
reportable data element department level and review before
from register and or tally submitted to HIT focal submission of the report
sheets person
296
0- 5- > 0- 5-
4 1 = 4 1
y 4 1 y 4
e Y 5 e y
Disease
ar e y ar e
s ar e s ar
s ar s
s
0
1 Priority infectious
0 diseases
0
Epidemic prone diseases
0
1 Malaria (clinical without
0 laboratory confirmation)
1
0
1 Malaria (confirmed with
0 P. falciparum)
2
0
Malaria (confirmed with
1
species other than P.
0
falciparum)
3
297
By Type:
• Service delivery report forms
• Disease (Morbidity & Mortality) report
form
• PHEM reports
Reporting By Health institution:

formats • Health post, Health center ,Hospital ,
clinics and WorHO/ZHD/RHB
By reporting Period:
• Immediate/ Weekly report

• Monthly /Quarterly/annual administrative
report
298
HMIS/M&E Reporting Flow Diagram
International Bodies
Comprehensive FMOH WHO, UN, etc
Specialized Hospital
Council of Ministers
Other Ministries
Specialty Center RHB
Development Partners
General Hospital
Regional Council
ZHD
Primary Hospital
Zonal Administrative
Specialty Clinic Office
Medium clinic
Sub-city/ woreda/ town health Woreda Council
Primary clinic offices
Kebele Council
Health center
Health Post
299
Routine Data Collection (HMIS) FMOH
RHB
Compiled
WorHO/
and
ZHD used
Compiled and
used /
reported
Compiled and
Facility Based Data used /
reported
Community Based Data
Compiled and Service delivery/disease report

used /
reported 300
Environment
The organizational hierarchy defines
the organization using the DHIS2, the
DHIS2 Meta Data health facilities, administrative areas
and other geographical areas used in
data collection and data analysis.
 The organizational hierarchy

It represents the “WHAT”
 Data Elements dimension, it explains what is
being collected or analyzed..
The indicators represent formulas

 Indicators providing coverage rates, incidence rates,
ratios and other formula-based units of
analysis..
 Datasets and data entry forms

All data entry in DHIS2 is organized
through the use of Datasets. A Dataset is
a collection of data elements grouped
together for data collection.
302
New requirement
• Data Entry :- Expiry date

would be set to 3 months • Content • Organization unit
(90 days completeness updates should be
done within MFR
• The data sets are re-
organized based on • The timeliness is set
thematic areas to 11 days • Version upgrade
• e.g MCH, HIV ,TB and expected.
others
303
Data entry
• DHIS2 has three data entry
apps
• Routine Data
• Plan Setting
• Disease Registration
304
The validation rule
analysis tests
validation rules
against the data
registered in the
system.
The follow-up analysis

creates a list of all data The standard deviation outlier
We can create a minimum
values marked for analysis identifies values that
maximum value range, either
follow-up. You can mark are numerically distant from
automatically or manually.
a data value for follow- the rest of the data.
Data Administration app &
up in the Data Entry The analysis is based on the
Data Entry app
app standard normal distribution.
Data Quality
Reporting
Functionality
• Generates dataset reports for multiple
periods/org units
• Has options to filter by other dimensions (Org unit

groups, Category option group sets)
• The disease registration dataset further generates

Top lists, filters by sex/age/disease)
• Integrated completeness/timeliness
• Introduced by Ethiopia DHIS2 team to address the limitations in the legacy Data Set Report module,
307
Analytics Features
 In-built tools within DHIS2
 Pivot Tables
 Charts
 GIS/Maps
 Dashboards & others
 Supplementary tools
 WHO Data Quality App
 Scorecard App
 Bottleneck analysis App
 WHO Meta Data Browser & others
308
Reporting hierarchy of public health facilities
30
9 From Reporting level
Report
arrival date
Frequency of
reporting Comment
HP HC Monthly & Annual
Health 20th of the month Monthly, Quarterly &

WorHOs closing
facility 26th of the month Annual
WorHOs ZHD / RHB 2nd of the month Monthly, Quarterly & Including private health
Annual facilities
Including private health

Monthly, Quarterly & facilities
ZHD RHB 5th of the month Annual
RHB MOH 5 of the month

th Monthly, Quarterly & Including
facilities
private health
Annual
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Revised HMIS Indicators and Tools

• Service year and Experience related with HMIS

o Rationale for HMIS Indicators revision

• HIS and HMIS • Revised Indicators

• Explain health system and its functions

• Describe HIS and its components

• Describe the routine HMIS as part of the bigger HIS

• Understand rationale of HMIS revision

• What is a health system?

• Why health systems matter?

• Three major objectives

o Responding to people’s expectations (Responsiveness)

o Providing financial protection against the costs of ill-health (Risk Protection)

• It refers to a system that captures, stores, manages or transmits information related

Legislative, regulatory, & planning

Population-based Census, civil registration, population based surveillance,

Data sources by level:

2. Using information for management purposes

• Problem identification: identifying problems using key indicators

• Prioritizing problems and decision making : Problems identified should be

• Action taking: Implementing the agreed action.

• Result monitoring: Assessing the desired result has been achieved.

S. No Type of Tools Maintained Modified New Total

Registers: for HCs/Hosp= 42 For Hosp only =13 For HC only= 1

 Understand Individual Medical Records

• Record - property of the Facility. • To communicate between attending

• Data - property of the Client. healthcare providers

NB: No. 1-5 are components

o Full name of the client (in Capital

• Summary Sheet: Summarizes date, identification,

• Patient card is a free form and has three sections:

o Section to write Diagnosis in NCoD (National Classification of Disease)

• It is kept in integrated individual folder

• Kept in integrated individual folder

• Kept in integrated individual folder

Clinical Procedures Used to document different clinical procedures done in different

Follow up cards Used when an individual's health status is documented on a periodic

• Patient with a health record at another health facility

• Find out if a patient holds a Service card or not

• Collect Service cards from those who have it.

Or Has Duplicate Records

• All clients should be registered on central register

• Nurses record all observations, medications administered, treatment and other

How to handle Medico-Legal Requests? 55

• Medical records should be safeguarded against unauthorized use.

1. Direct access to the medical record

2. Supply of an abstract giving details requested

By the end of this session, participants will:

• Describe tally sheet and its purposes

• Every register has columns & rows

• Each row contains information for one patient

• Contains reportable and non-reportable data elements

• Are data sources for computation of HMIS indicators

o Medical Record Number (MRN): Card number

o Name: clients’ full name (except VCT, OPD, IPD, Abortion …)

o Age: age in years/ in months

o Sex: M for Male and F for Female

• In tallying, each stroke represents a single unit to be counted in service;

• Service given should be tallied immediately after the service provided