MCH Service Report

Step 1 — Basic Information

Select the reporting department, month, and year before proceeding.

Department *

Month *

Year *

Step 2 — Family Planning

Contraceptive acceptors by age & method, PPFP, and PRLAFP.

New AcceptorsContraceptive new acceptors — by age

Age Group	Count
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 49 years

Repeat AcceptorsContraceptive repeat acceptors — by age

Age Group	Count
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 49 years

New — by MethodContraceptive new acceptors — by method

Oral contraceptives

Injectables

Implants

IUCD

Vasectomy

Tubal ligation

Others

Repeat — by MethodContraceptive repeat acceptors — by method

Oral contraceptives

Injectables

Implants

IUCD

Vasectomy

Tubal ligation

Others

IPPCARImmediate Postpartum Contraceptive Acceptance Rate

IPPCAR value

PPFP AgeTotal PPFP acceptors — by age

Age Group	Count
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 49 years

PPFP MethodTotal PPFP acceptors — by method

Pills (POP)

Implants

IUCD

Tubal ligation

Others

PRLAFPPremature Removal of Long-term Family Planning Methods

Total number of premature removal of LAFP within 6 months of insertion

Implants — premature removal

IUCD — premature removal

Others — premature removal

Total LAFP removal in the reporting period

Step 3 — ANC Coverage

First contact, four or more contacts, and eight or more contacts — by gestational age and maternal age.

ANC1 — Gestational AgePregnant women that received ANC first contact — by gestational age

Gestational Age	Count
≤ 12 weeks
> 12 and ≤ 16 weeks
> 16 weeks

ANC1 — Maternal AgePregnant women that received ANC first contact — by maternal age

Maternal Age	Count
10 – 14 years
15 – 19 years
≥ 20 years

ANC4+ — Maternal AgePregnant women that received four or more ANC contacts — by maternal age

Maternal Age	Count
10 – 14 years
15 – 19 years
≥ 20 years

ANC4+ — Gestational AgePregnant women that received four or more ANC contacts — by gestational age

Gestational Age	Count
< 30 weeks
≥ 30 weeks

ANC 8+Pregnant women that received eight or more ANC contacts

Number of pregnant women that received ANC 8 contacts and more

Step 4 — Syphilis, Hepatitis B & PMTCT

Syphilis testing & treatment, HBV testing & prophylaxis, and full PMTCT indicators during ANC, Labour & Delivery, and PNC.

SyphilisPregnant women tested for syphilis at ANC

Total Number of pregnant women tested for syphilis

Reactive

Non-Reactive

Total Number of pregnant women treated for syphilis

Hepatitis BPregnant women tested for Hepatitis B at ANC

Total Number of pregnant women tested for Hepatitis B

Reactive

Non-Reactive

Total Number of pregnant women who received prophylaxis for HBV

PMTCT — HIV TestingPregnant and lactating women tested for HIV and know their results

Tested and know result — during Pregnancy

Tested and know result — during Labour & Delivery

Tested and know result — during Postpartum period

Women with known HIV positive status attending ANC, delivery and postpartum (linked from Pre-ART and ART)

Number of new HIV positive women during ANC, L&D and Postpartum

PMTCT — ART for MTCTHIV-positive pregnant women who received ART to reduce MTCT risk

Received ART during ANC — first time

Received ART during L&D — first time

Received ART during PNC — first time (lactating women)

HIV-positive women who get pregnant while on ART and linked to ANC

PMTCT — Infant TestingHIV exposed infants — virological test results within 12 months

Total Number of infants within 12 months who received virological test result

HIV test at 0–2 months of birth:

Positive

Negative

HIV test at 2–12 months of birth:

Positive

Negative

PMTCT — ProphylaxisCo-trimoxazole & ARV prophylaxis for HIV-exposed infants

Infants born to HIV+ women started on co-trimoxazole prophylaxis within 2 months of birth

HIV exposed infants who received ARV prophylaxis for 12 weeks

Number of HIV positive women who gave birth at health institution

PMTCT — Partner TestingPartners of pregnant, laboring and lactating women tested for HIV

Partners tested and know their results

Partners whose test result is HIV positive

PMTCT — 18-Month ConfirmatoryHIV exposed infants receiving HIV confirmatory (antibody) test by 18 months

Number of HIV exposed infants receiving confirmatory test by 18 months

Positive

Negative

Step 5 — EPI / Vaccines & Vaccine Wastage

Immunization coverage for all vaccines, TD vaccination, and wastage rates for 10 vaccine types.

HepB-BDLive births who receive HepB Birth Dose

Within 24 hours after birth

Within 24 to 14 days after birth

Under-1 VaccinesChildren under one year of age — vaccine doses

Vaccine	Count
BCG
Pentavalent — 1st dose
Pentavalent — 3rd dose
Polio — 1st dose
Polio — 3rd dose
Pneumococcal — 1st dose
Pneumococcal — 3rd dose
IPV (Inactivated Polio Vaccine)
Rotavirus — 1st dose
Rotavirus — 2nd dose
Measles — 1st dose (MCV1)

MCV2Measles second dose coverage

Number of children (15–23 months) who received measles second dose vaccine

Full Immunization & PABFully immunized children and PAB coverage

Number of children who received all vaccine doses before 1st birthday

Number of infants whose mothers had protective doses of TD against NNT (PAB)

HPVHuman Papilloma Virus vaccine — 14-year-old girls

HPV 1st dose — girls aged 14 years

HPV 2nd dose — girls aged 14 years (6-month interval from 1st dose)

TD VaccinationWomen who received Tetanus-Diphtheria (TD) vaccination doses

TD Dose	Count
TD1
TD2
TD3
TD4
TD5

Vaccine WastageDoses given / doses opened / doses damaged / doses expired — by vaccine

For each vaccine enter: doses given (all ages), doses opened, doses damaged, and doses expired.

Vaccine	Doses Given	Doses Opened	Doses Damaged	Doses Expired
HepB-Birth Dose
BCG
Pentavalent (DPT-HepB-Hib)
Pneumococcal Conjugate
Rotavirus
Polio
Measles
TD
IPV
HPV

Step 6 — Child Development, Early PNC & PMTCT (PNC)

Developmental milestone assessment, early postnatal care visits, and PMTCT service provision during PNC.

PMTCT ProvisionProvision of PMTCT Service at this facility?

Does this facility provide PMTCT Service?

Child Dev — AssessedChildren aged 0–59 months assessed for developmental milestone

0 – 24 months

24 – 59 months

Child Dev — StatusChildren aged 0–59 months assessed — developmental milestone status

Suspected Developmental Delay

Developmental Delay

No Developmental Delay

Early PNCNumber of postnatal visits within 7 days of delivery — by timing

Total Number of postnatal visits within 7 days of delivery

Timing of PNC Visit	Count
0 – 24 hours
24 hours (1 day)
25 – 48 hours (1 – 2 days)
49 – 72 hours (2 – 3 days)
73 hours – 7 days (4 – 7 days)

PMTCT PNC — HIV TestingPMTCT service during PNC — HIV testing

Pregnant women tested and know HIV result — during Pregnancy

Tested and know HIV result — during Labour & Delivery

Tested and know HIV result — during Postpartum period

Women with known HIV positive status (linked from Pre-ART and ART)

Number of new HIV positive women during ANC, L&D and Postpartum

PMTCT PNC — ART for MTCTHIV-positive pregnant women who received ART — PNC setting

Received ART during ANC — first time

Received ART during L&D — first time

Received ART during PNC — first time (lactating women)

HIV-positive women who get pregnant while on ART and linked to ANC

PMTCT PNC — Infant TestingHIV exposed infants — virological tests (PNC setting)

HIV exposed infants — virologic test (sample) collected at 0–2 months of birth

HIV exposed infants — virologic test (sample) collected at 2–12 months of birth

Total infants within 12 months who received virological test result

Test result at 0–2 months of birth:

Positive

Negative

Test result at 2–12 months of birth:

Positive

Negative

PMTCT PNC — ProphylaxisCo-trimoxazole & ARV prophylaxis — PNC setting

Infants born to HIV+ women started on co-trimoxazole within 2 months of birth

HIV exposed infants who received ARV prophylaxis for 12 weeks

Number of HIV positive women who gave birth at health institution

PMTCT PNC — Partner TestingPartners tested — PNC setting

Partners tested and know their results

Partners whose test result is HIV positive

PMTCT PNC — 18-Month ConfirmatoryHIV exposed infants receiving confirmatory (antibody) test by 18 months — PNC

Number receiving confirmatory test by 18 months

Positive

Negative

Step 7 — Cervical Cancer Screening & Nutrition

Cervical Ca screening (VIA & HPV DNA), treatment, follow-up, IFA supplementation, deworming, malnutrition screening, and adolescent nutrition.

Cervical Ca — ScreeningWomen aged 30–49 years screened for cervical cancer (initial)

Total number of women aged 30–49 years screened for cervical Ca

By screening type — VIA

By screening type — HPV DNA

VIA screening results:

Negative

Positive — eligible for Cryotherapy / thermocoagulation

Positive — not eligible for Cryotherapy / thermocoagulation

Suspicious cancerous lesion

HPV/DNA screening results:

Positive

Negative

Cervical Ca — TreatmentEligible women who received treatment for cervical lesion

Total number of eligible women who received treatment for cervical lesion

Cryotherapy

LEEP

Thermal Abrasion / Thermocoagulation

Cervical Ca — Follow-upWomen screened 1 year after treatment (follow-up)

Total number of women screened 1 year after treatment follow-up

By screening type — VIA

By screening type — HPV DNA

Follow-up VIA screening results:

Negative

Positive — eligible for Cryotherapy / thermocoagulation

Positive — not eligible for Cryotherapy / thermocoagulation

Suspicious cancerous lesion

Follow-up HPV/DNA screening results:

Positive

Negative

Nutrition — IFA & DewormingIron & folic acid supplementation (90+ days) and deworming

Number of pregnant women de-wormed

Total number of pregnant women who received IFA supplements at least 90 days

IFA recipients by maternal age:

10 – 14 years

15 – 19 years

≥ 20 years

PLW MalnutritionPregnant and lactating women (PLW) screened for acute malnutrition

By MUAC status:

Total number of PLW screened for acute malnutrition

MUAC < 23 cm

MUAC ≥ 23 cm

By maternal status:

Pregnant

Lactating

Adolescent Nutrition — NormalAdolescent and youth aged 10–19 screened for nutrition — Normal

Age Group	Male	Female
10 – 14 years
15 – 19 years

Adolescent Nutrition — UnderweightAdolescent and youth aged 10–19 screened — Underweight

Age Group	Male	Female
10 – 14 years
15 – 19 years

Adolescent Nutrition — OverweightAdolescent and youth aged 10–19 screened — Overweight

Age Group	Male	Female
10 – 14 years
15 – 19 years

Step 8 — STI by Syndrome & Pregnancy Testing

STI cases by syndrome type, STI/HIV co-testing, pregnancy test results by age group.

Pregnancy TestingPositive pregnancy test results

Teenage girls aged 10 – 14 years tested positive for pregnancy

Teenage girls aged 15 – 19 years tested positive for pregnancy

Total number of women tested positive for pregnancy

STI — HIV TestingSTI cases tested for HIV

Category	Male	Female
Number of STI cases tested for HIV
Number of STI cases tested positive for HIV

STI — By SyndromeTotal number of STI cases by syndrome

Syndrome	Count
Urethral discharge
Persistent urethral discharge
Scrotal swelling
Vaginal discharge
PID (Pelvic Inflammatory Disease)
Non-vesicular genital ulcer disease (NVGUD)
Vesicular genital ulcer disease (VGUD)
Inguinal bubo
Neonatal conjunctivitis
Neonatal herpes

Adolescent GirlsAdolescent girls aged 14–19 years screened for malnutrition (total)

Total number of adolescent girls aged 14–19 years screened for malnutrition

Step 9 — HIV Testing (PITC)

Clients receiving HIV test results and testing positive at Provider-Initiated Testing and Counselling (PITC) — by age & sex.

PITC — Received ResultClients receiving HIV test results at PITC — by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
50+ years

PITC — Tested PositiveClients testing positive for HIV at PITC — by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
50+ years

PITC — Population GroupsHIV testing service — received result & tested positive by population group (PITC)

Population Group	Received Result	Positive
Female commercial sex workers
Long distance drivers
Mobile / Daily labourers
OVC of PLHIV
Children of PLHIV
Prisoners
Partners of PLHIV
Other MARPs
General population

Step 10 — HIV VCT & HCT by Population Group

Clients receiving results and testing positive at VCT — by age & sex, plus HCT population group breakdown.

VCT — Received ResultClients receiving HIV test results at VCT — by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
50+ years

VCT — Tested PositiveClients testing positive for HIV at VCT — by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
50+ years

HCT — Population Groups (VCT)HIV testing service — received result & tested positive by population group (VCT)

Population Group	Received Result	Positive
Female commercial sex workers
Long distance drivers
Mobile / Daily labourers
OVC of PLHIV
Children of PLHIV
Prisoners
Partners of PLHIV
Other MARPs
General population

Step 11 — Index Testing & HIV Self-Test Kits

Index cases offered, contacts elicited, contacts tested, positive results — by age & sex. Plus HIV self-test kit distribution.

Index Cases OfferedNumber of index cases offered index testing services — by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
≥ 50 years

Contacts ElicitedNumber of contacts elicited — by age & sex

Age Group	Male	Female
< 15 years
≥ 15 years

Contacts TestedNumber of contacts tested — by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
≥ 50 years

New Positive ContactsIndex case contacts — new positive results by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
≥ 50 years

Known Positive ContactsIndex case contacts — known positive results by age & sex

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 9 years
10 – 14 years
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
≥ 50 years

Self-Test Kits — Directly AssistedHIV self-test kits distributed — directly assisted, by age & sex

Age Group	Male	Female
15 – 19 years
20 – 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 – 44 years
45 – 49 years
≥ 50 years

Self-Test Kits — UnassistedHIV self-test kits distributed — unassisted

Male

Female

Step 12 — ART Services

Children and adults currently on ART — by age group, sex, and regimen line. Then submit the full report.

ART FacilityDoes this health facility provide ART Treatment Service?

ART Treatment Service provided

ART ChildrenChildren currently on ART — by age group, sex & regimen line (1st / 2nd / 3rd)

Age / Regimen	Male	Female
< 1 year — 1st line
< 1 year — 2nd line
< 1 year — 3rd line
1 – 4 years — 1st line
1 – 4 years — 2nd line
1 – 4 years — 3rd line
5 – 9 years — 1st line
5 – 9 years — 2nd line
5 – 9 years — 3rd line
10 – 14 years — 1st line
10 – 14 years — 2nd line
10 – 14 years — 3rd line

ART AdultsAdults currently on ART — by age group, sex & regimen line (1st / 2nd / 3rd)

Age / Regimen	Male	Female
15 – 19 years — 1st line
15 – 19 years — 2nd line
15 – 19 years — 3rd line
20 – 24 years — 1st line
20 – 24 years — 2nd line
20 – 24 years — 3rd line
25 – 29 years — 1st line
25 – 29 years — 2nd line
25 – 29 years — 3rd line
30 – 34 years — 1st line
30 – 34 years — 2nd line
30 – 34 years — 3rd line
35 – 39 years — 1st line
35 – 39 years — 2nd line
35 – 39 years — 3rd line
40 – 44 years — 1st line
40 – 44 years — 2nd line
40 – 44 years — 3rd line
45 – 49 years — 1st line
45 – 49 years — 2nd line
45 – 49 years — 3rd line
50+ years — 1st line
50+ years — 2nd line
50+ years — 3rd line

ART — Pregnancy StatusCurrently on ART by pregnancy status

Pregnant

Non-Pregnant

ART Children — Regimen TypesChildren (<15 yrs) currently on ART — by age group & specific regimen code

Enter the number of children on each specific drug regimen.

< 1 year — Regimen Types

1st Line:

4f = AZT + 3TC + LPV/r

4g = ABC + 3TC + LPV/r

4j = ABC + 3TC + DTG

4k = AZT + 3TC + DTG

4h = Other first line

2nd Line:

5e = ABC + 3TC + LPV/r

5f = AZT + 3TC + LPV/r

5m = ABC + 3TC + DTG

5n = AZT + 3TC + DTG

5j = Other Secondline

3rd Line:

6c = DRV/r + DTG + AZT + 3TC

6f = DRV/r + DTG + ABC + 3TC

1 – 4 years — Regimen Types

1st Line:

4f = AZT + 3TC + LPV/r

4g = ABC + 3TC + LPV/r

4j = ABC + 3TC + DTG

4k = AZT + 3TC + DTG

4h = Other first line

2nd Line:

5e = ABC + 3TC + LPV/r

5f = AZT + 3TC + LPV/r

5m = ABC + 3TC + DTG

5n = AZT + 3TC + DTG

5j = Other Secondline

3rd Line:

6c = DRV/r + DTG + AZT + 3TC

6f = DRV/r + DTG + ABC + 3TC

5 – 9 years — Regimen Types

1st Line:

4f = AZT + 3TC + LPV/r

4g = ABC + 3TC + LPV/r

4j = ABC + 3TC + DTG

4k = AZT + 3TC + DTG

4h = Other first line

2nd Line:

5e = ABC + 3TC + LPV/r

5f = AZT + 3TC + LPV/r

5m = ABC + 3TC + DTG

5n = AZT + 3TC + DTG

5j = Other Secondline

3rd Line:

6c = DRV/r + DTG + AZT + 3TC

6f = DRV/r + DTG + ABC + 3TC

10 – 14 years — Regimen Types

1st Line:

4f = AZT + 3TC + LPV/r

4g = ABC + 3TC + LPV/r

4j = ABC + 3TC + DTG

4k = AZT + 3TC + DTG

4h = Other first line

2nd Line:

5e = ABC + 3TC + LPV/r

5f = AZT + 3TC + LPV/r

5m = ABC + 3TC + DTG

5n = AZT + 3TC + DTG

5j = Other Secondline

3rd Line:

6c = DRV/r + DTG + AZT + 3TC

6f = DRV/r + DTG + ABC + 3TC

ART Adults — Regimen TypesAdults (≥15 yrs) currently on ART — by age group & specific regimen code

Adult 1st line uses TDF-based regimens. Enter counts per drug regimen code.

15 – 19 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

20 – 24 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

25 – 29 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

30 – 34 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

35 – 39 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

40 – 44 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

45 – 49 years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line

50+ years — Regimen Types

1st Line:

1a = TDF + 3TC + DTG

1b = TDF + 3TC + EFV

1e = AZT + 3TC + DTG

Other 1st line

2nd Line:

2a = AZT + 3TC + LPV/r

2b = TDF + 3TC + LPV/r

2c = AZT + 3TC + DTG

Other 2nd line

3rd Line:

3a = DRV/r + DTG + AZT + 3TC

Other 3rd line