FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH

ETHIOPIA HEALTH MANAGEMENT

INFORMATION SYSTEM:
DATA RECORDING AND REPORTING
PROCEDURES

POLICY, PLANNING
AND MONITORING PARTICIPANT MANUAL
& EVALUATION
DIRECTORATE

JUNE 2018
 FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
MINISTRY OF HEALTH

ETHIOPIA HEALTH MANAGEMENT

INFORMATION SYSTEM:
DATA RECORDING AND REPORTING
PROCEDURES

PARTICIPANT MANUAL
POLICY, PLANNING AND MONITORING &
EVALUATION DIRECTORATE
 ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
PARTICIPANT MANUAL
DATA RECORDING AND REPORTING PROCEDURES

CONTENTS
Acknowledgments......................................................................................................................................................VI
Acronyms...................................................................................................................................................................VII
List of Tables...............................................................................................................................................................IX
List of Figures..............................................................................................................................................................IX
Module Introduction: HMIS recording, reporting tools & Procedures manual...........................................................1
Section 1: Overview of Health System and Health Information Systems: Basic Concepts........................................4
1.1 Health system and its components.......................................................................................................................................5
1.2 Health Information System (HIS)...........................................................................................................................................7
1.2.1 Components of a Health Information System..............................................................................................................8
1.2.2 Sources of data..................................................................................................................................................................9
1.3 Health Management Information System (HIS)..................................................................................................................9
Section 2: Individual Medical Recording Tools and Procedure.............................................................................................11
2.1 Individual folder.......................................................................................................................................................................12
2.2 Patient form/Patient card......................................................................................................................................................14
2.3 Service Identification (ID) card.............................................................................................................................................15
2.4 Appointment card...................................................................................................................................................................15
2.5 Master Patient Card................................................................................................................................................................16
2.6 Tracer Card...............................................................................................................................................................................16
2.7 Individual medical record issuing and archiving tips......................................................................................................17
2.8 Other individual medical Records.......................................................................................................................................18
Section 3: Registers and Tally Sheets..........................................................................................................................................19
3.1 Maternal and Child Health (MCH) Cards, Registers & Tallies...........................................................................................20
3.1.1 Family Planning Register....................................................................................................................................................21
3.1.1.1 Family Planning Service tally......................................................................................................................................26
3.1.1.2 Family Planning Methods dispensing tally..............................................................................................................26
3.1.2 Long acting Family Planning (LAFP) Removal Register.................................................................................................28
3.1.3 Antenatal Care (ANC) Register...........................................................................................................................................30
3.1.3.1 ANC tally sheet..............................................................................................................................................................36
3.1.3.2 Pregnancy test tally.....................................................................................................................................................36
3.1.4 Delivery Register...................................................................................................................................................................38
3.1.5 Postnatal (PNC) Register.....................................................................................................................................................45
3.1.6 PMTCT Register.....................................................................................................................................................................50
2.1.6.1 PMTCT tally sheet.........................................................................................................................................................53
3.1.7 Comprehensive Abortion Care Register...........................................................................................................................55
2.1.7.1 Abortion Care tally sheet............................................................................................................................................57
2.1.8 Integrated RH Register for primary Private Clinics.........................................................................................................59
3.1.9 PREGNANT AND LACTATING WOMEN (PLW) SCREENING REGISTER...........................................................................60
3.1.10 INFANT IMMUNIZATION AND GROWTH MONITORING REGISTER..............................................................................62
3.1.10.1 Immunization tally.....................................................................................................................................................64
3.1.11 Tetanus Toxoid (TT) Immunization Register..................................................................................................................66
3. 1.12 Human Papilloma Virus (HPV) Immunization Register..............................................................................................68
3.1.13 Neonatal Intensive Care Unit (NICU) Register...............................................................................................................69
3.1.14 Comprehensive and Integrated Nutrition Services (CINuS) Register.......................................................................75
3.1.14.1 Comprehensive & Integrated Nutrition Services (CINuS) Tally Sheet..............................................................77
ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
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3.1.15 Therapeutic Feeding Program (TFP) register................................................................................................................78

3.2 Disease Prevention and Control Registers.........................................................................................................................81
3.2.1 VCT register............................................................................................................................................................................82
2.3.1.1 VCT tally sheet...............................................................................................................................................................84
3.3.1.2 PITC tally sheet.............................................................................................................................................................84
3.2.2 Pre-ART register....................................................................................................................................................................85
3.2.3 ART register...........................................................................................................................................................................86
3.2.3.1 HIV clinical care tally....................................................................................................................................................90
3.2.3.2 Currently on ART and regimen tally sheet................................................................................................................90
3.2.4 Post Exposure prophylaxis (PEP) register.........................................................................................................................92
3.2.5 Tuberculosis Register..........................................................................................................................................................94
3.2.6 Drug Resistant Tuberculosis (DR TB) Register...............................................................................................................105
3.2.7 Leprosy Register.................................................................................................................................................................109
3.2.8 OPD abstract register........................................................................................................................................................111
3.2.8.1 National Classification of Diseases (NCoD)..........................................................................................................114
3.2.8.2 NCoD Summary sheet...............................................................................................................................................118
3.2.8.3 NCoD Disease tally sheet..........................................................................................................................................119
3.2.9 Admission/Discharge (Inpatient) register......................................................................................................................120
3.3.9.1 IPD Service tally sheet...............................................................................................................................................122
3.2.10 Intensive Care Unit (ICU) Register..................................................................................................................................124
3.3 Other Registers......................................................................................................................................................................125
3.3.1 Emergency Department Register....................................................................................................................................126
3.3.2 Ambulance register............................................................................................................................................................128
3.3.3 Operation register..............................................................................................................................................................131
3.3.4 Referral register..................................................................................................................................................................132
3.3.5 Trachomatous Trichiasis (TT) Surgery register.............................................................................................................133
3.3.6 Central Register..................................................................................................................................................................135
3.3.6.1 Patient/Client Attendance Tally Sheet....................................................................................................................137
3.3.7 Cervical Cancer Register...................................................................................................................................................138
3.3.8 Leishmaniasis (VL) Register..............................................................................................................................................140
3.3.9 Dispensing Register...........................................................................................................................................................142
3.3.9.1 Tracer drug availability Tally sheet..........................................................................................................................144
3.3.9.2 Supplier fill tally..........................................................................................................................................................145
3.4 Birth and Death Notification...............................................................................................................................................145
3.4.1 Birth Notification Form and Procedure.....................................................................................................................145
3.4.2 Death Notification Form and Procedure...................................................................................................................146
Section 4: HMIS Reporting formats and procedures..............................................................................................................148
4.1 Introduction to HMIS reporting..........................................................................................................................................149
4.2 HMIS Reporting channel and period..................................................................................................................................149
4.3 HMIS Report Types................................................................................................................................................................150
4.4 Procedure of completing reporting formats....................................................................................................................152
Section 5: Annex.............................................................................................................................................................................154
5.1 Annex 1: Sample 1-HMIS Registers.....................................................................................................................................155
5.2 Annex 2: SAMPLE Tally sheets.............................................................................................................................................164
5.3 Annex 3: HMIS Reporting format (Sample).......................................................................................................................169
 ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
PARTICIPANT MANUAL
DATA RECORDING AND REPORTING PROCEDURES

ACKNOWLEDGMENTS
This HMIS recording and reporting procedures manual is developed with the involvement and
contributions of experts and managers from the Federal Ministry of Health, Regional Health Bu-
reaus, Universities and Partner organizations. The Policy, Planning and Monitoring & Evaluation
Directorate of the Federal Ministry of Health is grateful for all who have been in the preparation
of this procedures manual.

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ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
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DATA RECORDING AND REPORTING PROCEDURES

ACRONYMS
ANC Antenatal Care
ART AntiretroViral Therapy
CAC Comprehensive Abortion Care
CHIS Community Health Information System
CINuS Comprehensive and Integrated NutritionServices
DHS Demographic and Health Survey
DRTB Drug Resistance Tuberculosis
EPI Expanded Program on Immunization
FMOH Federal Ministry of Health
FP Family Planning
GM Growth Monitoring
GMP Growth Monitoring and Promotion
HC Health Center
HIS Health Information System
HMIS Health Management Information System
HPV Human Pappiloma Virus
HRH Human Resource for Health
ICT Information Communication technology
IPD Inpatient Department
LAFP Long Acting Family Planning
MARPS Most At Risk Population
M&E Monitoring and evaluation
MCH Maternal and Child Health
MPI Master Patient Index
MRN Medical Record Number
MRU Medical Record Unit
MUAC Mid Upper Arm Circumference
NCoD National Classification of Diseases
NHAs National Classification of Diseases
NICU National Health Accounts
OPD Out Patient Department
OVC Orphan and Vulnerable Children
PAB Protected At Birth
PHEM Public Health Emergency Management
PLHIV People Living With HIV/AIDS
PLW Pregnant and Lactatign Women
PMTCT Prevention of Mother to Child Transmission
PNC Postnatal Care
PSNP Productive Safety Net Program

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DATA RECORDING AND REPORTING PROCEDURES

RH Reproductive Health
RHB Regional Health Bureau
SAM Severe Acute Malnutrition
TB Tuberculosis
TFP Therapeutic Feeding Program
TT Tetanus Toxoid
VL Visceral Leshmaniasis
WoHO Woreda Health Office
ZHD Zonal Health Department

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DATA RECORDING AND REPORTING PROCEDURES

LIST OF TABLES
Table 1. ICD-10 List of Chapters, Block groups and Chapter titles....................................................................... 115

Table 2. NCoD Mapping to ICD-10............................................................................................................................... 116

Table 3. NCoD summary sheet.................................................................................................................................... 119

Table 4. Reporting level and reporting period of public health facilities............................................................ 150

Table 5. Reporting level and time of private health facilities................................................................................ 150

Table 6. Reporting level and time of all health institutions................................................................................... 150

LIST OF FIGURES
Figure 1. Building blocks of a well-functioning health system (From WHO).......................................................... 6

Figure 2. Ethiopian Health Tier System.......................................................................................................................... 7

Figure 3. HMN Framework: Components and strengthening national health information system.................. 8

Figure 4. Individual medical folder and Summary sheet......................................................................................... 14

Figure 5. Front and back side of Service Identification Card................................................................................... 15

Figure 6. Front and back side of appointment card.................................................................................................. 15

Figure 7. Master Patient Card......................................................................................................................................... 16

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DATA RECORDING AND REPORTING PROCEDURES

MODULE INTRODUCTION: HMIS

RECORDING, REPORTING TOOLS &
PROCEDURES MANUAL
Topics Covered

• Introduction to health system and health information system

• Individual medical records and its recording procedures

• HMIS registers and recording procedures

• HMIS tally sheets and recording procedures

• HMIS Reporting ( types of reporting formats, frequency of reporting and report/data flow)

Module Learning Objectives

At the end of this training, participants will be able to:

• Define and describe the basic concepts of health system and health information system

• Describe the types, purposes and contents of each individual medical record and register

• Describe the recording procedures of individual medical records, registers and tally sheets

• Describe the types, purposes and contents of reporting formats and reporting procedures for each
level of the health system

Teaching Methods

• Facilitator’s presentations

• Exercises and group work

• Presentations by participants

• Plenary discussion

Module training duration: 6 days

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DATA RECORDING AND REPORTING PROCEDURES

Module Introduction

In order to respond to the additional monitoring and evaluation M&E requirements by the Health Sector
Transformation Plan and the introduction of new health initiatives, Health Management Information Sys-
tem (HMIS) revision has recently been done by the Federal Ministry of Health (FMOH). The revision resulted
in addition of new indicators and modification and/or removal of the existing indicators. Following the re-
vised list of indicators, the existing recording and reporting formats have been modified and new recording
formats are also developed.

The recording instruments are developed based on the level and capacity of the health institutions and the
scope of health services they deliver. Health posts use a family folder to record health services that they
provide while health centers and hospitals (including private for profit and private for not profit facilities)
use individual medical records and registers to capture medical and health services from each individual.
Registers will be used to capture selected data elements from individual medical records that are important
for reporting. In order to simplify report compilation, tally sheets are developed for each level, including for
health posts. Routine reports follow the health system’s hierarchy to reach to the FMOH of Ethiopia so that
evidence based decisions and policy making can be done.

In this module, the revised recording and reporting tools and procedures will be discussed in detail. This
training manual is prepared for use by all health workers at health facilities and administrative health units
such as Woreda Health Offices (WoHOs), Zonal Health Departments (ZHDs), Regional health Bureaus (RHBs)
and FMOH. It will be useful to make health workers familiarized with the recording and reporting tools and
procedures.

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DATA RECORDING AND REPORTING PROCEDURES

Purpose of this module

This manual is primarily intended for use by health workers at all levels of the health system
who are involved in managing health related data. This document describes the procedures to
be used for routine data collection and reporting at all levels of the health system in Ethiopia.
Given the very dynamic nature of the health system, this document will be updated when
information systems procedures are changed. It provides detail instructions for completing
Health Management Information System (HMIS) recording and reporting tools. In addition,
reportable data elements and indicators from each recording tools are also described.

Organization of this manual

This manual is organized into five sections:

1. Section 1: Overview of Health System and Health Information Systems: basic concepts

2. Section 2: Individual Medical Recording tools and its procedures: Provides information
about the individual recording tools and how to complete each individual recording form

3. Section 3: Registers and tally sheets and its completing procedures: Provides detail
description of all HMIS registers and tally sheets and its recording procedures

4. Section 4: Reporting tools and Procedures: Provides description of the reporting formats,
reporting channel, period and reporting hierarchy.

5. Section 5: Annexes: This includes sample registers, tally sheets and reporting formats

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SECTION 1
OVERVIEW OF HEALTH SYSTEM AND HEALTH
INFORMATION SYSTEMS: BASIC CONCEPTS
 ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
PARTICIPANT MANUAL
DATA RECORDING AND REPORTING PROCEDURES

SECTION 1: OVERVIEW OF HEALTH

SYSTEM AND HEALTH INFORMATION
SYSTEMS: BASIC CONCEPTS
[

Topics covered

 Health system and health-system building blocks

 Health Information System and its components

 Introduction to the routine HMIS

Session Objectives

At the end of this session, participants will be able to:

 Define health system and its components

 Define and describe the concepts and functions of health information system (HIS) and HMIS

 List the different data sources of HIS

 Describe the relationship between HIS and other components of a health system

Time needed: 4 hours

1.1 HEALTH SYSTEM AND ITS COMPONENTS

A health system is the sum total of all the organizations, institutions, resources and all activities whose
primary purpose is to promote, restore or maintain health. A health system needs staff, funds, information,
supplies, transport, communications and overall guidance and direction. And a health system needs to
provide services that are responsive and financially fair (WHO, 2000). Health systems have a responsibility
not just to improve people’s health but to protect them against the financial cost of illness and to treat them
with dignity (WHO, 2000). Health systems have three fundamental objectives.

 Improving the health of the population

 Responding to people’s expectations (Responsiveness)

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

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DATA RECORDING AND REPORTING PROCEDURES

Health System Building Blocks

A health system has six components/building blocks. These include: Service delivery, health workforce,
health financing, health information system, medical products, and governance & leadership. (See figure 1
below). The health system framework below shows the six building blocks of a well-functioning health sys-
tem and the impact that it intends to bring (Responsiveness, Risk Protection and Improved health)> Health
Information system is a cross cutting component which helps us to measure the performance of the other
components of a health system.

Figure 1. Building blocks of a well-functioning health system (From WHO)

The Ethiopian health service arrangement

The Ethiopian heath service is arranged into three tier system (see the figure below). The three tiers are
primary level health care, secondary level health care and tertiary level health care.

1. Primary level health care: This is a level where health promotion, disease prevention and basic curative
service is provided. It consists of primary hospitals and Primary Health Care Units (PHCUs) that are
composed of one health center and five satellite health posts. A primary hospital is expected to provide
inpatient and ambulatory services to an average of 100,000 population. A PHCU is expected to provide
an average of 25,000 population.

2. Secondary level health care: Consists of general hospitals that provides to an average of 1 million peo-
ple. It is a referral center for primary hospitals.

3. Tertiary level health care: Consists of specialized hospital services to an average of 5 million population.
It also serves as a referral site for general hospitals.

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DATA RECORDING AND REPORTING PROCEDURES

Figure 2. Ethiopian Health Tier System

1.2 HEALTH INFORMATION SYSTEM (HIS)

Health Information System (HIS) refers to any system that captures, stores, manages or transmits informa-
tion related to the health of individuals or the activities of organizations, which will improve health care
management decisions at all levels of the health system. HIS is one of the building blocks of a health sys-
tem. It is used to avail and use timely information on health determinants, health systems performance and
health status.

Information is crucial to inform on the performance of the health system and about health challenges. HIS
is required for timely intelligence on the other building blocks of the health system:

• Progress in meeting health challenges and objectives

• Health financing, through National Health Accounts (NHAs) and analysis of financial catastrophes
and of financial and other barriers to health services for the poor/vulnerable

• Trends and needs for human resource for health (HRH); on consumption of and access to pharma-
ceuticals; on appropriateness and cost of technology; on distribution and adequacy of infrastruc-
ture

• Access to care and on the quality of services provided

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DATA RECORDING AND REPORTING PROCEDURES

1.2.1 Components of a Health Information System

A health information system has different components which includes health information system resourc-
es, indicators, data sources, data management, information products and dissemination and use. The six
components of a health information system are the following (see figure below).

1. Health information system resources: these include the legislative, regulatory and planning frame-
works required to ensure a fully functioning health information system, and the resources that are pre-
requisites for the system to be functional. The resources include personnel, financing, logistics, infor-
mation and communications technology (ICT), and coordinating mechanisms within and between the
six components.

2. Indicators: - a core set of indicators and related targets for the health information system. Indicators
need to include determinants of health, health system inputs, outputs & outcomes and health status.

3. Data sources: This includes population based or facility based sources for the health information sys-
tem

4. Data management: this covers all aspects of data handling from collection, storage, quality-assurance
and flow, to processing, compilation and analysis

5. Information products: data must be transformed into information that will become the basis for evi-
dence and knowledge to shape health action

6. Dissemination and use: the value of health information can be enhanced by making it readily ac-
cessible to decision-makers (giving due attention to behavioral and organizational constraints) and by
providing incentives for information use.

Figure 3. HMN Framework: Components and strengthening national health information system

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1.2.2 Sources of data

Data requirement is a continuum from patient care to strategic management level and this implies that
not everything needs to be known at every level of the system. The quantity and detail of data needed is
generally greater at lower levels of the system, where decisions on the care of individuals are made, than at
higher levels where broader policy-making takes place with different data sources. Data sources for health
information system can be divided into two. These are:

1. Population based: This includes census data, vital registration system, population based surveys,
researches etc..

2. Institution based: This includes institution based data sources such as administrative records, indi-
vidual records, service records etc…

In Ethiopia, the health information system captures data from different sources and is run under different
authorities. The sources of data include the routine HMIS, population and housing census, surveys includ-
ing the demographic and health survey and different researches. The routine HMIS is managed primarily by
the ministry of health and Population based information is mainly from CSA. Moreover, the Ethiopian Public
Health Institute (EPHI), Universities and individuals conduct various research activities.

Data sources of the Ethiopian health system can be categorized as follows based on the above framework.

Data sources of the Ethiopian HIS:

 Community level: Community Health Information System (CHIS), surveys and different household
studies

 Facility level (Health Centers (HCs), Hospitals and private health facilities: Routine HMIS report &
surveillance report from Public Health Emergency Management (PHEM), facility based researches
and surveys

 Woreda, Zonal and Regional levels: HMIS, Surveillance data, administrative data, surveys

 National level: HMIS, Census, demographic and health surveys (DHS), national household surveys,
different national level researches, modeling and estimates

1.3 HEALTH MANAGEMENT INFORMATION SYSTEM (HIS)

Health Management Information System (HMIS): is the routine collection, aggregation, analysis, presen-
tation and utilization of health and health related data for evidence based decisions for health workers,
managers, policy makers and others. It is the processing of data from various health components into infor-
mation that enables health workers & managers, planners, policy makers and other stakeholders to make
informed decisions.

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DATA RECORDING AND REPORTING PROCEDURES

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

Components of HMIS

HMIS has two main components: information management component and use of the information for ev-
idence based decision making.

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 infor-
mation in the form of sentence, tables and graphs.

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.

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SECTION 2
INDIVIDUAL MEDICAL RECORDING
TOOLS AND PROCEDURE
 ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
PARTICIPANT MANUAL
DATA RECORDING AND REPORTING PROCEDURES

SECTION 2: INDIVIDUAL MEDICAL

RECORDING TOOLS AND PROCEDURE
Session Learning Objectives

At the end of this session, participants will be able to:

• Define and describe the types of individual recording tool

• Describe the purposes and contents of each individual medical record

• Describe the recording procedures of individual medical records

Topics Covered

• Individual medical records: Individual folder, patient form, service ID card, appointment card, Master
Patient index, Tracer card

• Individual medical record issuing and archiving procedure

Time needed: 4 hours

Session Introduction

Individual Medical Recording tools are those which are used to record the medical and clinical information
of individual clients and/or patients. At health center and hospital levels, each client/patient is expected to
have an individual record where all the services provided are recorded and kept in medical record units. In
this section, each medical recording tools, its contents and procedures will be discussed in detail.

2.1 INDIVIDUAL FOLDER

It is a folder that is used as a pouch to contain all the medical records of each patient/client. The data el-
ements at the front part of the folder includes personal identification data elements (socio demographic
characteristics of the individual) and should be filled by Medical Record Unit (MRU) workers at the time of
registration. The inside part of the folder contains a summary sheet to summarize the medical record of
patients/clients at each visit and should be filled by service providers immediately after the service is pro-
vided.

Purpose of individual folder

• To integrate all medical & health service records of an individual patient or client so that the holistic
medical data of individuals can be accessed in one folder, whenever required.
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DATA RECORDING AND REPORTING PROCEDURES

Summary sheet

• It is available in the inside section of the folder

• It is used to summarize all services provided and helps to fast-track an individual’s service history. In
order to plan investigation and treat appropriately, the clinician/service provider can see the details of
the history inside the folder.

Notes:

 Each individual, who obtains service in the health facility, must have a folder kept in the medical record
department with a unique individual Medical Record Number (MRN).

 MRN should be written on the front part of the folder and also on the summary sheet section of the
folder (inside part of the folder).

 Medical Record Number (MRN):

• It is a unique number to an individual in a health facility.

• Identifies an individual client/patient to the specific facility.

• Helps to trace an individual folder during repeated visits to the facility (using the service ID card,
where MRN is written on it).

• Only one MRN is assigned to one client in one health facility.

• MRN should be a 5-digit number for a health center and a 6-digit number for a hospital, e.g. at a
health center, MRN starts with 00001, and at a hospital with 000001.

 An individual should obtain an individual folder to get any single service at the facility.

 All individual medical records, i.e. cards that have clinical notes, request forms etc…must be kept in the
folder.

 The folder is replaced by tracer card when it is distributed out for service, and rearranged with the tracer
card inserted in when it is back shelved. Meanwhile receipt of distributed folders should be signed by
respective service unit that received them. When the folder returns to the reception area, the tracer card
must be inserted in the folder and the folder will take its position to where it was before the distribution.

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 The following is a sample of the information to be completed on the individual integrated folder: Health
facility name, MRN, date of registration, client name, age (preferably date of birth); address etc.

 If summary sheet becomes full, another form can be prepared and be kept in the folder.

 Folder is preferably shelved in its spine by sequential order of medical record numbers in the MRU.

 Folder is distributed to individual service rooms/departments based on shown up request of an individ-

ual client/patient for required service

 No folder can be kept out of MRU after completion of service. However, folders of admitted patients can
be kept in the respective department until the patient is discharged.

2.2 PATIENT FORM/PATIENT CARD

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

1. Section to write chief complaint and detailed clinical notes

2. Section to write the main diagnosis and other diagnosis (if any).

3. Section to write National Classification of Disease (NCoD)

Main diagnosis may or may not exactly fit NCoD; however, it should be made to match in to the NCoD for
national reporting. Main diagnosis is always one disease entity; however, a patient can have one or more
other diagnosis for clinical management.

Individual medical folder and summary sheet are displayed in the figure below.

Figure 4. Individual medical folder and Summary sheet

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2.3 SERVICE IDENTIFICATION (ID) CARD

Service Identification Card (ID) is a small card which is used as an identification for patients/clients (Figure 5
below). It is issued at the time of registration at the Medical Record Unit (MRU). Whenever the patient/client
visits the facility at subsequent visits, he/she will show the service ID card so that the MRU worker can locate
the folder by using the MRN on the service ID card.

• It has the following data elements and should be completed by MRU workers: Name, age, sex, MRN,
date of registration, address etc..

• The card should be available in the MRU

Figure 5. Front and back side of Service Identification Card

2.4 APPOINTMENT CARD

• This is a small card which is used to remind for services which require appointments (Example: For FP,
ANC, ART, TB patients…)

• It should be made available in service departments which provide appointments.

• It will be completed / filled by service providers and be provided to patients/clients who are given an
appointment for another service.

Figure 6. Front and back side of appointment card

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2.5 MASTER PATIENT CARD

• It is a small card which is used to retrieve patient folder when MRN is unknown (if the service ID is lost).

• A file box (MPI box) should be prepared in a way which can accommodate all the English alphabets so
that a name which starts with each letter can be put together.

• It is placed in MRU (in file box) and it is archived based on English alphabetical order

• The EMR-MRU electronic system can simplify the arduous MPI archiving system. In facilities where elec-
tronic system is implemented, manual MPI archiving will not be necessary. EMR-MRU (Electronic Med-
ical Record-Medical Record Unit Module) is an electronic system which is used in MRUs to register and
retrieve patient’s folder using computers.

Figure 7. Master Patient Card

2.6 TRACER CARD

• This is an A4 size card which helps us to track the folder when it is not in the MRU.

• It is assigned during first registration at the MRU, immediately after a folder is issued to a patient/
client

• The folder must always be replaced by its tracer card when it is distributed out to service units.

• It should be signed by the folder receiving unit.

• When the folder is returned back to the MRU, the tracer card should be replaced by the folder, and
the tracer card will be out in the folder.

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2.7 INDIVIDUAL MEDICAL RECORD ISSUING AND ARCHIVING TIPS

• Issue folder with only patient form inside when a patient is presented only for an outpatient (OPD)
and is not admission case but if the patient is admitted to one of the inpatient departments, we
have to issue a folder with a patient form and admission/ discharge card inside.

• If a client is presented only for Antenatal Cate (ANC) service, delivery or Postnatal Care (PNC) ser-
vices, we have to issue a folder with only one integrated Reproductive Health (RH) card inside.

• Issue a folder with only woman’s card inside; when none pregnant client is presented for one or all
of the following services at a time: For family planning, Tetanus Toxoid (TT) vaccination, and abor-
tion (safe or post abortion) services.

• Issue a folder with all cards (patient form, RH card, woman’s card and admission/ discharge card
inside) when a patient requires all the associated services.

• No folder/patient record is kept overnight outside the MRU (card room) except for patients who are
admitted.

• HMIS proposes old inactive cards to be stored in an inactive storage after 5 years of their last visit.

Exercise 1: Exercise on individual medical records

Case scenario 1:

Kassahun Mulugeta, a 30 years old man, came to Akaki Health Center on Meskerem 23, 2010 EC. It was his
first visit to the health center. At the time he arrived at the health center, the last issued MRN number was
24,560. He was diagnosed and treated for pneumonia. Three weeks after his initial visit, he came back to the
health center for a 7 days gentamycin injection prescribed by a private clinic for his acute pyelonephritis.
Complete the following exercise:-

a. In which of the visits should Kassahun draw an integrated medical folder before he gets the services?

b. What would his MRN be?

c. Complete Kassahun’s summary sheet

d. List types of individual medical records that Kassahun could have.

e. Describe the importance of summary sheet in the folder

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Exercise 2: Exercise on service ID, appointment card and MPI

A. If a patient loses his/her appointment & service ID cards, how could the patient access to appointing
service unit/department in the health facility & what is the procedure to re-supply?

B. Map the difference and similarities between service ID and appointment cards, and point out the rea-
sons to issue and keep them separately instead of two in one.

C. Given a patient/client have both appointment and service ID cards, writing Medical Record Number
(MRN) in either of the cards is sufficient. Yes/ no? Justify your answer.

D. Describe the importance of tracer card and MPI card

2.8 OTHER INDIVIDUAL MEDICAL RECORDS

There are different types of individual medical recording tools other than the above mentioned ones that
are used for different services such as integrated reproductive health card, women card, prescription forms,
lab request formats etc.. In the following sections, the remaining individual medical records will be dis-
cussed with the registers corresponding to it. Example: Integrated RH card will be discussed while discuss-
ing RH registers and tally sheets.

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SECTION 3
REGISTERS AND TALLY SHEETS
 ETHIOPIA HEALTH MANAGEMENT INFORMATION SYSTEM:
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SECTION 3: REGISTERS AND TALLY

SHEETS
3.1 MATERNAL AND CHILD HEALTH (MCH) CARDS, REGISTERS & TALLIES

Contents

• Integrated Reproductive Health (RH) card and women’s card

• Types and contents of MCH registers: Fifteen registers that are used for maternal and child health
services including EPI and nutrition services

• Tally sheets used for MCH services

• Reportable data elements and indicators from MCH registers

• Exercises on MCH registers

Objectives of the session

At the end of this session, participants will be able to:

• Describe the purposes and filling procedure of integrated RH cared and women’s card.

• Describe the recording procedures of MCH related registers.

• Describe MCH related tally sheets

• Identify reportable data elements from MCH registers

Duration: 12 hours

In this section, all recording and report compilation procedures from the 15 MCH registers will be dealt in
detail. The MCH registers list includes registers that are used to record maternal health, child health, Ex-
panded Program on Immunization (EPI) and nutrition related services. MCH registers include the following:-
Family Planning (FP) register, Long acting FP (LAFP) Removal Register, ANC register, Delivery register, PNC
register, PMTCT register, Comprehensive Abortion Care Register, CINuS (Comprehensive and Integrated nu-
trition services) register, Pregnant and Lactating Women (PLW) register, Therapeutic Feeding Program (TFP)
register, EPI register, Human Papilloma Vaccination (HPV) register, Tetanus Toxoid (TT) register, Neonatal
Intensive Care Unit(NICU) register and Integrated RH register (for private clinics).

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Moreover, tally sheets that are required for MCH programs will be discussed. MCH related tally sheets in-
cludes the following: Family Planning (FP) tally, FP dispensing tally, ANC tally, abortion tally, pregnancy test
tally sheet, PMTCT tally, EPI tally and CINuS tally.

3.1.1 FAMILY PLANNING REGISTER

Topics Covered

• Introduction to Family Planning register

• Procedures of completing Family Planning register

• Reportable data element from Family Planning register

• Indicators calculated from Family Planning register

• Tally sheets used for Family Planning services

• Summary of FP register

Objectives of this session

• To describe the purposes of Family Planning (FP) register

• To properly record the required family planning service data elements to the FP register

• To accurately identify and able to extract reportable data elements from FP register.

• To compute and describe HMIS indicators from the family planning reportable data elements

Time needed: 1 hour

Introduction

Family Planning Register is a longitudinal register that is used to capture HMIS data related to family plan-
ning services. Once the FP client is registered, one row is adequate to record services for one fiscal year.
After the fiscal year is completed, the client should be registered again in the same registration book but
with different serial number and reported again in the new fiscal year as a repeat client. The information re-
quired to complete the FP register is obtained from woman’s card. The register should be kept in the Family
Planning service room. The women card should be kept in the individual folder. The register includes sum-
mary information for reporting FP data elements that are used for the calculation of indicators related to
family planning. After the service is provided, the service provider should take the abstracted data elements
from women card to the Family Planning register so that monthly report compilation can be easy from the
register.

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How to complete Family Planning Register

The cover page

 The cover page contains the Federal ministry of health logo to denote that the register is being used in
all public and private health facilities.

 In the Middle, it shows the level of health facilities intended to use this register, the name of the register
and the third component of the cover page is the part in which the care provider ought to record the
address of the health facility:- Region, Sub-city/Woreda, Health facility name, and beginning and end
date of the register.

 All the above data are crucial for the appropriate use of the register in the facility and needs to be re-
corded before starting to use the register for the first time and it should be written with legible hand
writing. If more than one department is available in the facility providing the service, we can denote
this by writing identifying note at any open space on the cover of the register with marker or bold hand
writing by writings such as “Family Planning unit #1”, “Family planning unit #2”.

The instruction

• The instruction part of FP register is found in the inside part next to the cover page. It contains in-
formation about all the basic procedures of how to use the Family Planning register appropriately.
Before using any register, all care providers are required to read the procedures thoroughly.

The main part of the register and its recording and reporting procedures

1. Personal Identification Section (columns 1-5): This section is used to record the personal identifi-
cation data elements for the family planning client.

 Serial Number (Column one): This column is to show the temporal sequence of the clients visit-
ing the facility for the specific family planning service. It should be filled with starting from positive
whole number (1, 2, 3….up to the end of the register). Restarting numbering in every new month or
at the end of each reporting period is not required. We have to continue numbering till the register
pages get exhausted & new register is started.

 MRN (Column 2): MRN is a unique individual identifier taken from the individual integrated folder in
health centers and hospitals. This is a uniquely identifying number for a client from other clients as
long as he/she visits one specific facility.

 Name (Column 3): Full name of the client should be recorded in legible hand writing (Name, Fa-
ther’s name and Grandfather’s name).

 Age (Column 4): To be completed in years

 Sex (Column 5): Sex of the client as M=Male; F=Female

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2. Registration date Section (Column 6): The date the client is registered in this registration book
should be written as Day / Month / Year (DD/MM/YY) in Ethiopian Calendar.

3. Type of acceptor section (column 7-8): This section is used to identify whether the client is new or
repeat family planning acceptor.

 New acceptor at registration (Column (7): Tick if the client is new acceptor at the time of registra-
tion by tick mark (√).

“New acceptors” refers to those acceptors who receive family planning services from a recog-
nized program for the first time irrespective of the method used. This is not the number of con-
sultations and emergency contraceptive. Each acceptor is enumerated once in the year, at the
first consultation for contraception in the fiscal year. The number of new acceptors measures
the ability of the program to attract new clients to its services.

 Repeat acceptor at registration (Column 8): Tick if client is repeat acceptor at the time of registra-
tion by tick mark (√).

“Repeat acceptors” refers to those acceptors who receive family planning services from a fami-
ly planning program previously irrespective of the method used. Long acting FP method users
will also be counted as repeat every year including routine checkup for ongoing use of a long
term method such as Implants, IUCD, TL and Vasectomy.

Note: - Definition of terms “New acceptor and Repeat acceptor”

Look at the family planning register column 7 and 8; one family planning client is considered as new
or repeat client only once in one fiscal year (From Senie 21 of the previous year up to Senie 20 of the
current year). So, if the client gets registered as new client in Meskerem 3, 2009 then the client won’t
be considered as new or repeat client till Senie 20 of 2009. At the end of one fiscal year, registration
should be started with a new page denoting that it starts with another fiscal year. Write the new fis-
cal year with a marker (BOLD WORDS). All clients in the previous fiscal year must be recorded once
again in new pages of the old register and considered as repeat clients in the new fiscal year.

4. HIV Counselling and testing Section (Columns 9-14): These columns of the register are reserved to
record HIV counseling and testing related services and its result.

 HIV test offered (Column 9): Tick if HIV test is offered based on provider initiated HIV counseling
and testing guidelines.

 HIV test performed (Column 10): Tick if client is tested for HIV/AIDS.

 HIV Test result (Column 11): Enter P in red pen if the test is positive; N in normal color pen if the
test result is negative.

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 HIV specific contraceptive counseling offered (Column 12):- Tick if HIV specific contraceptive
counseling on methods is offered.

Note: - HIV specific counseling indicates provision of comprehensive family planning counseling to
PLHIV to prevent acquisition of different strains of HIV virus and protection of unwanted pregnancy.
So, during the counseling of PLHIV family planning clients the following points should be reminded

 Dual protection is critical in reducing transmission of STIs and HIV.

 HIV positive women shall be informed about the implications of pregnancy and prevention of
pregnancy shall be encouraged.

 Use of hormonal contraceptives is possible in all HIV positive women

 Use of FP methods is recommended because the benefit to be obtained from use of the contra-
ceptives outweighs the potential risk of unwanted pregnancy. However, it should be known that
some antiretroviral drugs affect bioavailability and efficacy of hormonal contraceptives.

 HIV Positive linked to ART (Column13): Tick if the FP client is HIV Positive and linked to ART clinic
in the health facility and/or to other health facilities.

 Target Population category (Column 14): This is a column where we identify the target cate-
gory of the client for whom we provided a PITC service. Choose the code for the target category as
specified at the end of each page. The target population categories are: A=Female Commercial Sex
workers, B=Long distance drivers, C=mobile workers/daily laborers, D=Prisoners, E=OVC, F=Children
of PLHIV, G=Partner of PLHIV, H=other MARPS and I=General Population.

5. TT status checked (Column 15): Tick this column if the TT status of the woman is checked during the
FP service.

6. Contraindication for IUCD (Column 16): Tick if there is any identified contraindication for IUCD.

Note: - Contraindications for IUD includes the following

 Client (or partner) has other sex partners

 Sexually transmitted genital tract infections (GTI) within the last 3 months or other chronic STI
(e.g. HBV, HIV/AIDS).
 Pelvic infection (PID) or ectopic pregnancy (within the last 3 months)
 Heavy menstrual bleeding (twice as much or twice as long as normal)
 Severe menstrual cramping (dysmenorrhea) requiring analgesics and/or bed rest.
 Bleeding/spotting between periods or after intercourse
 Symptomatic valvular heart disease
 other

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7. Clinical exam and contraceptive method provided Section (Column 17-19): These columns are
used to record the date and type of contraceptive method provided to the client.

 Visit Number (1-5) (Column 17):- This is used to record the visit number in the current fiscal year.
Even though all the five rows are not finished in the fiscal year, we have to leave the remaining rows
blank and re-register the client in a new row in the new fiscal year.

Note on completing the five rows: - If for example one client came to a health center for the first time
on Tir 1, 2009 and attended two consecutive appointment with Oral contraceptive on Megabit 1 and
Ginbot 1, then the three consecutive fields (Row 1 on Tir 1; Row 2 on Megabit 1 and Row 3 on Ginbot 1)
get filled at the time of service provision. Let’s assume the client is appointed for Hamle 1, 2009 for her
fourth visit, then we should not record this client on the fourth row of this register. Rather we will record
this client on new row of the same register with new serial number or we must record on new register
for the new fiscal year as repeat client because the 2009 fiscal year is completed and a new fiscal year is
started starting from the month of Hamle.

 Visit Date (Column 18):- Write the date of visit, written as (Ethiopian Calendar) Day / Month / Year
(DD/MM/YY) format.

 Contraceptive provided (Column 19):- Write the contraceptive method provided (record modern
methods only by using the following abbreviations)

The following abbreviations are used in the register to record contraceptives provided

 MaC = Male Condom

 FeC = Female Condom

 OC = Oral Contraceptive

 Inj = Injectable

 EC=Emergency contraceptive

 Diaph = Diaphragme

 IUCD = Intra-utérine Contraceptive devise

 Imp= Implant

 TL= Permanent Contraception Method for Tubal Legation

 Vas= Permanent Contraception Method for Vasectomy

 Oth=Others

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8. Appointment date and remark columns (Column 20-21): This section is to record the appointment
date and any type of remark for each client.

 Appointment date (Column 20): Write the next appointment date

 Remark/Name &signature (Column 21):- Write any additional suggestions and comments. The
service provider should also write his/her name and put the signature in this column

3.1.1.1 Family Planning Service tally

FP service tally sheet is used to simplify reporting of FP reportable data elements from the FP register. Fami-
ly Planning tally sheet should be used to capture FP reports that are disaggregated by age, type of acceptors
and by Family planning method. The age categories are: 10-14 years, 15-19 years, 20-24 years, 25-29 years
and 30-49 years.

How the tally is completed:

• Complete the name of woreda, facility, department, year and month at the top of the tally sheet.

• For each contraceptive method provided, tally to the corresponding age category and the count
should be put in the “count” column. The tally should be done using a “/” mark for a single client.
For example: If there are seven new FP clients aged between 20-24 years who received oral con-
traceptives, then we have to tally “//// //” on the box that corresponds to New Oral contraceptive
acceptors on column 20-24 years.

3.1.1.2 Family Planning Methods dispensing tally

Family planning methods dispensed tally sheet is used to simplify reporting of the total number of contra-
ceptive methods dispensed in the reporting period. It uses data from the FP register. The number of each
FP method distributed for each month need to be tallied and the total count should be put at the end of
the year.

Reportable data elements and indicators from family planning register

For FP acceptors reporting, we need to use a FP tally sheet that can allow us identify FP clients by type of
acceptor (New and repeat), by age categories and by type of family planning methods. The reportable data
elements from this register are the following:

 Number of new acceptors (Column 7):- Disaggregated by five age categories as displayed at the
FP tally sheet. The total count of new FP acceptors in the count box at the end of each page should
be equal to what we tallied on the FP tally sheet.

 Number of Repeat acceptors (Column 8):- Disaggregated by five age categories as displayed at

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the FP tally sheet. The total count of repeat FP acceptors in the count box at the end of each page
should be equal to what we tallied on the FP tally sheet.

 Number of clients tested for HIV (Column 10):- Separate PITC tally sheet should be used to
report number of clients tested for HIV

 Number of clients tested positive for HIV (Column 11):- Separate PITC tally sheet should be
used for reporting this data element

 Contraceptives provided by method (Column 19): For logistic calculation, use a separate fami-
ly planning dispensed count tally sheet.

Indicators to be calculated from FP register are:

• Contraceptive acceptance rate (CAR)

• Percentage of people living with HIV who know their status (This is HIV indicator)

In order to compute these indicators, please refer to the “HMIS Indicator reference guide” and read the
definition, interpretation and other components of the above indicators.

Summary

Family planning register is kept at the family planning department but in some cases if the facility is pro-
viding integrated FP service with other services like ART, VCT, TB clinic etc…, a separate FP register may be
placed in these departments, filled by the respective care provider in the departments. The data for the re-
port is gathered on monthly basis by the HMIS focal person by directly copying the sum of the data element
at the end of each page and counting the figures from the family planning tally sheet. The health care pro-
viders at the department have the responsibility to ensure that the standardized recording and reporting
procedures have been followed.

The analysis of family planning service indicators should be performed on a regular basis and should be
displayed by using appropriate charts so that appropriate program monitoring and actions can be taken
according to the findings. The responsibility of analyzing the indicators, preparing and updating of the
display charts and presenting the information for the performance monitoring team for informed decision
making falls primarily on the HMIS focal person or the health information technician. For further informa-
tion on assuring data quality and information use, please refer to the data quality and Information Use
training modules.

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3.1.2 LONG ACTING FAMILY PLANNING (LAFP) REMOVAL REGISTER

Topics Covered

• Introduction to the LAFP Removal register

• Procedures of completing LAFP Removal register

• Reportable data elements from the LAFP Removal register

• Indicators calculated from the LAFP Removal register

Objectives of this session

• To describe the purpose of LAFP removal register

• To properly record the required family planning service data elements to the LAFP removal register

• To identify and extract reportable data elements from the LAFP removal register.

• To identify and describe HMIS indicators using the LAFP removal reportable data elements

Time needed: 30 minutes

Introduction

This register is used to record data for clients who have had long acting family planning methods and re-
turned back for removal. The family planning methods that are included for removal are implants (different
types) and IUCD. Data is abstracted from woman’s card and entered to the LAFP removal register.

Please refer to the LAFP Register at the annex section and follow the procedures of filling the data elements
as described below.

How to complete the register

The cover page

 The cover page contains the Federal ministry of health logo to denote that the register is being used in
all public and private health facilities.

 In the Middle, it shows the level of health facilities intended to use this register, the name of the register
and the third component of the cover page is the part in which the care provider ought to record the
address of the health facility:- Region, Sub-city/Woreda, Health facility name, and beginning and end
date of the register.

 All the above data are crucial for the appropriate use of the register in the facility and needs to be re-
corded before starting to use the register for the first time and it should be written with legible hand

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writing. If more than one department is available in the facility providing the service, we can denote
this by writing identifying note at any open space on the cover of the register with marker or bold hand
writing.

The instruction

• The instruction part of LAFP Removal register is found in the inside part next to the cover page. It
contains information about all the basic procedures of how to use the LAFP Removal register appro-
priately. Before using any register, all care providers are required to read the procedures thoroughly.

The main part of the register and its recording and reporting procedures

 Identification Section (Columns 1-4): This section is the identification section of the client including
S. No, MRN, Name and Age of the client.

 Registration related data elements (columns 5-6): This section includes the date the client came
and registered for removal and the date the insertion was done.

 Information about the insertion and removal of the LAFP (columns 7-11): It includes the follow-
ing data elements:

o Type of LAFP used (Column 7): Write the type of LAFP method such as Implanon, Jadel, Sino-im-
plant, or IUCD.

o Place of insertion (column 8): Write the place where the LAFP method was inserted using codes.
The codes include: WI if the insertion was done in the same facility where the removal is going
to be performed; write numbers from 1 to 4 if the LAFP was inserted in another facility (1 if it was
in another hospital, 2 if it was in another health center, write 3 if it was in a health post or 4 if it
was done in a private clinic).

o Date of removal service provided (Column 9): Write the date of removal in Ethiopian calendar
(DD/MM/YY).

o Duration of use (column 10): write the duration of LAFP use before removal. It shpuld be entered
in months.

o Reasons for removal (Column 11): write the reason for removal by selecting one of the codes
that are available at the end of each page of the register.

 Provider Initiated testing and Counselling (PITC) HIV testing and counselling information (Col-
umns 12-17): These columns are used to record PITC testing and counselling service and the result of
the testing, provision of HIV specific counselling and linkage to HIV services if the client is found to be
HIV positive. Target Population category (Column 17) is a column where we identify the target category
of the client for whom we provided a PITC service. Choose the code for the target category as speci-

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fied at the end of each page. The target population categories are: A=Female Commercial Sex work-
ers, B=Long distance drivers, C=mobile workers/daily laborers, D=Prisoners, E=Orphans and Vulnerable
Children (OVC), F=Children of People Living with HIV (PLHIV), G=Partner of PLHIV, H=other Most At Risk
Populations (MARPs) and I=General Population.

 Post removal contraceptive provided (Column 18): It is a column where you write a contraceptive
method code if you provided a post removal contraceptive method for the woman, otherwise leave the
space empty.

 Remark (Column 19): It is a remarks column where the provider writes anything relevant to the client.

Reportable data elements from the register

 Total number of Premature LAFP removals performed during the reporting period (within 6 months of
insertion) disaggregated by FP method type - This is found from the count box at the bottom of each
sheet of the register

 Total LAFP removals performed during the reporting period – This is found from the count box at the
bottom of each sheet

 Total number of clients tested for HIV, disaggregated by age and sex:- Separate PITC tally sheet used
for reporting

 Total number of clients tested positive for HIV, disaggregated by age and sex:- Separate PITC tally
sheet used for reporting

Indicators from this register

There is no HMIS indicator from this register. However, program people can monitor the implementation
and use of LAFP methods from the monthly report. We can compute the proportion of premature removal
of LAFP methods since we have the report on a monthly basis.

3.1.3 ANTENATAL CARE (ANC) REGISTER

Topics Covered

 Introduction to the ANC register

 Integrated RH card and its completing procedure
 Procedures of completing the ANC register
 Reportable data element from the ANC register
 Indicators calculated from the ANC register
 Summary of the ANC register

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Objectives

 To describe the purpose of ANC register

 To properly record the required ANC data elements from ANC service

 To identify and able to extract the reportable data elements from the ANC register.

 To identify and describe HMIS indicators using the ANC reportable data elements

Time needed: 1 hour

Introduction

Antenatal care (ANC) register is designed to record data elements regarding antenatal care service provid-
ed to a pregnant client. The Antenatal care register is a longitudinal register, where one row is used to doc-
ument follow up data for one pregnancy. Data elements for ANC register are abstracted from the integrated
RH card (Integrated ANC, labour, delivery, neonatal and postnatal care card). The RH card and ANC register
are both completed by the service provider at the time of ANC service. The register is kept in the Antenatal
care room. The RH card should be kept in the individual folder. The register includes summary information
for calculation of indicators related to Antenatal care.

Before we proceed on the details of ANC register, we will first discuss about the integrated RH card where
detail information about ANC, delivery and PNC care services is documented. After that, the details of the
three registers (ANC, Delivery and PNC registers) will be discussed.
Integrated RH (Integrated ANC, labor, delivery, neonatal & Post-natal care) card

Integrated RH card is an individual medical record/form which is used to document data for women and
neonates who received the following services: Antenatal Care service, delivery, PNC and neonatal services.
It helps us to document detailed history, physical examination results, laboratory investigations and other
clinical data for women and neonates who received one of the above mentioned services. The card is avail-
able in the annex section of this manual. Have a look at each data elements and discuss on it. Data for ANC,
delivery and PNC registers is abstracted from the integrated RH card.

Integrated RH card has four pages. The first page includes the following data elements: Socio-demographic
characteristics of the woman, obstetric and general medical history are documented in the first page of
the integrated RH card. The second page of the card is used to document ANC related data for pregnant
women. It includes documenting the following information: - Initial Evaluation of the pregnant woman
plus Promotive and Preventive services; and to document follow up of the current pregnancy during subse-
quent visits for pregnancy care. The third page of integrated RH card is used to document intrapartum care
and follow up related data. It is used to monitor the progress of labor using a partagraph. The health worker

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following the progress of the labour will document on the partograph. The fourth page of the integrated RH
card is used to document delivery summary and postnatal care related services. On the delivery summary
section, summary information about the woman and the newborn will be documented. Post-natal care
related data elements are documented for women who came for PNC services (at the PNC section of the
integrated RH card).

How to complete ANC register

The cover page

 The cover page contains the Federal ministry of health logo to denote that the register is being used in
all public and private facilities found under FMOH.

 In the middle of the register, the level of health facilities intended to use this register and the name of
the register itself are documented

 The third component of the cover page is the part in which the care provider ought to record the facili-
ty’s Region, Sub-city/Woreda, Health facility name, and beginning and end date of the register.

 All the above data are crucial for the use of the register appropriately in the facility and needs to be
recorded before starting to use the register by the care provided with legible hand writing. If more
than one department is available in the facility providing the service we can denote this by writing
identifying note at any open space on the cover of the register with parker or bold hand writing. Like
Antenatal care unit #1, Antenatal care unit #2.

The instruction

The instruction part is found in the inside part next to the cover. It contains all the basic procedures how
to use the Antenatal care register appropriately. Before using any register, all care providers are required to
read the instructions thoroughly.

The main part of the register and its recording and reporting procedures

1. Personal Identification Section (Columns 1-6): This section is used to record the demographic
characteristics of the woman that received ANC service. The data elements include Serial number (col-
umn 1), Name (Column 2), MRN (column 3), Age (column 4), Last Menstrual Period (LMP) (column 5) and
Expected Date of Delivery (EDD) (Column 6).

 Serial Number (Column 1) - Write sequential serial number in the registration book. This col-
umn is just to show the sequence of the clients visiting the facility for one pregnancy care. It
should be filled with starting from positive whole number (1, 2, and 3….Up to the end of the reg-
ister). We are not required to restart numbering in every new month or at the end of each report-
ing period, just continuous number till the register pages get exhausted & new register is started.

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 Name/Kebele (column 2): write the name of the woman on the upper section of the row and
write the kebele where the woman came in the lower row. Note that, if the woman came from
another woreda, the name of the woreda should also be documented.

 MRN (Medical record number) (Column 3): Write unique individual identifier from her ‘INDI-
VIDUAL FOLDER’. This is uniquely identifying number for the client from other clients as long as
she visits the specified facility.

 Age (Column 4): Write the age of the women in years from her ‘INDIVIDUAL FOLDER’.

 Last menstrual period (Column 5): Write last normal menstrual period of the women in day/
month and year (DD/MM/YY) from her RH integrated card. This is the date at which the client’s
menses just stopped, at the beginning of the pregnancy and should be recorded in Ethiopian
calendar, in two digits like DD/MM/YY. For example, if the client’s LMP is on Meskerem 20, 2009,
then you should record as 20 (the day in two digits)/01(Meskerem in two digits) /09 (to denote
the year in two digit standardized format. 20/01/10 not 20/01/2010.

 EDD (Expected date of delivery) (Column 6): Write the expected date of delivery in day/
month /year (dd/mm/yy) after calculation based on the LMP recorded in the format as the LMP.

2. Focus ANC section (column 7-18): this section is used to record data elements that are related to
focused ANC services. It is abstracted from the integrated RH card.

 Visit Number (column 7): This is to document the number of ANC visit as 1, 2, 3 or 4. An ANC client
should have at least 4 focused ANC visits during her pregnancy period. So, the number of visits is by
default printed on the register and the client gets registered on the first row (Visit 1) if she comes for
the first time despite her gestational age. This is simply designed to capture the number of clients
who have attended the ANC care for the first time up to four times for calculation of ANC 1st and ANC
4th care coverage indicators. If the woman received more than four ANC visits, it will not be recorded
on the register but should be documented on the integrated RH card. Clients coming from other
health facilities after attending the first ANC visit can be recorded at the second row(visit 2) by skip-
ping the first visit to prevent double reporting but it should be noted on the remark column where
the client have attended the first ANC visit.

 Date of visit (Column 8): Write the date of the visit recorded in the same way as Last menstrual
period.

 Gestational age in weeks (GA) (column 9): Put the gestational age of the woman in weeks. Ges-
tational age of the pregnancy is calculated based on the Last menstrual period and should be re-
corded with DD/MM/YY format as already been mentioned.

 Fundal Height in cm (Column 10): Write the fundal height of the pregnant mother using centime-
ters.

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 Syphilis test result (R/NR/ND) (Column 11): Write “R” for women tested reactive for syphilis,
write “N” for women tested non-reactive for syphilis and if the test is not done, write ND to denote
not done. Women who received syphilis screening test service should be documented on the inte-
grated RH card. Syphilis affects the health of pregnant mothers and their fetus. It may cause abor-
tion, still birth, premature birth and congenital anomalies. Performing syphilis screening test to all
pregnant mothers who attend antenatal care helps to detect the disease early so that appropriate
treatment can be provided to protect the mother and the fetus from complications.

 Syphilis Treatment Given (Column 12): Tick (√) if syphilis treatment is given.

 Hepatitis test result (R/NR/ND) Column 13): Write R if the test result is reactive and write NR if
the test result is non-reactive. If the test is not done, please write ND to denote that the hepatitis test
was not done.

 Hepatitis treatment given (Column 14): This is to document if the woman is provided with hep-
atitis treatment by putting a tick (√) mark in the column.

 TT provided (dose number) (Column 15): Write the actual dose of Tetanus toxoid (TT) the wom-
an received. TT immunization is one of the preventive therapies provided to all pregnant mothers at
any visit of the ANC service. During the ANC visit, provide TT vaccination for pregnant mothers and
record the cumulative no. of doses the client received in this column as 1, 2, 3 ….

 Ferrous sulphate/Folic acid provided (Column 16): Write the amount of tablets provided during
ANC visit. Ferrous sulphate/Folic acid is one of the preventive therapies provided to all pregnant
mothers at any visit of the ANC service. We will indicate this service provision by putting the number
of tablets provided to the pregnant woman. If not provided, leave the column blank.

 Deworming provided (Column 17): Deworming is provided for pregnant women in the 2nd or 3rd
trimester of pregnancy. Tick (√) for women received deworming at 2nd or 3rd trimester pregnancy.

 MUAC (cm) (Column 18): Record the Mid Upper Arm Circumference (MUAC) result of pregnant
woman in cm.

3. HIV Assessment and Follow up Section (Columns 19-24): In this section, assessment of the preg-
nant woman for HIV and its follow up will be documented. It includes HIV test offering and linkage with
HIV services if the woman is tested positive. From this section, the HIV testing and counselling should be
reported to the PMTCT testing and PITC sections of HMIS report.

 HIV test accepted (Column 19): Put a Tick mark (√) if the woman accepted HIV test and tested for
HIV.

 HIV test result (P/N) Column 20): Write” P” if the woman is tested positive for HIV and write “‘N’ if
the test result is negative.

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 Target population Category (column 21): This is a column where the woman’s target group cate-
gory is identified. There are codes at the end of the page (as footnote) for each population category.
Choose the code and enter in the column. If the woman is not one of the MARPS groups, choose
code I (general population).

 HIV Test results received with posttest counseling (column 22): This is to indicate if the wom-
an received her test result after HIV counselling.

 HIV positives linked to PMTCT (column 23): Tick (√) if the woman is positive and linked to PMTCT.

 Known HIV positive (transferred from ART) (Column 24): Tick this column if the pregnant wom-
an is known positive who is transferred from ART for ANC care/

4. Partner Testing section (Columns 25-28): This section is to document HIV testing and its result for
partners of ANC clients.

 HIV test accepted (Column 25): Tick if the partner has accepted HIV testing

 Partner HIV Test result (P/N) (Column 26): Write P with red pen if the partner HIV result is positive
and write N if the partner result is negative.

 Partner’s target population Category (column 27): This is a column where the woman’s partner
target group category is identified. There are codes at the end of the page (as footnote) for each
population category.

 HIV Positive partner Linked to ART (Column 28): Tick (√) if the partner is tested positive and
linked to ART service.

5. Counselling Section (columns 29-32): This section is used to document about the different counsel-
ling services (other than HIV counselling) during pregnancy.

 Counseled on infant feeding (Column 29): Put a tick mark (√) if the woman is advised and coun-
selled on infant feeding.

 Identified and advised on danger signs (Column 30): Put a Tick (√) mark for a woman on whom
danger signs are identified and advice was provided during pregnancy. Mark by putting tick mark in
this column only if any danger signs have been identified and counselled accordingly. Note: - Some
of the danger signs for the mother during pregnancy are the following:- Severe fatigue; Severe ab-
dominal pain; Bleeding from the vagina; Fever; Unusual swelling of face/fingers/legs; Severe and
continued headache; Rapid or difficult breathing; Foul smelling vaginal discharge; Convulsions/fits;
Loss of consciousness; Blurred vision

 Counselling on family planning (Column 31): Tick if the woman is advised on family planning
options to be used after delivery.

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 Nutritional Counseling provided (Column 32): Put a tick mark ( √) if the pregnant woman was
provided with nutritional Counseling (Example: Eat one extra meal every day, Eat variety and diver-
sified food, Deworming at 2nd or 3rd trimester ,Iron folic acid tablets every day minimum at least 90
days plus And Sleep under insecticide treated bed net).

6. Remark/Appointment/Action (Column 33): Write date of appointment and you may write any addi-
tional note which is not included in this registration book and any actions taken. For example we may
record the name of the facility received ANC 1st follow up at nearby facility and came to our health facil-
ity for the second visit. (Reason for leaving the first column blank)

3.1.3.1 ANC tally sheet

ANC tally sheet is used to simplify reporting of ANC reportable data elements from the ANC register. It is
used to capture ANC 1st visits disaggregated by maternal age and gestational age. It is captures ANC 4th visit,
deworming, iron supplementation, syphilis and hepatitis screening and treatment.

How the tally is completed:

 Complete the name of woreda, facility, department, year and month at the top of the tally sheet.

 The first row is about tallying ANC first visit in the first 16 weeks of gestational age disaggregated by
maternal age. In the second row, tally ANC first visit of gestational age greater than or equal to 16 weeks
disaggregated by maternal age. In the third row of ANC first visit, record the total number of tallies under
each maternal age groups.

 In the ANC 4th visit, tally for each maternal age group.

 In the Women received Iron (IFA) 90+ row, tally for each maternal age group.

 In the same token, please make a tally for the other data elements such as for deworming, syphilis
screening, syphilis treatment, hepatitis screening and hepatitis treatment. The total count should be
recorded at the last column in number.

3.1.3.2 Pregnancy test tally

Pregnancy test tally sheet is used to simplify reporting of laboratory tests for pregnancy and the result of
their test. Pregnancy test tally sheet should be used to capture women tested for pregnancy that are dis-
aggregated by age and by test result. The age categories are: 10-14 years, 15-19 and greater than years 20
years.
How the tally is completed:

• Complete the name of woreda, facility, department, year and month at the top of the tally sheet.

• For each women tested, tally to the corresponding age category and the count should be put in the
“count” column. The tally should be done using a “/” mark for a single client in the first row.
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• For each women tested and HCG result were positive, tally in the next row to the corresponding age
category.

Reportable data elements from ANC register

Please look at the bottom of the ANC register to identify some of the reportable data elements from this
register. For ANC related services, we need to use ANC service tally sheet to capture the reportable data
elements from ANC register. For HIV testing related reports (Both the woman and her partner), a PITC tally
sheet should be used to compile HIV testing and test result report disaggregated by age and population
category.

This first ANC attendant data (Column 7) is used as an input for the calculation of first ANC care coverage in
the catchment population of the respective facility. The fourth ANC care follow up is aggregated by using
ANC service tally sheet for convenience (Please look at the ANC service tally sheet); this data is used for
calculation of the ANC fourth care coverage.

The following are reportable data elements from the ANC register:

1. Number of pregnant women that received ANC first visit disaggregated by maternal age (Disaggregated
by age as 10-14, 15-19 and 20+)

2. Number of pregnant women that received ANC first visit disaggregated by gestational age (Disaggregat-
ed by gestational age as <16weeks and >=16 weeks)

3. Total number of pregnant women that received four antenatal care visits (Disaggregated by age as
10-14, 15-19 and 20+)

4. Total number of pregnant women who received Iron folate at least 90+, disaggregated by age

5. Number of pregnant women dewormed

6. Total Number of pregnant women tested for syphilis

7. Total Number of pregnant women tested for syphilis with Reactive Test result

8. Total Number of pregnant women tested for syphilis with Non-Reactive Test result

9. Total number of syphilis Reactive pregnant mother treated for syphilis

10. No. of pregnant women attending antenatal care tested for hepatitis

11. No. of pregnant women attending antenatal care tested Reactive for hepatitis test

12. No. of pregnant women attending antenatal care tested Non-Reactive for hepatitis test

13. No. of pregnant women attending antenatal care tested reactive and treated for hepatitis

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14. Number of pregnant women tested for HIV and know their result during pregnancy

15. Number of women with known HIV positive status attending ANC linked from ART

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

17. Number of partners of pregnant ,laboring and lactating women tested for HIV and know their results

Indicators to be computed from ANC register are

1. Antenatal care coverage – First visit (The proportion of women that received antenatal care at least once
during the current pregnancy)

2. Antenatal care coverage – four visits (The proportion of women that received antenatal care four or
more times during the current pregnancy.

3. Percentage of pregnant women attending antenatal care clinics tested for syphilis.

4. Percentage of pregnant women who were tested for HIV and who know their results during pregnancy,
labor and delivery and post-partum period

Summary on ANC register

ANC register is a longitudinal register that should be kept at ANC service delivery unit, filled by the respec-
tive care provider and the data for the report is gathered on monthly basis by the HMIS focal person from
the data on the ANC service tally. The health care provider at the department has the responsibility to ensure
that the standardized recording procedures have been followed and the data should be counterchecked
between the register and the ANC service tally being used at the department for each month.

The analysis of the ANC service indicators should be made on regular basis and should be displayed by
using appropriate charts to establish good Monitoring and Evaluation system of the program. The respon-
sibility of analyzing the ANC indicators, preparing and updating of the display charts and presenting the
information for the performance monitoring team for informed decision making falls on the HMIS focal per-
son or the health information technician hired for this purpose in the facility. Please look at the Information
use and data quality manual for further reading.

3.1.4 DELIVERY REGISTER

Topics covered

 Introduction to delivery register

 Procedures of completing delivery register
 Reportable data elements from Delivery register
 Indicators calculated from delivery register
 Summary of delivery register

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Objectives

 To describe the purpose of the delivery register

 To record the required delivery service data elements from delivery register
 To identify & be able to extract the reportable data elements from the delivery register
 To identify, compute and describe HMIS indicators from reportable data elements captured from deliv-
ery register
Time needed: 1:30 hour

Introduction

Delivery register is a serial register used to capture data elements for comprehensive maternal and new
born services provided at the delivery unit. It lists all clients who gave birth at the facility. Information for
the register is abstracted from the integrated RH card. Integrated RH card is completed at the time of service
and then abstracted data elements will be transferred to the delivery register afterwards, in the same day
of service delivery. The register should be kept in the delivery or MCH unit to capture the data elements
required from delivery and related services. Each care provider have the ethical and moral obligation to
record the data on the register. The register includes summary information for calculation of indicators
related to delivery. If twin or triple delivery occur, we have to use consecutive rows for each newborn.

How to complete the delivery register

The cover page

 The cover page contains the Federal ministry of health logo to denote that the register is being used in
all public and private facilities found under FMOH.

 In the Middle of the cover page is the level of health facilities intended to use this register and the name
of the register itself.

 The third component of the cover page is the part in which the care provider ought to record the facili-
ty’s Region, Sub-city/Woreda, Health facility name, and beginning and end date of the register.

 All the above data are crucial for the use of the register appropriately in the facility and needs to be
recorded before starting to use the register by the care provided with legible hand writing. If more
than one department is available in the facility providing the service we can denote this by writing
identifying note at any open space on the cover of the register with parker or bold hand writing such as
delivery unit #1, delivery unit #2.

 The instruction part is found in the inside part next to the cover. It contains all the basic procedures how
to use the delivery register appropriately. Before using any register, all care providers are required to
read the procedures thoroughly.
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The main part of the register and its recording and reporting procedures

Delivery care register is serial register printed on A3 size sheet in Landscape alignment with two pages;
right and left page.

1. Identification section (Columns 1-5): This section is a personal identification section that includes
demographic characteristics of the woman.

 Serial Number (Column 1): Write sequential serial number in the registration book. This column
is just to show the sequence of the clients visiting the facility.

 MRN (Medical record number) (Column 2): Write/copy the Medical Record Number (MRN) from
the client’s individual folder.

• Name of the mother (Column 3): Write the name of the mother who delivers in the health facility
and it should be recorded in legible hand writing.

• Age (Column 4): Write age of the mother in years.

• Kebele (column 5): This is a place where we write the address of the mother (Kebele information)

2. Labor and maternal outcome section (Column 6-14): In this section, you find information about the
mode of delivery and maternal status. It includes the following data elements:

• Delivery date and time (Column 6): Write date and time the client delivered written as (E.C.). DD/
MM/YY- 00:00 The date of the delivery (after expulsion of the placenta) in Ethiopian calendar & in
DD/MM/YY format as usual and the time should be recorded just next to the date in HH:MM format
in the same column.

• SVD (spontaneous vaginal delivery) (Column 7): Put a Tick mark if the delivery is spontaneous
vaginal delivery.

• Caesarean section (Column 8): Put a Tick mark if the delivery is by a caesarean section.

• Forceps / Vacuum Extraction (Column 9): Put a tick mark if the delivery is by a forceps or by a
vacuum extraction.

• Episiotomy (Column 10): Tick if the delivery supported by episiotomy.

• Other procedures (Column 11): Tick if the delivery is by other procedures than mentioned above.
If the delivery assisted with either Ergometrine, Oxytocine, Misoprostol and/or if a mix of them and
or use a mix of Forceps / Vacuum Extraction and/or Episiotomy delivery procedures.

• Maternal status Section (Column 12-14):- reserved for maternal condition and indicate by a tick
mark in each respective column. The maternal status after delivery could be stable or unstable/
deteriorated and referred or died.
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3. Obstetric complications section (Column 15-20):- indicate by a tick mark in each respective col-
umn with the specified type of complication. The complications include: pre-eclampsia, eclampsia,
Antepartum Hemorrhage (APH), Postpartum hemorrhage (PPH) and other complications. If the moth-
er had obstetric complication and referred to another facility, put a tick mark in column 20.

4. Newborn outcome section (Column 21-27):- This section is used to record newborn outcomes.

• Alive (Column 21): Put a tick mark if the newborn is alive at birth.

• Apgar score 1’/5’ (Column 22): Enter Apgar score at the 1st and 5th minutes, written as 1’/5’ (The
Apgar score should be recorded at first and fifth minute out of 10).

• Sex of the new born (Column 23): Enter M for male, F for female.

• Weight of newborn in grams (Column 24): Enter weight of newborn only in grams for the pur-
pose of standardization (Don’t record the weight in kilograms).

• Still birth (Column 25): This section is filled if the delivery is a still birth (dead born). Write 1 if the
still birth is fresh or write 2 if the still birth is macerated.

• Live birth, died before arrival at facility (Column 26): Put a tick mark if the born alive but died
before arrival at facility.

• Live birth, died after arrival or delivery in facility (Column 27): Tick if born alive but died after
arrival or delivery in facility. Total newborns should be reported as the sum of column 26 and 27.

5. Newborn Conditions section (Columns 28-33): This section is used to identify the newborn’s MRN
and to record (by putting a tick mark) whether we provide Vitamin K, TTC eye ointment, Chlorhexidine,
BCG and OPV 0 in the respective columns.

6. Maternal HIV+ care and follow up Section (Columns 34-42): In this section, we record HIV testing
and counselling service and linkage with HIV services if the mother is tested positive for HIV.

• HIV testing accepted (Column 34):-indicate by a tick mark if client is tested for HIV.

• HIV re-testing accepted (Column 35): Tick ( √) if the mother has already been tested and knew
her status and accepts re-testing for HIV during her current visit

• HIV test result (P/N) (Column 36): Write P in red pen if the test result is positive, write N in normal
color if the result is negative.

• Known HIV positives (transferred from ART) (Column 37): Tick this column if the mother is a
known HIV positive and transferred from ART.

• Target population Category (Column 38): Choose one of the population category that is avail-
able as footnote.
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• HIV positive delivery linked to PMTCT (Column 39): Write 1 if the mother is linked to PMTCT in
the same facility or write 2 if the mother is linked to PMTCT from other facility PMTCT.

• Counseled on feeding options (Column 40): Tick if the mother is counseled on feeding options
for HIV positives. This part should be ticked even though the mother does not reach on decision but
only for providing the counseling on feeding options.

• Mother’s ART Regimen (Column 41): Write mother’s regimen based on the code available at the
end of each page in the register.

• Newborn NVP for 6 weeks or 12 weeks (Column 42): Write 6 or 12 weeks if the newborn is given
NVP.

7. Partner testing section (columns 43-46)

• Partner’s HIV testing accepted (Column 43): Tick if the partner/husband accepted testing for
HIV.

• Partner HIV test result (P or N) (Column 44): Write P if the test result is positive, write N if the
result is negative.

• HIV Positive partner Linked to ART (Column 45): Tick if the partner is positive and linked to ART.

• Target population category(Column 46): select one of the listed categories at the footnote that
fits for the partner

8. Immediate Post-partum family planning (IPPFP) section (column 47-49): If the mother was pro-
vided with a family planning method within 48 hours after delivery, write the type of contraceptive pro-
vided in the column and tick on new or repeat acceptor column (Refer the FP register section for the
definition of new and repeat acceptor).

9. Problem identified on the newborn (columns 50-55): Indicate the presence of the specified health
problems with a tick mark (√). The problems could be immaturity, sepsis/VSD, respiratory distress/as-
phyxia, low birth weight or congenital malformation. If other problems are identified, please specify it
by writing in the column.

10. Breast feeding initiation time (Column 56): Write the time of breast feeding initiation by choosing
the codes available as footnotes in the register (<1, 2-3, >3hours).

11. Treatment and outcome (columns 57-59): Tick column 57 if the newborn was provided with oxy-
gen/resuscitated. If the newborn survived after resuscitation, tick column 58, or if the newborn died,
tick column 59. If the newborn died, write the age of death (in hours or days) on column 60.

12. Cause of death (column 61): If the newborn died, the cause of death should be recorded in column
61: The cause of death should be selected from the list available in the register.
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13. If alive, birth notification given for the mother (Column 62): Tick if the mother given information
about birth notification.

14. Managed by (Column 63):- Name of the care provider (clinician) who provided the service should be
documented in this column.

15. Remark (Column 64):- We can record any information we feel necessary to record.

Reportable data elements from delivery care register

Please look at the bottom of delivery register. You will find boxes which are used to enter sum of report-
able data elements that are reportable and used as input for indicator calculation from delivery register.
After counting the number of clients per each page, fill the boxes at the bottom of the register. The report-
able data elements from this register are the following:

1. Number of births attended by skilled health personnel

2. Number of deliveries by cesarean section

3. Number of institutional maternal deaths

4. Number of live births

5. Number of still births

6. Total number of newborns weighed

7. Number of newborns whose weight is less than 2500gms

8. Number of early neonatal deaths

9. Number of women who received HIV test (disaggregated by age)

10. Number of women tested HIV positive (disaggregated by age)

11. Total IPPFP acceptors, disaggregated by age and contraceptive methods

12. Number of neonates treated for birth asphyxia & survived

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Indicators that can be computed using data from this register are

• Proportion of births attended by skilled personnel

• Caesarean section rate

• Proportion of maternal (institutional) death

• Still birth rate (institutional)

• Early neonatal death rate (institutional)

• Proportion of asphyxiated neonates who were resuscitated (with bag & mask) and survived

• Percentage of Low birth weight newborns

• Percentage of pregnant women who were tested for HIV and who know their results during preg-
nancy, labor and delivery and post-partum period

For further information on the indicators and evidence based decision making, please look at the HMIS
Indicator reference guide and information use and data quality modules.

Summary

Delivery register is kept at delivery department, filled by the respective care provider and the data for the re-
port is gathered on monthly basis by directly copying the sum of the data element at the end of each page.
The health care provider at the department has the responsibility to ensure that the standardized recording
procedures have been followed.

The analysis of the delivery service indicators should be made on regular basis and should be displayed by
using appropriate charts; to establish good Monitoring and Evaluation system of the program. The respon-
sibility of analyzing the delivery indicators, preparing and updating of the display charts and presenting
the information for the performance monitoring team, for informed decision making falls on the HMIS
focal person or the health information technician hired for this purpose in the facility. Please look at the
Information use and data quality module for further reading.

Exercise on Delivery Register

W/ro Lemlem Shemsu, who has been an ANC client at Wolkite health center with an MRN of 02332 came
to the health center on 22/04/2010 EC since she has a labor pain. The labor started 10 hours back. Her
LNMP was on 20/07/2009. She was examined and investigated: Her weight is 60 kg; her height is 168 cm,
BP 110/60, Blood type O +ve, and also tested for HIV but negative. She gave SVD to a high active male baby
(Apgar score of 8 & 10 in 1st and 5th minute) weighing 2400gm after 6 hours of admission. She was registered
as the 120th mother in your delivery register and her new born was assigned an MRN of 23456 and time
specific antigens were given by the attending nurse. Her condition was stable after delivery.

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Answer the following questions and discuss the answers

1. Fill the delivery register accordingly

2. Assume W/ro Lemlem had post-partum hemorrhage (PPH) for which she was treated in the health
center, how would her record be filled in the register? What if she had PPH and referred to another
facility?

3. List reportable data elements and their corresponding columns (in the register) by referring to the
above case.

3.1.5 POSTNATAL (PNC) REGISTER

Topics covered

 Introduction to PNC register

 Procedures of completing PNC register

 Reportable data element from Delivery register.

 Indicators calculated from PNC register

Objectives

 To describe the purpose of PNC register

 To record the required PNC service data elements in the PNC register.

 To identify and able to extract the reportable data elements from the PNC register.

 To identify and compute indicators using PNC reportable data elements.

Time needed: 45 minutes

Introduction

Postnatal (PNC) register and its recording and reporting procedures used for public and private health facil-
ities (Health center, Clinic and Hospital) will be detailed in the following section.

PNC care is a care given to a woman within 42 days after they gave birth, irrespective of the time at their
first visit. The first 7 days after delivery, however, is the most critical period when the majority of maternal
and newborn deaths occur. As a result, it is recommended to give special attention to the first seven days
after delivery. The first seven days of PNC is further disaggregated as: PNC in the first 24 hours; PNC within
1-2days (25-48 hours) after delivery, PNC from 2 to 3 days (49hrs to 72 hrs) and PNC from 73 hours to 7th day
after delivery.

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The PNC register lists all clients who gave birth at the facility. It captures clients receiving postnatal services
at the health facility. One main row has five sub rows; each sub row is used for one visit. Information for the
register is abstracted from the integrated RH card (the postnatal section). The register includes summary
information for PNC related reportable data elements. The register is kept in the postnatal room.

How to complete the postnatal care register

The cover page

 The cover page contains the FMOH logo to denote that the register is being used in all public and private
facilities found under FMOH.

 In the middle the level of health facilities intended to use this register and the name of the register itself.

 The third component of the cover page is the part in which the care provider ought to record the facili-
ty’s Region, Sub-city/Woreda, Health facility name, and beginning and end date of the register.

 All the above data are crucial for the use of the register appropriately in the facility and needs to be
recorded before starting to use the register by the care provided with legible hand writing. If more than
one department is available in the facility providing the service we can denote this by writing identifying
note at any open space on the cover of the register with parker or bold hand writing. Like Postnatal care
unit #1, Postnatal care unit #2.

The instruction

The instruction part is found in the inside part next to the hard cover. It contains all the basic procedures
how to use the delivery register appropriately. Before using any register, all care providers are required to
read the procedures thoroughly.

The main part of the register and its recording and reporting procedures

PNC register is a longitudinal register and printed on A3 size sheet. Recording procedure of PNC register is
as follows:

1. Identification Section (columns 1-9): This is a section that is used to identify both the mother and
the newborn

 Serial Number (Column 1) - this column is just to show the temporal sequence of the clients vis-
iting the facility for the specific care. It should be filled with starting from positive whole number (1,
2, and 3….up to the end of the register).

 Name of mother (column 2): This is to record the name of the mother

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 Mother’s MRN (Column 3): is a five or six digit number given to the client in the medical record
department at the initial encounter of the client at the facility. This is uniquely identifying number
for the client from other clients as long as he/she visits the one specific facility.

 Mother’s age (Column 4):- Write the age of the mother in years

 Woreda/Kebele (column 5): Write the address of the mother (Name of Woreda and/or kebele)

 Infant’s data of birth (Column 6):- Write the date of birth of the newborn in Ethiopian calendar in
two digit format as DD/MM/YY.

 Place of delivery (column 7): write the place of delivery of the newborn using the codes available
at the footnote of the register.

 Infant”s MRN (Column 8):- Filled with the same way as above

 Sex of the baby (Column 9):- Write the sex of the newborn as F or M.

2. PNC Visits Section (Column 10 and 11): This section includes visit Period (column 10) and visit date.
Based on the corresponding time period the woman came after delivery, write the date in front of the
five time periods described in the register. If she came within 24 hours after delivery (Or if the mother
stayed in the facility for 24 hours after delivery), then write the date corresponding to the row that says
“in 24 hours”. In the same token, if she came between 49 hours and 72 hours, then write the date in front
of this time category. Fill the other rows accordingly.

3. Maternal Health Status (column 12): Write code after assessing the status of the mother as : 1= Nor-
mal, 2=Complicated and managed, 3= Died, 4= Complicated and referred

4. HIV assessment Section (Column 13-18): This section is for HIV testing and counselling and its result.
It should be completed as follows:

 HIV testing performed (Column 13):-indicate by a tick mark if the client is tested for HIV.

 HIV test result (P/N) (Column 14): Write P in red pen if the test result is positive, write N in normal
color pen if the result is negative.

 Target population Category (Column 15): Choose one of the population category that is avail-
able as footnote.

 HIV Posttest counselling (Column 16): Tick if the mother was provided with a posttest counsel-
ling service.

 HIV Positive linked to ART (Column 17): Tick this column if the mother is tested HIV positive
during the PNC service and linked to ART service in the facility or to another facility providing ART
service.

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 Known HIV positives (transferred from ART) (Column 18): Tick if the mother is known HIV pos-
itive and is linked to postnatal service during the PNC period.

16. Partner testing section (columns 19-22): this section is completed if the PNC client’s partner came
and tested for HIV. The columns are completed in the same way as in the other registers described pre-
viously.

17. Counselling section (Columns 23-26): These columns are completed by a tick mark if the woman
was counselled on FP, EPI, danger signs, nutrition & cord care in the respective columns.

18. Newborn assessment (Columns 27-33)

 Fill the weight of the newborn in grams in column 27

 Tick column 28 if the newborn is breast feeding at the time of the PNC visit.

 Column 29: If any problem is identified on the newborn, choose one of the complications coded in
the register. The problems are coded as: 1= Normal, 2= Prematurity, 3= Sepsis/VSD, 4= Respiratory
distress, 5= perinatal asphyxia, 6= Low birth weight and 7= congenital malformation. If the identified
problem is not available in the list, please specify.

 Treatment given (Column 30): Write the type of treatment given for the identified problem (using
codes that are listed in the column). The treatment options are coded as follows: 1= Oxygen resus-
citation; 2= Kangaroo mother care (KMC); 3= antibiotics; 4= Chlorhexidine; 5= Blood transfusion and
6= others (Specify the treatment if it is other than the coded treatment types).

 Treatment outcomes (Column 31): This is a column where we record the treatment outcome for
newborns for whom treatment have been provided. Choose the treatment outcomes coded in the
column. The outcome options are coded as: 1= Improved; 2= No change; 3= Died; 4= Referred; 5=
Unknown; 6= Resuscitated and survived.

 Age at death (Column 32): If died, write the age of death on column 32.

 Cause of death (column 33): Write the cause of death from the codes available: 1= Prematurity; 2=
Infection; 3= Asphyxia and 4= others (to be specified).

19. Immediate Post-partum family planning (IPPFP) section (column 34-36): If the mother was pro-
vided with a family planning method within 48 hours after deliver, tick the type of acceptor as new or
repeat and write the type of contraceptive provided in column 36 (use codes that are available at the
bottom of each page).

20. Managed by (Column 37):- Name of the care provider (clinician) who provided the service should be
documented in this column.

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21. Remark (Column 38):- We can record any information we render being necessary to record or next
appointment of the client

Reportable data elements from PNC register

At the end of some columns in the register, there are boxes to sum up the reportable data elements from the
PNC register for that specific page. The total monthly report should be the sum of all the total pages for that
specific reporting month. The following are the reportable data elements from the PNC register:

1. Number of postnatal visits within 7 days of delivery (disaggregated by period)

2. Number of institutional maternal death

3. Number of pregnant women who were tested for HIV and who know their results during pregnancy, labor
and delivery and post-partum period

4. Number of women tested positive for HIV

5. Number of neonatal deaths in the first 24 hrs of life/institutional/

6. Number of neonatal deaths between 1-7 days of life/institutional/

7. Number of sick young infants 0-2 months treated for sepsis

8. Total IPPFP acceptors, disaggregated by age and contraceptive methods

9. Number of newborns weighing <2000gm and/or premature newborns for which KMC was initiated

10. Number of neonates treated for birth asphyxia and survived

Indicators to be calculated from this register are

1. Early postnatal care coverage

2. Institutional maternal death

3. Percentage of pregnant women who were tested for HIV and who know their results during pregnancy,
labor and delivery and post-partum period

4. Early institutional neonatal death rate

5. Proportion of Sick Young infants treated for sepsis/VSD (Very Severe Disease)

6. Proportion of low birth weight or premature newborns for whom KMC was initiated after delivery

7. Proportion of asphyxiated neonates who were resuscitated (with bag & mask) and survived

Please refer to the HMIS Indicator reference guide for further information about the indicators from the PNC
register.
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3.1.6 PMTCT REGISTER

Topics Covered

 Introduction to PMTCT register

 Procedures how to complete PMTCT register

 Reportable data element from PMTCT register

 Indicators calculated from PMTCT register

 Summary of PMTCT register

Objectives

 To describe the purpose of the PMTCT register

 To properly record the required PMTCT data elements on PMTCT register

 To identify and able to extract the reportable data elements from the PMTCT register

 To identify and be enable the computation of PMTCT indicators from PMTCT register

Time needed: 1:30 hour

Introduction

The PMTCT register is a longitudinal register. It is used to follow HIV positive pregnant and lactating women
and their HIV exposed infants. Based on Option B+ strategy, all HIV positive pregnant and lactating women
should start ART, irrespective of their clinical stage and/or CD4 count. PMTCT register lists all clients who
received PMTCT services at the facility. Information for the register is abstracted from the RH card. The reg-
ister includes summary information for calculation of indicators related to PMTCT. The register is kept in
the PMTCT room.

How to complete PMTCT Register

The cover page

 The cover page contains the FMOH logo to denote that the register is being used in all public and private
facilities found under FMOH.

 In the middle is the level of health facilities that use this register and the name of the register itself.

 The third component of the cover page is the part in which the care provider ought to record the facili-
ty’s Region, Sub-city/Woreda, Health facility name, and beginning and end date of the register.

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 All the above data are crucial for the use of the register appropriately in the facility and needs to be
recorded before starting to use the register by the care provided with legible hand writing. If more
than one department is available in the facility providing the service we can denote this by writing iden-
tifying note at any open space on the cover of the register with parker or bold hand writing like PMTCT
unit #1, PMTCT unit #2.

The instruction

The instruction part is found in the inside part next to the cover. It contains all the basic procedures how to
use the PMTCT register appropriately. Before using any register, all care providers are required to read the
procedures thoroughly.

The main part of the register and its recording and reporting procedures

1. Identification Section (Columns 1-6): This section is used to record data elements that are used to
identify individual PMTCT clients. Basic demographic characteristics (Name and age), Unique ART num-
ber, MRN and booking date (date of registration) are recorded here.

2. Columns 7 and 8 are used to identify whether the PMTCT client started ART for the first time or whether
she has already known her HIV status (whether she started ART or not) before she came for ANC service.
Use column 7 to identify those who are newly diagnosed and started ART (at ANC, delivery or PNC ser-
vice points) and use column 8 to identify those who already knew their status.

3. ANC related data section (Columns 9-14): These columns are where ANC related data elements are
filled. It includes recording LNMP, EDD, gestational age in weeks, Ferrous Sulfate/Folic Acid Provision,
syphilis screening result and selection of infant feeding options. The filling procedure is already dis-
cussed on the ANC register section.

4. Delivery related data section (Columns 15-19): Record delivery related data elements under these
columns. It includes recording delivery date, sex of Infant, and place of delivery, delivery outcome (as
live birth or still birth) and whether ART was received by the mother during L&D. The completing proce-
dure is already discussed on the delivery register section above.

5. Family planning Section (Column 20-23): This section is used to record data for women who received
contraceptive counselling and contraceptive methods during PMTCT follow up period. On column 20,
write yes if the woman was counselled on FP, otherwise, write no. Columns 21 and 22 are used to iden-
tify whether the woman is new or repeat contraceptive acceptor (Tick on the appropriate column). In
column 23, write the type of contraceptive the mother was provided, filled based on the abbreviation
at the bottom of each page.

6. Partner HIV testing section (column 24-27): This section is used to document whether partners are
tested and its test result. On column 24, tick if the partner accepted HIV testing, on column 25, write the
test result as P or N (Positive or negative), or ND if partner testing was not done. On column 26, select

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the target population category by selecting one of the listed population categories. If the partner is HIV
positive and linked to ART service, tick column 27.

7. Maternal HIV care section (column 28-36): These columns are filled whenever applicable only. It
includes: TB symptom screening (write P for positive screening result, N for negative screening result
and ND if screening was not done); on column 29, write the date on which INH prophylaxis was started
(if provided); on column 30, write the date TB treatment was started if the woman was diagnosed for
TB on the upper section and the unit TB number in the lower section of the row. In column 31, write the
value of initial CD4 count if done otherwise write ND if it was not done. On column 32, write the WHO
clinical stage as I or II or III or IV. On column 33, write yes if maternal CPT was started, if not write no. In
column 34, write the date on which ART was initiated. In column 35, write the code of initial ART regimen
by choosing the codes available at the bottom of the register. In column 36, write the result of viral load
test at entry to PMTCT as <1000 /ml (undetectable) or >=1000/ml.

8. HIV exposed infant follow up section (column 37-45): These columns are used to follow HIV ex-
posed infants. Follow the instructions on the register on how to fill these columns. In column 37, write
the infant’s MRN. In column 38, write the date of enrollment of the HIV exposed infant to PMTC. In col-
umn 39, write 1 if the infant received NVP for 6 weeks or 2 if the infant received NVP for 12 weeks or 3 if
the infant has not received NVP at all. In column 40, write the date on which the infant received NVP as
DD/MM/YY. In column 41, write the infant feeding options selected for infant feeding with in the first 6
months as EBF if exclusive breast feeding was practiced; ERF if exclusive replacement feeding was prati-
ced or MF if mixed feeding was practiced. In column 42, write the age in weeks when CPT was started.
In column 43, write of the age of the infant (in months) on which DNA/PCR test was done. In column 44,
write the result of DNA/PCR test as P for positive result or N for negative result. In column 45, write the
result of rapid HIV antibody test at 18 months of age as P for positive result or N for negative result.

9. Remark column (column 46): This section is used to write any relevant information regarding the
mother and/or the exposed infant.

10. Mother and infant COHORT follow up section (column 47-87): Write the regimen the mother is tak-
ing in each month in the mother row. For data elements related with “Infant status”, there are two rows
(NVP and CPT). Write NVP for 1st month of life and CPT after 1st month of life whenever the infant was
given NVP and/or CPT. Write “TO” if the infant is Transferred Out to other facility; Write LTF if the infant is
lost to follow up; write D for Known Dead. Write DN for Discharged negative infants. At months 6, 12, 18,
24 and 30, additional assessment results should also be documented (MUA, CD4 count and viral load).
In the lower sections, summary of maternal PMTCT cohort outcomes and HEI PMTCT outcomes will be
documented. Count the total number of mothers alive and on ART; total lost to follow up, Transferred
out, viral load >=1000 copies, total malnourished and number of deaths for maternal outcomes. For HIV
exposed infant outcomes, write the total count of still on breast feeding and on CPT; total lost to follow
up, infants discharged negative after antibody test; Number of positives, number of infants transferred
out, number of malnourished or underweight for age HEI, number of deaths.
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2.1.6.1 PMTCT tally sheet

PMTCT tally sheet is used to simplify reporting of PMTCT reportable data elements from the PMTCT regis-
ter. We have to use the PMTCT tally sheet to easily capture reportable data elements that are listed below.
Please refer to the PMTCT tally sheet on the annex section to understand the disaggregation type for each
data element.

Reportable data elements from PMTCT register

1. Number of HIV positive pregnant women who received ART to reduce the risk of mother to child trans-
mission during ANC for the first time
2. Number of HIV positive Pregnant women who received ART to reduce the risk of mother to child trans-
mission (MTCT) during labour and delivery for the first time
3. Number of HIV positive Pregnant women who received ART to reduce the risk of mother to child trans-
mission during PNC for the first time
4. Number of known HIV-positive women who get pregnant and linked to ANC/PMTCT
5. Number of known HIV-positive women who get pregnant while on ART and linked to ANC/PMTCT
6. Number of HIV exposed infants who received an HIV test 0- 2 months of birth (Disaggregation: Negative,
Positive)
7. Number of HIV exposed infants who received an HIV test 2-12 months of birth (Disaggregation: Nega-
tive, Positive)
8. Number of infants born to HIV positive women started on co-trimoxazole prophylaxis within two months
of birth
9. Number of HIV exposed infants who received ARV prophylaxis (Disaggregation: For 6 weeks, For 12
weeks)
10. Number of HIV exposed infants receiving HIV confirmatory (antibody test) by 18 months (Disaggrega-
tion: HIV positive, HIV negative)
11. Total Number of partners of pregnant, laboring and lactating women tested and know their results.
12. Number of adults who are currently on ART by regimen type (Disaggregation: pregnant and non-preg-
nant)
13. Number of PLHIV who are documented as Lost/lost to follow up during the reporting period.
14. Number of adults and children with HIV infection newly started on ART.
15. Number of adults and children who are still on treatment at 12 months after initiating ART
16. Number of persons on ART in the original cohort including those transferred in, minus those transferred
out (net current cohort).
17. Total number of adult and pediatric ART patients with an undetectable viral load <1000copies/ml at 6
month

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18. Number of adults and children who initiated ART in the 6 months prior to the beginning of the reporting
period with a viral load count at 6 month visit
19. Total number of adult and pediatric ART patients with an undetectable viral load <1000copies/ml in the
reporting period
20. Number of adult and pediatric ART patients with a viral load test in the reporting period.
21. Number of PLHIV who were assessed/screened for malnutrition
22. Number of PLHIV that were nutritionally assessed and found to be clinically undernourished (disaggre-
gated by Age, Sex, Pregnancy and nutritional status)
23. Number of clients enrolled in HIV care who were screened for TB during the reporting period
24. Number of PLHIV women who are using modern family planning method

Indicators from PMTCT Register

 Percentage of pregnant, Laboring and lactating women who were tested for HIV and who know their
results

 Percentage of HIV-positive pregnant women who received ART to reduce the risk of mother-to
child-transmission (MTCT) during pregnancy, labour and delivery and PNC

 Proportion of HIV exposed Infants with Virological test

 Percentage of infants born to HIV-infected women who were started on co-trimoxazole prophylaxis
within two months of birth

 Percentage of infants born to HIV-infected women receiving antiretroviral (ARV) prophylaxis for PMTCT

 Percentage of partners of pregnant, laboring and lactating women tested for HIV during the reporting
month

 Percentage of HIV exposed infants receiving HIV confirmatory (antibody test) test by 18 months

Other Indicators which can be computed from the PMTCT Register

 Percentage of people living with HIV who know their status

 Percentage of people living with HIV receiving ART

 Percentage of patients on ART with a suppressed viral load (<1000 copies/ml) in the past 12 months
Early viral load suppression rate

 ART retention rate

 Number of adults and children with HIV infection newly started on ART

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 HIV screening for TB patients

 TB Screening for HIV positive Clients

 Latent TB infection (LTBI) treatment for HIV positive clients newly enrolled to care

 Anti-Retroviral Therapy (ART) for HIV positive TB patients

3.1.7 COMPREHENSIVE ABORTION CARE REGISTER

Topics Covered

 Introduction to comprehensive abortion care (CAC) register

 Procedures of completing CAC register

 Reportable data elements from CAC care register

 Indicators calculated from the CAC care register

Objectives

 To describe the purpose of CAC register

 To properly record the required data elements from CAC service

 To identify and able to extract reportable data elements from the CAC register.

 To identify and calculate HMIS indicators using the CAC reportable data elements.

Time needed: 45 minutes

Introduction

CAC register is used to document safe abortion and post abortion care services. It is a case/serial register
where one row is used once for a single patient/client. It lists all clients who received CAC services at the
facility. Information for the register is abstracted from the woman’s card. The women card and the CAC
register are both completed by the service provider at the time of service. The register is kept in the Com-
prehensive abortion care room.

How to complete the Comprehensive abortion care register

The cover page

 The cover page contains the Federal ministry of health logo to denote that the register is being used in
all public and private facilities found under FMOH.

 In the Middle the level of health facilities intended to use this register and the name of the register itself.
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 The third component of the cover page is the part in which the care provider ought to record the facili-
ty’s Region, Sub-city/Woreda, Health facility name, and beginning and end date of the register.

 All the above data are crucial for the use of the register appropriately in the facility and needs to be
recorded before starting to use the register by the care provided with legible hand writing. If more
than one department is available in the facility providing the service we can denote this by writing
identifying note at any open space on the cover of the register with parker or bold hand writing. Like
Comprehensive abortion care unit #1, Comprehensive abortion care unit #2.

The instruction

The instruction part is found in the inside part next to the hard cover. It contains all the basic procedures
how to use the Comprehensive abortion care register appropriately. Before using any register, all care pro-
viders are required to read the procedures thoroughly.

The main part of the register and its recording and reporting procedures

 Identification at registration section (Columns 1-4): This is to document basic demographic char-
acteristics of the woman who received safe or post abortion care services. Record the serial number,
date, MRN and age of the client in columns 1 to 4.

 Reproductive History Section (Columns 5-8): Gestational age should be documented in weeks in
column 5; write the gravidity in column 6; write the number of parity (births) of the woman in column 7
and the number of previous abortions in column 8.

 Type of abortion service (Columns 9-10): Identify the type of abortion service provided at the health
facility: If it is a safe abortion service, tick at column 9 or if it is a post abortion service, tick at column 10.

 Diagnosis/reason to conduct abortion (Column 11): Write the code at the bottom of the register to
indicate the reason for termination of pregnancy.

o For safe abortion cases, select one of the coded reasons for the services: 1=Rape, 2=incest,
3=maternal condition or 4= Fetal deformity

o For post abortion cases, select one of the coded diagnoses : A= incomplete abortion, B=inevita-
ble abortion, C=missed abortion or D=others

 Procedure used for uterine evacuation and its management (Column 12-16): Put a tick mark on
the appropriate option of procedure used (MVA or E&C or MA or D&C or if other, specify the procedure)

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 Management site (Column 17-18): Put a tick mark in the Out patient column if the procedure was
performed in an outpatient setting. If the procedure was performed in an inpatient setting, put a tick
mark in the “in-patient” column.

 Referral column (Column 19): Put a tick mark in this column if the patient/client was referred to indi-
cate that the abortion patient is referred for better care.

 Column 20: In this column, write the name of drug or anlgesics or anesthesia or sedetives on the upper
row and the dose in the lower row.

 Post abortion Contraception (Columns 21-25): Post abortion contraceptive counselling and provi-
sion is one of the most important services for women who have had abortion since fertility returns as
early as 2 weeks after abortion. In these columns, record the data elements related to FP counselling
and the type of FP method provided as per the instruction. Tick column 21 if she is counselled. Tick
22 if she expressed desire for FP, tick either column 23 or column 24 based on the type of acceptor the
mother is. On column 25, write the type of contraceptive provided.

 HIV assessment section (Column 26-30): This is a section where we record HIV testing and counsel-
ling service and the result of the test. The data elements are similar to the HIV assessment sections that
are discussed in the other registers previously.

 Outcome section (Columns 31-32): Document the outcome of the abortion care service in these col-
umns. In column 31, write the type complication if the woman had complication, otherwise write no. If
the woman died, it should be ticked under column 32.

 Columns 33 and 34: In column 33, put a tick mark if other service or treatment is provided. Write the
type of treatment in column 34 as: 1 for counselling; 2 for screening; 3 for diagnosis and treatment of
other sexual and reproductive health needs.

 Remarks column (Column 35): write any relevant information in this column

 Name and signature column (column 36): In this section, write the name and signature of the service
provider.

2.1.7.1 Abortion Care tally sheet

Abortion care tally sheet is used to simplify reporting of abortion service related reportable data elements
from the comprehensive abortion care register. We have to use this tally sheet to easily capture reportable
data elements that are listed below. Please refer to the abortion care tally sheet on the annex section to

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understand the disaggregation type for each data element. The tally sheet helps us to capture safe and
abortion care services disaggregated by trimester and maternal age. The trimester disaggregation is <12
weeks and >=12 weeks. The maternal age disaggregation is as: 10-14 years, 15-19 years, 20-24 years, 25-29
years and 30+ years for both safe and post abortion care services.

Reportable data elements from the comprehensive abortion care register

1. Number of safe abortions performed (disaggregated by age as: 10-14, 15-19, 20-24, 25-29, 30+).

2. Number of post abortions performed (disaggregated by age as: 10-14, 15-19, 20-24, 25-29, 30+)

3. Number of women receiving comprehensive abortion care in the first trimester

4. Number of women receiving comprehensive abortion care in the second trimester

5. PITC report: number of HIV tests performed

6. Number of Positive HIV tests

7. Number of maternal deaths (institutional)

8. Number of new and repeat family planning acceptors

Indicators from abortion register

 Number of women receiving comprehensive abortion care service

 Institutional maternal deaths

Other Indicators from abortion register

 Percentage of people living with HIV who know their status

 Contraceptive acceptance rate

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2.1.8 INTEGRATED RH REGISTER FOR PRIMARY PRIVATE CLINICS

Integrated RH register is used to document data of four main services in one; namely, family planning, ANC,
delivery and postnatal services. It is designed to be used by primary private clinics only. The register is
divided into four sections: Family planning, Antenatal Care, Delivery and Postnatal Care section.

Note: This register is to be used by primary private clinics only.

Family planning section of the RH register (for primary clinics only)

 This section of the integrated RH register is used to document family planning service (contraceptive
methods provided) at the primary clinic.

 The information required to complete the family planning section of integrated RH register is obtained
from woman’s card.

How to record data in the register?

 Please look at the Family Planning section of the RH Register at the annex section of this manual.

 The data elements are similar to FP data that we have seen in the previous sections (FP register section
above). Please refer to Family planning register above.

Antenatal care section of the RH register (for primary clinics only)

 The ANC section of the RH register is a longitudinal section, where a single row is for follow up of one
pregnancy at a primary private clinic.

 It lists all clients enrolled in antenatal care at your facility and will enable you to follow the pregnant
mother throughout her pregnancy.

 The RH register is completed by the service provider at time of service provision.

 Information for the register is abstracted from the integrated RH card.

 How to Record Data in the Register? Look the register at the annex section of this manual and refer
to the ANC register completing procedure for details.

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Delivery care section of the RH register (for primary clinics only)

 This section is used to record delivery and its outcome data

 The purpose of this section is to determine: skilled delivery attendance & other related indicators listed
on the indicator definition manual.

 Information for the register is abstracted from the integrated RH card.

 The completing procedure of this section is similar to what we discussed in the delivery register above.
Refer to the delivery register above.

Postnatal care sections of the RH register (for primary clinics only)

 The purpose of this section is to record PNC related data elements

 The postnatal section lists all clients receiving postnatal services at the health facility. One main row has
five sub rows; each sub row is for one visit.

 Information for the register is abstracted from the individual RH card.

 Refer to the PNC register above to understand the completing procedure of this section of the integrat-
ed RH card.

3.1.9 PREGNANT AND LACTATING WOMEN (PLW) SCREENING REGISTER

Topics Covered

 Introduction to PLW screening Register

 Procedure of completing PLW screening register

 Reportable data elements from the PLW screening register

 Indicators calculated from the PLW screening register

 Summary of the PLW screening register

Objectives

 To describe the purpose of the PLW screening register

 To properly record the required data elements from PLW screening service

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 To identify and able to extract the reportable data elements from PLW screening register

 To identify and calculate HMIS indicators using the PLW screening reportable data elements

Time needed: 30 minutes

Introduction

PLW Screening register is used to record information regarding screening of pregnant and lactating wom-
en for acute malnutrition. Nutritional screening for Pregnant and lactating women should be done on a
monthly basis to monitor the nutritional status of women and provide nutritional counselling and other
services accordingly.
How to complete the PLW screening register

1. Identification Section (Columns 1-8): In these columns, the personal identification related data el-
ements are recorded. The data elements include Serial number, MRN, Full Name, Woreda, Kebel, Gott/
Ketena, status (Pregnant or lactating) and age. The completing procedure of these data elements are
already discussed in the previous sections.

2. Productive Safety Net Program (PSNP) Section (Column 9): Write Yes if the woman is a PSNP ben-
eficiary. If the woman is not a PSNP beneficiary, write no.

3. Nutritional screening section (columns 10-22): In this section, the monthly nutritional screening
that includes weight and MUAC measurements and the corresponding nutritional assessment result will
be documented. On column 10, the data elements that are required to be measured and documented
during each month’s nutritional screening period are available. For each month when the screening is
done, write the screening result in the corresponding row. We have to use codes that are available at
the bottom of each page during recording of data elements such as nutritional counselling and Actions
taken. Write the day of visit as DD in the date of visit row, write the weight of the woman in kilograms,
MUAC measurement should be recorded in centimeters. Based on the assessment criteria, write yes if
she is malnourished or no if she is not malnourished in the malnourished (Y/N) row. If all the listed nu-
tritional counselling is provided to the woman, put a tick mark in the 5th row of the 10th column. In the
last row of the 10th column, write the codes for the actions taken. The action codes are: A= if counselling
is provided, B= if referred to Therapeutic and Supplementary Feeding Program (TSFP), C= if refered to
PSNP or D= if referred to other programs (Specify).

At the bottom of each page of PLW register, we have to write the count of the following data elements for
each month: MUAC <23cm, MUAC>=23cm, Total screened, number of referrals to TFSP and total counselled.

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Reportable data elements from this register

 Total number of PLW screened for acute malnutrition

 Total number of PLWA with MUAC < 23 cm

 Total number of PLWA with MUAC >= 23cm

 Number of pregnant women de-wormed

Indicators from PLW Screening register

 Proportion of pregnant and lactating women (PLW) screened for acute malnutrition

3.1.10 INFANT IMMUNIZATION AND GROWTH MONITORING REGISTER

Topics Covered

 Introduction to Infant Immunization and Growth Monitoring (GM) Register

 Procedure of completing Infant Immunization and GM register

 Reportable data elements from Infant Immunization and GM register

 Indicators calculated from Infant Immunization and GM register.

 Summary of the Infant Immunization and GM register.

Objectives

 To describe the purpose of Infant Immunization and GM register

 To properly record the required data elements from Infant Immunization and GM service

 To identify and able to extract reportable data elements from Infant Immunization and GM register

 To identify and calculate HMIS indicators using the Infant Immunization and GM reportable data
elements

Time needed: 1:00 hour

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Introduction

Infant immunization register is a longitudinal register, where one row is used to document all the required
immunization service data of one child. The register should be completed by the service provider at the
time of service. This register is kept in the immunization room.

How to record information on the register?

Look at the infant immunization register at the annex section and see each data element in each column of
the register. The recording procedure is as follows:

 Personal information section of the register (Columns 1-10): Complete the MRN, name of the
infant, date of birth in Day/Month/Year (DD/MM/YY) format, sex of the infant, name and MRN of the
mother, address and registration date. Write the date of registration on column 10, in Day/Month/Year
(DD/MM/YY) format.

 Column 11: This column shows the number of doses the child has received for each corresponding
antigen.

 Antigens provided (Columns 12-18): Each column contain the types of antigens provided for the
infant (BCG, OPV 0-3, IPV, Pentavalent vaccine 1-3, PCV 1-3, Rota vaccine 1-2 and measles vaccine). Write
the date when the infant has received each antigen. In the spaces provided document the date immuni-
zation was provided to the child in the corresponding column for each vaccine type. Some of the spaces
are shaded if the antigen is not required for that specific dose number. Example: Penta, PCV, Rota and
measles has no zero dose, as a result the spaces for the zero row are shaded. Likewise, rota and measles
vaccines have no third doses as a result the third dose number for these vaccines are shaded.

 Fully immunized by first birthday (column 19): Tick if the infant has received all types of vaccines
before his first birthday. If the child is fully immunized by the first birthday indicate with a (Ö) mark.

 Neonatal tetanus protection section of the register (Column 20-22): Ask the mother whether she
had received two doses of TT immunization during her last pregnancy (write the number of TT doses
in column 20) or ask her whether she had three or more doses of TT at any time before her pregnancy
(write the number of TT doses that she had in column 21). If the number of doses in column 20 is 2 or if
the number of doses in column 21 is three or more, then the child is considered as being protected at
birth (tick column 22).

 Growth monitoring section of the register (Column 23-25): This section is used to register the
date the infant’s weight was measured (column 23), to document the weight of the child on column 24
and write the WFA in z-score on column 25. To document the z-score of the WFA of the child, please use
standard nutrition charts.

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 Vitamin A (Column 26): If Vitamin A is received, write the date in Day/Month/Year (DD/MM/YY) format
in the space provided on column 26.

 Column 27 is used to write remarks (any type required to write about the infant).

What is Protection at birth (PAB)???

Protection at Birth against neonatal tetanus: infants who were protected from neonatal tetanus at birth
by the immunization of their mothers with protective dose of TT during pregnancy or before the pregnancy.
Protective dose of TT means if the mother had two doses of TT during her pregnancy or if she had three or
more doses at any time any time before the pregnancy.

a) Ask the mother of the infant if she has a TT record card.

 If she has, go to (b) below.

 If she has not, ask if she can remember receiving number of doses of TT during pregnancy.

b) You can consider that the infant was protected from NT at its birth (PAB) if the above holds true, and the
mother has received two doses of TT during the recent pregnancy or at least three doses of TT in the
past.

c) Ideally, PAB questions should take into account all doses received as well as intervals between these
doses.

3.1.10.1 Immunization tally

Immunization tally is used to simplify the reporting of data elements related to immunization from the
infant immunization and growth monitoring register. Once you complete filling the infant immunization
register, please follow the following procedure to complete the immunization tally and count.

Immunization tally uses data from two registers:

1. Infant immunization register

2. TT immunization register (discussed in the next session)

a) When/Where to complete the immunization tally?: Immunization tally is completed immediately

after the child/ woman is vaccinated.

b) Data elements used for Immunization Tally

 Infant Immunizations data elements are tallied as follows: The tally has two separate columns for under
one, and one year and older age infants further separated by tally and count for each vaccine type.

1. BCG - is tallied on line 1

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2. DPT-HepB-Hib1 - is tallied on line 2.1

3. DPT-HepB-Hib1 - is tallied on line 2.2

4. DPT-HepB-Hib3 - is tallied on line 2.3

5. OPV 1-3 and IPV- are tallied on line 3.1 to line 3.4

6. PCV is tallied on line 4.1 to 4.3

7. Rota vaccine is tallied on line 5.1 to 5.2

8. Measles (MCV 1 and MCV 2) - is tallied on line 6.1 and 6.2

9. Fully immunized children under 1 year - are tallied on line 7

10. A Child protected at birth from N. Tetanus - are tallied on line 8

11. TT tally is done separately for TT1-TT5.

Reportable data elements from infant immunization and growth monitoring register

Immunization data elements are reported from the EPI register. In addition, growth monitoring related data
is also reported from this register (see CINuS tally sheet in CINuS session to understand growth monitoring
related data elements).

1. BCG
2. OPV 1 and OPV 3
3. IPV
4. Pentavalent vaccine 1 and 3
5. PCV vaccine 1 and 3
6. Rota vaccine 1 and 2
7. Measles 1 and Measles 2
8. Fully immunized
9. Protected at birth
10. Total children vaccinated (for all the antigens)
11. Total weights weighed
12. Z score above -2
13. Z score between -2 and -3
14. Z score below -3
15. Vitamin A

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Indicators from Infant immunization and growth monitoring register

The following indicators are computed from immunization register

 DPT1-HepB1-Hib1 (pentavalent First dose) immunization coverage (< 1 year)

 DPT3-HepB3-Hib3 (Pentavalent third dose) immunization coverage (< 1 year)

 OPV 3 (Oral Polio Vaccine third dose) Immunization Coverage (< 1 year)

 Pneumococcal conjugated vaccine (PCV3) immunization coverage (< 1 year)

 Rotavirus vaccine 2nd dose (Rota2) immunization coverage (< 1 year)

 IPV (Inactivated Polio Vaccine) Immunization Coverage (< 1 year)

 Measles (MCV1) immunization coverage (< 1year)

 Measles second dose (MCV2) immunization coverage (1-2 year)

 Fully immunization coverage (< 1 year)

 Proportion of infants protected at birth against neonatal tetanus

 Vaccine wastage rate

 Proportion of children aged 6-59months who received vitamin A supplementation

3.1.11 TETANUS TOXOID (TT) IMMUNIZATION REGISTER

Topics Covered

 Introduction to TT register

 Procedures of completing TT register

 Reportable data elements from TT register

 Indicators calculated from TT register

Objectives

 To describe the purpose of TT register

 To record the required data elements from TT service

 To identify and able to extract the reportable data elements from TT register

 To identify and calculate HMIS indicators using TT immunization data elements.

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Time needed: 25 minutes

Introduction

TT immunization register is used to record information when tetanus toxoid immunization is provided to
women (pregnant and non-pregnant). The reportable data element from this register are the total number
of women who received TT1 to TT 5 and the total number of TT doses provided, in order to calculate TT
vaccine wastage rate. It is a longitudinal Register; one row is used for one client till she completes all the 5
doses. The register is completed by service providers at the time of service provision.

How to record data on the register?

TT immunization register is available at the annex section of this manual. The recording procedure is as
follows:

 Identification section (columns 1-7): These columns are used to record identification related data
elements (Serial number, MRN, Name, age and address of the woman).

 Registration column (Column 8): This is the date when the woman first received TT vaccine and is
recorded as DD/MM/YY.

 Immunization service for pregnant women (Column 9-13): These columns are used to record the
date when a pregnant woman receives TT immunization from dose 1 to 5.

 Immunization service for non-pregnant women (Column 14-18): these columns are used to
record the date when non-pregnant woman receives TT immunization.

 Column 19: If Vitamin A is provided to the woman, document the date (dd/mm/yy).

 Column 20 is a remarks column where any relevant information such as appointment date are re-
corded as required.

Data for reporting is abstracted by using the immunization tally sheet (See the previous section on immu-
nization tally).

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Reportable data elements from TT register

 Number of women who have received TT1 vaccination

 Number of women who have received TT2 vaccination

 Number of women who have received TT3 vaccination

 Number of women who have received TT4 vaccination

 Number of women who have received TT5 vaccination

 TT doses given / doses opened/dose damaged/dose expired

Indicators from TT register

 TT vaccine wastage rate

3. 1.12 HUMAN PAPILLOMA VIRUS (HPV) IMMUNIZATION REGISTER

Topics Covered

• Introduction to HPV register

• Procedures of completing HPV Register

• Reportable data elements from HPV Register

• Indicators calculated from HPV Register

Objectives

• To describe the purpose of HPV Register

• To properly record the required data elements from HPV services

• To identify and able to extract the reportable data elements from HPV Register

• To identify and calculate HMIS indicators using the HPV Register

Time needed: 25 minutes

Introduction

HPV register is used to document human papilloma virus immunization that is provided for children 9 years
of age. Human papilloma virus (HPV) vaccine for girls in early adolescence (before their first sexual contact)
addresses the common Human papilloma viruses which are associated with the development of cervical
cancer in later ages. The register captures doses of HPV provided to girls.

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Procedure of completing HPV immunization register

1. Identification Section (Column 1-7): this section is used to record the demographic characteristics
of girls receiving HPV vaccine. The data elements such as Serial number, MRN, name and date of birth
are recorded in the same way as described in the previous registers. For columns 6 and 7, fill based on
the education status of the girl. If the girl is in school, write her grade in column 6. If she is out of school,
tick column 7.

2. Address Section (Column 8-11): This is used to record the specific address of the girl including the
woreda, kebele, got and house number.

3. Registration section (column 12): Record the date of registration in Ethiopian calendar with a format
DD/MM/YY.

4. Vaccination Section (Column 13-14): Write the date HPV1 is provided on column 13 and write the
date HPV2 is provided on column 14.

5. Remarks/Appointment section (column 15): This is used to record any remark regarding the girl
such as appointment date for the second HPV.

Reportable data elements from HPV immunization register

 Number of girls 9 year of age who have received 1st dose of human papilloma virus vaccine

 Number of girls 9 year of age who have received 2nd dose of human papilloma virus vaccine

 HPV doses given /doses opened/dose damaged/dose expired

Indicators from HPV immunization register

 HPV 1 (Human Papilloma Virus vaccine (1st dose) Immunization coverage (9 years old girls.

 HPV 2 (Human Papilloma Virus vaccine (1st dose) Immunization coverage (9 years old girls)

 HPV Vaccine wastage rate

3.1.13 NEONATAL INTENSIVE CARE UNIT (NICU) REGISTER

Topics Covered

• Introduction to NICU register

• Procedures of completing NICU Register

• Reportable data elements from NICU Register

• Indicators calculated from NICU Register

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Objectives

• To describe the purpose of NICU Register

• To properly record the required data elements from NICU services

• To identify and able to extract the reportable data elements from NICU Register

• To identify and calculate HMIS indicators using the NICU Register

Time needed: 1 hour

INTRODUCTION

Neonatal Intensive Care Unit (NICU) register is a register that is used to record information about neonates
who have been treated in the neonatal intensive care unit. Neonatal intensive care unit (NICU) is a unit
where we provide treatment and care for babies who have problems such as Prematurity and other severe
problems. The service is only provided in Hospitals with NICU standard, which have a trained manpower
and allocated enough space as per the standard, with basic equipment as per the NICU level. The register
captures data that is related to the type of treatment provided and the treatment outcome of NICU man-
agement.

• The register is a serial register where one row is used to register a single neonate

• It has two wings: the left and right wings (pages).

• It should be completed by service providers after the service is provided.

• Reportable data elements will be compiled at the end of each month and be sent to the HMIS unit.

Procedure of completing NICU Register

The register has a total of 49 rows and users are expected to follow the instruction at the first page of the
register. The procedure of completing the register is as follows:

1. Identification Section (Columns 1-7): This section is used to identify individual neonates with their
demographic characteristics. It includes completing the following data elements:

 Serial number: Write the serial number as 1, 2, 3 etc to indicate the sequential number where
the neonate is registered.

 MRN: Medical record number of the neonate from the individual medical folder.

 Name of the neonate: Write the name of the neonate in full

 Sex: Write M for male and F for female

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 Name of mother: The name of the mother should be written in this column

 Adress: The Zone, Woreda, Kebele and Gott from where the neonate came should be document-
ed. The zone and Kebele should be recorded in column 6 (The zone in the upper row and the
woreda in the lower row); the Kebele and Gott should be recorded in column 7 (The kebele in
the upper row and Gott in the lower row).

2. Admission Information (Columns 8-12): This section is used to register information about the ad-
mission of the neonate. It includes the following information:

 Admission date and Time (DD/MM/YY - 00:00): On column 8, write the date and time of admis-
sion in Ethiopian Calendar and in the format that is written in the register.

 Temperature (Column 9): Record the temperature of the neonate at admission in degree celcius.

 Respiratory rate (column 10): Record the respiratory rate of the neonate per minute.

 Apical Heart rate per minute (Columnn11): record the number of heart beats per one minute in
the column.

3. Delivery Information Section (columns 13-18): In this section, there are data elements that are to
be completed.

 Gestational Age (weeks) (Column 13): Record the gestational age at the time of the neonate’s deliv-
ery. It should be recorded the number of weeks (Not months).

 Delivery date and Time (DD/MM/YY - 00:00) (Column 14): record the date and time of delivery in
Ethiopian calendar.

 Mode of delivery (Column 15): Write the mode of delivery by choosing one of the codes available at
the bottom end of each page. Write 1 for spontaneous, write 2 if the mode delivery was by CS and
write 3 if the mode of delivery was instrumental.

 Place of delivery (Column 16): This is to know the place of delivery by recording 1 if the delivery was
at home, write 2 if the delivery was in the same facility as the newborn is being treated and write 3 if
the delivery was in another facility and referred to this facility for NICU service.

 Apgar score (column 17): Write the Apgar score at the first and fifth minutes.

 Birth Weight (column 18): Write the weight of the neonate at admission in grams.

4. Maternal Condition Section (Columns 19-23): In this section, record the status of the mother (wheth-
er alive or dead and test results for HIV, Hepatitis B &C, VDRL)

 PITC (P/N): Write P if the mother is tested for HIV and tested positive; Write N if tested negative for
HIV, if HIV test is not done, leave the space empty.
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 Hepatitis B (P/N): Write P if the mother was tested for Hepatitis B and tested positive. If she was test-
ed negative for Hepatitis B, write N. If the test was not done, leave the space empty.

 Hepatitis C (P/N): Write P if the mother was tested for Hepatitis C and tested positive. If she was test-
ed negative for Hepatitis C, write N. If the test was not done, leave the space empty.

 VDRL (P/N): Write P if the mother was tested for syphilis and tested positive. If she was tested nega-
tive for Syphilis, write N. If the test was not done, leave the space empty.

 On column 23, write A if the mother is alive or D if she is dead.

5. Admission Problems Section (column 24-30): This section is used to document the type of prob-
lems diagnosed for the neonate that is admitted to the NICU.

 Prematurity: Tick column 24 if the neonate is admitted for prematurity. If not, leave the space empty.

 Low Birth Weight: Tick column 25 if the neonate has low birth weight. If not, leave the space empty.

 Sepsis: Tick column 26 if the neonate has sepsis at admission. If not, leave the space empty.

 RDS: Tick column 27 if the neonate had Respiratory Distress Syndrome. If not, leave the space emp-
ty.

 Perinatal Asphyxia (PAS): tick column 28 if the neonate had Perinatal Asphyxia. If not, leave the
space empty.

 Congenital malformation: tick column 29 if the neonate has perinatal asphyxia. If not, leave the
space empty.

 Other (Specify): Specify the type of complication that the newborn had other than the listed com-
plications.

6. Management Section (Column 31-41): In this section, write the type of medical treatment/manage-
ment that we provided to the neonate that is admitted to the NICU.

 CPAP (column 31): Tick (✔) the box if the newborn is treated with Continuous Positive Air way Pres-
sure (CPAP).

 Resuscitation (column 32): Tick (✔) if the newborn is resuscitated with Bag and Mask.

 KMC (column 33): Tick (✔) if KMC (kangaroo mother care) was initiated for the newborn.

 Antibiotics (column 34): Tick (✔) if the newborn is treated with any form of antibiotic

 Anticonvulsants (column 35): Tick (✔)if the newborn is treated with anticonvulsant

 Phototherapy (column 36): Tick (✔) if the newborn has received phototherapy treatment

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 Glucose (column 37): Tick (✔) if the newborn is treated with Glucose after admission

 O2 (oxygen) (column 38): Tick (✔) if the newborn is treated with oxygen (With nasal prong or face-
mask)

 Blood transfusion (column 39): Tick (✔)if the newborn has received blood transfusion

 Incubator/Thermal care (column 40): Tick (✔)if the newborn was placed in an incubator for treat-
ment

 Other specify (column 41): Specify the type of management provided other than the listed medical
treatment/management.

7. Discharge Information (column 42-48): This section is completed when the neonate is discharged
from the NICU.

 Discharge Date and Time: write the date and time of discharge in Ethiopian Calendar

 Discharge Weight (gms): Write the weight of the neonate at discharge in grams.

 Discharge status: Write the status of the neonate at discharge, by selecting the code that is available
at the bottom end of each page. The discharge status may be one of the following: Recovered, died,
transferred or Other (to be specified).

 Survived after resuscitation (column 45): Tick this column if the Newborn has received resuscitation
at the NICU and his/her condition has improved

 If died (age in days): In column 46, write the age of death in days if the neonate died during the
course of treatment.

 Cause of death (Column 47): if the neonate died, write the cause of death in column 47 by choos-
ing one of the codes available at the end of each page as footnote. The causes of death may be:
Prematurity; sepsis, prenatal asphyxia, congenital malformation or other causes that needs to be
specified.

 Length of stay: On column 48, write the total number of days the neonate stayed during the admis-
sion period.
8. Remarks Section: This column is used to write any type of remark that needs to be written for each
neonate who has been treated in the NICU. It may include remarks such as from where the neonate
was referred from or to where the neonate is referred to.

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Reportable data elements from NICU Register

The reportable data elements are taken from the boxes that are available at the bottom of each page in
the register. The following data elements are reported from NICU register on a monthly basis.

1. Number of newborn weighing <2000gm and premature newborns for which KMC initiated

2. Number of newborn weighing <2000gm and or premature

3. Number of neonates resuscitated and survived

4. Total number of neonates resuscitated

5. Total neonates admitted to NICU

6. Newborns who are diagnosed to have Sepsis

7. Total neonates discharged during the reporting period

8. Number of newborns who recovered

9. Number of newborns who died

10. Number of newborns who transferred out

11. Number of newborns who have other treatment outcome

12. Number of newborns who have survived after resuscitation

Indicators calculated from NICU register

 Low birth weight or premature newborns for whom KMC was initiated after delivery

 Asphyxiated neonates who were resuscitated (with bag & mask) and survived

 Treatment outcome of neonates admitted to NICU for management of severe newborn cases

 Number of sick young infants 0-2 months treated for sepsis

 Early institutional neonatal death

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3.1.14 COMPREHENSIVE AND INTEGRATED NUTRITION SERVICES (CINUS)

REGISTER
Topics Covered

 Introduction to CINuS Register register

 Procedures of completing the CINuS Register

 Reportable data elements from CINuS Register

 Indicators calculated from CINuS Register

Objectives

 To describe the purpose of CINuS Register

 To properly record the required data elements from CINuS services

 To identify and able to extract the reportable data elements from CINuS Register

 To identify and calculate HMIS indicators using the CINuS Register

Time needed: 1:00 Hour

Introduction

 Comprehensive and Integrated Nutrition Services (CINus) register is a longitudinal register, where one
row can be used for one child for one year in repeated visits.

 The information is completed by the service provider after delivering the service/ end of duty hours. It
should be placed in well-baby clinics.

 CINuS register is used to record for the following services:

1. Growth monitoring for children under 2 years of age: There is a growth monitoring and promotion
program that should be conducted on a monthly basis. Growth monitoring and promotion (GMP)
is a prevention activity that uses growth monitoring (GM), i.e. measuring and interpreting growth,
to facilitate communication and interaction with caregiver and to generate adequate action to pro-
mote child growth through: Increased caregiver’s awareness about child growth, improved caring
practices and increased demand for other services, as needed. It includes measurement of weight
and classification of the nutritional status of the child based on weight–for–age (WFA) metric.

2. Nutritional screening for children under 5 years of age: This is the process of identifying children
who may be at nutritional risk or potentially at risk, and who may benefit from appropriate nutri-
tional intervention. Screening may need to be repeated regularly (monthly based). Screening pro-

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gram helps to prevent or detect problems early by screening than discover serious problems later.
It includes measurement of weight, height/length, MUAC and checking for the presence of absence
of bilateral edema and then classifying the child based on the screening findings.

3. Deworming and Vitamin A supplementation: The CINuS register is also used to record vitamin A
supplementation and deworming services that we provide to children.

How to complete the register

 Personal identification section (column 1 to 8): These columns are used to record identification
related data elements (Serial number, MRN, name of child, address of the child, date of birth, age/sex,
and name of his/her mother).

 PSNP beneficiary (column 9): This is to document whether the family is a Productive Safety Net Pro-
gram (PSNP) beneficiary or not.

 GMP Section (Column 10-22): This section is used for children who are less than 2 years of age and
are participating in growth monitoring and promotion program. Each column is divided into four rows
which are used to record the date of visit, the age (in months), weight (kg) and the nutritional classifi-
cation based on WFA result as Normal, moderate underweight or severe underweight. The GMP data is
completed on a monthly basis longitudinally when the baby came for the service.

 Nutrition Screening Section (Column 23-35): This section is used for children who are less than 5
years of age for whom nutritional screening is done. Nutritional screening may be done on a monthly
basis and every time the child is screened, it should be recorded and reported. For a single child, there
are seven rows which are used to record date of screening, age, measurement of weight, height and
MUAC, checking for the presence of bilateral edema and categorization of the nutritional status of the
child based on the criteria as Normal, MAM (Moderate Acute Malnutrition) or SAM (Severe Acute Malnu-
trition) on a monthly basis.

 Vitamin A and Deworming Section (columns 36-48): this section is used to record the date of visit
and whether Vitamin A or deworming was provided in month X.

 Time and Age Appropriate Counseling Section (columns 49-61): These columns are to record ap-
propriate counselling service provision on breast feeding, initiation of complementary feeding, comple-
mentary feeding (DD= dietary diversity, FF= Food frequency, FC= Food consistency) and feeding of sick
child. It has to be completed for months when the service is provided.

 Referral column (column 62): This column is used to record referral related information. Writes the
referral codes as follows: OTP= if referred to outpatient Therapeutic Program; SC if referred to stabiliza-
tion center; TSP if referred to Target Supplementary program; PSNP if referred to Productive Safety Net

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Program; and Other (Specify) if referred to other services.

 Remark Column (Column 63):- This is used to write any relevant information for the child that is reg-
istered in that row.

Discussion points

 What is WFA (Percentage of Weight for Age)

 How do you calculate %WFA?

3.1.14.1 Comprehensive & Integrated Nutrition Services (CINuS) Tally Sheet

 It is used to simplify reporting of CINuS related reportable data elements

 The tally sheet is used to tally GMP, nutritional screening and Vit.A & deworming services, disaggregated
by age and nutritional status category.

 How the tally is completed:

 For GMP section: Number of weights recorded with WFA >-2 Z score, Z score between -2 and -3 and
Z score < -3 will be tallied (Age 0-5 months and 6-23 months separately). The total weighed will be
the sum of the three classifications mentioned. The tally and the corresponding count should be
recorded correctly.

 For Nutritional Screening Section: Number of children with nutritional classification of N, MAM and
SAM will be tallied. The sum will give us the total number of children screened for malnutrition. This
isn disaggregated into two age categories as: Age 0-5 months and Age 6-59 months.

 Vitamin A/Deworming section: This is to tally the number of children for whom Vit A was provid-
ed (disaggregated by age as 6-11 months and 12-59 months) and for children who have been de-
wormed. The corresponding count need to be recorded next to the tally.

Data elements for reporting from CINuS register

 Total number of children less than 2 years weighted during GMP session (disaggregated as 0-5 months
and 6-23 months)

 Number of weights recorded with moderate malnutrition, by age (Z‐score between -2 and -3) : moder-
ate Underweight (disaggregated as 0-5 months and 6-23 months)

 Number of weights recorded with severe malnutrition, by age (Z‐score below (-3) : Severely under-
weight (disaggregated as 0-5 months and 6-23 months)

 Total Number of children < 5 years screened for acute malnutrition (disaggregated as 0-5 months and
6-59 months)

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 Number of weights recorded with moderate acute malnutrition (disaggregated as 0-5 months and 6-59
months)

 Number of weights recorded with severe acute malnutrition (disaggregated as 0-5 months and 6-59
months)

 Number of children who were provided with vitamin A supplementation

 Number of children dewormed

Indicators computed from CINuS register

 Proportion of children under 2 years of age who participated in GMP

 Proportion of children under five years screened for acute malnutrition

 Proportion of children 24-59 month dewormed

 Proportion of children aged 6-59 months who received vitamin A supplementation

3.1.15 THERAPEUTIC FEEDING PROGRAM (TFP) REGISTER

Topics Covered

 Introduction to TFP register

 Procedures of completing TFP Register

 Reportable data elements from TFP Register

 Indicators calculated from TFP Register

Objectives

 To describe the purpose of TFP Register

 To properly record the required data elements from TFP services

 To identify and able to extract the reportable data elements from TFP Register

 To identify and calculate HMIS indicators using the TFP Register

Time needed: 45 minutes

Introduction

The TFP register is used to record the therapeutic feeding that is provided for Children < 5 with Severe Acute
Malnutrition (SAM). Data related to the admission and treatment outcome of children who have been ad-
mitted to TFP centers will be recorded in this register.
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Recording procedure for TFP Register

1. Personal Identification and address section (Columns 1-10): Personal demographic characteris-
tics and address of the child who is admitted to TFP are recorded in these columns. Completing such
types of demographic and address related data elements is already discussed in the other sections.
Check the register at the annex section of this manual.

2. Admission Section (Column 11-19): In this section, we record information regarding the child at ad-
mission

 Type of admission: if the child is admitted as new patient, then we write N in column 11, if he/she is
not new we write N to denote “No”.

 Transferred in /Readmission: Write “T” if the child is transferred from another facility or “R” if the
child is a re-admission case.

 Date of admission: Write the date the child is admitted in column 13.

 Weight: Write the weight of the child in Kg in column 14.

 Height: The height of the child should be recorded in centimeters under column 15.

 WFH%: This is to record the Weight-for-Height percentage that is plotted based on the measure-
ments on column 14 and 15 against WHO WFH reference curve. It should be recorded as: <70%,
70%-80% or >80%.

 Oedema (0, +, ++, +, +++): This column is used to record the presence or absence of Oedema and
its severity. If there is no bilateral pitting oedema, write 0. If there is oedema, use the following to
denote the degree of edema:

o += grade + ( Mild :Both feet/ankles bilateral pitting Oedema)

o ++= Grade ++ ( Moderate :Both feet ,plus legs, hands or lower arms)
o +++= Grade +++ (Severe : generalized bilateral pitting oedema, including both feet, legs,
arms and face)
 MUAC (cm): In column 18, write the mid upper arm circumference in centimeters

 Diagnosis (Marasmus, Kwashiorkor or, both): In column 19, Write the nutritional diagnosis of the
child by writing codes as MA for Marasmus or KA for Kwashiorkor or BO= both (if Diagnosis is Maras-
mus and Kwashiorkor).

3. Discharge Section (columns 20-25): These columns are used to document measurements of the
child at discharge. It includes recording the date of discharge in column 20, the weight at discharge in
column 21, the height at discharge in column 22, the WFH% in column 23, presence or absence of oede-
ma and its severity in column 24 and the MUAC at discharge in column 25.
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4. Minimum weight for non-edematous children Recovered Section (Column 26-27): Write the
minimum weight in kg during stay at OTP or SC and record the date the minimum weight is gained.

5. Length of stay (Column 29): Write total number of days between admission and discharge for cured
non edematous children

6. Treatment outcome section (column 29): In this column, write the codes for the outcome of the
treatment for each individual child. The treatment outcomes are defined as follows:

 Recovered (Cured): If the child is free from medical complications and have achieved and
maintained sufficient weight gains. Malnourished Children admitted to feeding programs are
discharged with the following criteria: MUAC ≥11.0 cm AND ≥15% weight gain from admission
weight with no edema for 2 consecutive visits (at hospital level WFH ≥85 %.).

 Died = Child that has died while he was in the program. For out-patient program, the death has
to be confirmed by a home visit

 Unknown: Patient that has left the program but his outcome (actual defaulting or death) is not
confirmed/ verified by a home visit

 Defaulter: Patient that is absent for 2 consecutive weighing (2 days in in-patient and 2 weeks in
out-patient), confirmed by a home visit

 Non-responder: Patient that has not reached the discharge criteria after 40 days in the in-patient
program or 2 months in the out-patient program

 Medical transfer: Patient that is referred to a health facility/ hospital for medical reasons and this
health facility will not continue the nutritional treatment

 Transfer Out :Patient that has started the nutritional therapeutic treatment in your program and
is referred to another site to continue the treatment

7. Remarks column (Column 30): This column is used to write anything that deemed necessary for each
individual child.

Reportable data elements from TFP register

1. Total number of children with SAM admitted to TFP (OTP &SC) during the reporting period

2. Total number of children who exit from severe acute malnutrition treatment

3. Number of children who recovered from severe malnutrition

4. Number of children who died from severe malnutrition

5. Number of children who have been transferred out to another TFP center

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6. Number of children who defaulted from severe malnutrition treatment

7. Number of children who became non-respondent for severe malnutrition treatment

8. Number of children who were medically transferred out during severe malnutrition treatment

9. Number of children whose treatment outcome is unknown after treatment in TFP

Indicators from TFP register

 Treatment outcome for management of SAM in children under 5 year: Proportion of children who have
been treated for severe malnutrition and:

 Recovered

 Died

 Defaulted

 Non-respondent

 Medically transferred

 Transferred out

 Unknown treatment outcome

3.2 DISEASE PREVENTION AND CONTROL REGISTERS

In this section, we will discuss:

• HIV recording and reporting tools: VCT Register, Pre ART and ART register

• Tuberculosis and Leprosy recording tools: Tuberculosis, DR TB and Leprosy Register

• All diseases recording and reporting tools: OPD and IPD registers

Contents

 Recording procedure of Voluntary Counselling and Testing (VCT), PreART (Pre-AntiRetroviral Therapy
(PreART), Anti-Retroviral Therapy (ART), Post Exposure Prophylaxis (PEP), Tuberculosis, leprosy, OPD
and IPD registers

 Tally sheets used in HIV and all diseases programs

 Reportable data elements and indicators from VCT, PreART, ART, PEP, Tuberculosis, leprosy, OPD and
IPD registers

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Objectives of the section:

At the end of this section, participants will be able to:

 Describe the recording procedures of VCT, PreART, ART, PEP, Tuberculosis, leprosy, OPD and IPD
registers

 Recognize reportable data elements from VCT, PreART, ART, PEP, Tuberculosis, leprosy, OPD and IPD
registers

Time needed: 18 hours

3.2.1 VCT REGISTER

Topics covered

• Introduction to VCT registers

• Procedures of completing VCT register

• VCT tally

• Reportable data elements from VCT register

• Indicators calculated from VCT register

Objectives of this section

At the end of this session, participants will be able to:

• describe the purposes of VCT register

• Understand the data elements and recording procedures of VCT registers

• Identify reportable data elements and indicators from VCT register

• identify and calculate HMIS indicators using VCT Register

Time needed: 1 hour

Introduction

VCT register is used to record and document data of people who came for voluntary HIV counselling and
testing. It is used to capture HMIS data related to HIV testing services. VCT register captures clients receiving
VCT services at the health facility. The register should be available in VCT service room.

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How to complete VCT register

 Identification (Column 1-6): Record the demographic information of the client as follows:

 Serial Number: Write the sequential number of clients as 1, 2, 3…

 Date: enter the date the client is counseled and tested as DD/MM/YY

 Client code: enter code given to the client at the VCT center

 Couple code: assign couple code for those who came for couple counselling

 Age & sex: Write the age in years and the sex as “M” and “F” for male and female respectively.

 Counseling Services and its result (column 7-13): This section is used to record data on HIV coun-
selling and its result

 Pre-Test Counseling Offered: Put a tick mark () if the client is offered a pretest counseling service

 HIV Test Accepted: Put a tick mark () if the client accepted the HIV test after the pretest counselling

 HIV test result: Write P if the client is tested positive for HIV or write N if the test result is negative

 Received HIV Test Result: Put a tick mark () if client received HIV test result

 Target population category: write the code for the target population category that is listed at the
bottom of each page of the register. The codes are: A for Female Commercial Sex workers, B for
long distance drivers, C for mobile workers/daily laborers, D for prisoners, E for OVC, F for children of
PLHIV, G for partner of PLHIV “H” for Other MARPS and “I” for general Population.

 Post-test Counseled: Put a tick mark () if the client received post-test counseling

 If positive and linked to HIV care and treatment, write the MRN of the client in column 13.

 Screening section (Column 14-20): This section is used to record information about TB and STI
screening and its results

 Screened for STI: Put a tick mark () in column 14 if the client is screened for STI using STI screening
criteria

 Result of STI screening: Write “P” if the client’s STI screening result is positive; Write “N” if the client’s
STI screening result is negative

 In column 16, put a tick mark if the client is positive for STI screening and referred for further STI
investigation.

 Screened for TB column: Put a tick mark () in column 17 if the client is screened for TB using symp-
tomatic TB screening criteria.
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 Result of TB screening: In column 18, write “P” if the client’s TB screening result is positive or write
“N” if the client’s TB screening result is negative.

 If positive referred for TB: In column 19, put a tick mark () if the client was positive for TB screening
and referred for further TB investigation.

 Referral column: write the code at the bottom of the register to show to where the client was re-
ferred.

 Remark (column 21): Write any relevant information deemed necessary

2.3.1.1 VCT tally sheet

This tally is used to simplify reporting of data elements from the VCT register. VCT data is reported disag-
gregated by age, sex, and test result and population category. In the left side of the tally sheet, you find the
target population categories for HIV testing and on the upper side of the tally sheet are Sex, age and test
result. Make a tally of each population group with the corresponding age, sex and HIV test result. The age
categories are: <1 year, 1-4 years, 5-9 years, 10-14 years, 15-19 years, 20-24 years, 25-49 years, and 50+ years.
Tally each target population category that received PITC test and their result in the appropriate age and sex
columns and put the total of the tallies in the count column. See VCT tally from the annex section and check
each data element.

Reportable data elements from VCT register

 Number of individuals who have been tested for HIV and who received their results (disaggregated by
age and sex).

 Number of people who tested positive for HIV (disaggregated by age and sex).

Indicators from VCT register

 Percentage of people living with HIV who know their status (Disaggregated by test result)

3.3.1.2 PITC tally sheet

PICT tally sheet is used to document provider initiated counselling and testing and its result. The tally sheet
is completed from different registers that have a PITC component like OPD register, IPD, TB, family plan-
ning, ANC, delivery registers etc… The tally should be available at all service outlets except VCT and ART
service units. In the left side of the tally is target population category and in the upper section of the tally is
PITC tests and its result disaggregated by age and sex. The age categories are: <1 year, 1-4 years, 5-9 years,
10-14 years, 15-19 years, 20-24 years, 25-49 years, and 50+ years. Tally each target population category that
received PITC test and their result in the appropriate age and sex columns and put the total of the tallies in
the count column. In addition to the PITC testing and result sections, PITC tally also captures STI screening
and its result, disaggregated by sex and population category. Please look at the tally in the annex section.

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3.2.2 PRE-ART REGISTER

Topics covered

• Recording procedures of Pre-ART register

• Reportable data elements and indicators from Pre-ART registers

Objectives of the section

At the end of this session, participants will be able to:

• Describe the purposes of Pre-ART register

• Understand the recording procedures of Pre-ART register

• Identify reportable data elements from Pre-ART register

Time needed: 30 minutes

Introduction

Pre-ART register is used to record and document data for patients who are HIV positive until they start ART.
All patients who are HIV positive are expected to start ART immediately after they are diagnosed as HIV
positive based on the test-treat strategy. However, some PLHIV may not start ART immediately due to some
reasons. These PLHIV who couldn’t start ART immediately will be followed with a Pre ART register till they
start ART. It will be for a very short period only. The HIV intake and/or follow up forms Pre-ART register are
both completed by the service provider at the time of service delivery.

How to complete the Pre-ART register

 Registration section (Column 1-7): These columns are where demographic characteristics of the
patient are recorded at the time of registration. It includes date of enrollment to HIV care, MRN, name,
age, sex, address and the date at which the patient is confirmed HIV positive.

 Follow up section (Column 8-14): These columns are used to record follow up data elements at each
visit. It has seven column where the follow up data are recorded during all the five visit periods. The
follow up data elements are: weight, height, MUAC measurements, BMI (which is calculate as weight/
(height)2, nutritional screening result, therapeutic/food support, clinical staging and CD4 count.

 TB/HIV co-infection section (Columns 15-18): In column 15, tick in the upper row if the patient was
screened for TB and write the result of the screening as “P” for positives and as “N” for negative TB
screening results in the lower row. In column 16, put a tick mark if the patient is diagnosed with active
TB. In column 17, write TB treatment start and stop date at the upper and lower sections of the row
respectively. In column 18, write the date on which INH prophylaxis is started as DD/MM/YY.

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 Columns 19-22: These columns are to be completed when applicable only. In column 19, enter the
start and end date of co-trimoxazole prophylxis in the upper and lower section of the row respectively.
In column 20-23, enter the date on which the client died (if the patient died) or lost to follow up or trans-
ferred out.

 Entry to ART (column 23-24): Write the date ART is started in column 23 and write the unique ART
number in column 24.

Tallies used for pre-ART register

Clinical care tally sheet: This tally sheet is used to simplify reporting of data elements from the pre-ART
and ART registers. The data elements in clinical care tally sheet are disaggregated by age and sex. It includes
tallying the following data elements from the registers:

 Number of PLWHIV who had TB screening

 Number of PLHIV screened positive for TB

 Number of PLWHIV who were screened for nutritional status and found to be under nourished

 Number of undernourished PLWHIV who received therapetic or food support

Reportable data elements from pre-ART register

 Number of PLWHIV who had TB screening

 Number of PLHIV screened positive for TB

 Number of PLWHIV who were screened for nutritional status and found to be under nourished

 Number of undernourished PLWHIV who received therapeutic or food support

3.2.3 ART REGISTER

Contents

• Recording procedure of ART register

• Tally sheets used for ART register

• Reportable data elements from ART register

• Indicators from ART register

Objectives of the section

At the end of this session, participants will be able to:

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• Understand the recording procedures of ART registers

• Identify reportable data elements from ART register

• Identify and compute HIV/AIDS care and treatment indicators from ART register

Time needed: 3 hours

Introduction

ART register is used to record and document data for PLHIV who are on HIV treatment. It is also used as a
patient monitoring tool throughout their ARV therapy. It is used to capture HMIS data related to HIV services.
The information required to complete ART register is obtained from HIV intake and/or follow up form. Data
is extracting from the ART register report compilation. The HIV intake and/or follow up forms ART register
are both completed by the service provider at the time of service delivery and should be placed in the in-
dividual folder of each patient.

How to complete ART register

 Registration section (Column 1-7): These columns are where demographic characteristics of the
patient are recorded at the time of registration. It includes ART start date (in DD/MM/YY), Unique ART
number, MRN, Full Name, Age, Sex and address.

 Status at starting ART section (column 8-15): These columns are used to record data elements
about the status of the patient at initiation of ART. The assessment and data elements include the fol-
lowing:

o Functional status of the patient should be recorded as “A” for ambulatory patients, “B” for bed-rid-
den and “W” for working functional statuses.

o Weight of the patient should be recorded in kilograms in column 9

o The height of the patient should be recorded in centimeters in column 10

o The Mid Upper Arm Circumference (MUAC) should be recorded in centimeters in column 11.

o The Body Mass Index (BMI) or %of WFA (for under 5 children) should be recorded in column 12

o In the upper section of column 13, please write the result of nutritional screening as: 1= Normal; 2=
Mild malnutrition; 3= Moderate Malnutrition; 4= Severe Malnutrition; 5=overweight

o In the lower section of column 13, put a tick mark if the patient is malnourished and provided with
supplementary /therapeutic feeding.

o In column 14, write the patient’s WHO clinical stage at the time of ART initiation.

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o In column 15, write the CD4 count for adults or CD4% for children at the time of ART initiation.

 TB/HIV co-infection section (Columns 16-24): These columns are used to document TB screening,
its result and INH prophylaxis.

o In the upper section column 16, put a tick mark if the patient was screened for TB. In the lower
section, write the result of the screening as “P” for positive screening result or “N” for negative
screening result.

o In the upper section of column 17, put a tick mark if Xpert MTB/RIF (Gene Xpert) is sent to diagnose
active TB. In the lower section, write the result of the Xpert MTB /RIF as “P” for positive result or “N”
for negative result.

o In the upper and lower sections of column 18, write the TB treatment start and stop dates respec-
tively.

o INH Prophylaxis (column 19-24): Write the date INH prophylaxis is provided monthly if the patient
was screened for TB and active TB was ruled out.

 Fluconazole preventive therapy (Column 25): Put a tick mark in this column if fluconazole is provid-
ed for the patient.

 Columns 26-29: these columns are to be filled whenever applicable only.

o Enrolled to appointment spacing model (Column 26): Enter the date on which the patient was en-
rolled into Appointment Spacing Model, written as (EC) Day/ Month/ Year (DD/ MM/YY)

o CTX start and stop date (Column 26): fill the date when co trimoxazole prophylaxis was started on
the upper row and the date the treatment is stopped in the upper row of column 27.

o Contraceptive provision (Column 27): Tick if the woman is not pregnant and is using any modern
contraceptive methods.

o Date Referred to PMTCT /Date Returned (Column 29): If the patient is pregnant, enter the Date Re-
ferred to PMTCT Clinic for Option B+ on the upper row and date returned from PMTCT on the lower
row.

 1st line regimen (Column 30-31): This is to document the first line regimen that the patient is taking

⇒ Original Regimen: write the code for the 1st line original regimen that that patient has started.
(See code at the bottom of the ART register)

⇒ Substitutions:

• If there is a 1st substitution within the 1st line regimen, write the code for the 1st substitute reg-
imen, the reason code, and the date substitution was done in the upper row of column 31. If
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there is a 2nd substitution, transfer this information to the bottom line and write in the code for
the 2nd substitute regimen, the reason code, and the date substitution was done.

 2nd line regimen (Column 32-33):

⇒ Regimen: if the patient has been switched to a 2nd line regimen, write the code for this regimen
in column 32.

⇒ Switches:

 If there is a switch within the 2nd line regimen, write in the code for the substitute regimen, the
reason code, and the date in the upper row. If there is a 2nd switch, write in the code for the sub-
stitute regimen, the reason code, and the date.

 3nd line regimen (Column 34-35): Enter the codes for third line regimens, if provided

⇒ Regimen: if the patient has been switched to a 3nd line regimen, write the code for this regimen.

⇒ Switches:

 If there is a switch within the 3nd line regimen, write in the code for the substitute regimen, the
reason code, and the date in the upper row. If there is a 3nd switch, write in the code for the sub-
stitute regimen, the reason code, and the date.

 Follow up section (column 36-88): Write the drug regimen code at each column, for each month. In the
6th, I2th, 24th, and 36th months enter the regimen, functional status, weight/height, CD4 and date viral
load is collected and its result as described above. For viral load at 6th, I2th , 24th , and 36th --- months,
write the date VL sample is collected as (EC) Day/ Month/ Year (DD/MM/YY) on the upper row if viral load
is performed at 6th, I2th , 24th , and 36th months. On the lower row, write undetectable if the viral load
is < 1,000 copies per ml, write detectable if viral load is >= 1,000 copies per ml.

Important points about the ART register

 The second page of the register is used to document ARV regimens or ART treatment out come during
the first 36 months after starting ART.

 Under “Month 0” enter the name of the month and the year (EC) on which the patient has started ART
in this cohort. This applies for all the patients on this page of the register since they are all in the same
cohort, starting in this month.

 Under “Month 1” write the name of the next month and year (EC) and continue in this manner for all 36
columns.

 When you reach the end of a calendar year, be sure to change the year.

 In the 6th, 12th, 24th, and 36th months, enter the regimen, functional status, wt / ht, and CD4.
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 Transferred patients are to be grouped into a similar cohort by keeping some space for possible transfer
in patients.

Tallies used for ART register

Two types of tallies are used to facilitate reporting from the ART register. These include Clinical Care tally
and currently on ART & regimen tallies.

3.2.3.1 HIV clinical care tally

This tally sheet is used to simplify reporting of ART data elements for patients who are currently receiving
clinical care. The data elements are disaggregated by age and sex. It includes tallying the following data
elements:

 Number of PLHIV newly started on ART

 Total viral load test performed

 Total viral load tests with suppressed test result

 Number of PLWHIV who had TB screening

 Number of PLHIV with positive TB screening result

 Number of PLHIV with active TB

 Number of PLHIV with active TB and on TB treatment

 Number of PLHIV using a modern family planning method

 Number of PLWHIV who were screened for nutritional status

 Number of PLWHIV who were screened for nutritional status and found to be under nourished

 Number of undernourished PLWHIV who received therapeutic or food support

3.2.3.2 Currently on ART and regimen tally sheet

This tally sheet is used to simplify reporting of ART data elements for patients who are currently receiving
ART by type of regimen. The data elements are disaggregated by regimen, age and sex. Please look at this
tally sheet at the annex section of this manual. On the left side of the tally sheet, you find the list of ART
regimens (as first line, second line and third line) for adults and children. On the upper section of the tally,
you find the age and sex disaggregation level. Make a tally of each regimen type for each corresponding age
and sex group.

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Reportable data elements from ART register

 Number of adults and children who are currently on ART (Disaggregated by age, sex and regimen
type)

 Number of adults and children with HIV infection newly started on ART (Disaggregated by age, sex
and pregnancy status)

 Number of adults and children who are still on treatment at 12 months after initiating ART (Disag-
gregated by age, sex and pregnancy status)

 Number of persons on ART in the original cohort including those transferred in, minus those trans-
ferred out (Net current cohort) (Disaggregated by age, sex and pregnancy status)

 Total number of adult and pediatric ART patients with an undetectable viral load (<1000 copies per
ml) at 6 months after initiating ART (Disaggregated by age, sex and pregnancy status)

 Number of adults and children who initiated ART in the 6 months prior to the beginning of the re-
porting period with a viral load count at 6 month visit (Disaggregated by age, sex and pregnancy
status)

 Total number of adult and pediatric ART patients with an undetectable viral load (<1000 copies per
ml) in the reporting period (Disaggregated by age, sex and pregnancy status)

 Total number of adult and pediatric ART patients with a viral load test in the reporting period (Dis-
aggregated by age, sex and pregnancy status)

 Number of PLHIV who were assessed/screened for malnutrition (Disaggregated by age, sex and
pregnancy status)

 Number of PLWHIV who were screened for nutritional status and found to be under nourished (Dis-
aggregated by age, sex , pregnancy status)

 Clinically undernourished PLHIV who received therapeutic or supplementary food (Disaggregated

by age, sex and pregnancy status)

 Number of women living with HIV aged 15-49 using any modern family planning method

 Number of clients enrolled into HIV care who were screened for TB during the reporting period.

 Total number of HIV positive patients with active TB (Disaggregated by age and sex)

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Indicators from ART register

1. Percentage of people living with HIV who know their status

2. Percentage of adults and children living with HIV receiving ART

3. Early viral load suppression rate (Percentage of ART patients with an undetectable viral load at 6
month after initiation of ART)

4. Viral load suppression (Percentage of patients on ART with a suppressed viral load (<1000 copies/
ml) in the past 12 months)

5. ART retention rate (Percentage of adults and children known to be on treatment 12 months after
initiation of ART)

6. Number of adults and children with HIV infection newly started on ART

7. Proportion of clinically undernourished People Living with HIV (PLHIV) on ART who received thera-
peutic or supplementary food

8. Percentage of non-pregnant women living with HIV on ART using a modern family planning method

3.2.4 POST EXPOSURE PROPHYLAXIS (PEP) REGISTER

Contents

• Recording procedure of PEP register

• Reportable data elements from PEP registers

• Indicators from PEP register

Objectives of the section

At the end of this session, participants will be able to:

• Understand the recording procedures of PEP registers

• Recognize reportable data elements and indicators from PEP register

Time needed: 30 minutes

Introduction

This register is used to record for people who are taking post exposure prophylaxis, either for occupational
or non-occupational risks. The reportable data elements from this register are number of people who re-
ceived PEP for occupational and non0-occupational risks.

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Recording procedure

The register is completed in the following way:

 Serial Number (SN): A sequential number assigned to patients up on registration (e.g. 1, 2, 3, etc) for
later identification

 Reporting Date: Use Ethiopian Calendar and a format of DD/MM/YYYY to register when patient is en-
rolled in PEP service

 MRN: Unique individual identifier used on medical information folder, for HC and hospital.

 Age: Enter client’s age in year

 Sex: Enter ‘M’ for male and ‘F’ for Female

 Occupation: Enter the code given for the current Occupation of the exposed person. The codes are: 1=
Physician, 2= Health Offcier; 3= Nurse; 4= Heath assistant; 5= Lab professional; 6= cleaner; 7= sanitarian;
8= Others 9Specify the occupation)

 Case Team: Enter the code given here for the Department or case team in which the client works. The
codes include: 1= labour ward, 2= emergency; 3= regular OPD; 4= Inpatient; 5= Operation room; 6= Oth-
er case teams (Specify)

 Exposure Duration: Write the time from time of exposure to the time the exposed person appeared for
PEP service in hours

 Exposure Type: Enter the code given for the different types of exposures. The codes are:- 1=Occupa-
tional or 2=non-occupational

 Exposure Code: Put the exposure code types among the lists provided under the foot note of the PEP
register. E.g. If a client is exposed to few drops of blood for short duration of time, write “EC1” under the
‘Exposure code/type’ column.

 Baseline HIV status

o Source person: Write ‘P’ for positive or ‘N’ for negative or ‘UK’ for unknown status (not tested)

o Exposed person: Write ‘P’ for positive or ‘N’ for negative or ‘UK’ for unknown status (not tested)

o Source of Exposure: Write the following codes; 1. Needle stick injury 2. Skin injury with sharps
3. Blood and products splash 4. Potentially infectious body fluids 5. Rape 6. Other (Specify )

 PEP PROVISION (column 14-16)

o Eligible: If the client is eligible for PEP Write ‘Y’ to denote yes , if the client is not eligible for PEP
write “N” indicating No
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o Time b/n exposure and PEP (in hours): Write the spent from time of exposure to the initiation
of the ARV regimen in hours

o ARV Regimen: Put the PEP drug regimen code 1. AZT +3TC 2. TDF +3TC 3. TDF+3TC+EFV 4. AZ-
T+3TC+EFV 5. AZT+3TC+LPV/r 6. TDF+3TC+LPV/r

 Exposed person follow up section (Column 17-22): this section is used to document follow up of the
exposed client for drug adherence, drug side effects and HIV status at the end of 6 weeks, 3 months and
6 months.

o Adherence to PEP: check the adherence status of the exposed person at the end of and 4th weeks
and write the result as: “P” for poor adherence; “F” for fair or “G” for good adherence

o IN column 19, write any side effect of ARV drugs that the exposed person may have developed
during the Pep period.

o HIV status: In column 20, 21 and 22, write the HIV status of the exposed person as: “P” for posi-
tive; “N” for negative or “UK” for unknown at the 6th week, 3 month and 6 months after exposure.

 Remark column (Column 23): Write any information or remark that is needed to be written.

Reportable data elements from PEP register

 Number of persons provided with post-exposure prophylaxis (PEP) disaggregated as occupational

and non-occupational

Indicators from PEP register

 Number of persons provided with Post-Exposure prophylaxis

3.2.5 TUBERCULOSIS REGISTER

Topics covered

 Recording procedures of TB register

 Reportable data elements from TB register

 Indicators from Unit TB register

Objectives

At the end of this session, participants will be able to:

• Describe the purposes of TB register

• Understand the recording procedures of TB registers

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• Recognize reportable data elements from TB register

Time needed: 3.30 hours

Introduction

Unit Tuberculosis register is used to record and document data for patients who are on tuberculosis treat-
ment. It is used as a patient monitoring tool during the intensive and continuous phases of TB treatment.
It is used to capture HMIS data related to TB services. Once the TB client is registered, one row is used to re-
cord till the final outcome of the patient is evaluated. The information required to complete the TB register
is obtained from TB treatment card.

 It is a longitudinal register where patients are followed for the whole period of treatment (up to 8
months) once they are registered.

 Data is abstracted from the patient’s folder/patient form, especially at the beginning of the registration
period. Then, follow up can be performed on the register (by ticking on the follow up columns of the
register).

 The TB treatment card & register are both completed by the service provider at the time of service de-
livery.

 The register includes information for clinical monitoring in the health facility only and for reporting TB
data for the analysis of TB indicators by different users.

 The register is kept in the TB room.

How to complete the TB register

The main part of the register and its recording and reporting procedures are as follows:

 MRN (Column 1): It is a unique individual identifier taken from the individual integrated folder in health
centers and hospitals. Write the MRN of the TB patient in this column.

 Unit TB No. (Column 2): This column is just to show the temporal sequence of the patients visiting
the facility for TB treatment service. It should be filled with starting from positive whole number (1, 2,
and 3….Up to the end of the register). Restarting numbering in every new month or at the end of each
reporting period is not required.

 Name and address of the TB patient (Column 3): On the upper space: Write the patient’s name (in-
dividual, father, grandfather) i.e Full name of the patient should be recorded in legible hand writing. On
the Lower space: Write the address of the patient, ie. The woreda, kebele, House .No, and phone No
of the patient. Patient address information is very important to trace back if incase patient is lost from
follow up.

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 Sex and Age (Column 4): Upper space: Write the patient’s sex as: M for Male or F for Female Lower
space: Write the patient’s age in years. If the patient is a child under one year old, write the number of
months.

 TB most at risk group (Column 5): In this column, write the appropriate code of TB most at risk cate-
gory (key population groups) as:- 1 for health care staff including HEWs, 2 for diabetics, 3 for homeless, 4
for refugees, 5 for prisoners, 6 for miners, 7 for people living in other congregated settings like university
students, developmental mega project workers.

 Address of the contact person of the TB patient (Column 6): On the upper space: Write the contact
person’s name (individual, father, grandfather) and full address of the contact in the lower space of the
column including Woreda, kebele, House No and Phone number.

 Linked to TB service by (Column 7): in this column, write “HP” if the patient was initially identified
and referred from health post; write “Public HF” if the patient was diagnosed ad linked to this facility
from a public health facility (same or other public facility; write “PPM HF” if referred from public private
mix sites. This section helps to assess the contribution of community health workers/health extension
(HEWs) and private health facilities in identifying presumptive TB cases. Note that PPM HFs includes
public health facilities not directly under the scope of the national TB program including Prison, Uni-
formed Health facilities; NGO clinic, Faith Based Organization clinics and private health facilities.

 Baseline Xpert MTB/RIF test as initial diagnosis (Column 8): write “Y” if XPert MTB/RIF test was
done as initial diagnosis, otherwise, write “N” to denote No.

 Xpert MTB/RIF test result/Lab no. (Column 9): Xpert MTB/RIF test is a rapid diagnostic test that
helps to improve TB and DR TB case detection in specific groups of patients such as children and HIV
infected presumptive TB cases and Presumptive DR TB patients. On the upper space, write Xpert MTB/
RIF test result resistance type as:-

TB = MTB detected, rifampicin resistance not detected

RR = MTB detected, rifampicin resistance detected

TI = MTB detected, rifampicin resistance indeterminate

N = MTB not detected

I = invalid / no result / error

In the lower space, write the Lab. Serial number of the Xpert MTB/RIF test.

 Diagnostic Smear result (Column 10): On the upper space, write the smear result as “P” for positive
result using red pen; “N” for negative results and “U” for not done/results not available. In the lower
space, write the Lab. Serial number of the smear test. This Smear examination result record the results

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of the patient’s pre-treatment sputum smear result. In all cases (except young children), three sputum
examinations should be done (spot, morning, spot).

 Category and type of TB (Column 11): In the upper section, write the category of TB as: N, R, F, L,T, O
and in the lower section, write the type of TB as: P/Pos, P/Neg or EP

N=new case: A patient who has never had treatment for TB or has been on anti-TB treatment for less
than one month.

R=Relapse: A TB patient who have previously been treated for TB, were declared cured or treatment
completed at the end of their most recent course of treatment, and are now diagnosed with a recur-
rent episode of TB (either a true relapse or a new episode of TB caused by reinfection).

F=Treatment after Failure: Treatment after failure patients are those who have previously been treated
for TB and whose treatment failed at the end of their most recent course of treatment.(it is similar with
previous definition, a patient who, while on treatment remained smear or culture positive at the end
of the five ‘months’ or later, after commencing treatment)

L= Treatment after loss to follow-up: patients who have previously been treated for TB and were de-
clared lost to follow-up at the end of their most recent course of treatment.

T=Transfer in: A patient who started treatment in one health facility (reporting unit) and transferred to
another health facility (reporting unit) to continue treatment.

O=other previously treated patients are those who have previously been treated for TB but whose
outcome after their most recent course of treatment is unknown or undocumented

NB: Category of patient should be recorded in this section. The proper category of patient is necessary
to determine the appropriate treatment regimen.

In the lower space: Write the type of TB:

P/Pos= Bacteriologically confirmed TB cases using available confirmatory diagnostic methods

P/Neg= clinically diagnosed pulmonary TB cases

EPTB= Extra-pulmonary TB cases (Bacteriologically & clinically diagnosed)

 Nutritional Assessment and status (Column 12-13): In column 12 on the upper space: Enter the
weight of the patient in Kgs, in the middle write the height in centimeters and then on the lower space,
calculate BMI/MUAC and enter the value. BMI is computed as weight in kg divided by height in meter
square. For patients aged 5-18 years, use BMI-for-age and refer standard charts. Measure and enter
MUAC in cm for pregnant, bedridden or under-five patient. In column 13, enter the nutritional status
of the patient. The nutritional status of the patient as: Normal or MAM or SAM based the criteria
described below.

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o SAM (Severe Acute Malnutrition) criteria in Adults: BMI <16 OR MUAC <18cm; for preg-
nant women and lactating mothers MUAC <19 cm OR edema of both feet without clear cut
other cause.

o MAM (Moderate Acute Malnutrition) criteria in Adults: BMI 16 - <17.5 OR MUAC 18 - <21
cm. For pregnant women and lactating mothers: MUAC 19- <23 cm OR for HIV positive client:
Confirmed (>5% weight loss since last visit) or reported weight loss (e.g. loose clothing) AND
No edema of both feet.

o No Acute Malnutrition/Normal: BMI >17.5 OR MUAC >21 cm or pregnant women and lac-
tating mothers >23 cm) AND No edema of both feet

 Intensive phase Drug (Column 14): Enter the treatment regimen (Fixed Dose Combination) used
in the intensive phase.

 Intensive phase Dose (Column 15): Enter the treatment dosage (Fixed Dose Combination) used
in the intensive phase.

 Treatment Started (DD/MM/YY) (Column 16): Enter the date TB treatment is started in EC using
DD/MM/YY format.

 Write the month (Column 17): Write the name of month for each month of intensive treatment as
follows: If treatment begins in Tikmt, write “Tik” on the first line of column 17. When the month is
completed, and if the patient continues treatment, write the name of the next Month Hidar as “Hid”
on the second line of column 17, etc, as long as intensive phase treatment continues.

 Intensive phase treatment monitoring chart days (column 18-47): Tick () each day the pa-
tient receives DOTS treatment and mark(X) for days not receiving DOTS treatment. These columns
are used to follow/monitor when the patient takes his/her daily treatment. Tick under each column
whenever the patient takes the drugs. Start the tick mark with the actual day in the month. Example:
if the patient start TB treatment on Meskerem 20, start putting the tick mark on the 20th day, not on
the first day of meskerem.

 TB-HIV co-infection (Column 48-53): This section is used to document TB-HIV co-infection relat-
ed data elements.

 HIV test offered (Column 48): Tick () if HIV test offered under provider initiated HIV counsel-
ing and testing guidelines.

 HIV test performed (Column 49): Tick () if the patient is tested for HIV/AIDS.

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 Target population category (Column 50): Write the code for target population category as:
A=Female Commercial Sex workers, B=Long distance drivers, C=mobile workers/daily laborers,
D=Prisoners, E=OVC, F=Children of PLHIV, G=Partner of PLHIV, H=other MARPS and I=General
Population.

 HIV Test results (Column 51): Enter “P” in red pen if the test result is positive or the patient
has documented evidence of enrolment in HIV care such as enrolment to pre-ART register or in
the ART register. Enter “N” in normal color of pen if the test result is negative.

 CPT Started (Column 52): Enter the date CPT is started, written as DD/MM/YY in EC.

 Enrolled in HIV care (Column 53): Enter the date on which the patient is enrolled into HIV care,
written as DD/MM/YY.

 ART started/Unique ART number: (Column 54):

o Upper space: Enter the date the patient started ART, written as DD/MM/YY.

o Lower space: Enter the unique ART number for a patient who started ART treatment in the
same facility. If the patient is referred to another facility, write as “referred to other facility”.

NB: It is the responsibility of the TB focal person of the facility to ensure the effectiveness of referral
linkage and its outcome of the patients to the patient preferred and nearest ART Clinic.

 Presumptive DR-TB and DST Result (column 55):

In the upper space:

o Enter Y=Yes in the upper section if the patient is presumptive DR-TB as per the national
guideline

o Enter N=No if the patient is not presumptive DR-TB case

In the lower space: Write the following DST results based on the lab result as:

 No RR - if the DST result of the patient shows no resistance at least to Rifampicin

 ’RR-TB’ if patient DST result is resistance to Rifampicin only

 MDR-TB’= if patient DST result of the patient is resistance to both Rifampicin and INH (MDR-
TB)

 Pre-XDR = if the DST result of the patient shows resistance to Isoniazid and rifampicin and
either a fluoroquinolone or second-line injectable drugs but not both.

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 XDR= if the DST result of the patient show resistance to any fluoroquinolone and to at least
one of three second-line injectable drugs (capreomycin, kanamycin and amikacin), in addi-
tion to multidrug resistance.

 Column 56: This column is divided into three rows

 Upper space: If the patient is confirmed with DR TB, write the name of the health facility that
the patient is referred for treatment

 Middle space: Enter treatment started date using Ethiopian Calendar (DD/MM/YY). Record the
date when the clinical team decided that the patient deserve DR-TB treatment. In most cases,
the date of registration and date of start will be the same if the patient started the treatment
upon arrival and if no other investigation/s are important before the start of the DR-TB treat-
ment.

 Lower Space: Write a new unique patient identification number assigned by DR TB treatment
initiating center. The DR-TB unique number is assigned as follows: Region/Type of facility/facility
code/five digit serial number with DR prefix. For instance, If a patient is started on SLD treatment
at St peter hospital and is the 22nd patient to be put on SLD at the center, his/her unique MDR
number will be: 14/08/020/DR00022. Please write only the five digit number with DR prefix on
the space provided as the facility type and code are already written at the top of each page.

 Contact screening: Household /Close contacts (Column 57)

 Upper space: Write total number of Household and/ or close contacts including under 5 children

 Middle space: Enter total contacts screened for TB at HF at least once

 Lower space: Enter number of TB cases diagnosed among contact of index TB cases.

 Under 5 contact Screening and treatment (column 58): In the first row of this column, enter the
number of total under 5 contacts. In the second row of this column, enter the total number of under 5
contacts screened for TB. IN the third row of this column, enter the total number of under 5 contacts
screened negative for TB. In the fourth row of this column, enter the total number of under 5 contacts
put on IPT (LTBI treatment).

 Column 59-61: This section for sputum smear result follow up

 Upper space: Enter the smear result as “P” for positive result using red pen; “N” for negative
results and “U” for not done/results not available at the 2nd, 5th and/or 6th months.

 Lower Space: Write Lab. Serial number of the sputum smear test of the 2nd, 5th and/or 6th months.

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 Nutritional Assessment and status (Column 62-63):

 Upper space of column 62: Enter the weight of the patient in Kg.

 Lower space of column 62: Calculate BMI and enter the value. BMI is computed as weight in kg
divided by height in meter square. For patient’s age 5-18 years, use BMI-for-age and refer a standard
chart. Measure and enter MUAC in cm for pregnant & lactating women, bedridden or under-five
patient

 In column 63, write the nutritional status of the patient as: Normal, MAM or SAM. See description
on column #13 above and enter the classification in the space provided.

 Continuation phase (Column 64-65):

 Continuation phase: Drug: Write the TB regimen type for the continuation phase

 Continuation phase: Dose Column: Enter the TB drugs therapy dosage used during the continua-
tion phase.

 Continuation phase treatment monitoring chart weekly attendance (Column 66-79): Write the
date in the appropriate week row of the month, when the TB client collects the weekly doses of TB
treatment.

 Treatment outcome (Column 80): Enter the final treatment outcome of the patient as follows:

 Cured: A pulmonary TB patient with bacteriologically confirmed TB at the beginning of treatment

who was smear- or culture-negative in the last month of treatment and on at least one previous
occasion.

 Treatment completed : A TB patient who completed treatment without evidence of failure BUT
with no record to show that sputum smear or culture results in the last month of treatment and
on at least one previous occasion were negative, either because tests were not done or because
results are unavailable.

 Treatment failure: A TB patient whose sputum smear or culture is positive at month 5 or later
during treatment.

 Died: A TB patient who dies for any reason before starting or during the course of TB Treatment.

 Lost to follow up: A TB patient who did not start treatment or whose treatment was interrupted
for 2 consecutive months or more.

 Not evaluated: A TB patient for whom no treatment outcome is assigned. This includes cases
“transferred out” to another treatment unit as well as cases for whom the treatment outcome is
unknown to the reporting unit.

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 Moved to DR-TB Register : A patient who has been diagnosed as having DR-TB as per the nation-
al guideline prior to being declared as’ Failure’ and is placed on DR-TB TB treatment

NB: If a patient is transferred out to another facility, write the receiving HF name and contact address
on the remark column and confirm the final result and report to the next level during the appropriate
reporting period.

Lower space: Enter the date on which final outcome is assigned in EC using DD/MM/YY format

 Nutritional intervention (Column 81):

 Upper space: Enter the type of nutritional treatment as “RUTF” or “RUSF”

 Lower space: Enter the data on which nutritional treatment is started using DD/MM/YY format
in EC

 Nutritional treatment outcome (Column 82):

 Upper space: Record the final outcome of the therapeutic or supplementary food treatment as:
recovered/cured, no change, other outcome (specify)

Note: The following arithmetic measure should be consider to label patients as recovered/cured
from nutrition related problem: For adult (non-pregnant/lactating) with BMI ≥18.5, for Pregnant
and lactating women-with MUAC ≥ 23 cm, for Children

Under 5 years –WFH Z-score above the -2 or WFH greater than 80% ; and for children aged 5-18
years -BMI for-Age Z- score above the -2

 Lower space: Enter the data on which nutritional treatment outcome was assigned using DD/
MM/YY format

 TB Treatment Adherence support (Column 83-84):

 Put a tick mark () under Health Post column if the individual patient received support for TB
treatment adherence (all efforts and services provided including treatment observation, adher-
ence counseling, pill counting and other activities to monitor both the quantity and timing of
the medication taken by a patient) at health post by HEWs at least during continuation phase
of the treatment.

 Put a tick mark () under Health facility If the treatment adherence support is provided by the
health care worker at health facility throughout the course of the treatment.

 Remarks column (Column 85): Write any additional information about the patient that may assist the
treatment provision service.

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Data elements for reporting from TB register

1. Number of bacteriologically confirmed New Pulmonary TB cases detected in the quarter (Disaggregat-
ed by age and sex)
2. Number of clinically diagnosed New pulmonary TB cases detected in the quarter (Disaggregated by
age and sex)
3. Number of clinically diagnosed and bacteriologically confirmed new EPTB cases detected in the quar-
ter (Disaggregated by age and sex)
4. Number of RELAPSE (bacteriological confirmed and clinically diagnosed) TB cases detected in the
quarter (Disaggregated by age and sex)
5. Number of bacteriologically confirmed relapse TB cases (Disaggregated by sex)
6. Number of clinically diagnosed relapse TB cases (Disaggregated by sex)
7. Number of Treatment after failure (Disaggregated by sex)
8. Number of Treatment after lost to follow-up (Disaggregated by sex)
9. Number of Other previously treated (unknown & undocumented treatment outcome (Disaggregated by
sex)
10. Total number of new bacteriologically confirmed TB cases enrolled in cohort (PTB+)
11. Number of cured TB cases
12. Number of Treatment completed TB cases
13. Number of Died TB cases
14. Number of Lost to follow up
15. Number of Not evaluated
16. Number of Moved to MDR TB treatment
17. Total number of new clinically diagnosed pulmonary TB cases enrolled in the cohort (P/Neg)
18. Treatment outcomes of P/Neg patients (Treatment completed, died, Lost to follow up, failure, not eval-
uated, moved to MDR Tb treatment)
19. Total number of clinically diagnosed and bacteriologically confirmed new EPTB cases enrolled in the
cohort (EPTB)
20. Treatment outcomes of EPTB patients (Treatment completed, died, Lost to follow up, failure, not evalu-
ated, moved to MDR Tb treatment)
21. Number of TB case detected and registered on TB unit register who are initially referred by the com-
munity
22. Number of cohort new TB cases(all forms ) successfully treated and provided with treatment adherence
support by the community in the same quarter of the previous EFY

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23. Total number of new patients with TB (all forms) given treatment adherence support at community
level for at least full course of the continuation phase treatment in the same quarter of the previous EFY
24. Number of TB cases (all forms) notified in public health facilities with initial referral by PPM sites for TB
diagnosis or initiation of TB treatment
25. Total number of children under 5 contacts with index of drug suscptible pulmonary TB cases during the
reporting period
26. The number of under-five years contacts with index of pulmonary TB cases screened for TB in the
reporting period
27. The number of under-five years contacts with index of pulmonary with TB cases screen negative result
in the reporting period
28. Total number of under-five years contact free from TB and put on treatment of LTBI treatment ( IPT)
in the reporting period

Indicators from TB Register

 Tuberculosis case detection rate (all forms)

 Tuberculosis Re-treatment Rate
 Cure Rate for bacteriologically confirmed new PTB cases
 Treatment Success Rate (TSR) among bacteriologically confirmed NEW PTB cases
 Treatment success rate among clinically diagnosed new TB cases
 Death Rate among new all forms of TB cases
 Lost to follow up rate among new all forms of TB cases
 TB case detection contributed by community
 Treatment success of TB patients who received community-based treatment support
 Latent TB Infection (LTBI) treatment coverage for under five years children who are contacts of pulmo-
nary TB cases
 Drug Susceptibility Test (DST) coverage for TB patients
 Number of Drug Resistant (DR) TB cases detected

 DR-TB cases enrolled on DR TB Treatment (Second Line Drugs)

 Percentage of Drug resistant TB (DR TB) cases with six month interim result

Exercise on TB register

Tizita Seife Merga, a 30 years old woman, is a resident of Bishoftu town, Kebele 02, house number 234. Her
MRN is 03252 in Bishoftu Health Center. She was working as a commercial sex worker for the last 10 years.
She had cough for more than two months and was advised to visit nearby health center and to get tested

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for TB by her colleagues. She visited Bishoftu health center on Tir 12, 2010. A sputum examination was done
and the result was smear positive. She was ordered to have an XPert MTB/RIF test and the test result was
positive for pulmonary TB. Her lab number was 123/10. Her weight was 49 kg. She was put on DOTS with
fixed dose combination chemotherapy (RHZ) on the following day. Her contact person was Martha Desalew
who is resident of Bishoftu, Kebele 02, and house number 123. Tizta was also offered HIV test and the result
was positive. Cotrimoxazole chemoprophylaxis was started on the same day when anti-TB treatment is
initiated. She was also linked to HIV care on the same day

1. Complete the registers appropriately

2. Describe the cases that all four rows in unit TB register can be used during DOT’s intensive phase

3. Assume Tizita was living with three people aged 3 months, 2 years and 12 years old children. What
additional counselling and services do you provide for the family and how do you record it on TB
register?

3.2.6 DRUG RESISTANT TUBERCULOSIS (DR TB) REGISTER

Topics covered

 Recording procedures of DR TB register

 Reportable data elements from DR TB register

 Indicators from DR TB register

Objectives

At the end of this session, participants will be able to:

• Describe the purposes of DR TB register

• Understand the recording procedures of DR TB registers

• Recognize reportable data elements from DR TB register

Time needed: 2 hours

Introduction

 This register is used by facilities which started the treatment of multi drug resistant tuberculosis. It is
used to record data for patients who are on MDR TB treatment. It is also used as a monitoring tool
during the intensive and continuous phases of MDR TB treatment.

 It is a longitudinal register where patients are followed for the whole period of treatment once they are
registered.

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 Data is abstracted from the patient’s card, especially at the beginning of the registration period. Then,
follow up can be performed on the register (by ticking on the follow up columns of the register).

 The register has to be completed by the health service provider at the time of service provision.

 It should be kept in MDRTB treatment room.

How to complete the register

The register has sections for registration, laboratory test results, follow up sections for the intensive and
continuous sections, and treatment outcome section. The register is completed in a similar way as tuber-
culosis register is completed as described above. Follow the instruction on the register and complete it
accordingly.

The main part of the register and its recording and reporting procedures are as follows:

 MRN and DR TB register no. (Column 1): In the upper section, write the MRN and in the lower section
write the DR Tb register number that shows the temporal sequence of the patients visiting the facility
for DR TB treatment service.

 Treatment started date (Column 2): enter the date the patient has started treatment as DD/MM/YY.

 Full Name of the DR TB patient (Column 3): Write the patient’s name (individual, father, grandfather)
i.e Full name of the patient should be recorded in legible hand writing.

 Sex (Column 4): Write the sex of the patient as M or F

 Age (column 5): Write the patient’s age in years. If the patient is a child under one year old, write the
number of months.

 Adress (column 6): Write the address of the patient, ie. The Region, zone, woreda/subcity, towm,
House .no, and phone no of the patient. Patient address information is very important to trace back if
incase patient is lost from follow up.

 Resistance type (Column 7): Write the type of TB resistance as: RR, MDR, PreXDR or XDR

 Site of disease (Column 8): Write the site of TB disease as: P for pulmonary, EP for Extra Pulmonary

 Registration group (column 9): Write the code of the patient’s registration group by choosing from
the list available at the bottom of each page of the register as: 1 for New; 2 for Relapse; 3 for treatment
after lost to follow up; 4 for treatment after failure with first line drug; 5 for after failure of treatment with
SLD; 6 for Transfer in from another DR TB initiating center; 7 for Other groups (To be specified, to be
recorded in the remark column as well).

 Diagnosed by (Column 10): In this column, write the DST diagnostic technique used for the diagnosis
of DR TB as: LPA, XPERT or Phenotypic DST.
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 Date Sample is taken for DST (Column 11): Write the date of sample collection for diagnosis of DR TB

 Result of Drug susceptibility test (Column 12-23): Write the DST result for each drug that is listed in
each column: R for Resistant, S for Susceptible or I for Indeterminate

 Bacteriology column (Column 24-25): Tick column 24 if DR TB case was confirmed by smear micros-
copy or culture or WHO approved rapid diagnostic technology such as XpertMTB/RIF. In column 25, put
a tick mark for DRTB cases which does not fulfill the criteria for bacteriological confirmation.

 Previous treatment history (Column 26-27): In column 26, write Y for yes if the patient was previous-
ly treated more than a month with first line drugs, if not write N for no. In column 27, write Y for yes if the
patient was previously treated with SLD, if not write N for no.

 TB-HIV activities (Column 28-34):

 HIV test performed (Column 28): Write Y for yes if the patient is tested for HIV/AIDS or else
write N for no.

 HIV test date (Column 29): Write the date of HIV test

 HIV Test results (Column 30): Enter “P” in red pen if the test result is positive. Enter “N” in
normal color of pen if the test result is negative.

 Target population category (Column 31): Write the code for target population category as:
A=Female Commercial Sex workers, B=Long distance drivers, C=mobile workers/daily laborers,
D=Prisoners, E=OVC, F=Children of PLHIV, G=Partner of PLHIV, H=other MARPS and I=General
Population.

 CPT Start date (Column 32): Write the date of cotrimoxazole prophylactic therapy initiation

 ART start date (column 33): Write the date of ART initiation if the patient is on ART

 Unique ART number (Column 34): Write the unique ART number

 Regimen eligibility column (column 35): Write the type of regimen that the patient is eligible for by
choosing one of the following: 1 if the patient is eligible for short term DRTB regimen; 2 if eligible for long
term regimen without new drug; 3 if eligible for long term regimen with new DR TB drugs

 Nutritional Assessment classification (Column 36-38)

 In column 36, write the nutritional status of the patient as: Normal or MAM or SAM based the criteria
described below.

o SAM (Severe Acute Malnutrition) criteria in Adults: BMI <16 OR MUAC <18cm; for pregnant
women and lactating mothers MUAC <19 cm OR edema of both feet without clear cut other
cause.
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o MAM (Moderate Acute Malnutrition) criteria in Adults: BMI 16 - <17.5 OR MUAC 18 - <21 cm.
For pregnant women and lactating mothers: MUAC 19- <23 cm OR for HIV positive client:
Confirmed (>5% weight loss since last visit) or reported weight loss (e.g. loose clothing) AND
No edema of both feet.

o No Acute Malnutrition/Normal: BMI >17.5 OR MUAC >21 cm or pregnant women and lactat-
ing mothers >23 cm) AND No edema of both feet

 In column 37, write the type of nutritional management that was done for the patient as: 1 for nutri-
tional advice; 2 for supplementary food; 3 for therapeutic food

 In column 38, write the outcome of the nutritional management as recovered/cured or no change
or if other, specify in the upper column AND in the lower column, write the date of the outcome was
determined

 DR TB treatment outcome (Column 39): In the upper space, write the outcome of DRTB treatment
as: Cured/recovered, treatment completed, failed, died, lost to follow up, not evaluated, moved to preX-
DR TB treatment. In the lower space, write the date of treatment outcome was determined by the TIC.

 Remark column (Column 40): Write any relevant information regarding the patient

 DR TB treatment column (Column 41-42): In the upper section of column 41, write the regimen of
the intensive phase and in the lower column, write the date the intensive phase is started. In the upper
section of column 42, write the regimen of the continuation phase and in the lower column, write the
date the continuation phase is started.

 Smear and culture result monitoring (Column 43-77): Write all smear and culture results and the
date in the upper and lower rows respectively for each month. The result should be written as P for pos-
itive and N for negative result and U if not done/not available.

Reportable data elements from DR register

 Number of Drug Resistant (DR) TB cases detected

 DR-TB cases enrolled on DR TB Treatment (Second Line Drugs) (Disaggregated by regimen type, HIV
status, registration group and diagnosis type)

 Number of Drug resistant TB (DR TB) cases with six month interim result

 Total number of cohort of DR tB cases initiated on Second Line TB drugs 9-12 months earlier (Disaggre-
gated by regimen type)

 Total number of cohort DR TB cases on short term second line anti TB treatment regimen 24 moths
earlier who are cured, completed, died, failed, LTF, not evaluated

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 Total number of cohort DR TB cases on long term second line anti TB treatment regimen 24 moths ear-
lier who are cured, completed, died, failed, LTF, not evaluated

 Total number of cohort DR TB cases on long term second line anti TB treatment regimen 36 moths ear-
lier who are cured, completed, died, failed, LTF, not evaluated

Indicators from DR Register

 Number of Drug Resistant (DR) TB cases detected

 DR-TB cases enrolled on DR TB Treatment (Second Line Drugs)

 Percentage of Drug resistant TB (DR TB) cases with six month interim result

 Final Outcome of DR-TB cases

3.2.7 LEPROSY REGISTER

Topics covered

 Recording procedures of Leprosy register

 Reportable data elements from Leprosy register

 Indicators from Leprosy register

Objectives

At the end of this session, participants will be able to:

• Describe the purposes of Leprosy register

• Understand the recording procedures of Leprosy registers

• Recognize reportable data elements from Leprosy register

Time needed: 1 hour

Introduction

Leprosy register is a longitudinal register where a patient registered is followed until the end of the treat-
ment period. The register is used to monitor leprosy patients who are on treatment. The register is kept in
leprosy treatment room and is completed by the leprosy care provider

How to complete the register

• Identification section of the register (column 1-5): These columns are used to document the de-
mographic characteristics of the patient, including the name and address of the contact person of the
patient.
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• Lab result and patient category (columns 6-7): these columns are used to record the laboratory
result of the patient (the smear result), lab number and category of the patient (PB or MB).

• Disability Grade (Col. 8-10): These columns are used to record the disability grade of the eyes, hands
and feet and total disability status.

• Date starting treatment (Col 11): Write the date treatment is started

• Total number of HH contacts (Col. 12): Write the number of HH contacts on the upper row and the
total number of HH contacts diagnosed with leprosy on the lower row.

• Attendance table (Column 13-25): column for each month with name at the top.

o For MDT, enter the date MDT given in the column for the appropriate month.

o For steroids, enter the dosage in Mgs in red color.

• Treatment outcome (Column 26 -29): enter the treatment outcome in the appropriate column. Enter
the date that treatment was stopped.

o Treatment completed (col. 26): A patient who has completed a full course of MDT within the
prescribed period.

o Died (col. 27): A patient who dies of any cause during the course of MDT.

o Default (col. 28): A patient who has failed to collect more than three fourweekly (monthly) doses
(consecutive or cumulative) of MDT.

o Transfer out (col. 29): A patient who has started treatment in one Woreda (reporting unit) and
has been transferred to another Woreda (reporting unit) and for whom the treatment outcome
is not known at the time of evaluation of treatment results.

• Complete the other columns as per the instruction in the register

Reportable data elements from leprosy register

 New leprosy cases detected (by age, and type of leprosy)

 Total relapse leprosy cases detected
 Total retreatment cases other than relapse detected (Defaulter, other)
 New leprosy cases with grade 2 disability
 Treatment result of new leprosy cases
 Registered cohort of MB
 Treatment completed MB cases

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 Registered cohort of PB cases

 Treatment completed PB cases
Indicators from leprosy register

 Leprosy case notification

 Grade II disability rate among new cases of leprosy
 Leprosy treatment completion rate

3.2.8 OPD ABSTRACT REGISTER

Topics Covered

 Introduction to OPD abstract register

 Procedures of completing OPD abstract register
 National Classification of Diseases (NCoD)
 Reportable data element from OPD abstract register
 Indicators calculated from OPD abstract register
Objectives

 To describe the purposes of OPD abstract register

 To define & properly record data elements from outpatient department services
 To describe the National Classification of Diseases (NCoD)
 To identify & able to extract the reportable data elements from the OPD abstract register
 To define and calculate indicators using the OPD abstract reportable data elements
Time needed: 3.30 hours

Introduction

OPD abstract register is a serial register. The register lists all patients who received outpatient services at
the health facility. It is used for outpatient patients 5 years and older in health facility. Under five years old
children will be recorded in the IMNCI register and the service is provided in IMNCI unit. The register is kept
in the OPD unit to capture the diagnosis disease data based on the nationally customized diseases classi-
fication (NCoD – National classification of Diseases). Information for the register is abstracted from patient
form. The patient form and register are both completed by the service provider at the time of OPD service.

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How to complete OPD register

• Serial Number (Column 1): Write the sequential number

• Service date (Column 2): Write the date the patient received the service.

• MRN (Column 3): Write the Medical record number of the patient from the folder

• Age (Column 4): Write the age of the patient in years

• Sex (Column 5): Write the sex of the patient as M or F

• Adress (Column 6): Write the address of the patient (Woreda, kebele)

• Diagnosis column (Column 7-9)

o In column 7, write the national classification of disease (NCoD). If the patient is admitted, don’t
wire the NCoD, rather write “Admitted”.

NOTE: National Classification of Diseases (NCoD) is described below. Please refer to the note
to understand the details of it.

o In columns 8 and 9, identify the visit type of the patient as: new or repeat by putting a tick mark
in the respective column.

How would you define a new visit? Repeat visit?

• New Visit is patient visit for a new episode of illness.

• Repeat Visitis a patient who visits the health facility for the same episode of illness and or for
follow up etc

Note: The ultimate decision, whether a patient is defined as new or repeat diagnose is left to the knowl-
edge of attending clinician

• Road Traffic Accident (Column 10): If the patient is a road traffic accident case, write the type of the
victim as: 1 for pedestrian; 2 for motorcyclist; 3 for vehicle occupant

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• PICT (Column 11-14)

 HIV test offered (Column 11): Tick () if HIV test is offered

 HIV test performed (Column 12): Tick () if the patient is tested for HIV/AIDS.

 Target population category (Column 13): Write the code for target population category as:
A=Female Commercial Sex workers, B=Long distance drivers, C=mobile workers/daily laborers,
D=Prisoners, E=OVC, F=Children of PLHIV, G=Partner of PLHIV, H=other MARPS and I=General
Population.

 HIV Test result (Column 14): Enter “P” in red pen if the test result is positive or the patient
has documented evidence of enrolment in HIV care such as enrolment to pre-ART register or in
the ART register. Enter “N” in normal color of pen if the test result is negative.

• TB Screening column (Column 15-18): This section is used to document TB screening and its result.

• In column 15, put a tick mark is the patient is screened for TB

• In column 16, write P if the TB screening result is positive and write N if the result is negative

• In column 17, enter the code of the type of diagnostic evaluation for those whose screening result is
positive. Write 1 for sputum smear microscopy; 2 for sputum Gene Xpert; 3 for X ray or other imaging
techniques; 4 for histopathologic test; 5 for other tests (Specify); 6 is for not done

• In column 18, write the result of TB diagnosis as: TB or No TB or not decided

• Column 19: In this column, write the typoe of facility where the patient is referreed to if a referral is done
as: 1 for hospital, 2 for health center; 3 for heath post; 4 for MCH; 5 for ART clinic; 6 for Surgical OPD; 7 for
Oby gyn; 8 for TB clinic and 9 for “another service unit or health institution”

• Column 20: Tick If the patient died at OPD level (Dead on arrival) before admission

• Remarks (column 21): write any relevant information

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3.2.8.1 National Classification of Diseases (NCoD)

The NCoD was developed as part of the HMIS reform to organize health information. It is the nation-
al standard system of defining, monitoring and reporting health conditions and their outcomes.

The preparation of the NCoD started with a countrywide study of samples from service points & ad-
ministrative units. It also includes the relationship of geographical setup in respect to a disease. This
study produced a list of diseases, from which a selection of priority diseases was made. The disease
list was then harmonised with different international standards: Integrated Disease Surveillance
and Response (IDSR) protocols (using disease names in IDSR list), ICD-10 codes and Global Burden
of Disease (GBD) classification. The NCoD was finalized after the recommendations of healthcare
providers and specialists in each discipline were incorporated.

The main target of the revised disease classification is morbidity and mortality reporting with focus
on priority diseases. The national level report is limited only to diseases that are relevant for epide-
miological surveillance, planning and management purposes.
Features NCoD

The NCoD comprises of three documents that incorporate essential list of diseases corresponding to the
diagnostic capacity of the respective level of the health care system.

The Health Post edition of the NCoD comprises of 45 diseases. The Mini Edition modified for the primary
level health care contains a selection 617 diseases. The Compact Edition for use by secondary level facilities
has 1,849 diseases. The Extended Edition with 2,055 diseases is developed as a reference and for tertiary
level health care providers.
Organization of NCoD

The NCoD is a simplified disease classification system; it is organized according to the ICD-10 framework
with specification of ICD-codes corresponding to each diagnosis or disease categories. It is also fully
mapped to the ICD-10.

ICD-10 is a system of categorising diseases and health problems. It translates their lengthy descriptions into
unique codes, which are easier to store, retrieve and analyse. It is used to systematically record, analyse,
interpret and compare mortality and morbidity data collected at different times, at any level of the health
system. ICD-10 constitutes about 12,000 diseases and conditions distributed in 21 chapters: broken down
into 261 groups containing a total of about 2,036 categories. Chapters’ I–XVII relate to diseases and other
morbid conditions, and Chapter XIX relates to Injury, poisoning and certain other consequences of external
causes. Chapter XVIII covers Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere
classified. Chapter XX, External causes of morbidity and mortality. Finally, Chapter XXI, Factors influencing
health status and contact with health services, for the classification of data explaining the reason for con-
tact with health-care services. The chapters are subdivided into homogeneous blocks of three-character
categories.
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Table 1. ICD-10 List of Chapters, Block groups and Chapter titles.

Chapter Block Title

I A00-B99 Certain infectious and parasitic diseases
II C00-D48 Neoplasms
III D50-D89 Diseases of the blood and blood-forming organs and certain disorders in-
volving the immune mechanism
IV E00-E90 Endocrine, nutritional and metabolic diseases
V F00-F99 Mental and behavioural disorders
VI G00-G99 Diseases of the nervous system
VII H00-H59 Diseases of the eye and adnexa
VIII H60-H95 Diseases of the ear and mastoid process
IX I00-I99 Diseases of the circulatory system
X J00-J99 Diseases of the respiratory system
XI K00-K93 Diseases of the digestive system
XII L00-L99 Diseases of the skin and subcutaneous tissue
XIII M00-M99 Diseases of the musculoskeletal system and connective tissue
XIV N00-N99 Diseases of the genitourinary system
XV O00-O99 Pregnancy, childbirth and the puerperium
XVI P00-P96 Certain conditions originating in the perinatal period
XVII Q00-Q99 Congenital malformations, deformations and chromosomal abnormalities
XVIII R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not else-
where classified
XIX S00-T98 Injury, poisoning and certain other consequences of external causes
XX V01-Y98 External causes of morbidity and mortality
XXI Z00-Z99 Factors influencing health status and contact with health services
XXII U00-U99 Codes for special purposes

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Table 2. NCoD Mapping to ICD-10

NCOD CODE HEADING ICD-10 CODES

0100 Certain infectious and parasitic diseases A00-B99
  Epidemic prone diseases  

0101 Malaria (clinical without laboratory confirmation) B54

0102 Malaria (confirmed with P. falciparum) B50
0103 Malaria (confirmed with species other than P. falciparum) B51-B53
0104 Diarrhoea (non-bloody) A09
0105 Diarrhea with dehydration A09
A02.0, A03.0-A03.9,
0106 Diarrhea with blood (dysentery) A04.0-A04.9, A06.0-A06.1,
A07.0-A07.9
0107 Meningitis A39.0, G00-G03
0108 Typhoid fever A01.0
0109 Relapsing fever A68.0-A68.9
0100 Certain infectious and parasitic diseases A00-B99

Instructions for use

A. Conventions Used

1. Parentheses ()

Used to enclose supplementary words, which may follow a diagnostic term without affecting
the code number to which the words outside the parentheses would be assigned. For example,

Mini Compact Extended Chapter Disease Name

Hypertension (Essential (primary)
171 569 619 Circulatory System hypertension)

‘Hypertension (Essential (primary) hypertension)’, implies that the code number for the word ‘Hyper-
tension’ alone or when qualified by any, or any combination, of the words in parentheses is one and the
same.

2. Square brackets [ ]
Used for enclosing synonyms, alternative words or explanatory phrases; for example:

Mini Compact Extended Chapter Disease Name

Schistosomiasis (Schistosomiasis due
to Schistosoma haematobium [urinary
85 197 213 Infectious & Parasitic schistosomiasis])

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3. Colon :

Colon is used in terms when the words that precede it are not complete terms for assignment to
that code. They require one or more of the modifying or qualifying words indented under them
before they can be assigned to the code. For example, the diagnosis ‘Malignant neoplasm’ is to be
classified there only if qualified by the word ‘Stomach, unspecified’.

Mini Compact Extended Chapter Disease Name

Malignant (Malignant neoplasm: Stomach,
103 244 261 Neoplasms unspecified)

4. Semicolon ;

Semicolon is used to provide description of a term.

Mini Compact Extended Chapter Disease Name

Dental Disorder (Fluorosis; Abnormalities
204 661 744 Digestive System of size and form of teeth)

5. ‘NOS’

The letter ‘NOS’ is an abbreviation for ‘not otherwise specified’, implying ‘unspecified’ or ‘unquali-
fied’.

Mini Compact Extended Chapter Disease Name

103 244 976 Skin & Subcutaneous Alopecia (NOS)

6. Not elsewhere classified

Not elsewhere classified serves as a warning that certain specified variants of the listed conditions
may appear in other parts of the classification. For example:

Extended Chapter Disease Name

Bacterial Diseases (Other bacterial diseases, not elsewhere
79 Infectious & Parasitic classified)

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7. ‘And’

‘And’ stands for ‘and/or’. For example, cases of ‘tuberculosis of bones’, ‘tuberculosis of joints’ and
‘tuberculosis of bones and joints’ are to be classified in the code Tuberculosis of bones and joints.

Compact Extended Chapter Disease Name

46 49 Infectious & Parasitic Tuberculosis of bones and joints

Basic Coding Guidelines

To find a code from NCoD editions;

1. Identify the statement to be coded
2. Find the chapter to which the condition belongs to
3. Locate the lead term for the condition from the list in the chapter.
4. Read any terms enclosed in parentheses after the lead term as well as any terms under the lead term
until all the words in the diagnostic expression have been accounted for.
5. The corresponding code in digits will be adjacent to the disease name in the tabular list.
6. Verify the suitability of the code number selected.
7. Assign the code.

3.2.8.2 NCoD Summary sheet

NCoD summay sheet is used to abstract the list of NCoD diseases from the OPD and IPD registers.

• From the NCoD summary sheet, case and death will be tallied to the NCoD disease tally sheet.

• From the tally sheet, gross data will be entered into the DHIS 2 software.

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Table 3. NCoD summary sheet

Disease Summary sheet

OPD No/Name______________________
Date (DD/MM/YY)_____________________________
S/No MRN Disease Name (NCoD) Age Sex Case (√) Death (√) Remark
 1              
 2              
 3              
               

3.2.8.3 NCoD Disease tally sheet

This tally sheet is used to simplify reporting of disease cases and deaths disaggregated by age, sex and
setting (OPD/IPD). The tally sheet is completed from the NCoD summary sheet. The age disaggregation
is as follows: <1 year, 1-4 years, 5-14 years, 15-29 years, 30-64 years and >=65 years. The total tally for each
age and sex group should be summed and put in the “count” column. Please look at the tally in the annex
section.

Summary points for discussion

The participants should be clear about the following points on OPD register and tally sheets

• Definitions of new and repeat OPD visits

• Correctly defining each data element on OPD register

• The different editions of NCoD (Mini edition, compact edition and extended edition). These editions
should be made available at each facility as a pocket guide for health care providers for easy refer-
ence.

• NCoD disease summary and disease tally sheet

• Review reportable data elements and indicators from OPD register

Exercise : Exercise on OPD register and tallies

W/ro Aregash Hailu, a 25 years old woman is brought in to Agaro health center supported by her family on
Yekatit 10, 2010. Her old card is found in the health center with an MRN of 12340. She complains of high
grade fever, chills and rigors. On arrival, the nurse measured the vital signs and documented a temperature
of 39.8 0C, pulse was 120/minute & BP was 110/70 mmHg. Pallor is found on physical examination. Labo-
ratory results confirmed the diagnosis of Falciparum malaria and Anemia. She was given a prescription for
Co-artem and sent home.

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W/ro Aregash returns after 7 days on Ginbot 17. Her fever has resolved. She now complains that she has
persistent watery diarrhea for the last 2 days. The vital signs are normal and physical examination is normal
& Stool examination is negative. She was given ORS and advised to return if she has no improvement. She
is offered counseling & testing for HIV at this visit but declines to be tested without talking to her husband.

W/roAregash returns after two days on Ginbot 19. She still has diarrhea and you gave her additional ORS &
reassured her that she will get better. She has discussed about getting tested for HIV with her husband and
wants to be tested today. HIV test is performed & was negative.

1. Fill the OPD abstract register accordingly.

2. What NCoD do you write on this register for each visit?

3. List appropriate tally/ies can be used for W/ro Aregash

3.2.9 ADMISSION/DISCHARGE (INPATIENT) REGISTER

Topics Covered

 Introduction to admission/discharge (IPD) register

 Procedures of completing admission/discharge (IPD) register

 Reportable data element from admission/discharge (IPD) register

 Indicators calculated from I admission/discharge (IPD) register PD register

Objectives

 To describe the purposes of admission/discharge (IPD) register

 To define & properly record data elements from admission/discharge (IPD) register

 To identify & able to extract the reportable data elements from the admission/discharge (IPD) register

 To define & calculate indicators using the reportable data elements from admission/discharge (IPD) reg-
ister

Time needed: 1.30 hours

Introduction

Admission/Discharge (Inpatient Department-IPD) register is a serial register that lists all patients who re-
ceived inpatient services at the health facility. The register is kept in all the inpatients wards such as surgi-
cal, pediatric, medical etc. It is used to capture the number of cases and deaths in inpatient settings based
on the NCoD. Information for the register is abstracted from the patient form.

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How to complete the admission/discharge register

• Identification section (Column 1-4): In this section, write the serial number, MRN, age, sex and ad-
dress of the patient as described in the previous sections.

• Admission (Column 6-7): In column 6 write the date the patient is admitted in the ward. It should be
in Ethiopian Calendar and follow the format DD/MM/YYYY. In column 7, write the diagnosis based on the
National Classification of Disease (NCoD) as it appears on the NCoD pocket guide.

• Road Traffic Accident (Column 8): If the patient is a road traffic accident case, write the type of the
victim as: 1 for pedestrian; 2 for motorcyclist; 3 for vehicle occupant

• PICT (Column 9-12)

 HIV test offered (Column 9): Tick () if HIV test is offered

 HIV test performed (Column 10): Tick () if the patient is tested for HIV/AIDS.

 Target population category (Column 11): Write the code for target population category as:
A=Female Commercial Sex workers, B=Long distance drivers, C=mobile workers/daily laborers,
D=Prisoners, E=OVC, F=Children of PLHIV, G=Partner of PLHIV, H=other MARPS and I=General
Population.

 HIV Test result (Column 12): Enter “P” in red pen if the test result is positive or the patient
has documented evidence of enrolment in HIV care such as enrolment to pre-ART register or in
the ART register. Enter “N” in normal color of pen if the test result is negative.

• TB Screening column (Column 13-16): This section is used to document TB screening and its result.

 In column 13, put a tick mark is the patient is screened for TB

 In column 14, write P if the TB screening result is positive and write N if the result is negative

 In column 15, enter the code of the type of diagnostic evaluation for those whose screening result is
positive. Write 1 for sputum smear microscopy; 2 for sputum Gene Xpert; 3 for X ray or other imaging
techniques; 4 for histopathologic test; 5 for other tests (Specify); 6 is for not done

 In column 186 write the result of TB diagnosis as: TB or No TB or not decided

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• Discharge Information (Columns 17-20): These columns are used to write information about the
patient’s status at discharge. If the discharge diagnosis is similar to the admission diagnosis, then col-
umn 7 and 17 will be same. Otherwise, the two diagnoses can be different. It is the discharge diagnosis
which is used for reporting. In column 17, write the date of discharge, in column 18 write the length of
stay in days. In column 19, write the condition of the patient at discharge by choosing the codes that
are available at the bottom of each of page of the register as: A for improved; B for same status; C for
deteriorated; D for Left against Medical Advice (LAMA); E for died; F for referred to higher facility and G
for absconded. In column 20, write the diagnosis at discharge based on the National Classification of
Disease (NCoD) as it appears on the NCoD pocket guide.

• Finance (Column 21-23): In column 21, write the amount of money in birr that is charged by the ser-
vice provider during admission. In column 22, write the payment presented by the service recipient for
the service throught the stay. In column 23, write the voucher number on receipt for payment.

• Remarks (column 24): write any relevant information deemed necessary

Tally sheets used in IPD

The following tallies from IPD register are completed by the service provider.

• NCoD summary sheet: This is described the previous section.

• NCoD Disease tally sheet: This has been discussed in the previous section

• PITC tally sheet: This is discussed under “PITC tally” section previously

• IPD service tally sheet: This tally sheet is discussed below as follows

3.3.9.1 IPD Service tally sheet

This tally sheet is used to simplify reporting of some data elements from the IPD register. The data elements
captured with this tally sheet includes inpatient discharge cases, inpatient deaths, length of stay at dis-
charge and data related with Intensive care units such as death with out mechanical ventilator at discharge,
death with mechanical ventilator at discharge and total ICU discharged cases.

Please look at the IPD tally sheet in the annex section.

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Data elements for reporting from IPD register

1. Number of admissions

2. Number of discharges

3. Total length of stay

4. Number of inpatient deaths

5. Number of PITC tests performed (disaggregated by age, sex and population group)

6. Number of positive PITC results result (disaggregated by age, sex and population group)

7. NCoD on discharge

Indicators computed from IPD register

 Inpatient mortality rate

 Top ten leading causes of mortality

 Admission rate

 Bed occupancy rate

 Average length of stay

Exercise: Exercise on admission/discharge register

A 25 years old Sara Alemayehu from Dejen woreda came to DebreMarkos hospital on Tikimt 10, 2010. She
was the 5th visiting patient to get a ward physician on the same day and 1678th patient after HMIS imple-
mentation in that hospital. She is admitted for lower abdominal pain with rebound tenderness and hypo-
tension. The surgeon evaluated her on admission and documented acute abdomen with a possibility of a
ruptured appendix, ectopic pregnancy or pelvic inflammatory disease. She also accepted HIV testing offer
and HIV test was negative. She was taken to the OR and a ruptured appendix was removed. She developed
acute peritonitis and was kept on antibiotics for 14 days. She also developed pneumonia and UTI while she
was in the hospital. She was discharged on Hidar 18 improved for which she paid 400 birr all in one with
receipt number of 002321.

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1. Complete Admission/discharge register accordingly and complete the appropriate tally (ies) for the
above patient.

2. What are admission and discharge diagnosis of the above patient?

3. Assuming that Sara is one among the 5 companions on discharge, 2 of whom were co-admitted and
others were on Tikimit 20. What is average length of stay? Given there will be ten times similar admis-
sions to 20 available beds and the condition continues for a couple of years. What will be your action as
East Gojam Zone health manager?

4. Assume that Sara left the hospital on her own, what will be filled & in which column?

5. What are the reportable data elements from this register?

6. List the indicators that will be calculated from this register

3.2.10 INTENSIVE CARE UNIT (ICU) REGISTER

Topics Covered

• Procedures of completing ICU register

• Reportable data element from ICU register

• Indicators calculated from ICU register

Objectives

• To describe the purpose of ICU register

• To properly record the required data elements from ICU service

• To identify and extract the reportable data elements from the ICU register.

• To compute and describe HMIS indicators using the ICU reportable data elements

Time needed: 1 hour

Recording Procedure of ICU register

ICU register is used to record information about patients who are treated in the Intensive Care Unit (ICU).

• Identification Section (column 1-5): This section is used to record the personal identification data
elements such as S. No, MRN, Name, age and sex. The recording procedure for these data elements is
similar to our discussion in previous sections. It is also available at the instruction section of the register.

• Admission Section (column 6-7): in this section, write the date of admission to the ICU unit in column
6 and the diagnosis at admission (NoCD) in column 7.
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• HIV assessment section (8-11): In this section, document the HIV assessment and its result, if PICT is
provided for the patient. Tick columns 8 and 9 if HIV test is offered and performed respectively. In col-
umn 10, choose one of the target population category that is available in the bottom section of each
page. In column 11, write the result of the HIV test as P for positive tests or N for negative test results.

• Invasive mechanical ventilation section (column 12-13): In column 12, write yes if invasive mechan-
ical ventilation is provided, otherwise, write no. In column 13, write the number of days the patient was
on invasive mechanical ventilation.

• Patient information at discharge (column 14-17): In this section, document the date, length of stay,
diagnosis and status of the patient at discharge from the ICU. Write the date of discharge in column
14, the diagnosis at discharge (NoCD) in column 15, the length of stay in column16 and the patient
outcome at discharge in column 17. The patient outcome at discharge are coded as: 1 for discharged, 2
for admitted to inpatient department, 3 for died, 4 for referred/transferred out or 5 for other outcomes.

• Remark column (19): This column is used to record any relevant information about the patient.

Reportable data elements from ICU register

• Total number of patients admitted to ICU

• Number of deaths in ICU

• Number of clients tested for HIV

• Number of clients tested positive for HIV

Indicators from ICU register

• Admission rate

• Mortality rate in ICU

• Number of individuals Tested and counseled for HIV and who received their test results

3.3 OTHER REGISTERS

Contents

 Recording procedure of Emergency register, Operation register, Referral registers, Ambulance regis-
ters, TT surgery, Central register, Cervical Ca and Visceral leishmaniosis register

 Reportable data elements and indicators from these registers

Objectives of the session

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At the end of this session, participants will be able to:

 Understand how data is abstracted from individual medical records to the above mentioned regis-
ters

 Understand the recording procedures of these registers

 Recognize reportable data elements

In the next sessions, we will see the details of these registers one by one.

Time needed: 6 hours

3.3.1 EMERGENCY DEPARTMENT REGISTER

Topics Covered

 Procedures of completing Emergency register

 Reportable data element from Emergency register

 Indicators calculated from Emergency register

Objectives

 To properly record the required Emergency data elements from Emergency service

 To identify and able to extract the reportable data elements from the Emergency register

 To identify and describe HMIS indicators using the Emergency reportable data elements

Time needed: 45 minutes

Introduction

Emergency register is a register that is prepared for use in the emergency department. It should be placed
in the emergency department and filled by service providers after service is provided.

Recording procedure

1. Identification Section (column 1-7): This section is used to record the personal identification of pa-
tients. It includes recording serial number, date, MRN from the patient’s folder, age in years, sex and
address of the patient.

2. Arrival information (Column 8-11): In these columns, arrival related information should be docu-
mented. In column 8, write the time of arrival as HH:MM (Hour and minute) and in column 9, write the
time the patient is seen by a triage officer in HH:MM format. In column 10, write the arrival status of the
patient using the codes available in the register as: 1 for alive or 2 for dead. In column 11, write the trans-
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port type used to bring the patient to the health facility by writing the codes available in the register as:
1 for Ambulance; 2 for Police car; 3 for other transportation ways.

3. Referral source (column 12): The referral source should be documented in column 12 as: self-re-
ferred, referred from HC or Hospital or other (specified).

4. Triage and diagnosis section (column 13 and 14): In column 13, the triage category of the patient
should be documented by choosing one of the coded categories. The triage categories include Red (1),
Orange (2), Yellow (3), Green (4) or blue (5). In column 14, write the diagnosis of the patient at arrival. It
should be the NCoD diagnosis.

5. Patient category (column 15 and 16): In these columns, the patient should be classified as new or
repeat and ticked under one of the columns. For the definition of new and repeat patient, refer to the
OPD register where the definitions of new and repeat are defined and described.

• Road Traffic Accident (Column 17): If the patient is a road traffic accident case, write the type of the
victim as: 1 for pedestrian; 2 for motorcyclist; 3 for vehicle occupant

• Disposition after triage (column 18): In this column, write the code from the description on the foot
note: 1 = Resuscitation, 2 = procedure/OR , 3 = Examination room, 4 = Waiting area

• PICT (Column 19-22)

 HIV test offered (Column 19): Tick () if HIV test is offered

 HIV test performed (Column 20): Tick () if the patient is tested for HIV/AIDS.

 Target population category (Column 21): Write the code for target population category as:
A=Female Commercial Sex workers, B=Long distance drivers, C=mobile workers/daily laborers,
D=Prisoners, E=OVC, F=Children of PLHIV, G=Partner of PLHIV, H=other MARPS and I=General
Population.

 HIV Test result (Column 22): Enter “P” in red pen if the test result is positive or the patient
has documented evidence of enrolment in HIV care such as enrolment to pre-ART register or in
the ART register. Enter “N” in normal color of pen if the test result is negative.

6. Diagnosis at discharge (column 23): Write the NCoD diagnosis of the patient at discharge.

7. Date of discharge (column 24): Write the date of discharge as DD/MM/YY and the time of discharge in
HH:MM format

8. Length of stay (column 25): Write the total number of days the patient stayed

9. Patient outcome section (column 26-29): Tick the outcome of the treatment on the appropriate

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outcome column. The outcomes include: Referred, stabilized and discharged, admitted or died.

10. Remarks column (column 30): Write any relevant data in this column.

Reportable data elements from emergency register

 Number of patient attendance in emergency room

 Total length of stay

 Total number of deaths

 Number of cases by NCoDs

Indicators from emergency register

 Top 10 causes of morbidity

 Average length of stay

 OPD attendance per capita

 Emergency room mortality

3.3.2 AMBULANCE REGISTER

Topics Covered

 Procedures of completing Ambulance register

 Reportable data element from ambulance register

 Indicators calculated from ambulance register

Objectives

 To describe the purpose of ambulance register

 To properly record the required Emergency data elements from ambulance service

 To identify and extract the reportable data elements from the ambulance register

 To identify and describe HMIS indicators using the operation reportable data elements

Time needed: 45 minutes

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Introduction

Ambulance register is used to record information about calls for emergency ambulance service request
and the type of ambulance service provided. It is to be placed in Woreda ambulance dispatch centers. Am-
bulance related reportable data elements will be compiled on a monthly basis and reported on a monthly
reporting format of Woreda Health Offices. The woreda health office should collect data about the number
of calls and the type of ambulance service disaggregated by the type of cases served and the type of profes-
sional who accompanied during the ambulance service on a monthly basis.

Recording procedures

1. Identification section (column 1-10): This section is used to record data elements that are required
to identify individuals who called the dispatch center and those who are patients that need the ambu-
lance service.

 Serial Number (column 1): Enter the serial number sequentially starting from 1 until the end of the
budget year and start again from 1 at the first day of new budget year.

 Date: Enter the date of the call to the ambulance dispatch center, written as DD/MM/YY in Ethiopian
calendar.

 Time of call: In column 3, write the time of call, written as HH:MM (Hour: Minute: Second) in Ethiopi-
an system

 Name of call person: In column 4, write the name of the person who called to the ambulance dis-
patch center. This is not the place where you write the name of the patient.

 Place of call (column 5): Ask the caller from where he/she is calling and write the answer in this col-
umn. If the call is from a health facility, write HF; if it is from home, write ‘home’, if it is from kebele,
write ‘kebel’, if from other places, specify the place and enter into the column.

 Tel. number (column 6): Write the telephone number of the caller in this column

 Demographics of the patient (column 7-10): In these columns, ask the demographic characteristics
of the patient and enter the date in the respective columns including name of patient, sex, age and
his/her address.

2. Reason for calling section (column 11-13): The call receiver should ask the reason for calling to ini-
tially identify the problems of the patient. Tick column 11 if the reason is for labor and delivery service;
tick column 12 if the reason is for traffic accident, write the other reasons in column 13.

3. Ambulance service received section (Column 14-16): This section is to document if the service is
provided for the specified reason. This should be completed only if the service is provided by putting a
tick mark in the respective columns.

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4. Ambulance dispatch and the time it takes section (column 17-21): This section is used to docu-
ment when and for how long the ambulance service has taken.

• Time of ambulance dispatch: Write the time of ambulance dispatch as HH:MM

• Person who accompanied the patient in ambulance: Write the type of professional who accom-
panied the patient by choosing one of the codes. If the patient is accompanied by EMTs (Emer-
gency Medical Technicians), write 1; if the patient was accompanied by other health profession-
als such as nurses, write 2.

• Time of arrival to the patient or accident place should be documented in column 19 as HH:MM

• Time of Ambulance arrival at HF: Document the time the ambulance has arrived at a health fa-
cility after the patient is taken.

• Average time of travel: In column 21, write the time that takes from dispatch to arrival to a health
facility (The time length between time in column 17 & time in column 20).

5. Name of health facility: In column 22, write the name of the health facility to where the patient is
taken to.

6. Distance from patient address: Write the distance from the patent’s address to the health facility.

7. Reason for not providing ambulance service: This column is completed if there was an ambulance
call but the ambulance service was not provided. The reasons should be filled by using the available
codes at the bottom of each page: 1 = ambulance is dispatched to another place / on service at the time
of call; 2 = ambulance on maintenance/not functional at the time of the call, 3 = No driver at the time of
the call, 4 = No fuel, 5.= other reasons

8. Remarks column: This column is used to write any relevant information about the patient.

Reportable data elements from ambulance register

• Total number of Ambulance dispatched in the reporting period

• Total number of Ambulance dispatched with Emergency Medical Technicians (EMT)

• Total number of Ambulance dispatched without Emergency Medical Technicians

• Total number of Ambulance dispatched for labour and delivery cases

• Total number of Ambulance dispatched for road traffic accident

• Total number of Ambulance dispatched for other health problems

• Total number of community calls made during the reporting period

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Indicators from ambulance register

• Ambulance service response rate

3.3.3 OPERATION REGISTER

Topics Covered

 Procedures of completing operation register

 Reportable data element from operation register

 Indicators calculated from operation register

Objectives

 To describe the purpose of operation register

 To properly record the required Emergency data elements from operation service

 To identify and extract the reportable data elements from the operation register

 To compute and describe HMIS indicators using the operation reportable data elements

Time needed: 45 minutes

Introduction

Operation register is used to record data from patients who have had an operation (major or minor surgery)
in the facility. The register should be placed in Operation Theaters (both in minor and major OR rooms. It
should be completed by service providers in the department.

Recording Procedures

1. Personal Information Section (column 1-6): In these columns, please write the personal identifica-
tion data elements that includes Serial number, MRN (Form the individual medical folder), Date (Write
as DD/MM/YY), the time of operation (In Ethiopian timing system as 00:00) and the ward where the op-
eration is performed.

2. Preoperative diagnosis (Column 7): in this section, write the diagnosis of the patient before the op-
eration was performed.

3. Operation procedure Section (Column 8-10): This section is used to record the type of procedure
performed and the post-operative diagnosis. The preoperative and post-operative diagnosis may or
may not be the same. If the post-operative diagnosis is the same as the post-operative diagnosis, then
write the word “Same” in column 10.

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4. Anesthesia section (Column 11-12): this section is used to record the type of anesthesia used during
the operation procedure, identified as general anesthesia or regional anesthesia. If the patient was pro-
vided with general anesthesia, then tick column 11 but if the patient was provided with regional anes-
thesia, then tick column 12.

5. Opertion/Scrub team (Name of professionals involved) (column 13-18): The names of the sur-
geon (in column 13), first assistant (in column 14), second assistant (in column 15), anesthetist (column
16), Scrub nurse (column 17) and runner (column 18) should be documented.

6. Operation outcome section (column 19-21): The outcome of the operation procedure is document-
ed in this section. If the patient is stable after the operation, then tick column 19; if the patient is criti-
cally sick after the procedure, then tick column 20 and if the patient died after the operation, then tick
column 21.

7. Remarks Section (column 22): This section is used to write any relevant information regarding the
patient who undergo the surgical operation.

Reportable data elements from OR register

• Number of Cataract surgeries performed

Indicators from OR register

• Cataract surgical rate

3.3.4 REFERRAL REGISTER

Topics Covered

 Procedures of completing referral register

 Reportable data element from referral register

 Indicators calculated from referral register

Objectives

 To describe the purpose of referral register

 To properly record the required data elements from referral service

 To identify and able to extract the reportable data elements from the referral register.

 To compute and describe HMIS indicators using the referral reportable data elements

Time needed: 45 minutes

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Introduction

Referral register is used to document patients who are referred to other facilities for better medical care or
follow up care. The referral can be to higher health facilities (for better care) or to lower health facilities for
continuity of care. It is also used to document referred-in patients from other health facilities or from the
community. This register is kept at the liaison office/department for hospitals and at outpatient depart-
ment for health centers. The information required to complete this register is found on the referral paper of
the patient/client. Refer the instruction on how the register can be completed.

Recording Procedure of referral register

1. Identification Section (Column 1-6): These columns are used to record the identification related
data elements. It is completed in the same way as other registers discussed before.

2. Emergency Referral Section (column 7-12): This is used to document those who are emergency
patients. The transfer-in cases are recorded in columns 7-9. If the patient is referred from other health
facility with communication before arrival, column 7 should be ticked, otherwise if the referral is done
without communication, column 8 will be ticked. If the patient is self-referred, then he will be ticked un-
der column 9. For Transferred out patients, tick column 10 if the patient is referred with communication
to the other facility, tick column 11 if the patient is transferred out without communicating the other
facility and if the referral is with an ambulance, tick column 12.

3. Cold case Referral Section (Column 13-14): For non-emergency (cold cases), if the patient is referred
out, tick column 11. Otherwise if the cold case is referred-in, tick column 12.

4. Reason for referral (columns 15-18): This section is used to document the reasons for the referral
in or referral out. Tick on the corresponding column based on the reason of the referral that includes:
Gynecology/Obstetrics (column 15), Medical reasons (column 16), Surgical reason (column 17), Trauma
(column 18)

5. Feedback section (Column 19): This is to document if feedback is received or provided (to be ticked).

Reportable data elements

• Number of people referred to other health facility (emergency + non- emergency)

Indicators from the referral register

• Referral Rate

3.3.5 TRACHOMATOUS TRICHIASIS (TT) SURGERY REGISTER

Topics Covered

 Procedure of completing TT surgery register

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 Reportable data element from TT surgery register

 Indicators calculated from TT surgery register

Objectives

 To describe the purpose of TT surgery register

 To properly record the required data elements from referral service

 To identify and extract the reportable data elements from the TT surgery register.

 To compute and describe HMIS indicators using TT surgery reportable data elements

Time needed: 45 minutes

Introduction

TT surgery register is used to record data for patients for whom trachomatous trichiasis surgery is done. It
should be placed in a room where TT surgery is performed. If the TT surgery is performed at an outreach
place, the register should be taken to the outreach site and the recording should be done there.

Recording Procedure

1. Identification Section (Column 1-7): This section is used to record the personal identification data
elements that includes name, age, sex, address and date of registration. For name, use the upper row
to record the name of the individual and use the lower row to record his/her father’s and grand father’s
name.

2. Modality (column 8): This is used to record the modality (site) where the TT surgery was performed.
The modality may be static (write static), mobile (write mobile) or outreach (write outreach).

3. Diagnosis section (column 9-12): Tick the appropriate diagnosis for the upper lid and lower lid. If the
diagnosis is on the Right Upper Lid, tick under RUL, If it is on left upper lid, write LUL. For the lower lid,
if it is on the right side, tick under RLL (Right lower lid). If the diagnosis is on the left lower lid, tick under
LLL.

4. Post Operation follow up section (column 13-16): The result of the post OP follow up between 7-14
days and between 3 to 6 onths should be documented in this section. For 7-14 post OP follow up, use
the codes to document the presence or absence of the listed outcomes after the operation. Write 1 if
there is a good result and only suture is removed; write 2 if there is eyelid closure defect; write 3 if there
is cellulitis; write 4 if there is local infection. For the 3 to 6 months post follow up, write 1 if there is good
correction; write 2 if there is trichiasis; write 3 if there infection; write 4 if there is lagophthalmos.

5. Treatment Offered Section (column 17): Write 1 if Zithromax is provided, or write 2 if TEO (Tetracy-
cline eye Ointment).
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6. Name of IECW (Surgeon): on column 18, write the name of the surgeon who performed the operation.

7. Remarks column: Column 19 is used to record any information that is relevant to the patient.

Reportable data elements from TT surgery register

• Numbers of individuals who are treated by Zithromax or TEO for Trachoma

Indicators computed from TT surgery register

• Therapeutic Coverage for preventive chemotherapy diseases (PCT)

3.3.6 CENTRAL REGISTER

Topics Covered

 Procedures of completing central register

 Reportable data element from central register

 Indicators calculated from central register

Objectives

 To describe the purpose of central register

 To properly record the required data elements for central register

 To accurately identify and extract the reportable data elements from the central register

 To compute and describe HMIS indicators using the central reportable data elements

Time needed: 45 Minutes

Introduction

Central Register is used to record basic demographic and financing related information about individual
patients or clients receiving services at health facilities. It is placed at the Medical Record Unit & should be
completed by MRU workers. This register captures all individuals coming to the facility so that total number
of visits in the facility can easily be known.

Recording procedure

1. Column 1: This is used to record the serial number of patients/clients.

2. Column 2: In this column, write the date the patient/client is registered

3. Column 3: Write the Medical Record Number (MRN) of the individual patient/client

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4. Column 4: Name of the patient/client should be registered in this column

5. Column 5: Age in years

6. Column 6: Sex of the patient/client

7. Column 7: Disability status of the patient/client should be documented in this column. Disability types
that are visible to the MRU worker need to be documented in this section. The MRU worker should ask
the patient/client if she/he has any type of disability and put the finding into this column by choosing
the coded disability types. Write 1 if there is a vision loss; write 2 if there is hearing loss; write 3 if there
is a mobility impairment, If there is any other disability, it should be specified.

8. Column 8: Enter the patient/client’s payment type as 1 if he/she has a Community Based Health Insur-
ance (CBHI); Write 2 if he/she is to be served by a credit; Write 3 if he/she is a cash paying person; Write
4 if he/she has an exempted service and Write 5 if he/she has a fee waiver.
Reportable data elements from Central register
• Total number of Outpatient Visits
• OPD visits <5: Male
• OPD visits < 5: – Female
• OPD visits 5-10: – Male
• OPD visits 5-10: – Female
• OPD visits 11-19: – Male
• OPD visits 11-19: – Female
• OPD visits 20-29: – Male
• OPD visits 20-29: – Female
• OPD visits 30-45: – Male
• OPD visits 30-45: – Female
• OPD visits 46-65: – Male
• OPD visits 46-65: – Female
• OPD visits >=66: – male
• OPD visits >=66:– Female
• Total number of CBHI Members visit made to HF within a month
Indicators computed from Central register
• Outpatient attendance per capita

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• Total number of CBHI Members visit made to HF within a month

3.3.6.1 Patient/Client Attendance Tally Sheet

Topics covered

 Introduction to Patient/Client Attendance Tally Sheet

 Procedures of completing Patient/Client Attendance Tally Sheet

 Reportable data elements from Patient/Client Attendance Tally Sheet

Objectives

 To describe the purpose of Patient/Client Attendance Tally Sheet

 To record the required service delivery data elements from Patient/Client Attendance tally

 To identify & extract reportable data elements from Patient/Client attendance tally

Time needed: 10 minute

Introduction

Patient/Client Attendance Tally Sheet is used to tally patients or clients who come to a health facility for all
kinds of services.

The tally Sheet is used to analyze OPD attendance per capita indicator and should be kept at Medical
Record Unit and departments where patients do not visit Medical Record Unit to get service at follow up
such as TB clinic, dressing and others

How to complete the tally

On the left side of the tally is age and sex category of patients or clients.

Put tally for each patient or client attending the health facility for any kind of services according to the
patient’s or client’s specific age and sex category.

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Reportable data elements from Patient/Client Attendance Tally Sheet

• OPD attendances disaggregated by age and sex

Indicators computed from Patient/Client Attendance Tally Sheet

• OPD attendance per capita

3.3.7 CERVICAL CANCER REGISTER

Topics Covered

 Procedures of completing Cervical Cancer register

 Reportable data element from Cervical Cancer register

 Indicators calculated from Cervical Cancer register

Objectives

 To describe the purpose of Cervical Cancer register

 To properly record the required data elements for Cervical Cancer register

 To identify and extract the reportable data elements from Cervical Cancer register

 To compute and describe HMIS indicators using the Cervical Cancer reportable data elements

Time needed: 45 Minutes

Introduction

Cervical cancer register is a longitudinal register that is used to capture basic personal and service related
information of clients who are screened for cervical Cancer. It also helps to follow clients with suspicious
cervical cancer treatment. Each row of the register is used for one client. The register is kept in a room where
the service is provided.

Recording procedure

Personal Information Section (column 1-7): in columns 1 and 2 you record the Serial number and med-
ical registration number of the patient respectively. In the upper and lower section of column 3 you record
the date of visit to health facility and phone number of the patient respectively. In the upper and lower
section of column 4 you record the full name and address that is woreda/ sub city and Kebele of the patient
respectively. In column 5 you record the age of the patient in years. In column 6 , you write the marital status
of the patient by choosing from the codes that are available at the bottom of each page of the register as 1

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for Single, 2 for married, 3 for divorced and 4 for widowed. In column 7, you enter the educational status of
the patient by choosing from the codes that are available at the bottom of each page of the register as 1 for
illiterate, 2 for “can read and write”, 3 for “elementary/junior school”, 4 for “high school”, and 5 for “tertiary
school”

Risk factors (Column 8-9): in column 8, write the total number of births (alive or dead) that the client has
ever experienced. In column 9, write yes if the patient or her sexual partner had any history of STI and write
no if the patient or her sexual partner had no history of STI and write UN if the patient doesn’t know about
History of STI of self or partner

HIV Assessment: (Column 10-14): in columns 10 and 11, put a tick mark (√) in the respective columns
if the patient was offered and accepted HIV Test. In column 12, write” P” if the patient tested positive for
HIV or “‘N’ if the patient tested negative for HIV test. In column 13, enter the codes of targeted population
category by choosing from the codes available at the bottom of each page of this register as “A” for Female
Commercial Sex workers, “B” for Long distance drivers, “ C” for Mobile/Daily Laborers, “D” for Prisoners,
“E” for OVC, “F” for Children of PLHIV, “G” for Partners of PLHIV, “ H” for Other MARPS and “I” for General
population. In column 14, put a tick mark (√) if the patient is known HIV positive and transferred from ART.

Screening Outcome and Treatment (Columns 15-18): in column 15, put a tick mark if patient is screened
for cervical cancer with visual inspection with acetic acid (VIA).

In column 16, enter the code representing the screening result of VIS screening by choosing from the codes
available at the bottom of each page of this register as 1 for VIA negative , 2 for VIA positive; eligible for cray-
on-therapy, 3 for VIA positive; non eligible for crayon-therapy and 4 for Suspicious for cervical cancer.

In column 17, write “Yes” if patient was counseled on crayon-therapy and if patient was not counseled on
crayon-therapy write “No”.

In column 18, Write code of treatment that the patient received as “1” for “Patients with precancerous le-
sion and eligible for crayon-therapy, who accepted and treated with crayon-therapy”,”2 “for “Patients with
precancerous lesion but not eligible for crayo-therapy, who accepted and treated with LEEP, “3” for “Pa-
tients who are not eligible for both crayon-therapy and LEEP and received other treatment).

Referral column: In this column, Write the code of referral reasons as “1” if “Client was identified as a sus-
picious for cervical cancer case”, “2” if “client was not eligible for Crayo-therapy”,” 3” if “Client was referred
due to findings on the breast”, “4” if “ client was referred due to other reasons which should be specified in
the column”

Appointment column: In this column, enter the date on which the patient was appointed for follow up as
DD/MM/YY in E.C.

Remark column: In this section of the column, address issues which are not specifically addressed in the
log book like reason for other treatment, reason for referrals, refusals…

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Reportable data elements from cervical cancer register

• Number women aged 30 – 49 yr screened with VIA for cervical cancer
• Number women aged 30 – 49 yr screened with VIA for cervical cancer With Normal cervix
• Number women aged 30 – 49 yr screened with VIA for cervical cancer With Precancerous lesion
• Number women aged 30 – 49 yr screened with VIA for cervical cancer With Suspicious Cancerous
lesion
• Number of women aged 30-49 yr with cervical lesion received treatment
• Number of women aged 30-49 yr with cervical lesion received treatment with Crayotherapy
• Number of women aged 30-49 yr with cervical lesion received treatment with LEEP

Indicators computed from cervical cancer register

• Proportion of women between ages 30 – 49 years screened with VIA for cervical cancer
• Percentage of women tested positive with acetic acid (VIA) and treated for cervical lesions

3.3.8 LEISHMANIASIS (VL) REGISTER

Topics Covered

 Procedures of completing Leishmaniasis (VL) Register

 Reportable data element from Leishmaniasis (VL) Register

 Indicators calculated from Leishmaniasis (VL) Register

Objectives

 To describe the purpose of Leishmaniasis (VL) Register

 To properly record the required data elements for Leishmaniasis (VL) Register

 To identify and extract the reportable data elements from Leishmaniasis (VL) register

 To identify & describe HMIS indicators using the Leishmaniasis (VL) reportable data elements

Time needed: 45 Minutes

Introduction

Leishmaniasis (VL) register is used to capture data about basic personal and services related with Visceral
Leishmaniasis. It helps to follow clients with Visceral Leishmaniasis treatment and follow up. Each row of
the register is used for one client. The register is kept in a room where the service is provided.

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Recording procedure

Registration column (1-10): In column 1, write Sequential serial number of the patient in the registration.
In column 2, write the date of registration of the patient as DD/MM/YY in E.C. Write the MRN of the patient in
column 3, the full name in column 4, age in column 5, sex in column 5 and address of the patient in column
7. If the patient is female and pregnant, write yes in column 8, if she is not pregnant write No in the column.
If the patient is male or children, write NA in column 8 to denote not applicable. In column 9, write the travel
history of the patient to VL endemic area: Write yes if the patient had a history of travel to VL endemic area
or Unknown if the travel history is unknown. In column 10, write the number of months that the patient has
been sick before admission for VL.

Diagnosis/treatment column (Column 11): in the upper column of this column, write the diagnosis as
Primary VL, Relapse VL or PKDL. In the lower row, write the drug and dose that the patient is give. Example:
SSG 30 for patients who has been taking 30 days of SSG.

Lab Result (Column 12): Write the laboratory result as: Pos (for positive result), Neg (for negative result) or
BL (For borderline result) of DAT lab test. For Aspirate result, write the result with the parasitic load as: SA/
BMA/LA +1, +2, +3 etc. For RDT (Rapid Diagnostic Test), write the result as pos or Neg. For skin test result,
write the result as POS or NEG to denote positive or negative result respectively.

Nutritional status/Management (Column 13): In the upper row, write the nutritional status of the VL
patient as: A for not malnourished; B for Wt/HT <= 70% or MUAC<=11cm in children; C for BMI<16 or nu-
tritional edema or MUAC <=18.5 cm in adults. In the lower row of column 13, write the type of nutritional
management provided.

HIV Serostatus (Column 14): write the HIV status of the patient as POS or NEG or UNKNOWN to denote
positive, negative or unknown HIV status respectively.

Other opportunistic Infection (Column 15): In the upper row of this column, write the type of opportu-
nistic infection and in the lower section write the type of treatment provided for the opportunistic infection.

Complications/side effects (Column 16): In the Upper space, write the complication the patient devel-
oped due to Leishmania illness or the anti-Leishmania drug(s). In the lower space, write the side effect the
patient developed due to the anti-Leishmania drug(s).

Date of Discharge (Column 17): Write the date the patient is discharged from the inpatient treatment as
DD/MM/YY.

Treatment outcome (Column 18): In the upper space, write the treatment outcome as follows: cured,
referred, Defaulted, Relapse, Died or Failure. In the lower space, write the date the treatment outcome is
determined in DD/MM/YY format.

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Test of cure (Column 19): Write the test for confirmation of Cure as: clinical or parasitological

Remarks (Column 20): Write any relevant data or comment

Reportable data elements from VL register

• Number of visceral leishmaniosis patients treated disaggregated by age: <5, 5-14, >=15

• Number of visceral leishmaniosis patients treated by disaggregated by VL type as: Primary VL, Re-
lapse VL, Post Kala-azar dermal leishmaniosis (PKDL) Age: <5, 5-14, >=15

• Number of visceral leishmaniosis patients treated by disaggregated by treatment outcome as:

Cured, Defaulted, Death, Treatment failure

• Number of visceral leishmaniosis patients treated by disaggregated by HIV status as positive and
negative HIV status
Indicators from VL register

• Number of visceral leishmaniasis cases treated

3.3.9 DISPENSING REGISTER

Topics covered

 Introduction to dispensing register

 Procedures of completing dispensing register

 Reportable data elements from dispensing register

 Indicators calculated from dispensing register

Objectives

 To describe the purpose of dispensing register

 To record the required delivery service data elements from dispensing register

 To identify & be able to extract the reportable data elements from dispensing register

 To identify, compute and describe HMIS indicators from reportable data elements captured from dis-
pensing register

Time needed: 30 minute

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Introduction

Dispensing register is a serial register used to capture data elements for drug despising at dispensary unit. It
lists all clients who get prescribed drug at the facility. The register should be kept in the pharmacy dispensa-
ry unit. The register includes summary information for calculation of indicator related to drug dispensary.
Dispensary register is serial register.
How to complete dispensary register

The main part of the register and its recording and reporting procedures

 Serial Number (Column 1): Write sequential serial number in the registration book. This column
is just to show the sequence of the clients visiting the facility.

 MRN (Medical record number) (Column 2): Write/copy the Medical Record Number (MRN) from
the client’s individual folder.

• Name of the client (Column 3): Write the name of the client who go to dispensary unit in the
health facility and it should be recorded in legible hand writing.

• Age (Column 4): Write age of the client in years.

• Sex (Column 5): Write sex of the client as M for male and F for female.

• Diagnosis NCoD (Column 6) write the national classification of disease (NCoD).

• Medicines Prescribed (Column 7) write the name of prescribed drugs.

• Therapeutic Category (Column 8) write the therapeutic category of prescribed drug.

• Level of Importance section (Column 9-11): In this section, you find information about the Level
of Importance by VEN. It includes the following data elements:

o Vital (Column 9): Put a Tick (√) mark if the drug is vital.

o Essential (Column 10): Put a Tick (√) mark if the drug is essential.

o Non-essential (Column 11): Put a Tick (√) mark if the drug is non essential.

• Dispensed (Column 12): write Y if the drug was dispensed if not write N

• Overall (Column 13): write ‘1’ if all the prescribed medicines are dispensed and ‘0’ if one or more
medicines not dispensed

• Remarks (column 14): write any relevant information.

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3.3.9.1 Tracer drug availability Tally sheet

Topics covered

• Introduction to dispensing register

• Procedures of completing dispensing register

• Reportable data elements from dispensing register

Objectives

• To describe the purpose of the Tracer drug availability Tally sheet

• To record the required service delivery data elements from Tracer drug availability Tally sheet

• To identify & be able to extract the reportable data elements from the Tracer drug availability Tally
sheet

Time needed: 10 minute

Introduction

Tracer drug availability Tally sheet is used to follow the availability of tracer drugs in each day of the month.
The Tally sheet is kept at Pharmacy unit/Department

How to complete the tally

On the left side of the tally is the list of tracer dugs and on the upper section of the tally is the list of days of
the month from 1 to 30. Each tracer drug is tallied against the days of the month based on its availability
on that specific day.

Tick on each day, if the drug is available on the working day or leave it as blank if the drug is not available.
Enter 1 in ‘’overall’’ column if the drug is available on working days and zero if it is out of stock for one or
more working days in that reporting period. If the facility doesn’t give service on holidays and weekends,
enter “NA” in the specific dates and exclude the dates from the list of stock out dates.

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Reportable data elements from Tracer drug availability Tally sheet

• Tracer drug availability

3.3.9.2 Supplier fill tally

Supplier fill tally sheet is used to simplify reporting of the availability of drugs by type of supplier and cat-
egory. Supplier fill tally has two categories of disaggregation, one types of drug: program and RDF and the
second category is by type of supplier: PFSA and others.
How the tally is completed:

• The first row (heading row) is about line items requested and delivered disaggregated by PFSA and
other supplier.

• On the second row drugs were disaggregated by Program and RDF in each day requested write the
number of line items requested and delivered in the respected row.

3.4 BIRTH AND DEATH NOTIFICATION

Topics Covered

 Introduction to birth and death notification

 Procedures completing birth and death notification forms

Objectives

 To describe the purpose of birth and death notification from

 To properly record the required birth and death notification data elements on birth and death noti-
fication form

Time needed: 30 minutes

3.4.1 Birth Notification Form and Procedure

Introduction

This form is used to record and notify births that occurred in health facilities. Health facility staff should use
the birth notification form and give the completed form to the mother or guardian. This form is kept in the
delivery room of health facilities and health posts. It is completed from delivery register, integrated MNCH
card and by asking the mother (parents). This form is intended to capture births occurring at health institu-
tions, not for home births.

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This form is to be completed within 24 hours of delivery or as early as possible when the mother is stable to
provide the information. The information can be given either by the mother, father or legal guardian.

If the mother gives birth for more than one child, each child has to be registered on a separate birth notifi-
cation form. The form is to be completed by birth attendant/ focal person. The form should have the facility
stamp at the end.

Procedure of completing the birth notification form (Please check the instruction that is attached to
the birth notification format for detail description of each data element)

Place of delivery Section: Tick the type of facility and ownership of the facility where the mother delivered

Section 1 (Mother’s Information): write the full name of the mother and her age at the time of delivery.

Section 2 (Delivery Type & Complications on the Mother): Write the type of delivery and the compli-
cation, if any.

Section 3 (Characteristics/ Information of the Child): Write the name of the child, the weight, date and
time of birth, sex as M or F and type of birth as single or twin or higher multiple (if more than two)

Section 4 (Information on the Birth Attendant): Write the full name of the attendant, his/her signature
and the qualification in the space provided.

Section 5 (Notification form Issued by): In this section, write the name and signature of the person who
issue the notification form. It should be stamped with the facility’s stamp.

3.4.2 Death Notification Form and Procedure

Introduction

To record death related data for communication to the nearby civil status or vital registration office as part
of implementation of vital events registration and national identification card implementation. This form is
kept in the outpatient department, inpatient department, emergency department & delivery rooms (Hos-
pitals, Health post/HC/Clinics/MCH Specialty centers). It is completed from IPD, OPD & delivery register
books, individual folder, from administrative records, health care workers (from the person who declare
death).

This form is to be completed within 24 hours of death or as early as possible when the person declares the
death (The physician or health officer).

This form is intended to capture deaths occurring at health institution. The form should have the facility
stamp at the end.

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Procedure of completing the death notification form (Please check the instruction that is attached to
the death notification format for detail description of each data element)

• Facility Information: in this section, tick the place of death, the ownership where the facility where
death has occurred and the detail address of the health facility in the appropriate space

 Section 1 (Deceased’s information): In this section, write the full name of the deceased, the age in
years and his/her sex.

 Section 2 (Death Information): Write the date of death as DD/MM/YY, the time of death in hours and
minutes and the time as day or night.

 Section 3 (Cause of death): The immediate cause of death, intermediate cause of death and under-
lying cause of death should be recorded in the space provided.

 Section 4 (Person who declares death): Write the full name of the person, the qualification, date and
signature of the person who declares the death

 Section 5 (Notification form issued by section): in this section, write the full name, date and sig-
nature of the person who issued the form. The form should be provided to family members of the
deceased person.

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SECTION 4
HMIS REPORTING FORMATS AND PROCEDURES
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SECTION 4: HMIS REPORTING

FORMATS AND PROCEDURES
Topics covered

 HMIS report types and reporting channel

 HMIS reporting procedures

 Report Timeliness and completeness

Objectives of this section:

At the end of this section, participants will be able to:

• Identify and define the types of HMIS reports by type and period

• Describe HMIS reporting channel, schedule and procedures

• Define reporting timeliness and completeness

Time required: 4 hours

4.1 INTRODUCTION TO HMIS REPORTING

The Ethiopian HMIS is designed in a way that can capture data from the different level health institu-
tions (health facilities and administrative health units) in the country, including public health institutions,
Non-governmental health facilities, private for profit, and other governmental organizations. The HMIS re-
port includes data elements regarding the services they provide, the disease cases they treat, mortality
data and on administrative data such as human resources, finance, and logistics. Data from facilities will
be aggregate and reviewed on a monthly and/quarterly basis and are transmitted through an integrated
channel to assure standardization, consistency, and quality.

4.2 HMIS REPORTING CHANNEL AND PERIOD

HMIS reports of health institutions will be through an integrated and one channel only. An HMIS unit of
health institutions will be responsible for the overall management of HMIS data for that specific institution.
Routinely collected data will be collected from service units/departments and will be compiled by Health
Information System professionals working in HMIS unit. Reporting to the next level follows the health sys-
tem’s hierarchy. Health posts will submit their report to their cluster health center, which then compiles
data from the health center and satellite health posts to send to Woreda Health Office. Woreda Health Of-
fices compile routine reports from the health centers and from the WoHOs and send it to the Zonal Health
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Departments (ZHDs). Zonal Health Departments then send their report to the RHB and then to the FMOH.
For regions that have no functional WoHOs, health facilities will send their report to ZHDs (Example: In Ad-
dis Ababa city Administration, health centers report to subcities). For regions that have no functional ZHDs,
the WoHOs will send their report to the RHB. A monthly report is compiled from the 21st of the previous
month up to the 20th of the reporting month. Example: For Tikimt 2009 EC monthly report, the data should
be collected from Meskerem 21 up to Tikimt 20, 2009. The reporting channel and period of public, private
health facilities and administrative health units will follow the following schedule, as depicted in the table.
Table 4. Reporting level and reporting period of public health facilities

S.No. Type of Health facility Reporting level Latest date report should be
submitted
1 Health posts Cluster health center 26 of the month
th

2 Health Centers Sub-city/woreda/town health offices 26th of the month

3 Primary Hospital Zone/sub-city/woreda 26th of the month
4 General Hospital Region/sub city/Zone 26th of the month
5 Specialized Hospital FMoH 26th of the month
Table 5. Reporting level and time of private health facilities

S.No. Type of Health care Reporting level Latest date report

facility should be submitted
1 Primary clinic Sub-city/woreda/town health offices 26th of the month
2 Medium clinic Sub-city/woreda/town health offices 26th of the month
3 Specialty Clinic Sub-city/ woreda/ town health 26th of the month
offices
4 Specialty Center Woreda/Region 26th of the month
5 Primary Hospital Region/Sub-city 26th of the month
6 General Hospital Region /Zone/Subcity 26th of the month
8 Specialized Hospital RHB 26th of the month
Table 6. Reporting level and time of all health institutions

S.No. Type of Health care facility Reporting level Latest date report
should be submitted
1 Health facilities Sub-city/woreda/town health offices 26th of the month
2 Woreda Health Offices Zonal Health Departments (Sub-cities) 2nd of the next month
3 ZHDs/Sub-cities Regional Health Bureaus 7th of the next month
4 Regional Health Bureaus FMOH 15th of the next month

4.3 HMIS REPORT TYPES

The HMIS is designed to generate different types of reports that can capture important data elements to
routinely monitor and evaluate health programs in Ethiopia.

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Types of reports by period:

• Monthly reports

• Quarterly reports

• Annual reports

• Weekly reports

Quarters for HMIS reporting

 Quarter 1: Sene 21 – Meskerem 20

 Quarter 2: Meskerem 21 – Tahsas 20

 Quarter 3: Tahsas 21 – Megabit 20

 Quarter 4: Megabit 21 – Sene 20

Types of reports by content

• Service reports

• OPD morbidity report

• IPD morbidity and mortality report

• PHEM reports

Each health facility is expected to send service and disease reports on a monthly basis. In addition, diseases
which are under surveillance should be reported on a weekly basis or immediately when an immediately
reportable disease is seen in the facility.

Each type of the above mentioned reporting formats are available in the annex section. Check it and use
the following section to understand how it is completed.

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4.4 PROCEDURE OF COMPLETING REPORTING FORMATS

Health centers, clinics and hospitals

 The report that health facilities collect includes data on the services they provide, the disease cases
they see, and on administrative data such as human resources, finances, and logistics.

 Data will be collected by health workers in each service unit or department at the time of service pro-
vision. The data is captured on individual medical records, register and tally sheets that have been
discussed in the previous sections of this module.

 Data from the different service units will be compiled to produce an aggregated report for the health
facility.

 Data are transmitted through an integrated channel to assure standardization, consistency, and quality
control. Report should be transmitted to the next reporting level through the HMIS unit only. Before
sending report to the next level, a thorough review of the report should be made.

 Health facilities submit regular HMIS report to their respective administrative office monthly, quarterly
and annualy (to Woreda, Zone or Regional Health Bureau).

 Health facilities may also report to local government or other partners.

Administrative health offices:

Administrative health offices (Woreda Health offices, Zonal health departments and Regional Health Bu-
reaus) aggregates the data they received from health facilities, adds their own routine data, monitor their
own performance based on these reported data elements and reports to the next level by aggregating the
data of all the health facilities in their catchment area.

Summary of HMIS data flow

 Who: Most HMIS data are generated at health facilities. The HMIS gathers data from all participating
facilities, including MOH, NGO, private for profit, and other governmental organizations. Health facil-
ities check and review HMIS data and then forward it to their designated administrative office. The
administrative office aggregates the data it receives, adds its own administrative data, monitors its own
performance based on these reported and self-generated data, and forwards the HMIS report to the
next level. The administrative level that receives data from facilities aggregates the data by facility type
and ownership. This aggregation methodology is maintained throughout the reporting chain so that
even at the federal level it is possible to disaggregate data by facility type and ownership. Other data
that have an influence on health care provision may be available from other sectors, from surveys, etc.
While these data may be important for health sector decision-making, they are not collected through
the HMIS and are not a part of the HMIS data flow.

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 What: Facilities report on the services they provide, the disease cases they see, and on administrative
data such as human resources etc... Administrative health units report administrative data and data
from facilities in their jurisdiction. They disaggregate data by facility type and ownership.

 When: Facilities aggregate, review and report their data monthly, quarterly and annually. Adminis-
trative levels also submit their data on a monthly, quarterly and annual basis. The specific dates are
described in the table above.

 How: Data are transmitted through an integrated channel to assure standardization, consistency, and
quality. HMIS units of health institutions will be used as channels for data transmission vertically to the
next reporting units and/or laterally to the local government or other partners.

 To respond to immediate events, particularly for the purpose of outbreak detection and control, the
data channel has a fast track system. Immediately notifiable diseases data is communicated through
appropriate channel, directly to the designated disease prevention and control unit (public health
emergency management unit) at each level of the health system.

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SECTION 5
ANNEX
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SECTION 5: ANNEX
5.1 ANNEX 1: SAMPLE 1-HMIS REGISTERS

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5.2 ANNEX 2: SAMPLE TALLY SHEETS

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5.3 ANNEX 3: HMIS REPORTING FORMAT (SAMPLE)

Hospital/Health Center/Clinic/Center monthly Service Delivery Report Form
Region__________ Zone___________Woreda_________________ Name of the health facility________________
 
year _____________ month __________
HMIS_Code Activity Number data entry level
RMH Reproductive and Maternal Health    
RMH_FP_CAR Contraceptive acceptance rate    
FP_CAR_Age Total new and repeat acceptors, disaggregated by age sum HC&Hosp
FP_CAR_Age.1 New acceptors by age sum HC&Hosp
FP_CAR_Age.1.1 10-14 yr   HC&Hosp
FP_CAR_Age.1.2 15-19 yr   HC&Hosp
FP_CAR_Age.1.3 20 - 24 yr   HC&Hosp
FP_CAR_Age.1.4 25 -29 yr   HC&Hosp
FP_CAR_Age.1.5 30 -49 yr   HC&Hosp
FP_CAR_Age.2 Repeat acceptors by age sum HC&Hosp
FP_CAR_Age.2.1 10-14 yr   HC&Hosp
FP_CAR_Age.2.2 15-19 yr   HC&Hosp
FP_CAR_Age.2.3 20 - 24 yr   HC&Hosp
FP_CAR_Age.2.4 25 -29 yr   HC&Hosp
FP_CAR_Age.2.5 30 -49 yr   HC&Hosp
FP_CAR_Mtd Total new and repeat acceptors, disaggregated by method sum HC&Hosp
FP_CAR_Mtd.1 New acceptors, by method sum HC&Hosp
FP_CAR_Mtd.1.1 Oral contraceptives   HC&Hosp
FP_CAR_Mtd.1.2 Injectable   HC&Hosp

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