Government of Tripura

Office of the Medical Officer In-charge, *PHC Name

*HWC Name , Health & Welness Centre, Sub Health Centre
Indicators wise Monthly Performance Incentive of *HWC Name HWC-SHC Reporting Format of CHO for Monthly
of *CHO Name Performance Base Incentive
Monthly Achivement for
Maxim Yearly
Source of Target the Month of Evalution
um Populati Target of Benchmark
Sl. No Assessment Indicator Verification/ of SC onth Name of MOIC
weight on SC
Reporting
age
Fig Fig % Fig %
Proportion of Pregnant Women
registered who received ANC as RCH register/ RCH Rs.
1 0 0 0 80% #DIV/0!
per scheduled portal /ANMOL 1000
due date
Proportion of RCH register/ RCH
Rs.
2 new-borns who received HBNC portal /
1000
0 0 0 80% #DIV/0!
services ANMOL
Proportion of Children up to 2 RCH register/ RCH
years of age who received Rs.
3 portal /
1000
0 0 0 80% #DIV/0!
immunization as per the due ANMOL
date
Nikshay/
Proportion of
4.a SHC — HWC Rs. 500 0 0 0 100% #DIV/0!
cases referred for TB screening
Register
Proportion of
Sub Center M4
4.b population screened for malaria
Register
Rs. 500 0 0 0 100% #DIV/0!
(by RDT/ Blood Slide or both
Number of footfalls in the HWC portal/
Rs.
5 month(No. of OPD cases Register at the
1000
0 0 0 100% #DIV/0!
including new and old cases) public health facility
Proportion of
individuals 30 years and above
HWC NCD
whose CBAC form was filled Rs.
6 Application 0 0 0 100% #DIV/0!
(Only digital entry 1000
through concerned portal/
application will be considered)
 Proportion of
individual 30 years or above
7.a screened for Hypertension NCD Portal Rs. 500 0 0 0 100% #DIV/0!
(including repeat yearly
screenings for Hypertension
Proportion of HTN patients on
7.b NCD Portal Rs. 500 0 0 0 70% #DIV/0!
treatment
Proportion of individual 30 years
or above screened for Diabetes
8.a
(including repeat yearly
NCD Portal Rs. 500 0 0 0 100% #DIV/0!
screenings for Diabetes)
Proportion of patients with
8.b NCD Portal Rs. 500 0 0 0 70% #DIV/0!
Diabetes on treatment
e-Sanjeevani/ Rs.
9 Tele-consultation services 0 300 25 100% 0
HWC portal 1000
Wellness session organized at Rs.
10 HWC Portal 0 120 10 100% 0
HWC 1000
Wellness activities Rs.
11 HWC Portal 0 0 0 100% #DIV/0!
held as per annual calendar 1000
Monthly JAS Self Reported/
Rs.
12 meeting held with minimum HWC Portal 0 12 1 100% 0
1000
60% of the members
VHSND held against planned Self- reported /
Rs.
13 CHO/ MO to monitor a minimum CPHC-NCD 0 48 4 90% 0
1000
of two per month application
Self- reported
Village Meetings (VHSNC/ MAS Rs.
14
held)
/ CPHC-NCD
1000
0 12 1 100% 0
application
Monitoring of Referral cases
15.a CPHC- NCD App Rs. 500 0 0 0 80% #DIV/0!
upward
Monitoring of Referral cases -
15.b CPHC- NCD App Rs. 500 0 0 0 80% #DIV/0!
Downward
 Evaluated by Verified by Submitted by
Medical Officer In-Charge HMIS Assistant Community Health Officer
 Indicators for monthly estimation of Performance Linked Incentive or Performance Based Incentive (PBI)
Sl No. Assessment Indicator Definition Benchmark Source of Verification/ Reporting

Proportion of Numerator - No. of pregnant women

Pregnant Women who received ANC services (as pet
1 registered who received schedule) in a month Denominator - total no. or 80% RCH register/ RCH portal /ANMOL
ANC as per scheduled registered pregnant women whose ANC is due that
due date month
Proportion of Numerator - No. of new-borns who
RCH register/ RCH portal /
new-borns who received received visits (as per schedule) as
2 80% ANMOL
HBNC services Per HBNC schedule Denominator - Total no. of new-
borns due for visit that month.
Proportion of Numerator - No. of children who
Children up to 2 years of received immunization (as per RCH register/ RCH portal /
3 age who received schedule) in a month 80% ANMOL
immunization Denominator - Total no. of registered children whose
as per the due immunization was due that month
date
Proportion of Numerator-Number of Nikshay/
suspected TB cases referred for diagnosis Den0minator Minimum 3% cases
cases referred for TB SHC — HWC
4.a Total number of patients identified from OPD
screening Register
attended in OPD
Proportion of Numerator-Population covered Minimum 1.5 % of
population screened for Sub Center M4
under the Sub Center HWC Denominator- the population per
4.b malaria (by RDT/ Blood Register
No of persons tested for malaria by RDK/ Slide or both month
Slide or both

Number of 300-400 per month

No. of OPD cases HWC portal/
footballs in for 5000 population (Estimated @60
5 including new and old cases Register at the public health facility
the month cases per 1000 population)

Proportion of Numerator-No of 120 individuals over

individuals 30 years and CBAC form filled 30 years of age per 5O00 population
above whose CBAC form Denominator- Total and 74 individuals over 30 years of HWC NCD
6 was filled (Only digital population above 30 years and above of age per 3000 population- CBAC form Application
entry age to be filled every month. once CBAC
through concerned portal/ of all the targeted population is done,
application will be the HWC would be awarded full
 120 individuals over
30 years of age per
Proportion of 5000 population and
individual 30 years or 74 individuals over 30 years of age
Numerator — No. of individuals
above screened for per 3000 population screened for
screened for Hypertension Denominator-Total population
7.a Hypertension (including Hypertension every month. Once NCD Portal
of 30 years and above of age
repeat yearly screenings hypertension screening of all the
for Hypertension targeted population is done, the HWC
would be awarded full points in all
the
subsequent months
Proportion of HTN Numerator — No. of HTN patients
7.b patients on treatment who received treatment including follow up treatment 70% NCD Portal
Denominator — Total no. of diagnosed patients for HTN

120 individuals over 30 years of

age per 5000 Population and 74
Proportion of
individuals over 30 years of age per
individual 30 years or Numerator — No. of individuals
3000 population screened for DM
above screened for screened for Diabetes
every month.Once DM screening of
8.a Diabetes (including repeat Denominator-Total population of 30 NCD Portal
all the targeted population is done,
yearly screenings for years and above of age
the HWC would be awarded full
Diabetes)
points in all the
Subsequent months.

Numerator — No. of DM patients on

Proportion of
treatment who received follow up
patients with Diabetes on
8.b care Denominator — Total no. Of diagnosed patients for 70% NCD Portal
treatment
DM

Tele-consultation Tele-consultation services provided to At least 25 tele- e-Sanjeevani/

9 services the patients by CHO consultations to be HWC portal
done in the reporting
Wellness session Number of Wellness sessions At least 10
10 organized at HWC organized At H WC in the reporting sessions/month HWC Portal

Numerator-No. of Wellness
Wellness activities
activities held
held as per annual
11 Denominator - Total no. of Wellness activities to be held 100% HWC Portal
calendar
in the month as per annual health calendar

Monthly JAS
Numerator - No. of meetings held
meeting held with Self Reported/
with 60% members present Denominator - Total no. of
12 minimum 60% of the 100% HWC Portal
meetings
members
planned
 VHSND held against
planned CHO/ MO to Numerator - No. of VHSND held Denominator - Total no.
13 90% Self- reported in CPHC-NCD application
monitor a minimum of two of VHSND planned (1 VHSND/village/month)
per month

Numerator — to. of VHSNC

Village Meetings Self- reported
meetings held as per monthly plan Denominator — Total
(VHSNC/ MAS in CPHC-NCD
14 no. of VHSNC formed in HWC catchment area 100%
held) application
(1 meeting/ VHSNC/ month)

Monitoring of Numerator: Number of cases seen at CPHC- NCD

15.a Referral cases upward the receiving higher Centre Denominator: Total cases 80% App
referred to higher canters
Numerator: Number of patients seen
Monitoring of at home/SHC after being referred downwards by the
15.b Referral cases - Downward higher centre Denominator: Number of JHC referred 80% CPHC- NCD App
patients seen at higher centre