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HMIS INDICATORS
REFERENCE GUIDE

POLICY,
POLICY, PLANNING,
MONITORING
& EVALUATION
DIRECTORATE
2021
FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
MINISTRY OF HEALTH

POLICY, PLANNING AND MONITORING &

EVALUATION DIRECTORATE

HMIS INDICATORS
REFERENCE GUIDE

2021
Table of Contents
Foreword ...................................................................................................................................................... 4
Acknowledgements ...................................................................................................................................... 5
Acronyms ...................................................................................................................................................... 6
Background ................................................................................................................................................... 8
Indicators section ....................................................................................................................................... 11
1. Reproductive, Maternal, Neonatal, Child, Adolescent and Youth Health-Nutrition ....... 11
1.1. Reproductive and maternal health........................................................................................ 11
1.2. Prevention of mother to Child transmission of HIV (PMTCT) .............................................. 21
1.3. Expanded program on Immunization (EPI).......................................................................... 25
1.4. Child health............................................................................................................................. 32
1.5. Nutrition ................................................................................................................................. 39
2. Prevention and Control of Communicable Diseases ............................................................ 45
2.1. HIV Prevention and Control Indicators ................................................................................. 45
2.2. Tuberculosis and Leprosy Prevention and Control Indicators ............................................. 55
2.3. Malaria Prevention and Control ............................................................................................ 69
3. Prevention and Control of Neglected Tropical Diseases ..................................................... 73
4. Prevention and Control of Non-Communicable Diseases and Mental Health ................. 77
Mental Health ..................................................................................................................................... 82
5. Hygiene and Environmental Health ........................................................................................ 83
6. Health Extension and Primary Health Care ........................................................................... 89
7. Medical services .......................................................................................................................... 91
8. Pharmaceuticals and medical devices and their rational and proper use .................... 104
9. Regulatory systems................................................................................................................... 109
10. Human resource development and management .......................................................... 110
11. Enhance informed decision making and innovations.................................................... 112
12. Health financing .................................................................................................................... 117
13. Strengthen leadership and governance ............................................................................ 120
14. Health infrastructure ........................................................................................................... 122
Foreword
Acknowledgements
The HMIS revision process and the development of this HMIS indicators reference guide
has passed through a series of consultations and deliberations with different directorates
of MOH, agencies, Regional Health Bureaus, Universities and partner organizations. The
Ministry extends its warmest gratitude to all individuals who contributed in this document
development. The ministry also expresses special thanks to those implementing partners
that provided technical and financial support for realizing this reference guide.
Acronyms
ANC Antenatal Care
ART Antiretroviral therapy
BPR Business Processreengineering
CAC Comprehensive Abortion Care
CBNC community based newborn care
CDC Center for Disease Control
CHX chlorhexidine digluconate
CINuS Comprehensive Integrated Nutrition Service
CSA Central Statistics agency
CVD Cardio Vascular Disease
DM Diabetes Mellitus
DR-TB Drug resistant TB
EDHS Ethiopian demographic and health survey
EPI Expanded Program on Immunization
EPTB Extra Pulmonary Tuberculosis
FF Family Folder
FIC Fully Immunized Child
FP Family Planning
GMP Growth Monitoring and promotion
HBV Hepatitis B vaccine
HEP Health extension program
HEW Health extension Workers
HMIS Health Management system
HP Health Post
HPV Human papilloma virus
HR Human resource
HSTP Health sector transformation plan
HTN Hypertension
Integrated community based case management of childhood
iCCM illnesses
ICU Intensive care Unit
IFA Iron Folic Acid
IMNCI Integrated management of newborn and childhood illnesses
IPD Inpatient department
IRS Indoor residual spraying
IUCD Intra Unterine Contraceptive device
KMC Kangaroo Mother Care
LBW Low birth weight
MAM Moderate acute malnutrition
MDA Mass Drug Administration
MOH Ministry of Health
MTCT Mother to Child transmission
MUAC Mid Upper ARM Circumference
NCD NON-Communicable diseases
NICU Neonatal intensive care Unit
NNT neonatal tetanus
NTD Neglected Tropical diseases
ODF Open defecation free
OPD Outpatient department
OPV Oral Polio Vaccine
ORS Oral rehydration Solution
OTP Outpatient Therapeutic feeding Program
PAB Protection at Birth
PAC Post abortion Care
PHCU Primary Health care Unit
PLHIV People living with HIV
PNC Postnatal care
PoP Propgestogen Only Contraceptive Pills
PrEP pre-exposure prophylaxis
RHB Regional Health Bureau
RHB Reproductive Health
SAM Severe acute malnutrition
SARA Service availability and readiness assessment
SC Stabilization center
SDG Sustainable development goals
SFP Supplementary feeding program
TB Tuberculosis
TPT TB Preventive Treatment
TT Tetanus Toxoid
VSD Very sever disease
WFH weight for height
WHO World Health Organization
WoHO Woreda Health Office
ZHD Zonal Health department
Background
Health Management Information System (HMIS) is the routine collection, aggregation,
analysis, presentation and utilization of health and health related data for evidence based
decisions by health workers, managers, policy makers and others. The design and
implementation of an appropriate information system that generates quality data and
fosters evidence-based decision-making to inform health programs have been a challenge
to resource-limited countries[2-4].
In Ethiopia, HIS has been rife with multifaceted challenges that include fragmentation of
M&E systems demonstrated by various vertical parallel reporting channels, lack of
standards, a huge burden of reporting, limited funding, poor design of tools and processes.
The fragmentation created redundancies in data collection and reporting which has
overburdened health workers as they had to fill the same information on several different
forms and as they have to report same content in different reporting channels.
To address these challenges, the health sector started a business process re-engineering
(BPR) in 2006 with the focus of strengthening the system to generate quality data and
improve the use of information starting from point of data generation.
The HMIS redesign and its development considered three major principles, namely
Standardization, integration and simplification.
Standardization:Common definitions of indicators, data collection instruments, and data
processing and analysis procedures form the foundation for effective HMIS/M&E. Without
consistent principles and definitions performance cannot be systematically measured and
improved across locations or over time.

Simplification:Collecting, analyzing, and interpreting only the information that is

immediately relevant to performance improvement makes best use of scarce resources,
especially human resources.

Integration:A single HMIS/M&E plan, shared by all partners, is a cornerstone of HSDP III &
IV. Implementation of this principle requires integrating data from different programs into
a shared channel from which all derive their information.

Institutionalization:

Indicator revision process

In line with the indicator revision protocol and to enable the health system to measure its
performance based on the contemporary strategic plans, the list of indicators and their
associated recording and reporting tools were revised periodically since the HMIS
redesigning. The driving factors for revision included but were not limited to change in
program implementation, emergence, maturity and saturation of programs and mainly due
to new strategic plans. Four revisions were conducted since 2006, and figure 2 shows the
number of HMIS indicators selected during each of the revision periods.

108 122 131 177

2008 G.C 2014G.C 2017 G.C 2021G.C

This HMIS indicators reference guide represents a summary of key health and health
systems data that are routinely collected and analyzed on a monthly, quarterly or annually
basis at different levels of the health system (health posts, public health centers, public
hospitals, private health facilities, WoHOs, ZHDs, RHBs and MOH). The sources for the HMIS
indicators are primarily data collected from routine health and administrative services. The
indicators from the routine HMIS can further be triangulated with other sources such as
household surveys, facility surveys, surveillances, research studies and other sources.

The current indicator revision process was guided by a ToR and passed through a series of
consultations with all relevant stakeholders including representatives from MOH
directorates and agencies, regional health bureaus, partners, and universities.

The purpose of this reference guide is to:

 Serve as a standard reference and guidance for health indicators in the health sector
of Ethiopia
 Enhance the availability and quality of data on performance and results
 Avoid duplicative reporting requirements so that data burden on health workers
can be reduced
 Standardize data collection tools and procedures based on the selected core
indicators at all levels of the health system

Scope
This HMIS indicators reference guide contains a standard set of core HMIS indicators that
were developed and prioritized through a consultative approach spear headed by the MOH
and RHBs and their implementing partners. The process of participatory process and was
meant to provide adequate deliberations and consultations on the implementation of the
current HSTP. It has indicators that are relevant to measure the status and performance of
health programs implemented in Ethiopia. It is intended for use at different levels of the
health system. The intended users of this document are a range of stakeholders including
health workers at different levels of the health system, program managers, policy makers
and other stakeholders such as non-governmental organizations.

Organization of the guide

The guide presents the current 1776 HMIS indicators under 14 programmatic areas
categorized (table 1). Each of the indicators are presented with short names, codes,
definitions, formula, interpretations with their limitations, disaggregation, source,
reporting level and frequency.
Table 1, Distribution of 2021 HMIS indicators by their thematic areas

Thematic area Code Number

of
indicators
1. Reproductive, Maternal, Neonatal, Child, Adolescent and RMNCH 51
Youth Health-Nutrition
1.1. Reproductive &Maternal Health RMH 15
1.2. PMTCT MTCT 6
1.3. Expanded program on Immunization EPI 12
1.4. Child Health CH 10
1.5. Nutrition NUT 8
2. Prevention and Control of Communicable Diseases PCCD 45
2.1. HIV Prevention and Control HIV 15
2.2. Tuberculosis and Leprosy TB 22
LEP
2.3. Malaria Prevention and Control MAL 8
3. Prevention and Control of Neglected Tropical Diseases NTD 8
4. Prevention & Control of Non-Communicable Diseases & NCD 10
Mental Health MH
5. Hygiene and Environmental Health HEH 10
6. Health Extension and Primary Health Care HEP 4
7. Medical services MS 21
8. Pharmaceuticals & medical devices & their rational & PMS 7
proper use
9. Regulatory systems RS 2
10. Human resource development and management HRDM 3
11. Informed decision making and innovations EIDM 6
12. Health financing HCF 4
13. Governance and leadership GL 4
14. Health infrastructure HI 2
Total 177
Indicators section
1. Reproductive, Maternal, Neonatal, Child, Adolescent and Youth Health-Nutrition

1.1. Reproductive and maternal health

1.1.1. MAT_CAR:Contraceptive Acceptance Rate (CAR)

Definition Proportion of women of reproductive age (15-49 years) who are not pregnant and
are accepting a modern contraceptive method (new and repeat acceptors)
Formula Number of new and repeat acceptors
Total number of women of reproductive age (15-49 years) who are not
pregnant X 100
Interpretation This indicator is directly related to operations and measures the number of
new and repeat contraceptive acceptors in one fiscal year. To increase
contraceptive utilization (and hence prevalence), the numbers of both new and
repeat acceptors should increase. Each acceptor is counted only once, during
the first visit when s/he receives contraceptive services in the specified
Ethiopian fiscal year. “New acceptors” refers to the number of modern
contraceptive method acceptors who receive family planning services from a
recognized family planning providing facility for the first time irrespective of
the method used. This does not include the number of consultations and
emergency contraceptive. Each acceptor is counted once in the year, at the
time a woman receives a modern contraceptive for the first time in her life
during the fiscal year. The number of new acceptors measures the ability of the
program to attract new clients to its services. “Repeat acceptors” refers to the
number of acceptors who have had received family planning services from a
recognized family planning providing facility previously irrespective of the
method used. Each repeat acceptor is counter once during the fiscal year,
irrespective of number of times family planning services were received during
that fiscal year. 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. New and repeat contraceptive
acceptors are reported as two separate counts, so that it will be possible to
calculate each rate separately as needed. Contraceptive acceptors data is
reported from NGOs, Private-for-Profit health facilities and other community-
based non MOH sources should also be included in this calculation.
Note: Recognized family planning providing facilities are those that are
approved to provide family planning service by Ethiopian EFDA (Ethiopian
Food and Drug Authority).
Disaggregation By type of acceptors: New, repeat; By Age: 10-14, 15 - 19, 20–24, 25–29 , 30-49
years By Methods: OCP, Injectable, Implants, IUCD, Vasectomy , Tubal ligation
(TL) and Others
Source Family planning register; Service delivery tally (for HP), RH register (clinics
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.2. MAT_IPPCAR:Immediate postpartum contraceptive acceptance rate (IPPCAR)

Definition The proportion of women of reproductive age (15-49 years) who are accepting a
modern contraceptive method immediately (0- 48 hrs.) after delivery
Formula Number of women who accepted a modern contraceptive method
immediately after delivery (0-48hours) X 100
Total Number of women who delivered in a facility
Interpretation This indicator measures family planning (FP) services for women who have
been provided contraceptives in the immediate post-partum period (0-48
hours after delivery). Women in the post-partum period are groups with the
greatest unmet needs to FP. The post-partum Period, especially the immediate
postpartum period, is an opportunity to reach this group and hence increase
the access to the FP service. Providing contraception during this time is cost-
effective and efficient because it does not require significant increases in staff,
supervision or infrastructure. Moreover, where there are taboos that prevents
mothers from going out or visiting the health facilities before 45 days after
delivery, providing FP services during post-partum period has additional
benefits. Immediate Post-Partum Contraception (IPPC) can result in dramatic
reductions of high risk and unwanted pregnancies, increase in meeting the
need for FP, and improvements in the health and survival of mothers and
children. For the definitions of new and repeat acceptors, refer to the indicator
above (i.e, Contraceptive Acceptance Rate).

The denominator may exclude women who delivered at home and came for
PNC in the first 48 hours and received family planning methods
Disaggregation By Age: 10-14, 15 - 19, 20–24, 25–29, 30-49 years and
By Methods: POP, Implants, IUCD, Tuba Ligation, Others
Source Delivery registers, PNC register, Service delivery tally (for HP), RH register (or
primary private clinics)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.3. MAT_ANC1:Antenatal Care (ANC) coverage – First visit

Definition Proportion of pregnant women who received antenatal care first visit during
the current pregnancy
Formula Number of pregnant women that received antenatal care – First X 100
Visit
Total number of expected pregnancies
Interpretation Antenatal Care (ANC) coverage is an indicator of access and use of health
care services during pregnancy. The antenatal period presents opportunities
for reaching pregnant women with interventions that may be vital to their
health and wellbeing and that of their fetuses. ANC first visit coverage is
categorized into two as: - early ANC (<=16 weeks so that ANC initiation
period (Early Vs late) can be determined and monitored. Early ANC is often
detected if the woman exactly knows her last normal menstrual period
(LNMP), and/or using Ultrasound detection. Pregnant women who begin
ANC visit before 16 weeks of pregnancy play a crucial role in early detection
of complications that may affect the outcome of the pregnancy. Besides, early
antenatal care first visit also increases the likelihood of a pregnant woman
receiving continued care throughout her pregnancy by having four or more
ANC visits for effective maternal health interventions and outcomes. Note:
Referral linkage should be strengthened between health posts and health
centers to avoid double reporting. If a mother received ANC 1st visit in a
health post and referred to a health center, it should be send via a referral
form so that the health center can avoid double reporting.
Disaggregation By Gestational Period: (<=12 weeks), (>12 and <=16 weeks), & (>16 weeks),
Age: 10-14,15-19, >=20
Source ANC register, Service delivery tally (for HP), Integrated RH register ( clinics)
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.1.4. MAT_ANC4+: Antenatal Care (ANC) coverage – Four visits

Definition Proportion of pregnant women who received antenatal care four or more times
during the current pregnancy.
Formula Number of pregnant women that received four or more antenatal care X 100
visits
Total number of expected pregnancies
Interpretation The fourth antenatal care visit is an indicator of quality and continued use of
health care during pregnancy. The antenatal period presents opportunities
for reaching pregnant women with interventions that may be vital to their
health and wellbeing and to their infants. Receiving four focused antenatal
care visits increases the likelihood of receiving effective maternal health
interventions during antenatal visits. ANC service should be provided based
on the focused antenatal care approach. Pregnant women who have had visit
for medical illness is not part of the focused ANC service and should not be
reported as ANC report.
Also, women who have received four or more ANC visits will be counted only
once as having completed four or more ANC visits.

Note: All of the first four ANC visits are supposed to happen before 30 weeks
 of gestation.

Disaggregation By Age: 10-14,15-19, >=20

By Gestational week: <30 weeks , >= 30 weeks

Source ANC register, Integrated RH register ( clinics)/Service delivery tally (for HP)
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.1.5. MAT_ANC8+:Antenatal Care (ANC) coverage – Eight or more contact

Definition Proportion of pregnant women who received antenatal care 8 contacts and
more during the current pregnancy
Formula Number of pregnant women that received antenatal care –8 Contacts
and more
Total number of expected pregnancies X 100
Interpretation Quality indicator (need to be described), improve client satisfaction, reduce
mortality (perinatal and maternal). The 8 contacts should be at 12, 20, 26, 30,
34, 36, 38 and 40 weeks of GA. Mothers who didn’t have contact as per
schedule of 8 contacts will not be reported.

Disaggregation None
Source ANC register, Service delivery tally (for HP), Integrated RH register (for
clinics)
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.1.6. MAT_SYPH: Proportion of pregnant women tested for syphilis

Definition Proportion of pregnant women attending antenatal care tested for syphilis
Formula Number of pregnant women tested for syphilis
X 100
Total number of pregnant women who attended first ANC visit
Interpretation Syphilis affects the health of pregnant mothers and their fetus. It may cause
abortion, still birth, premature birth and congenital anomalies like saddle nose.
Performing syphilis screening test for all pregnant mothers helps to detect the
disease early so that appropriate treatment can be provided to protect the
mother and the fetus from complications. Nowadays syphilis can be detected
form during routine blood test (whole blood, plasma or serum) using rapid
antibody test kits like syphilis-check. The tests are very sensitive and specific
and the test can be performed even in areas with no electric power. For
pregnant women, usually this syphilis testing is done during the first ANC visit
Disaggregation By test Result:- Reactive and Non-reactive
Source ANC Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.7. MAT_SBA:Skilled delivery attendance

Definition Proportion of births attended by skilled health personnel at a health facility
Formula The number of births attended by skilled health personnel at a health
facility
Total number of expected deliveries X 100

Interpretation All women should have access to skilled care during pregnancy and childbirth
to ensure prevention, early detection and management of complications of
child birth. Assistance by properly trained health personnel with adequate
equipment is key to reducing maternal deaths. It is one of the most important
proved intervention that plays a great role in reducing the maternal mortality
rate and is one of the Sustainable Development Goals (SDGs) indicators to
track national effort towards safe motherhood. In addition, the proportion of
births attended by skilled personnel at the given facility is a measure of the
health system’s function, accessibility, and quality of care. “Skilled attendant at
birth” has been proposed as an intermediary, process or proxy indicator for
monitoring progress towards the reduction of maternal mortality. A skilled
personnel is defined as a health professional (such as a midwife, nurse, health
officer or doctor who has been trained in the skills needed to manage normal
(uncomplicated) pregnancies, childbirth and the immediate postnatal period
and in the identification, management and referral of complications in women
at the time of child birth and immediately thereafter. Note: For this indicator,
the birth should be attended by the skilled health personnel at a health facility
and service provided for a retained placenta should not be count as a delivery
service report.
Disaggregation None
Source Delivery Register, Integrated RH register for clinics)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.8. MAT_SBR:Stillbirth Rate

Definition Proportion of stillbirths from total births attended
Formula Number of stillbirths
Total number of births (still and live) attended X 100
Interpretation The stillbirth rate mainly defines the access, availability and quality of
obstetric care and the result of neglected obstructed labor in the Ethiopian set
up, but could also be due to major congenital malformation, RH
incompatibility, or many other causes. Still birth is birth of a baby born with no
signs of life at or after 28 weeks of gestation. Still birth includes Intra Uterine
Fetal Death (IUFD)
Disaggregation None
Source Delivery register, Service delivery tally (for HP)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.9. MAT_EPNC:Early Postnatal care (PNC) coverage

Definition Proportion of women who received post-natal care at least once during the early
post-partum period (within 7 days after delivery).
Formula Number of women who received post-natal care visits at least once
within 7 days of delivery
X 100
Total number of expected deliveries
Interpretation Early Postnatal care (PNC) coverage is the proportion of women and newborns
that get care, at least once during the first 7 days after delivery for reasons
relating to post-partum services. For mothers who delivered in a health facility,
the first post-partum visit is held within the first 24 hours after stay at facility
and the woman is checked for bleeding, uterine contraction, fundal height,
temperature and pulse. Those mothers who are discharged before 24 hour stay
at facility are not recorded as first PNC. For home deliveries the first postnatal
care contact should be within 0-24 hours. The second post-natal care visit is
held within 25-48 hours followed by 49-72 hours and 73hours-7 days. During
this periods mothers are checked for urinary incontinence, bowl functioning,
healing of perineal wound, fatigue, back pain, breast pain and lochia. In each
PNC visit, the neonate should also be evaluated for any ill health conditions.
Ideally the PNC visit should be given for both the neonate and the mother at a
time. Even though the post-partum period is 6 weeks (42 days) after delivery,
the reproductive health program especially encourages a visit within the first 7
days, and specifically the first two days after delivery because it is considered
as critical period. This indicator shows the utilization (accessibility and
acceptability) of postnatal care services. For women who delivered at home
and came to a health facility within the first day, it should be counted as a PNC
if she stays for at least 24 hours in the facility. Note: A woman who received
Postnatal Care services should be counted only once even though she may have
a PNC care service more than once in the first seven days after delivery. The
first postnatal visit that the woman had is the one that should be reported.
Disaggregation 0-24 hours( 1st day) 25-48 hours 49 – 72hours 73hrs-7 days
Source Postnatal care register, Service delivery tally (for HP), Integrated RH register
(for primary private clinics)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.10. MAT_CS:Caesarean Section (C/S) Rate

Definition Percentage of births delivered by caesarean section among all births in a given
time period
Formula Number of women having given birth by caesarean section X 100
Total number of expected deliveries
Interpretation The percentage of births by caesarean section from the total expected
deliveries is an indicator of access to and use of health care during
childbirth. Caesarean section rate is one of the process indicators that tells
us about the availability and quality of Comprehensive Emergency Obstetric
Care (CEmONC) in the country. Five to fifteen percent of all pregnancies are
expected to end up in complications and may require a caesarean section
intervention during delivery. Therefore, C/S rate is expected to be between
5% and 15%. If C/s Rate is below 5% or more than 15%, further
investigation should be done. If the C/S rate is below 5%, it may show less
coverage of caesarean section service and if it is more than 15%, it may
show unnecessary caesarean sections are performed for women who can
deliver normally without a caesarean intervention. Nevertheless, even if C-
section rate is within 5-15 %, it could be that those who need might not be
receiving the services, while C-sections are performed unnecessarily on
others. Corroboration of the data may be necessary to establish that C-
sections are performed rationally and with due diligence.
Disaggregation None
Source Delivery register
Reporting level Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.1.11. MAT_ABOR:Women receiving comprehensive abortion care services

Definition Number of women receiving comprehensive abortion care. It includes women
who received safe abortion and emergency post abortion care services.
Formula Number of women receiving comprehensive abortion care services, including safe
abortion and emergency post abortion care services
Interpretation In Ethiopia, complications resulting from abortions account for one third of all
maternal deaths. The Government of Ethiopia has enacted legislation that
 requires health care providers to provide services for safe abortion
termination of pregnancy service including women who receive post-abortion
care in exceptional circumstances when the women asks for, and/or consents
to the service.
This indicator measures the burden of unplanned pregnancy and access to
abortion care services.
Disaggregation Type: Safe and PAC
Age: 10-14, 15-19, 20- 24, 25-29 and 30+
Trimester: First Trimester (<12 weeks) and Second Trimester (≥12 -28
weeks)
Source Abortion care register
Reporting level Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.1.12. MAT_IMD:Institutional maternal deaths

Definition The proportion of maternal deaths from any cause related to or aggravated by
pregnancy or its management in the community (at home, on the way to HF and
in the HP) among those deliveries in a health facility.
Formula Number of maternal deaths in health facility
Total number of deliveries in health facility X 100
Interpretation Maternal death is the death of a woman from conditions caused or aggravated
by pregnancy, which occurs from time of conception to six weeks postpartum,
but not from incidental or accidental causes. The cause of death could be direct
– abortion, hemorrhage, pregnancy induced hypertension, obstructed labor or
sepsis; or could be indirect like heart disease aggravated by pregnancy, malaria
in pregnancy, anemia, etc... Ideally, the institutional proportion of maternal
deaths should be less than 1%. Five major obstetric complications are known
to be the major cause of maternal mortality: hemorrhage (post-partum, ante-
partum), ruptured uterus, eclampsia, obstructed labor, infection. These
conditions are included in the HMIS disease classification list for inpatient
morbidity and mortality. The fatality rate for all five conditions taken together
should be less than 1% of all deliveries. The reasons for every maternal death
in a health institution should be investigated and appropriate quality/service
improvement measures should be taken. Since the mortality is calculated from
the total births in the facility, it is like a case fatality rate and be computed as a
percentage.

Note: To capture all institutional maternal deaths, it is essential to review

deaths from different registers where deaths are recorded, that includes all in
patient registers from surgical, medical, obstetric, and gynecological wards;
from delivery, PNC, OPD, emergency and ICU registers.

Limitation: Mothers who did not deliver in the health facility but later came to
 the health facility for postpartum complication may die at the health facility
and get counted as an institutional maternal death even though the
denominator does not include these mothers.
Note: In order to understand the whole picture of maternal death rate per
100,000LBs , the numerator should include number of maternal deaths both at
the facility and at the community levels.
Disaggregation None
Source Admission/Discharge register; Delivery register; PNC register; OPD register;
Emergency register, abortion register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.13. MAT_CMD:Number of maternal deaths in the community

Definition Number of maternal deaths from any cause related to or aggravated by
pregnancy or its management in the community ( at home, on the way to HF and
in the HP)
Formula Number of maternal deaths from any cause related to or aggravated by
pregnancy or its management in the community ( at home, on the way to HF and
in the HP)
Interpretation Maternal death is the death of a woman from conditions caused or aggravated
by pregnancy, which occurs from time of conception to six weeks postpartum,
but not from incidental or accidental causes. The cause of death could be direct
– abortion, hemorrhage, hypertension, obstructed labor or sepsis; or could be
indirect like heart disease aggravated by pregnancy, or malaria in pregnancy.
Five major obstetric complications are known to be the major cause of
maternal mortality: hemorrhage (post-partum, ante-partum), ruptured uterus,
eclampsia, obstructed labor, infection. The reasons for every maternal death in
the community should be investigated and appropriate improvements
measures taken.
Disaggregation Place of death: at home, on the way to health facility, at HP
Source Service delivery tally (for HP), Administrative record
Reporting Heath Post
level
Reporting Monthly
Frequency

1.1.14. MAT_PPH:Women who developed Post-partum Hemorrhage (PPH)

Definition Percentage of women who developed PPH after facility or home delivery
Formula Number of women who developed PPH after home delivery or
Institution delivery X 100
Total number of expected deliveries
Interpretation Indicates quality of delivery care. This indicator should be disaggregated to
PPH from Home delivery and PPH from Institution delivery.

Mothers who delivered outside of the health facility (Example: on the way to a
health facility) and developed PPH are included under home delivery for this
indicator.

Limitation: Home delivered women may die before coming to the facility
Disaggregation By Place of delivery : Home delivery and facility delivery
Source Delivery register and PNC register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.1.15. MAT_UTER:Delivered women who received Uterotonics

Definition Percentage of women who received uterotonics in the first one min after delivery
Formula Number of delivered women who received uterotonics in the first one
min after delivery
X 100
Total number of deliveries
Interpretation Administration of uterotonic agents after delivery of the baby is an effective
strategy to reduce maternal mortality and morbidity by preventing excessive
bleeding after birth (postpartum hemorrhage) which contributes for more than
half of maternal death in Ethiopia. Routine administration of uterotonics with
in one minute of delivery to contract the uterus is a standard practice. Different
drugs given routinely at birth have been used for reducing excessive bleeding.
They include oxytocin (IM/IV), misoprostol (PO), ergometrine (IM/IV),
carbetocin (IV), and fixed combination of oxytocin and ergometrine (IM).
Currently, oxytocin is recommended as the standard drug of choice to reduce
excessive bleeding. However, any of the drugs can be given if oxytocin is not
available.
The indicator shows the proportion of women delivered at health center and
hospital who received uterotonics with in one minute after delivery from the
total birth attended. It is one of the indicators to measure quality of delivery
care and helps to monitor the use of uterotonics after birth for the prevention of
postpartum hemorrhage.
Disaggregation By: Utrotonic types(Oxytocin, Mesoprostol Ergometrin and other)
Source Delivery register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency
1.2. Prevention of mother to Child transmission of HIV (PMTCT)

1.2.1. MTCT_TST:Percentage of pregnant, laboring and lactating women who were tested
for HIV and who know their results
Definition Percentage of women who were tested and know their HIV status during
pregnancy, labor or delivery and post-partum period
Formula Number of women who were tested and know their HIV status during
pregnancy, labor or delivery and post-partum period X 100
Estimated number of pregnant women
Interpretation Mother-to-child transmission of HIV infection can occur during pregnancy,
labor and delivery or during breastfeeding. The risk of mother-to-child
transmission can be reduced by a range of interventions, including providing
antiretroviral therapy (ART) to women during pregnancy and labor and to the
infant in the first weeks of life; obstetrical interventions, including elective
caesarean delivery. Receiving HIV testing and counseling services as early as
possible during pregnancy enables pregnant women living with HIV to benefit
from HIV services and to access interventions for reducing HIV transmission to
their infants. This indicator is used to track progress towards ensuring that all
pregnant and lactating women attending ANC, labor and delivery and PNC
know their HIV status and are initiated on ART.

The numerator is the sum of the following: a) Pregnant women with an

unknown HIV status who received an HIV test and result during antenatal care;
b) Pregnant women attending labor and delivery with unknown HIV status
who were tested for HIV in the labor and delivery facility and received their
result; c) Women with unknown HIV status attending postpartum services
who were tested for HIV and received their result; and` d) Pregnant women
with known HIV positive status attending antenatal care, labor and delivery
and postpartum for a new pregnancy linked from ART through formal Transfer
out format (TO) provided from ART unit.
Note:- These women who are listed on a), b) and C) should be reported under
PITC report (HIV testing and counseling section)
Disaggregation By Service area: ANC, L&D and PNC
Source ANC, L&D and PNC Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.2.2. MTCT_ART:Percentage of HIV-positive pregnant women who received ART to reduce

the risk of mother-to child-transmission during pregnancy, labor & delivery (L&D)
and postpartum
Definition Percentage of HIV-positive pregnant women who received ART to reduce the
risk of mother-to child-transmission (MTCT) during pregnancy, L&D and
postnatal.
Formula Number of HIV positive pregnant and lactating women who received
ART at ANC, L&D and PNC for the first time and those women who get
pregnant while on ART & linked to ANC
Estimated HIV positive pregnant women in the year X 100
Interpretation In the absence of any preventive interventions, infants born to and breastfed
by women living with HIV have roughly a one in three chance of acquiring
infection. This can happen during pregnancy, during labor and delivery or after
delivery through breastfeeding. The risk of mother to child transmission can be
significantly reduced through the complementary approaches of providing
antiretroviral therapy for the mother and with prophylaxis to the infant,
implementing safe delivery practices and using safe breastfeeding practices.
Antiretroviral prophylaxis followed by exclusive breastfeeding for the first 6
months reduces the risk of vertical transmission. According to option B+, HIV
positive pregnant and lactating women will be started on ART irrespective of
their CD4 count and WHO clinical staging. This indicator measures the
provision and coverage of antiretroviral treatment, by regimen type, for HIV-
positive pregnant women in order to reduce the risk of mother to child
transmission of HIV.

The numerator includes the number of HIV positive pregnant and lactating
women who received ART to reduce the risk of mother to child transmission at
ANC, L&D and PNC for the first time and HIV positive pregnant, laboring and
lactating women who get pregnant while on ART and linked to ANC to reduce
the risk of mother-to child transmission. This linkage has to be functional for
the purpose of counseling the mothers on birth preparedness plan, awareness
on danger sign during pregnancy and during laboring, Provision of vaccination
on Tetanus toxoid, maternal nutrition and improves counseling on the 1000
days practices for the mother and the family.
Disaggregation Newly started at: ANC, L&D, PNC and those already on ART Linked from ART
Source PMTCT Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.2.3. MTCT_HEI_EID:Proportion of HIV exposed infants with virological test

Definition Percentage of infants born to HIV-positive women who received a virological
(DNA/ PCR) HIV test within 12 months of birth
Formula Number of HIV exposed infants who received a virologic HIV test within
12 months of birth X 100
 Total number of expected live births from HIV positive mothers
Interpretation This indicator measures the extent to which infants born to HIV-positive
women are tested to determine their HIV status within the first 12 months of
life. Additionally, the yield of HIV testing at 2 months of age may be a useful
proxy of early mother-to-child transmission rates if coverage of testing is >
80%. It is recommended to establish the capacity to provide early irological
testing of infants for HIV at 6 weeks, or as soon as possible thereafter to guide
clinical decision-making at the earliest possible stage. Data from this indicator
will be used to determine the rate of scale up and progress with Early Infant
Diagnosis, to strategize scale-up programs and inform how the PMTCT
program is successful in averting infection. The numerator is calculated from
the PMTCT Register. The number of infants who received an HIV test within 12
months of birth should only be counted once. Only the first test for each HIV
exposed infant should be counted in this indicator. Even though there is
ongoing exposure of infants to HIV (through breastfeeding), this indicator is
only measures early access to testing, and not repeat testing of exposed infants.

The numerator should only include the initial test and not any subsequent
tests. Infants infected with HIV during pregnancy, delivery or early postpartum
period often die before they are recognized as having HIV infection. Early
diagnosis of infants who acquired HIV during pregnancy, delivery or in the
early postpartum period is critical as infants have an increased risk of
mortality if they go undiagnosed and untreated.
Disaggregation Disaggregated by testing period and test result Negative: within 2 Months ,
between 2-12 Months Positive: within 2 Months , between 2-12 Months
Source PMTCT Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.2.4. MTCT_HEI_COTR:Percentage of exposed infants born to HIV-infected women who

were started on co-trimoxazole prophylaxis within two months of birth
Definition Percentage of exposed infants born to HIV-positive women who started on co-
trimoxazole prophylaxis within two months of birth
Formula Number of infants born to HIV infected women started on co- X 100
trimoxazole prophylaxis within two months of birth during the
reporting period
Estimated number of HIV- infected pregnant women who gave live birth
Interpretation This indicator permits monitoring trends in the numbers and proportion of
HIV exposed infants who started CTX prophylaxis. Co-trimoxazole prophylaxis
is a simple and cost-effective intervention to prevent Pneumocystis Caroni
Pneumonia (PCP) among HIV-exposed and -infected infants. PCP is the leading
 cause of serious respiratory disease among young HIV-infected infants and
often occurs before HIV infection can be diagnosed. Because diagnosing HIV
infection among young infants is difficult, all infants born to women living with
HIV should receive Co-trimoxazole (CTX) prophylaxis starting at 4–6 weeks
after birth and continuing until HIV infection has been excluded and the infant
is no longer at risk of acquiring HIV through breastfeeding. Individuals should
be considered to be “receiving” CTX prophylaxis if CTX has been prescribed
and obtained by the patient (provided by a program or procured by the
patient). The indicator does not attempt to capture interruptions in drug
availability or patient adherence to prescribed therapy. The reports will need
to be interpreted in the context of national policies.
Disaggregation None
Source PMTCT Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.2.5. MTCT_HEI_ARV:Percentage of infants born to HIV-infected women receiving

antiretroviral (ARV) prophylaxis for prevention of mother-to-child transmission
(PMTCT)
Definition Percentage of infants born to HIV positive women who received ARV prophylaxis
to reduce risk of mother-to-child transmission
Formula Number of HIV exposed infants who received ARV prophylaxis X 100
Total number of expected live births from HIV positive mothers
Interpretation In the absence of any preventive interventions, infants born to and breastfed
by women living with HIV have roughly a one in three chance of acquiring
infection. This can happen during pregnancy, during labor and delivery, or
after delivery through breastfeeding. The risk of mother to child transmission
can be significantly reduced through the complementaryapproaches of
providing antiretroviral therapy for the mother and with prophylaxis to the
infant, implementing safe delivery practices and using safe breastfeeding for
the first 6 months. HIV positive pregnant women will be started on ART
irrespective of its CD4 count and WHO clinical staging. Infants born to HIV
positive women should receive Dual (NVP+AZT) prophylaxis as per the
national guideline.

All HIV exposed infant (HEI) born to HIV positive mothers should receive dual
prophylaxis (NVP+AZT) for six weeks which is followed NVP only for
additional six weeks.
The numerator is the number of HIV exposed infants (HEI) who took ARV
prophylaxis for a total of 12 weeks.
Disaggregation No disaggregation
Source PMTCT Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.2.6. MTCT_HEI_ABTST:Percentage of HIV exposed infants receiving HIV confirmatory

(antibody test) test by 18 months
Definition Percentage of HIV exposed infants tested and confirmed HIV status at 18 months
by rapid antibody test
Formula Number of HIV exposed infants receiving HIV confirmatory (antibody
test) by 18 months
X 100
Total number of expected live births from HIV positive mothers
Interpretation HIV exposed infants will acquire risk of HIV transmission from their mothers
during pregnancy, L&D, and during breast-feeding period. The risk of acquiring
HIV infection during breast feeding period ranges from 10-25%. Appropriate
breast feeding practices can reduce the risk of transmission during breast
feeding. The national guideline for HIV exposed infants feeding practice
recommends exclusive breast feeding for the first 6 months and continuing
breast feeding with complementary feeding up to 18-24 months. Mixing in
complementary foods in the first 6 months will increase the transmission of
HIV. An HIV exposed infant will have DNA/PCR HIV test in the first 12 months
of life, preferably within 2 months. At this time if the infant is positive he/she
will be automatically put on ART and those negative infants will continue their
follow up with their mothers up to 18-24 months in PMTCT services.
Disaggregation By test Result: Positive, Negative
Source PMTCT Register
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3. Expanded program on Immunization (EPI)

1.3.1. EPI_HePB-BD:HepatitisB -Birth dose(BD) immunization coverage

Definition Proportion of live births who receive a HepB-Birth dose(BD) within 24 hours after
birth
Formula Number of live births who received a HepB-BD within 24 hours after
birth X 100
Estimated number of live births
Interpretation HepBD coverage has a strong inverse correlation with the prevalence of the
hepatitis disease. The first dose of hepatitis B vaccine should be given as soon
 as possible after birth, ideally within 24 hours, followed by at least 2 additional
doses with a minimum interval of 4 weeks between doses. Administration of
the birth dose is particularly important in areas with high and intermediate
HBV prevalence where mother-to-infant spread of HBV is common. Since
Ethiopia is thought to have intermediate to high HBV prevalence and thus a
likely high proportion of MTCT HBV transmission, CDC and WHO strongly
recommend the provision of the monovalent HBV vaccine at birth to help
prevent infants from developing chronic HBV infections. Additionally, the
national hepatitis strategic action plan strongly recommends the introduction
and scale up of hepatitis B vaccine birth dose (within 24 hours).The existing
Previously 3 doses of HepB combined with other antigens (In the form of DPT1-
HepB1-Hib1) will continue as per the schedule.
Disaggregation By time of vaccination: Within 24hr after birth, 24 to 14 days after birth
Source Service delivery tally (for HP), Immunization register and Immunization Tally
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.2. EPI_DPT3:DPT3-HepB3-Hib3 (Pentavalent third dose) immunization coverage (< 1

year)

Definition Proportion of surviving infants who have received third dose of the combined
diphtheria, tetanus toxoid, pertussis, Hepatitis B and Homophiles influenza type b
vaccine
Formula Number of children under one year of age who have received third
dose of pentavalent vaccine
Estimated number of surviving infants X 100

Interpretation DTP-HepB3-Hib3 coverage indicates continuity of use by parents or care

takers, client satisfaction with services, and capability of the system to deliver
a series of vaccinations. Pentavalent third dose (DPT3-HepB3-Hib3)
immunization coverage has a strong inverse correlation with the prevalence of
these diseases, especially amongst children under 5. It is an essential
component for reducing under-five mortality. Increasing coverage should be
accompanied by decreasing cases of disease. It is a good indicator of health
system performance and utilization by the beneficiary.
Disaggregation None
Source Immunization register, Service delivery tally (for HP),
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency
1.3.3. EPI_OPV3:OPV 3 (Oral Polio Vaccine third dose) Immunization Coverage (< 1 year)
Definition Proportion of surviving infants less than 1 year who have received three doses of
the oral polio vaccine (OPV3)
Formula Number of surviving infants who have received third dose of oral polio
vaccine
Estimated number of surviving infants X 100
Interpretation It is an essential component for the global polio eradication initiative where
the OPV use hastens and maintains the interruption of poliovirus transmission.
OPV3 coverage indicates continuity of the antigen use for infants irrespective
of the birth dose of OPV (OPV0) they get. Increasing coverage should be
accompanied by maintaining polio free status. As with other sequential
scheduled vaccinations, it is a good indicator of health system performance and
service utilization by the community
Disaggregation None
Source Immunization register, Service delivery tally (for HP)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.4. EPI_PCV3:Pneumococcal conjugated vaccine (PCV3) immunization coverage (< 1

year)
Definition Proportion of surviving infants who have received the third dose of the
pneumococcal conjugated vaccine
Formula Number of children under one year of age who have received third dose
of pneumococcal vaccine
Estimated number of surviving infants X 100
Interpretation Pneumococcal conjugated vaccine 3 immunization coverage has a strong
inverse correlation with the prevalence of pneumococcal disease, it has direct
effect in under five mortality rate (it can reduce by 10%), and it also indirectly
significantly decreases adult pneumococcal morbidity and mortality through
the herd effect. It is a good indicator of health system performance and will
indicate the impact of this life-saving vaccine.
Disaggregation None
Source Service delivery tally (for HP), Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency
1.3.5. EPI_ROTA2:Rotavirus vaccine 2nd dose (Rota2) immunization coverage (< 1 year)
Definition Proportion of surviving infants who have received second dose of the Rotavirus
vaccine
Formula Number of surviving infants who have received 2nd dose of Rotavirus
vaccine X 100
Estimated number of surviving infants
Interpretation The second dose of the Rotavirus vaccine (Rota2) immunization coverage has a
strong inverse correlation with the prevalence of Rotavirus diseases; it can
reduce under five mortality by 5%. It is a good indicator of the ability of the
program to deliver the vaccine series, ensuring that the vaccinated child is
protected. Its schedule is different from Penta and PCV vaccine, and it is
delivered in a narrow time period. The child will complete its Rotavirus
vaccine series by the 2nd dose (Rota2) which is given four weeks after the first
dose; ideally at 10 weeks of age.
Disaggregation None
Source Service delivery tally (for HP), Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital)
level
Reporting Monthly
Frequency

1.3.6. EPI_IPV:IPV (Inactivated Polio Vaccine) Immunization Coverage (< 1 year)

Definition Proportion of surviving infants who have received one dose of the inactivated
polio vaccine (IPV)
Formula Number of surviving infants who have received one dose of inactivated
polio vaccine
Estimated number of surviving infants
X 100
Interpretation As per global guidelines, Ethiopia introduced this new vaccine in late 2015
(G.C.). It is an essential component for the global polio end game strategy where
the IPV hasten the interruption of all poliovirus transmissions and helps
strengthen immunization systems. IPV is administered for children in a single
dose after 14 weeks of age, irrespective of their OPV vaccination status.
Increasing coverage should be accompanied by maintaining polio free status
along with and beyond withdrawal of OPV from the immunization schedule.
Disaggregation None
Source Service delivery tally (for HP), Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.7. EPI_MCV1:Measles (MCV1) immunization coverage (< 1year)

Definition Proportion of surviving infants who have received first dose measles (MCV1)
vaccine before their first birthday
Formula Number of surviving infants who have received first dose of measles
vaccine X 100
Total number of surviving infants
Interpretation Measles immunization coverage has a strong inverse correlation with the
prevalence of the disease, especially amongst children under 5 years of age. It
is an essential component for reducing under-five mortality. Increasing
coverage should be accompanied by decreasing cases of the disease. It is a
good indicator of health system performance. Measles is usually the last
antigen for infant immunizations given, as per the current EPI schedule. Effect
of the vaccine will be maximal after 9 months of age and that makes the
vaccine dose as valid.
Disaggregation None
Source1.7. Service delivery tally (for HP), Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.8. EPI_MCV2:Measles second dose (MCV2) immunization coverage (15-24 months)

Definition Proportion of children from 15-23 months who have received a second dose of
measles vaccine before their second birthday.
Formula Number of children aged 15 to 23 months of age who have received
measles second dose vaccine
Total surviving infant of the previous year X 100

Interpretation Measles immunization coverage has a strong inverse correlation with the
prevalence of the disease, especially amongst children under 5 years of age. It is
an essential component for reducing under-five mortality. Increasing coverage
should be accompanied by decreasing cases of the disease. Having the first dose
of measles vaccine by the first year of life alone will not guarantee that a child
would be fully protected from measles disease. Giving a second dose chance of
measles containing vaccine to a child in the second year of life (preferably by
15-23 months of age) would maximize the chance of sero-conversion and
development of measles antigen closer to 100%. Aiming for the elimination of
the measles disease, this indicator will provide closer and timely information
for programs for action
Disaggregation None
Source Service delivery tally (for HP), Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.9. EPI_FULLY:Full immunization coverage (< 1 year)

Definition Proportion of surviving infants who receive all doses of vaccines before their first
birthday.
Formula Number of children who received all vaccine doses before their first
birthday X 100
Total number of surviving infants
Interpretation Fully immunized child (FIC): The indicator measures the capability of the
system to provide all vaccines in the childhood schedule at the appropriate age
and the appropriate interval between doses in the first year of life; also
measures public demand and perceived quality of services. Different surveys
and routine reports consider all the antigens included in the routine EPI
program to determine the FIC coverage (EDHS 2016, EPI coverage survey,
2006 &2011). Therefore, by definition all the antigens including the newly
introduced PCV, Rota vaccines should be included in the definition of a fully
vaccinated child in the context of Ethiopia. Though the definition of FIC varies
from country to country, the definition in Ethiopia should consider a child as
fully immunized when he/she received BCG vaccine, 3 doses of DPT-Hib-HepB,
3 doses of Oral Polio, 3 doses of PCV, 2 doses of Rota , a dose of IPV and 1 dose
of measles before the age of 1 year. Surviving infants refers to infants who
survive to their first birthday
Disaggregation None
Source Service delivery tally (for HP), Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.10. EPI_PAB:Proportion of infants protected at birth against neonatal tetanus

Definition Proportion of infants who were protected from neonatal tetanus (NNT) by the
immunization of their mothers with tetanus toxoid.
Formula Number of Infants whose mothers had protective doses of TT
X 100
Estimated number of live births
Interpretation A case of maternal or neonatal tetanus represents a triple failure of public
health system in terms of routine immunization, antenatal care and clean and
safe delivery. TT immunization for pregnant and child bearing age women is a
proven strategy for achieving the goal of eliminating neonatal tetanus.

A child is considered as protected at birth against NNT if the child is born

 within the period of protection provided by the last valid dose of TT vaccine
given to the mother. In Ethiopia PAB is considered as NNT prevention
indicator. This indicator measures the percentage of infants who were
protected from NNT at birth by the immunization of their mothers with TT
before birth. Protection at birth is estimated by asking mothers about their TT
immunization history (or reviewing TT record card, if available) when they
bring an infant for Pentavalent-1 immunization. One can consider that the
infant was protected from NNT at its birth (PAB) if the mother has received:
Two doses of TT during the recent pregnancy or at least three doses of TT in
the past.
Disaggregation None
Source Service delivery tally (for HP), Immunization register and Growth Monitoring
register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.3.11. EPI_HPV2:HPV 2 (Human Papilloma Virus vaccine (2nd dose) Immunization

coverage (14 years old girls)
Definition Proportion of girls 14 years old who have received second dose of human
papilloma virus vaccine.
Formula Number of girls 14 years of age who have received second dose of X 100
human papilloma virus vaccine in 6 months interval from the first dose
Estimated number of girls (14 years old)
Interpretation 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.
Globally it is estimated to avert about 70% of cervical cancer in women by fully
vaccinating a girl against HPV. As the impact of the vaccine takes many years,
routine disease surveillance and cancer registry need to be strengthened. The
second dose of the vaccine (HPV2) is administered to fully vaccinate the girl
with 6 months interval from time of HPV1 vaccination. As girls get the first
dose soon after age 14 years, by the time they get the second dose six months
later, their age could fall in 10th year. HPV2 is a good indicator of the service
utilization and ability of the program to deliver the vaccine using the school
platform as well.
Disaggregation None
Source Service delivery tally (for HP), HPV Immunization register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency
1.3.12. EPI_VWR:Vaccine wastage rate
Definition Proportion of vaccine doses opened but not consumed during the delivery of
immunization service to children.
Formula Vaccine Wastage Rate = 100% – Vaccine usage Rate
Vaccine Number of Doses Given
Usage Rate = Sum of Doses Opened, damaged/expired X 100
Doses opened = Sum of all doses in all vials opened. ( Note: the same vaccine
may be packaged in different size vials)
Interpretation Vaccines and their management form a major component of the national
immunization Program. Regular supply of vaccines and their efficient
management is paramount to the success and effectiveness of all immunization
Programs. The acceptable vaccine wastage rate for a specific antigen is
influenced by several factors that can be controlled by policy and vial size
available. The wastage rate should be monitored for each vaccine, and
particularly for the more expensive ones. The policy in Ethiopia is to provide
immunization on demand; this means that vaccine wastage rates may increase
and may be difficult to control. Vaccine wastage includes wastage due to non-
use after opening the vial or due to breakage or expiration or other factors. This
wastage rate traces only facility level wastage.
NOTE: Vaccine wastage rate for each specific vaccine should be calculated
separately
Disaggregation Doses opened/Damaged, Expired
By vaccine type: HepB-Birth dose, BCG, Pentavalent (DPT-HepB-Hib),
Pneumococcal conjugated, Rota, Polio, Measles, TT, IPV, HPV
Source Service delivery tally (for HP), Immunization register and EPI logistics records
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.4. Child health

1.4.1. CH_IND:Institutional Neonatal Death Rate

Definition The proportion of neonatal deaths at the facility within the first 28 days of life
among the total live births attended by skilled birth attendants at health centers,
clinics and hospitals.
Formula Number of facility neonatal deaths in the first 28 days of life
Total number of live births attended by skilled health attendants X 100
Interpretation The early neonatal death rate mainly defines the quality of obstetric care in the
facility in the Ethiopian context. Among other potential causes of early neonatal
death, the three main causes are prematurity, birth asphyxia, and neonatal
sepsis (The three main causes, along with other neonatal conditions, are
included in the HMIS inpatient morbidity and mortality report).
 Neonatal death delivered in a facility, but who die outside the facility in the first
28 days of life is not captured and not included in the calculation of this
indicator.
In real set-up, neonates born at a health facility could die either in the facility
where they were born or outside the health facility after discharge. Thus,
estimating this indicator from facility records (service statistics) introduces
huge bias as it excludes neonatal deaths that happen in the community after
they were born in the facility and were discharged.
In some instances, there is a chance for deaths to be omitted with intention to
avoid blames and hence data quality checks are of paramount importance to
ensure quality of this and death related data elements.
Note: In order to understand the whole picture of neonatal death rate per
1000LBs, the numerator should include number of neonatal deaths at the facility
and at the community.
Disaggregation Time of death: 0-24hrs; 1-7 days and 7-28 days
Source Delivery, PNC, IPD & NICU registers
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.4.2. CH_CND:Number of Neonatal death at community

Definition The number of deaths that happen in the community within 28 days of life from
total births.
Formula Number of deaths in the first 28 days of life in the community
Interpretation The Community neonatal death is used to measures the impact of the
community based newborn care that relays on the continuum of care in the
Ethiopian context. In order to have a full data for this indicator it is mandatory
to introduce a pregnant women identification register which captures the
place of delivery and outcomes of the newborn for all deliveries in each kebele
whether it is in facility or home. Among other potential causes, the three main
causes are prematurity, birth asphyxia, and neonatal sepsis. (The three main
causes, along with other neonatal conditions, are included in the HMIS
inpatient morbidity and mortality report.) Neonatal community death captures
death of neonates within 28 days of life only.

This indicator measures the death of Newborn death at home, before arrival of
the Health posts, and at health post.
Disaggregation Time of death: 0-24hrs; 1-7 days ; 7-28days &
By Place of Death: At home, on the way to HP and at HP
Source Family folder & pregnant women registration, Integrated Maternal Child Health
Card
Reporting Health post
level
Reporting Monthly
Frequency

1.4.3. CH_TX_PNEU:Proportion of under-five children with pneumonia received antibiotic

treatment

Definition Proportion of children treated for pneumonia at health facility and community (HP)
Formula Number of under 5 children treated for pneumonia X 100
estimated number of under 5 children with pneumonia*

Interpretation Pneumonia is one of the leading causes of death among children younger than five
years of age. In Ethiopia, several interventions have been in place to reduce child
mortality due to pneumonia to realize the achievement of SDGs 3.2.1 and 3.2.2
(reducing under-five mortality and neonatal mortality rates respectively).
Integrated management of newborn and childhood illnesses (IMNCI) has been
implemented at health center and hospital levels for over a decade and Integrated
community based case management of childhood illnesses (iCCM) has been
implemented at health post level since 2010. With the intention to bolster the
newborn component of iCCM, community based newborn care (CBNC) has been
implemented since 2013. The key activities in all these interventions for
controlling pneumonia in children are prompt diagnosis and treatment of cases
with a full course of appropriate antibiotics. Effective case management at health
post and health facility levels is needed to ensure that sick children receive
appropriate treatment.

This indicator shows the proportion of under-five children treated for pneumonia
at health post and higher level health facilities from among the estimated cases. It
measures the effectiveness of the above mentioned interventions in increasing
care-seeking of communities and utilization of curative services for childhood
pneumonia. As it is one of the HSTP indicators, it can help track the progress
towards HSTP target.

*During the calculation of this indicator, the estimated prevalence should be

updated based on recent research findings.
Disaggregatio No disaggregation
n
Source ICMNCI, IMNCI, Service delivery tally sheets (for HPs)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.4.4. CH_TX_SYI: Proportion of Sick Young infant treated for Newborn infection
Definition Proportion of sick Young infants treated for Newborn infection within a given
 period
Formula Number of sick young infants 0-2 months treated for Newborn infection
Estimated number of Sick young infant 0-2 months with Newborn X 100
infection*
Interpretation The implementation of community based newborn care (CBNC) has brought the
identification of sick young infants with PSBI at community level. Health
extension workers trained in CBNC are supposed to provide antibiotic treatment
for possible severe bacterial infection among neonates when referral is not
possible & can treat newborns with local bacterial infection (LBI) at health post
level. At health centers, health care providers are supposed to treat neonates with
very severe disease & local bacterial infection according to the IMNCI guideline.

This indicator shows the proportion of neonatal sepsis (very severe disease &LBI)
cases who received treatment at all levels of the health system. It measures the
demand for neonatal sepsis (very severe disease) and utilization of health
services in a given catchment population. In addition, the trend and comparative
analysis of this indicator shows the effectiveness of demand generation activities.
In situations when health facilities face stock of essential drugs required for the
management of neonatal sepsis (very severe disease), the indicator may not
actually indicate the care seeking in the catchment area for the period essential
supplies were out of stock.
*During the calculation of this indicator, the estimated prevalence should be
determined based on recent research findings or estimates.
Disaggregation Classification type :- Critical illness; Very sever disease ( VSD), Local bacterial
infection (LBI) and pneumonia
Source ICMNCI, IMNCI, and Health post service delivery tally
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.4.5. CH_TX_DIAR:Proportion of children with diarrhea who are treated by both ORS and
Zinc at community and facility level
Definition Proportion of children treated by Zinc and ORS for Diarrhea at health facility and
community (HP)
Formula Number of under 5 children treated for Diarrhea by ORS & Zinc
Estimated number of under 5 children with Diarrhea* X 100

Interpretation Diarrhea is one of the leading causes of death among children younger than five
years of age. Along with increasing demand for and improving awareness of
communities on prevention and management of diarrhea at home and generating
demand for care at health facility level, prompt treatment of cases with a full course
of Zinc & ORS is a key intervention to reduce morbidities and mortalities among
children younger than five years of age. Accessing effective diarrheal cases
management at health post and higher level health facilities is needed to ensure that
 sick children receive appropriate treatment. Therefore, prevention of diarrhea and
treatment of cases are essential to the achievement of SDG 3.2.1 and 3.2.2.

As such, this indicator shows the proportion of under-five children treated for
diarrhea at health post and higher level health facilities. It measures the utilization of
services for diarrheal cases and indicates the effectiveness of interventions to
increase care seeking for childhood diarrhea. In addition, as it is one of the HSTP
indicators, it can help track the progress towards HSTP target.

*During the calculation of this indicator, the estimated prevalence should be

updated based on recent research findings.
Disaggregation Treated by zinc and ORS; Treated by ORS only
Source ICMNCI,IMNCI , service delivery tally(HP)
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.4.6. CH_KMC:Proportion of low birth weight or premature newborns for whom Kangaroo
Mother Care (KMC) was initiated after delivery
Definition Proportion of Newborn weighing <2,000gm and premature newborns for whom
thermal care in the form of KMC was initiated after delivery.
Formula Number of Newborn weighing <2000gm and premature newborns for which
KMC initiated
Estimated number of Newborn weighing <2000gm and premature delivery* X 100

Interpretation Kangaroo Mother Care (KMC) has proven effect on mortality for babies <2,000 g.
This indicator shows the proportion of low birth weight or premature newborns for
which KMC was initiated after delivery. It measures the practice of initiation of KMC
for low birth weight or premature babies with advices from health care workers at
the facilities.

*During the calculation of this indicator, the estimated prevalence of low birth
weight or prematurity should be updated based on recent research findings.
Disaggregation None
Source Delivery, PNC & NICU
Reporting level Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.4.7. CH_ASPH:Proportion of asphyxiated neonates who were resuscitated (with bag &
mask)

Definition Proportion of newborns who were resuscitated and survived

Formula Number of neonates treated for birth asphyxia & survived
 Estimated number of neonates with birth asphyxia X 100

Interpretation This indicator shows the proportion of asphyxiated newborns that were resuscitated
and have survived. It measures the readiness of facilities (i.e. availability of trained
health care provider and equipment) and the quality of neonatal resuscitation
services (i.e. mainly related to the competency and skills of health care providers) at
the health facilities. In addition, as it is one of the HSTP indicators, it can help track
the progress towards HSTP target.

*During the calculation of this indicator, the estimated prevalence should be

updated based on recent research findings.
Disaggregation Total number of neonate resuscitated (with bag and mask) and survived, Total
number of neonate resuscitated
Source Delivery , PNC & NICU
Reporting Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.4.8. CH_TX_NICU:Treatment outcome of neonates admitted to NICU

Proportion of Neonates admitted with problems that were treated and discharged as
Definition
cured, improved,died, and others from the NICU among total discharges.
The number of admitted neonate that were recovered/cured, transferred out,
Formula died , and others from NICU treatment centers X 100
The total number of admitted neonates discharged from NICU
Interpretation Neonatal intensive care unit (NICU) is a unit where intensive treatment and care is
provided for babies who have problems such as prematurity, who have problems
during delivery, or who develop problems while still in the hospital. The service is
only provided in Hospitals with NICU standard, with a trained manpower, adequate
space as per the standard and with basic equipment.
This indicator measures the quality of NICU service in hospitals. The total number of
neonates discharged from NICU is the sum of those who are cured, transferred out,
died and other treatment outcomes.
Treatment outcomes:
Cured: When the admitted neonates were cleared clinically or confirmed by
laboratory investigation. It is decided by health professionals to go to home with
good health condition and the expected cure rate is more than 85%.
Transferred out: When the admitted neonate is transferred to other facility for
further investigation or treatment.
Dead: When the neonate is dead while he/she is on follow up in the NICU and the
expected death rate is less than 15%.
Others: - When the neonate is discharged from the NICU neither cured, transferred
out nor died, but may be discharged against medical advice or absconded
Definition of terms:
Disaggregation Total Admitted , Total discharged,
By treatment outcome: cured/recovered, Dead transferred out & others
Source NICU registers
Reporting Hospital
level
Reporting Monthly
Frequency

1.4.9. CH_CHX:Proportion of newborns that received at least one dose of Chlorhexidine

Digluconate (CHX) to the cord on the first day after birth
Definition Proportion of newborns that received at least one dose of CHX to the cord on the
first day after birth
Formula Newborns that received at least one dose of CHX to the cord on the first day
after birth X100
Total expected delivery

Interpretation Among the most common causes of death in newborns is infection, contributing to
20% of neonatal deaths. The umbilicus is an important source of infection in the
first few days of life due to unhygienic cord care practices including cord cutting &
tying and application of potentially harmful substances on the cord. Umbilical cord
hygiene prevents sepsis, a leading cause of neonatal mortality. In high neonatal
mortality settings, 7.1% chlorhexidine digluconate (CHX) application to the
umbilicus after both home and health facility birth is recommended. Application of
chlorhexidine gel on the umbilical cord immediately after cord cutting helps reduce
neonatal mortality by 23% and prevent infection (Omphalitis) by 68%. As a result,
Ethiopia contextualized WHO’s recommendation of daily application chlorhexidine
gel to the umbilical cord stump during the first week of life to be implemented at all
levels of delivery.
It is an essential component of newborn care immediately after delivery for
reducing neonatal mortality. Use of Chlorhexidine for umbilical cord care is
integrated into different training manuals.
This indicator shows the proportion of newborns delivered at health centers and
hospitals who received first dose of chlorhexidine application for umbilical cord
care at delivery units from the total live births attended. It measures the readiness
of facilities (i.e., availability of trained health care provider and chlorhexidine Gel)
and the quality of essential newborn care services (i.e., mainly related to the
competency and practice of health care providers) at the health facilities.
*During the calculation of this indicator, the expected delivery should be updated
based on recent research findings.
Disaggregation None
Source Delivery,PNC, Service delivery tall sheet (HP)
Reporting level Heath center /Clinic/ Hospital
Reporting Monthly
Frequency
1.4.10. CH_CHDM:Proportion of under-five children monitored for child
development
Definition Proportion of under-five children monitored for child development
Formula Number of under 5 children monitored/assessed for child development
X 100
Estimated number children aged 0 to 59 months

Interpretation One important way to promote child development is to monitor all children for any
developmental delays [3]. Developmental monitoring allows detecting and @PA
addressing many problems in child development early on. The earlier
developmental problems are addressed, the greater are the chances to reduce or
even to overcome them.Ethiopia is now introducing developmental monitoring to
be part of Growth Monitoring/EPI and Sick Child /Under 5 consultation.

Usually children are expected to be monitored for developmental milestone

together with growth monitoring, routine vaccination, Vitamin A supplementation
or growth monitoring etc.

With regard to the newborns development we need to monitor certain aspects such
as reflexes, posture, hearing, should be checked immediately after birth and during
the first month (in Maternity ward and in PNC consultation), to ensure timely
intervention.
After conducting the child development monitoring and classifying the child as No
delay (ND), Suspected Delay (SD), and Delay in Child Development (DD), the service
provider counsel caregiver/deliver key message on how to play and talk with the
child in responsive manner to improve development, and ask the caregiver to come
back in 30 days for follow-up or refer the child to the next level of care for
assessment and intervention. The introduction of child developmental monitoring
and interventions will eventually contribute to the holistic child development in
addition to reduction of child mortality and morbidity.
This indicator measures the effectiveness of the above-mentioned interventions in
increasing responsive care-giving of caregivers and utilization of child development
monitoring.

Limitation: A child may be assessed for developmental milestone multiple times a

reporting year. This will result in duplication of counts.
Disaggregation Classification: No Developmental Delay (ND); Suspected Developmental Delay (SD);
Developmental Delay (DD)
Age: 0-2years and 2yrs to 5 years
Source EPI, CINUs, ICMNCI , IMNCI, service delivery tally sheet of HP
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5. Nutrition
1.5.1. NUT_LBW:Percentage of live births that weigh less than 2,500gm out of the total live
births weighed
Definition Percentage of live births that weigh less than 2,500 gm out of the total live births
during the same time period
Formula Number of live-born babies with birth weight less than 2,500 gm
X 100
Total number of live births weighed
Interpretation The LBW proportion is a rough summary measure of many factors, including
maternal nutrition (during childhood, adolescence, pre-pregnancy and pregnancy),
lifestyle (e.g. alcohol, tobacco and drug use), and other exposures in pregnancy.
LBW is strongly associated with a range of adverse health outcomes, such as peri-
natal mortality and morbidity, infant mortality, disability and disease in later life,
but is not necessarily part of the cause. The main strength of LBW data is that they
are relatively easy to measure. LBW is a strong predictor of an individual baby’s
survival. The lower the birth weight, the higher the risk of death. Groups with
lower mean birth weights show higher infant mortality rates. Examples are twins
and infants of mothers with lower socioeconomic status. Efforts should focus on
measuring birth weight immediately after delivery, on its accuracy and on
appropriate care after birth, including growth monitoring
Disaggregation None
Source Delivery Register; Service delivery tally (HPs)
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5.2. NUT_GMP:Proportion of children under two years who participated in Growth

Monitoring and Promotion
Definition Proportion of children under two years who participated in Growth Monitoring and
Promotion
Formula Number of Children less than 2 year weighted during GMP session
Estimated children under 2 years X 100
Interpretation Growth Monitoring (GM) is one of the key components of community nutrition
programs.
Evidences showed that Growth monitoring and promotion (GMP), as part of a
package of nutrition and health programs, brought positive impacts on child growth
outcomes. GMP is a prevention activity and is based on growth monitoring of
children, especially children under 2 years of age. It primary focuses on monthly
measurement of weight on children under 2 because early identification of
malnutrition in children under 2 years of age can be reversible with appropriate
nutritional interventions.
These conditions can best be met in the community setting, and have the best
opportunity for producing results on a public health level if all children 0-24
months are reached in a defined catchment area.
Based on weight measurement, the child’s nutritional status can be classified as
follows:
 Severe Underweight : WFA Z Score less than -3 standard deviations of the
 WHO Child Growth Standards
 Moderate Undereweight: WFA Z Score between -2 and -3 ( -3 < Z Score < -2 )
less than -3 standard deviations of the WHO Child Growth Standards
 Normal: WFA Z Score greater or equal to -2 standard deviations of the WHO
Child Growth Standards

Disaggregation Age: 0-5, 6-59 months

Normal , Moderate underweight and Severe underweight
Source CINuS register, IMNCI register, Nutrition Card(HP), ICMNCI registers(HP), Service
delivery tally(HP)
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5.3. NUT_VITA:Proportion of children aged 6–59 months who received two doses of
vitamin A supplement
Proportion of children aged 6–59 months who received two doses of vitamin A
Definition supplement in the fiscal year
Formula Total number of children aged 6-59 months who received two doses of
vitamin A supplementation X 100
Estimated number of children aged 6-59 month
Interpretation Supplementation with vitamin A is a critically important intervention for child
survival owing to the strong evidence that exists for its impact on reducing child
mortality by 23 %. Therefore, monitoring the number of children who have
received vitamin A every 6 month/twice per a year is crucial for monitoring
coverage of interventions towards the child survival-related Sustainable
development Goals. Children are expected to receive vitamin-A twice in last 12
months.

However, this indicator measures the number of children who received two doses
of vitamin A in the fiscal year. In the first six months (First semester) of the year,
only first dose of Vitamin A will be reported and in the second six months (Starting
from Tir/January) those who received 2 doses will be reported.

N.B. There may be children who may get their first vitamin A dose in the second six
months (Second semester).

Note: Vitamin A doses given for treatment purpose should not be counted as
supplementation
Disaggregation Age: 6-11 and 12-59 months
By dose: First and second dose
Source Service delivery tally sheet (HPs), CINuS register, Immunization register,
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5.4. NUT_DeW:Proportion of children 24-59 months de-wormed

Definition Proportion of children aged 24-59 months who received de-worming drugs twice in
the fiscal year
Formula Total number of children aged 24-59 months de-wormed twice per year
Estimated number of children aged 24-59 months X 100
Interpretation Supplementation with Albendazole (de-worming) is a critically important
intervention for prevention of anemia in children and it has an impact on reducing
child mortality. Therefore, measuring the proportion of children who have received
of Albendazole (de-wormed) every 6 months /twice per year is crucial for
monitoring coverage of interventions. This indicator shows the coverage of de-
worming in children aged 2 to 5 years of age in the fiscal year.

This indicator measures the number of children who received two doses of
Albendazole (de-worming) in the fiscal year. In the first six months (First
semester) of the year, only first dose of Albendazole will be reported and in the
second six months (Starting from Tir/January) those who received 2 doses will be
reported.

Note: There may be children who may get their first Albendazole dose in the second
six months (Second semester).

Disaggregation By dose: Dose1, Dose 2

Source Service delivery tally sheet (HPs), CINuS register
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5.5. NUT_IFA:Proportion of pregnant women received IFA 90 plus

Proportion of pregnant women who received iron and folic acid (IFA) supplements
Definition for at least 3 months during their pregnancy
Formula Total number of Pregnant women received IFA at least 90 plus
Estimated number of pregnant women X 100
Interpretation Pregnant women should take daily oral Iron and Folic Acid supplements for 180
days/ or at least 90 days during pregnancy as part of the antenatal care service, in
order to reduce the risk of low birth weight, maternal anemia and Iron deficiency
(WHO). If she didn’t finish the full dose during pregnancy, she can finish the dose
after delivery to the maximum of 180 tabs (for 6 months). A formulation containing
30-60 mg elemental Iron and 400μg Folic Acid is recommended. In addition to Iron
and folic acid supplementation, pregnant women should receive de-worming during
the second or third trimesters of pregnancy.
Disaggregation Age group: 10-14 years; 15-19 years; >=20 years
Source Service delivery tally sheet (HPs), ANC Register
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5.6. NUT_PreSMN:Proportion of Pregnant and lactating women screened for

malnutrition
Definition Proportion of Pregnant and lactating women screened for malnutrition
Formula Total number Pregnant and lactating women screened for acute malnutrition
Estimated number of Pregnant and lactating women X 100

Interpretation A mother’s nutritional status, diet and lifestyle influence pregnancy & lactation
outcomes and can have lasting effects on her offspring’s health. Inadequate intake of
certain micronutrients during pregnancy, such as folic acid & iodine, can contribute
to birth defects and/or the inability of the child to develop to his/her full cognitive
potential.
Screening pregnant and lactating women for malnutrition and providing the
appropriate nutrition counseling and services greatly reduces adverse malnutrition
related health effects on the mother and the infant. This should be provided in a
program that is designed for a nutritional screening service in health facilities and at
community levels. Additionally, antenatal care offers an opportunity for
assessment/screening of the nutritional status of a pregnant woman, as well as the
assessment of essential nutritional actions and continuous monitoring throughout
pregnancy and also after delivery till 6 months.

Note: Pregnant and lactating women are supposed to be nutritionally assessed every
month. In calculating this indictor for aggregated number of months, the numerator
should be the average of the months under calculation.
Disaggregation By status: MUAC <23cms and > 23cms
By maternal status: Pregnant and lactating
Source Service delivery tally (HPs); PLW screening Register
Reporting Health post/ Heath center /Clinic/ Hospital
level
Reporting Monthly
Frequency

1.5.7. NUT_U5SMN:Proportion of children under five years screened for malnutrition

Definition Proportion of children under five years screened for malnutrition
Formula Total number of children under five years screened for acute malnutrition
Total number of children under five years X 100
Interpretation This is an indicator used for monitoring/identification of nutritional status of
children under five years of age, complement early warning system through
provision of nutrition data and prevents acute severe malnutrition through linkages
 with supplementary feeding and prevents deaths from acute severe malnutrition.

Severe acute malnutrition(SAM): MUAC <11.5cm or WFH (weight for height)

<-3 Z score (Used in health centers and hospitals)
and/or any bilateral pitting edema (used in all health facilities)
 Moderate acute malnutrition(MAM): MUAC 11.5cm to <12.5cm or WFH
(weight for height/ length) Z score between -2 and -3 (Z score ≥ -3Z to < -
2Z), (Used in health centers and hospitals) and No edema of both feet
 Normal: MUAC ≥ 12.5 cm ≥-2Z score and No edema of both feet.

Infants and children who are 6–59 months of age and have a mid-upper arm
Circumference <11.5 cm or a weight-for-height/length <–3 Z-scores of the WHO
growth standards, or have bilateral edema, should be immediately admitted to OTP
or SC program for the management of severe acute malnutrition.
If the infant 0-6 months WFL<-3Z score or any grade of bilateral pitting edema
should be admitted to SC.
Disaggregation Age: 0-5, 6-59 months
By Severity: SAM, MAM
Source TFP Register, Service delivery tally (HPs), Nutrition card,CINuS register/
IMNCI/ICMNCI registers
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

1.5.8. NUT_TX_U5MN:Treatment outcomes for management of complicated severe acute

malnutrition in children 0-59 months
Definition Treatment outcomes for management of complicated severe acute malnutrition in
children 0-59months
Formula Number of children 0-59 months that are Cured, died, defaulter, non-
responder, stabilized ,Transfer out X 100
The total number of children exiting from treatment for acute malnutrition

Interpretation The time needed to achieve the outcome indicators for a therapeutic feeding
program (TFP) is 1-2 months and for targeted supplementary feeding program
(SFP) is 2-3 months. The total number of exited individuals is the sum of those who
have recovered, referred, defaulted, died, medically transferred, non-respondents
and others with unknown treatment outcomes.
Disaggregation By treatment center:
- OTP
By age: 0-6 month,6month-59month
By Outcome: Recovered/Cured, died, defaulted, non-respondent, medical
transfer, transfer out, Unknown)
- SC
By age: 0-6 month,6month-59month
 By Outcome: Recovered/Cured, died, defaulted, non-respondent, medical
transfer, transfer out, Unknown)
Source TFP Register, Service delivery tally (HPs)
Reporting level Health post/ Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

2. Prevention and Control of Communicable Diseases

2.1. HIV Prevention and Control Indicators

2.1.1. HIV_HTS_TST:Percentage of people living with HIV who know their status
Definition Percentage of adult and children living with HIV who know their status
Formula Number of adult and children living with HIV who know their status
X 100
Estimated number of people living with HIV
Interpretation This indicator can be used as a proxy measure for the first 95 target of the 95-95-
95 HIV prevention and control program targets. It is an important measure to
determine the proportion of people living with HIV (PLHIV) who know their HIV
sero-status, as this knowledge is the entry point to the continuum of care for
PLHIV. The three 95s are:
 1st 95 = 95% of all people living with HIV will know their HIV status
 2nd 95 = 95% of all people with diagnosed HIV infection will receive ART
 3rd 95= 95% of all people receiving antiretroviral therapy (ART) will have
viral suppression
The numerator should be the sum of: 1) PLHIV who were reported as currently on
ART in the previous reporting month 2) Total new HIV positives identified through
HCT program in the reporting period 3) Total number of PLHIVs who were
lost/interruptedfrom ART in the previous reporting period.

Limitation: This indicator may miss those previously identified positives and those
who are alive and not started on ART. Moreover, it is difficult to identify repeat
HIV-positive tests. At Zonal, Woreda and facility levels, it is difficult to get
estimates of PLHIV to compute the first 95. Therefore, these levels should monitor
HCT uptake (Number of people tested for HIV) and its yield (Number of people
tested positive for HIV).
Disaggregation HTC Testing disaggregation:
Age:<1, 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+
Sex: Male, Female
HIV test Result: Positive
Population groups:Female commercial sex workers (FCSW), Long-distance
drivers, mobile or daily laborers, prisoners, OVC, children of PLHIV, Partners of
PLHIV, Other MARPs, General population
Sources VCT register and PITC tally, PMTCT Register, ART register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.2. HIV_TX_CURR: Percentage of people living with HIV currently receiving ART

Definition Percentage of adults and children living with HIV currently receiving ART
Formula Number of adults & children receiving ART at the end of the reporting
period X 100
Number of PLHIV who know their status
Interpretation This indicator measures the ongoing scale-upand uptake of ART service and
retention of PLHIV in ART programs as a critical step in HIV service provision and
assesses progress towards coverage of ART service. It also measures the extent to
which the need for ART is met. Provision of ART has been shown to reduce HIV-
related morbidity and mortality among PLHIV and onward HIV transmission. This
indicator measures the 2nd 95 targets.

Data for this indicator is generated by counting the number of adults and children
who are currently receiving ART at the end of the reporting period. Patients who
have died, stopped treatment, transferred out, lost to follow-up, and interrupted
treatment are NOT counted. PLHIV currently on ART who initiated or transferred
in during the reporting period should be counted. Some people pick up several
months of antiretroviral medicines (ARVs) at one visit, and efforts should be made
to include these people in the numerator as receiving antiretroviral even if they do
not attend the clinic in the last month of the reporting period. Besides, it includes
PLHIV currently receiving clients at ART clinic and those currently receiving ART
at PMTCT clinic based on option B+ regimen. All option B+ implementing PMTCT
only sites are expected to report ART currently receiving clients on monthly basis.
As it will be difficult to get the PLHIV estimate or the expected number of
individuals who know their status at the zone, woreda, and lower levels, this
indicator will be calculated at these levels based on the target allocation made
during the planning phase.
Disaggregation Currently on ART disaggregated by age, sex and regimen category
Pediatric:
Age:<1, 1-4, 5-9, 10-14,15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+
Sex: Male, Female;
By Pregnancy Status: pregnant, non-pregnant
By regimen category: 1st line, 2nd line and 3rd line
By specific regimen: For ages <19 years
Sources ART Register, PMTCT register, Currently on ART and regimen tally, EMR-ART
Software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.1.3. HIV_TX_NEW:Number of adults and children with HIV infection newly started on
ART
Definition Number of adults and children with HIV infection newly started on ART
Formula Number of clients newly started ART in the reporting period
Interpretation The indicator measures the ongoing scale-up and uptake of ART programs.
This measure is critical to monitorthe HIV services cascade, specifically the
successful linkage between HIV diagnosis and initiating ART.

This indicator includes newly initiated clients at ART clinic and those newly
started ART at PMTCT clinic based on option B+.

All option B+ implementing PMTCT only sites are expected to report ART new
initiation on monthly basis. The indicator permits monitoring trends in
initiation but does not attempt to distinguish between different lines or
regimens of ART or to measure the cost, quality or effectiveness of treatment
provided. These will each vary within and between countries and are liable to
change over time.

Disaggregation Age:<1, 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+
Sex: Male, Female;
By Pregnancy Status: pregnant, non-pregnant

Sources ART Register, PMTCT register, Currently on ART and regimen tally, EMR-ART
Software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.4. HIV_ART_RET:ART retention rate

Definition Percentage of adults and children known to be on treatment 12 months after

initiation of ART
Formula Number of adults and children who are still on treatment at 12
months after initiating ART X 100
Net Current Cohort
Interpretation This indicator measures the proportion of adults and children with HIV known
to be on treatment 12 months after initiation of antiretroviral therapy and it is
one important measure of program success and is a proxy for overall quality of
ART program.

The Numerator: Number of adults and children still alive and on ART at 12
months after initiating ART treatment. A 12-month outcome is defined as the
outcome (i.e. whether the patient is still alive and on ART, dead or lost to
follow-up) 12 months after starting treatment. The numerator does not require
patients to have been on ART continuously for the 12-month period. Patients
may be included in the numerator (and denominator) if they have missed an
appointment (not more than 30 days) or drug pick-up or temporarily stopped
treatment during the 12 months since initiating treatment, as long as they are
recorded as still being on treatment at month 12. On the contrary, those
patients who have died, stopped treatment, or been lost to follow-up as of 12
months since starting treatment are not included in the numerator. The
 number of adults and children on ART at 12 months includes patients who
have transferred in (and their initiation date is known) at any point from
initiation of treatment to the end of the 12-month period and excludes patients
who have transferred out during this same period to reflect the net current
cohort at each facility.

The denominator: Number of adults and children in the ART start-up groups
initiating ART 12 months prior to the end of the reporting period. (The
denominator is the total number of adults and children in the ART start-up
groups who initiated ART at a point 12 months prior to the beginning of the
reporting period, regardless of their 12-month outcome. This includes all
patients, both those on ART as well as those who are dead, have stopped
treatment or are lost to follow-up at month 12. It includes patients that have
transferred in (and their initiation date is known) and excludes patients that
transferred out during the time. The net current cohort is the number of
patients in the start-up group plus any transfers in, minus any transfers out.
Disaggregation Age: 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+
Sex: Male, Female;
By Pregnancy Status: pregnant, non-pregnant
Sources ART Register, PMTCT register, Currently on ART and regimen tally, EMR-ART
Software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.5. HIV_ART_INTR:Number of ART Clients that interrupted Treatment

Definition Number of ART clients (who were on ART in the previous reporting month) and
then had no clinical contact since their drug refill
Formula Number of ART patients with no clinical contact or ARV pick-up for greater than
28 days since their last expected clinical contact or ARV pick-up
Interpretation This indicator is intended to:
(1) help better understand fluctuations or steady growth in “PLHIV
currently on ART” over time,
(2) Encourage tracing of patients when a patient has had no clinical
contact for greater than 28 days since their last expected contact and
(3) Promote timely identification of patient outcomes among patients
known to have missed clinical visits or drug pickups. Serious and
repeated attempts should be made to re-engage any such patients and
return them to treatment. In case of death, mortality data should be
analyzed and investigated to determine the causes of death, where
possible.

Disaggregation Disaggregated by age, sex and outcome

Age and sex:

<15 M/F,
15+ M/F
By Outcome
 Lost/ interrupted treatment (<3 months; > 3months)
Transferred Out:
Refused (Stopped) Treatment:
Died
Sources ART Register, PMTCT register, ART regimen tally, EMR-ART Software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.6. HIV_TX_PVLS:Viral load Suppression

Definition Percentage of patients on ART with a suppressed viral load (<1000 copies/ml) in
the past 12 months
Formula Number of ART patients with suppressed Viral load results (<1,000
copies/ml) documented within the past 12 months X 100
Number of ART patients with a viral load test result documented within
the past 12 months
Interpretation This indicator could provide information that can contribute to quality
improvement activities designed to maximize rates of viral suppression in
patients on ART and therefore prevent the emergence of HIV drug resistance.
The viral load of patients receiving antiretroviral therapy provides an
indication of adherence to treatment, patient compliance with disease
monitoring and the quality of care delivered. To sustain the progress made in
reducing morbidity and mortality from HIV through ART, HIV-infected patients
must continue to have access to safe, tolerable, and potent ARVs. To
accomplish this, the use of viral load test to monitor HIV treatment will need to
be expanded.

Measuring viral suppression is a key programmatic indicator related to

effective treatment. It helps as a proxy indicator to monitor the third 95 of 95-
95-95 HIV targets, that 95% of people receiving antiretroviral therapy will
have viral suppression.

For the numerator: It is the actual number of people that have suppressed viral
loads at the end of the reporting period. In either case, viral load testing should
be routine rather than episodic: for example, when treatment failure is
suspected. If a viral load test is done repeatedly, it should be reported only
once.

For the denominator: Estimation models such as Spectrum are the preferred
source for the number of people living with HIV. As it will be difficult to get the
PLHIV estimate or the expected number of individuals who know their status
at the Zone/woreda and lower levels level, this indicator can be monitored by
calculating from the total viral load tested. Note: Viral load tests for PMTCT
clients should also be included in this indicator.
Disaggregation Age: 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+
Sex: Male, Female;
Pregnant/Breastfeeding: Non-pregnant, Pregnant, Breastfeeding
Sources ART Register, PMTCT register, Currently on ART and regimen tally, EMR-ART
 Software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.7. HIV_PrEP:Number of individuals receiving Pre-Exposure Prophylaxis

Definition Number of individuals, inclusive of those newly enrolled, that received oral
antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV during the reporting
period
Formula Number of clients that received Pre-exposure Prophylaxis
Interpretation This indicator intends to measure client demand and access for PrEP at any point
within the reporting period.
It counts the number of individuals that received PrEP at any point during the
reporting period. It includes those who have been enrolled in the previous period
and receiving PrEP and those who are newly enrolled in the reporting period. It
excludes those who have been enrolled to PrEP but stopped taking it due to
different reasons.
Use of PrEP may stop once an individual is no longer at risk for HIV. Once they stop
taking PrEP, they will not be counted.
Disaggregation Disaggregated as PrEP New And PrEP Current by age, sex and client category

Type: PrEP_Curr, PrEP_New

Age:15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+
Sex: Male, Female
Client Category: Female sex workers (FSW); Discordant Couples
Sources PrEP Register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.8. HIV_PEP:Number of persons provided with Post-Exposure prophylaxis

Definition Number of persons provided with post-exposure prophylaxis (PEP) for risk of HIV
infection through occupational and/or non-occupational exposure to HIV
Formula Number of persons provided with post-exposure prophylaxis (PEP) for risk of HIV
infection as per the national guideline
Interpretation This indicator measures the demand for and access to the PEP services. The
indicator can be generated by counting the number of individuals receiving
PEP for occupational and non-occupational purposes. PEP services for
occupational exposure include a comprehensive package of services for
occupationally exposed health care workers and patients. PEP services for non-
occupational exposure include sexual violence.

Individuals should be counted only if they have received PEP drugs (in
accordance with national protocols).This indicator does not intend to capture
the type and quality of PEP services provided. PEP services include first aid,
 counseling, testing, provision of ARVs, medical care, trauma counseling,
linkages with police, and other follow-up and support. Simple monitoring of
PEP availability through program records does not ensure that all PEP-related
services are adequately provided to those who need them.
Disaggregation Exposure type:
- Occupational,
- Sexual Violence
Other non-occupational
Sources Post Exposure Prophylaxis Register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.9. HIV_PLHIV_TSP:Proportion of clinically undernourished People Living with HIV

(PLHIV) who received therapeutic or supplementary food
Definition The proportion of individuals receiving therapeutic or supplementary food
among those whose nutritional status was assessed and found to be
undernourished
Formula No. of clinically undernourished PLHIV on ART who received therapeutic
or supplementary food X100
No. of PLHIV on ART who were nutritionally assessed & found to be
clinically undernourished
Interpretation Provision of nutritional treatment, care and support for those undernourished
PLHIVs is important to prevent morbidity and mortality. Under nutrition
significantly increases mortality risk for HIV-infected individuals regardless of
treatment status among the clinically undernourished PLHIVs, those with
severely undernourished (SAM) cases will receive the Ready -To-Use
Therapeutic food(RUTF) and those with moderately undernourished (MAM)
cases receive Supplementary food(RUSF) based on availability of supplies.
Severe acute malnutrition (SAM):
- Adult: -BMI less than 16 kg/m2;
- Pregnant and lactating: -MUAC less than 19 cm
- Children; under 5: MUAC <11cm or WFH (weight for height) <70%
median or <-3 Z score,
- 5-18 years of age: BMI -for-Age <-3 z-score
Moderate acute malnutrition(MAM):
- Adult: BMI 16-18.49 kg/m2 ;
- Pregnant and lactating: MUAC 19-23 cm Children
- Under 5: MUAC 11cm to <12cm or WFH (weight for height/ length) <-3
Z or ≥ 70% to < 80% median or ≥ -3Z to < -2Z score;
- 5-18 years of age: BMI-for-Age between -2 and -3 z-score

Disaggregation Age:<15 and 15+ years

Sex: Male/Female
Nutritional Status: Normal, MAM, SAM
Pregnancy status: Pregnant, Non-Pregnant
Sources ART Register, PMTCT register, Clinical care tally, EMR-ART Software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.10. HIV_STI_SCRN: Proportion of STI cases tested for HIV

Definition Proportion of STI cases tested for HIV in the reporting period
Formula Number of STI cases tested for HIV in the reporting period
X 100
Total number of STI cases in the reporting period
Interpretation This indicator is intended to provide information on the proportion of STI cases
that are tested for HIV. It is helpful to measure the magnitude of the HIV and STI
co-infection and to intensify the HIV prevention interventions. It also helps to
track the number of STI cases. Additionally, the proportion of STI cases detected
can be tracked by dividing the number of detected STI cases by the estimated
number of STI cases in the catchment area.

Note: Total number of STI cases can be obtained from the monthly OPD and IPD
disease reports and STI cases tested for HIV is reported from monthly service
delivery report.

Disaggregation HIV test result: Positive, Negative

Sex: Male, Female
STI case by syndrome
Sources PICT Tally, OPD and IPD registers
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.11. HIV_ART_FP:Percentage of non-pregnant women in the reproductive age living with

HIV on ART using a modern family planning method

Definition Percentage of non-pregnant women living with HIV and on ART using a modern
family planning method
Formula Number of non-pregnant women living with HIV on ART aged 15-49
reporting the use of any method of modern family planning X100
Total number of non-pregnant women living with HIV on ART aged 15-
49
Interpretation This indicator will be used to monitor HIV/FP integration at ART sites. This
indicator is a subset of contraceptive prevalence rate, but focuses specifically
on women living with HIV to measure progress in prong 2 (“prevent
unwanted pregnancies among women living with HIV”) of the four prongs of
PMTCT.

Preventing unintended pregnancies in women living with HIV is a critical step

towards reducing mother-to-child transmission and is a core component of
the international standards for a comprehensive approach to PMTCT.
Inherent within this indicator is the principle that integrated HIV/FP program
 activities must respect a client’s right to make informed decisions about his or
her reproductive life. This means that clients should have access to an
appropriate and comprehensive range of contraceptive options; and/or to
safer conception/pregnancy counseling depending upon their fertility desire
and intentions. All non-pregnant PLHIV women on ART reporting the use of
modern contraceptive irrespective of where the service provided will be
reported as using modern family planning method.
Disaggregation Age: 10-14 F, 15-19 F, 20-24 F, 25-29 F, 30-49 F

Method: OCP, Injectable, Implant, IUCD, Other methods

Sources ART Registers and EMR-ART software
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.12. HIV_TB_SCRN:Proportion of patients enrolled in HIV care who were screened for TB
Definition The proportion of patients on ART who were screened for TB during the
reporting period
Formula Number of patients on ART whose TB status was assessed during the
reporting period X100
Total number of patients on ART during the reporting period
Interpretation This indicator is intended to provide information on the proportion of HIV
positive patients in HIV care and treatment who are screened for TB at last
visit. This indicator measures the burden of known TB co-morbidity among
people in HIV care. It may be used in drug supply planning for ART drug
substitution in people treated for TB. An increase in this indicator suggests
that a higher proportion of HIV patients are being screened for TB and other
increased efforts such as: developing a standard screening algorithm, training
HIV staff, revising cards/registers, etc. A decrease in this indicator suggests
that a lower proportion of PLWH are being screened for TB and change in
policy or program. For example, a turnover in trained staff, decreased
supervision visits, shortage of screening tools, etc. Enrolled in care includes all
those continuing in care and those newly enrolled during the reporting
period. The numerator is taken from ART registers by counting the number of
patients whose TB status was assessed during the reporting period. Any
patients who started on ART during the reporting period should be counted in
the ART register. For ART patients, the denominator is those current on ART
during the reporting period. The denominator is taken from ART registers by
counting the number of patients with a visit during the reporting period.
Disaggregation Start of ART by Screen Result and by Age/Sex:
• New on ART/Screen Positive: <15 F/M, 15+ F/M,
• Previously on ART/Screen Positive: <15 F/M, 15+ F/M

Sources ART Register, PMTCT register, HIV clinical care tally sheet and EMR-ART
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.1.13. HIV_CXCA_SCRN:Proportion of HIV positive women (15+) on ART screened for
Cervical Ca
Definition The proportion of HIV-positive clients (aged 15+) who received cervical ca screening
in the reporting period

Formula Number of clients that received cervical cancer screening during the
reporting period X 100
Total 15+ women on ART
Interpretation Cervical cancer is among the most prevalent cancers among women worldwide
and women living with HIV are at increased risk. As a result, screening all women
living with HIV aged 15+ is essential for early identification and treatment of
cervical lesions.

Clients eligible for Cervical ca should be screened at ART clinical visit or ARV refill
site. All clients screened positive should get immediate treatment in the facility
based on MOH’s guideline.

Data for the numerator should be generated by counting the total number of HIV-
positive women on ART who received a cervical cancer-screening test. The
screening may be done using VIA or HPV DNA testing modalities.

Disaggregation Age: 15-19, 20-24, 25-29, 30-49, 50+

Screening type: VIA, HPV DNA
Result:
For VIA: Normal, precancerous lesion, suspicious cancerous lesion
For HPV DNA: Positive, Negative
Type of treatment: Cryotherapy, LEEP, Thermal ablation/thermo-coagulation
Sources ART register, HIV clinical care tally sheet, EMR-ART
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.14. HIV_HeP_TST:Number of individuals tested for Hepatitis

Definition Number of individuals tested for Hepatitis (Hepatitis B and Hepatitis C)
Formula Number of individuals tested for Hepatitis (Hepatitis B and Hepatitis C)
Interpretation Epidemiologically, Ethiopia is in the region where Hepatitis B infection
prevalence is labeled hyper-endemic with a prevalence of between 8 – 12%
and that of Hepatitis C prevalence is estimated at not less than 2.5%. Principally
with application of appropriate measures, infection from viral hepatitis and
subsequent chronicity is preventable. Effective vaccines are available to prevent
Hepatitis A, B and E viruses whereas, primary prevention of Hepatitis B and C are
possible and cost effective by promoting safe blood and safe sexual behavior.
Screening and early identification is an essential component of hepatitis
prevention and control program.

This indicator is intended to monitor the trends of hepatitis-tested service, which

in forecasting the supply need to ensure continuity of the service. Testing for
hepatitis is an entry point to the continuum of care for patient who are positive for
 hepatitis.

Disaggregation Type of Hepatitis: Hepatitis B; Hepatitis C

Sex: M, F
Age: <15 and >=15
Sources Lab Register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.15. HIV_HeP_TX:Proportion of diagnosed Hepatitis B and C patients who received

treatment

Definition Proportion of diagnosed Hepatitis B and C patients who received treatment

Formula Number of Hepatitis positive patients who received hepatitis treatment
X100
Total number of individuals diagnosed positive for hepatitis
Interpretation This indicator measures access to treatment service for hepatitis B and hepatitis C
patients. It measures the percentage of hepatitis B & C positive client who received
treatment during the reporting period. Indicator for hepatitis B and C have to be
calculated separately since their treatment modality is different.

Disaggregation Type of Hepatitis: Hepatitis B; Hepatitis C

Sex: M, F,
Age: <15 and >=15
Sources Hepatitis Treatment Register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2. Tuberculosis and Leprosy Prevention and Control Indicators

2.2.1. TB_TX:TB Treatment coverage

Definition Percentage of new and relapse TB cases that were notified and treated during the
reporting period among the estimated TB cases in the same period
Formula Number of all forms of TB (New and Relapse) cases that were notified X 100
and treated during the reporting period
Estimated number of incident TB cases in the population during the
reporting period
Interpretation TB treatment coverage is one of the key indicators in evaluating the effectiveness
of TB control. It helps to measure the burden of the disease and to monitor TB
identification and treatment. TB treatment coverage is calculated as the number
of notified and treated all forms of TB cases (including new bacteriologically
confirmed, new clinically diagnosed and relapses) divided by the total number of
TB cases estimated to occur in the area during a given time period.
 *The denominator is provided by annual WHO-Estimates for the whole country.
There may be real differences in TB epidemiology in urban, Agrarian and
pastoralist regions, though this indicator tells annual trend in TB treatment
coverage of the country. However, over and under achievement of this indicator
should be interpreted by considering existing factors including burden of the
diseases, and other population factors.

NOTE: TB cases diagnosed by Smear microscopy, any WHO approved Rapid

diagnostics (WRD) such as GeneXpert MTB/RIF, Ultra, Truenat) and Culture are
classified under Bacteriologically Confirmed TB cases.
Disaggregation Age: 0-4, 5-9, 10-14, 15-19, 20-24, 25-34, 35-44, 45-54, 55-64, 65+
Sex: Male, Female
Type TB:
- Bacteriologically Confirmed :New and Relapse :
- Clinically diagnosed : (New Pulmonary negative TB, all Extra Pulmonary TB)
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.2. TB_RETX:Tuberculosis Re-treatment Rate

Definition The Proportion of re-treatment TB Cases (Treatment after relapse, Treatment –

after -failures Treatment –after -lost to follow up & other previous treated with
unknown or undocumented treatment outcome) among new and retreatment TB
cases detected in the reporting period
Formula Total number of retreatment TB cases during the reporting period
Total number of new and retreatment TB cases registered during X100
reporting period
Interpretation Ineffective treatment or incorrect administration of medication may result in a
large proportion of retreatment cases, which points to deficiencies in the
medication used and/or non-adherence to DOTS on the part of patients and
providers. This indicator indirectly reveals the effectiveness of the National TB
Program, since under a well-functioning TB control program, retreatment
cases should make up a smaller proportion than new cases. Additionally,
relapse is more likely in patients with HIV, so the indicator should be
interpreted in light of HIV prevalence.
Disaggregation Sex: Male/Female
Type: Treatment after Relapse, treatment after Failure, treatment after lost to
follow up cases, other previously treated cases
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.3. TB_CR:Cure Rate for bacteriologically confirmed Pulmonary TB cases

Definition The percentage of a cohort of new and relapse bacteriologically confirmed PTB
cases that were cured as demonstrated by bacteriologic evidence in the reporting
period
Formula Number of cohort of (new & relapse) bacteriologically confirmed
Pulmonary TB cases registered during specified cohort period (e.g.
during a given month of the previous year) that were cured X 100
Total number of new & relapse bacteriologically confirmed PTB cases
registered in the same cohort period
Interpretation TB cases recorded as cured must have a negative sputum smear or culture result
recorded during the last month of treatment and on at least on one previous
occasion during treatment. This indicator measures the program’s capacity to
retain patients through a complete course of chemotherapy with a favorable
clinical result. TB cure rate is the key indicator in evaluating the effectiveness of
TB control. TB treatment cure rates can be calculated at all Health Centers,
hospitals and other health facilities that provide DOTS services. Cure rate at
woredas, Zones, regions, and MOH can also be calculated by aggregating the
reported data from health facilities that provide DOTS.
Disaggregation Type of bacteriologically confirmed TB : New; Relapse
Treatment outcomes type: Cured, Treatment completed, lost to follow up,
death, failure, not evaluated, moved to DR-TB register
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.4. TB_TSR:TB Treatment Success rate (TSR) among all forms of TB cases
Definition Percentage of TB cases successfully treated (cured plus treatment completed)
among TB cases notified during a specified period
Formula Number of all forms of TB diagnosed cohort of TB cases registered Formula
during the specified cohort period of the previous year that
successfully completed the treatment
The total number all forms of diagnosed TB cases registered during
the same cohort period during
Interpretation It measure the degree of successful TB treatment completion. TB cases
recorded as cured and completed for their course of treatment are included for
this indicator. This indicator measures the program’s capacity to retain
patients (quality DOTs) through a complete course of chemotherapy with a
favorable clinical result. TSR is the key indicator in evaluating the effectiveness
of TB control. TB treatment success rate can be calculated at all Health Centers
and hospitals and other health facilities that provide DOTS services. TSR at
woredas, Zones, regions, and MOH can also be calculated by aggregating the
reported data from health facilities that provide DOTS.
Disaggregation Type of TB
- Bacteriological confirmed new Pulmonary TB
- Bacteriologically confirmed relapse Pulmonary TB
- Clinically diagnose pulmonary TB
- Clinical diagnosed EPTB
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.5. TB_UTX:Unsuccessful treatment outcome among all forms of TB

Definition The percentage of cohort of all forms (new and relapse) of TB cases
(Bacteriologically confirmed, clinically diagnosed) registered in a specified period
that failed (A TB patient whose sputum smear or culture is positive at month 5 or
later during treatment), died during treatment and interrupted treatment for two
or more consecutive months among all forms of TB cases in the same period
Formula Number of all forms of TB cases registered in the specific cohort period
with unsuccessful treatment outcome ( lost to follow up, died and failed )
X 100
The total number of all forms of TB cases registered during the same
cohort period
Interpretation The unsuccessful outcome measures the quality of DOTs or TB care. Unsuccessful
treatment outcome includes death, lost to follow up, failure. Death is one of the
unsuccessful outcome; The target in the END TB strategy is to reduce TB deaths by
35% in 2020 and by 95% in 2035 compared to the 2015 level. Unsuccessful
outcome can be calculated at all Health Centers, hospitals and other health
facilities that provide DOTS services, woredas, zones, regions, and MOH.
Disaggregation Death, LTFU, Failure, Not evaluated
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.6. TB_COMM:Proportion of all forms of TB cases notified and treated from community
referral
Definition Proportion of TB case detection contributed by the community out of all TB cases
identified during reporting period
Formula Number of all forms of TB cases notified and treated who were Formula
referred by HEWs during the reporting period
Total Number of TB cases that were notified and treated during the
reporting period
Interpretation The indicator is intended to measure the extent of community involvement in
TB case detection. Efficient community involvement translates into early
detection of cases, one of the main and most effective strategies for reducing
the transmission of TB. The community in the context of community TB care
refers to trained community volunteers, Health Development Agents, health
extension workers or, community members supporting patients (treatment
supporter)

NB: the denominator of this indicator “all forms of notified TB cases” refers to
the number of all forms of TB cases registered in TB unit. The numerator of
this indicator doesn’t include those presumed TB cases referred by the
community for further investigation and diagnosis

Disaggregation None
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.7. TB_CBTSR:Community based TB Treatment success rate

Definition Proportion of all forms of TB cases successfully treated (cured plus completed
treatment) among those received treatment adherence support at community for at
least full course of the continuation phase treatment
Formula Number of cohort of TB cases who were cured or completed treatment
among all forms TB patients registered during a specified cohort period
that received community based adherence support by HEWs
X 100
Total number of patients who started TB treatment in same reporting
period of pervious year and who received any form of treatment
adherence support from Health extension workers
Interpretation Evidence has shown that community-based treatment results in treatment success
rates comparable to or higher than those of hospital- or facility-based do
treatment. In settings with high-quality implementation, the vast majority of
patients choose community-based treatment. The indicator therefore is intended
to measure the scope and quality of implementation of community involvement
particularly relating to treatment outcome of patients. The data for calculating this
indicator should be reported along with treatment outcome report for the same
cohort by the health care workers at the health facility.

Note that at least full course of continuation phase refers to patients who took
their treatment during intensive phase and continuation phase or during
continuation phase only at the community
Disaggregation None
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.8. TB_DX_PRIV:Proportion of notified TB cases (all forms) contributed by other

governmental and private facilities
Definition Percentage of notified TB cases (all forms) contributed by PPM sites ( other
governmental, private-for profit and private-not for profit facilities) during the
reporting period among notified all forms of TB in the same period
Formula The number of all forms of TB cases notified by PPM TB Sites during Formula
the reporting period
Total number of all forms of TB cases notified during the same period
Interpretation This indicator measures the contribution of the PPM sites (other governmental,
private-for profit and private-not for profit facilities) in detecting all forms of
TB cases. A patient diagnosed at facilities and referred to a public facility for
diagnosis and/or initiation of anti TB treatment should be considered as a PPM
contribution and be included in the numerator.
Disaggregation None
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.9. TB_CI:Contact investigation coverage

Definition Percentage of contacts of people with bacteriologically (new and Relapse) confirmed
TB cases who were evaluated for TB

Formula Number of contacts of people with bacteriologically-confirmed index TB

cases who were evaluated for TB
X 100
The total number eligible contacts with bacteriologically confirmed index
TB cases
Interpretation People who are exposed to active TB are at increased risk for TB infection and
disease. TB disease may be as high as 5% or more among household contacts,
particularly children. PLHIV exposed to active TB have a higher risk for rapid
progression to TB disease. Contact investigation aims to identify these people and
evaluate if they need treatment for TB disease or TPT. These activities can arrest
the progression of infection and treat the disease early on in its course, reducing
its severity, lethality and transmission. Contact tracing and investigation is key to
increase TB detection among people who have had contact with index
bacteriologically confirmed cases. It is one of the underperformed activities of TB
prevention and control programs. The indicator measures the performance of
tracing and investigating contacts of people with bacteriologically confirmed T
patients.

Disaggregation - Type of index case: Drug susceptible and DR-TB contact,

- Age: (<5; 5-14; >=15)
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.10. TB_TPT:TB Preventive Therapy (TPT) Coverage

Definition Number of individuals initiated on TPT out of those eligible, expressed as a
percentage
Formula Total number of individuals eligible for TPT who initiated treatment Formula
during the reporting period
Total number of individuals eligible for TPT during the reporting period
Interpretation Tuberculosis (TB) is one of the leading causes of morbidity and mortality, and
the risk is high for persons living with HIV (PLHIV). TB preventive therapy
(TPT) works synergistically with, and independently of, antiretroviral therapy
(ART) to reduce TB morbidity, mortality and incidence among PLHIV. TB
Preventive Treatment (TPT) is one of the most powerful ways to prevent TB
disease after exposure to the TB bacteria. This indicator (also referred to as TPT
initiation) should include all people deemed to be at risk and eligible for TPT by
the national policy. Those who are eligible for TPT include PLHIV who are
screened negative for active TB; people who are close contacts with
 bacteriological confirmed TB index cases. Monitoring the number of PLHIVs and
close contacts of index TB cases who receive TPT is an important component of
TB prevention program.

All clients whoare eligible and started TPT in the reporting period should be
counted and reported. TPT data is reported from two departments: 1) from TB
clinic and 2) from ART clinic

Disaggregation by PLHIV (newly or currently enrolled on ARV), contacts of index

TB cases allows monitoring the eligible target groups.

Disaggregation by TPT regimen (6H, 3HP, 3HR) helps to assess the uptake of
each regimen, inform the procurement, and supply chain management.
Disaggregation Age disaggregation (<5, 5-14, >=15),
Disaggregation by regimen: 6H, 3HP and 3RH
Sources TB unit register; ART register, HIV clinical care tally sheet, EMR-ART
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.11. TB_IPT:TPT Completion Rate

Definition Number of individuals completing TPT out of those initiating treatment

Formula Number of cohort of individuals that completed TPT treatment among
those who started 12 months prior to the reporting period
X 100
Number of cohort of individuals started TPT 12 months prior to the
reporting period
Interpretation This indicator measures the performance of TB and HIV programs in scaling up
TPT, with the goal of preventing progression to active TB disease among eligible
population groups and decreasing ongoing TB transmission in this population.
This indicator helps assess the quality of implementation of programmatic
management of tuberculosis preventive treatment (PMTPT) given that the
effectiveness of TPT depends upon its completion. The reporting period for this
particular indicator is every 12 months.

This indicator helps assess the quality of implementation of TPT given that the
effectiveness of TPT depends upon its completion. The reporting period for TPT
completion should be earlier, i.e 12 months preceding the reporting period to
allow time for completion of the TPT.

Disaggregation Age disaggregation (<5, 5-14, >=15),

Disaggregation by regimen: 6H, 3HP and 3RH
Sources TB unit register; ART register, HIV clinical care tally sheet, EMR-ART
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.2.12. TB_TST_WHO:Percentage of new and relapse TB patients tested using a WHO
recommended rapid tests at the time of diagnosis
Definition Patients tested using a WHO recommended rapid test at the time of diagnosis,
divided by the total number of new and relapse TB patients, expressed as a
percentage
Formula Number of new and relapse TB patients initially tested using a WHO
recommended rapid test at the time of TB diagnosis X 100
Total number of new and relapse TB patients
Interpretation Early and accurate diagnosis of TB and drug resistance will require rapid
diagnostic tests. This facilitate early and prompt treatment and help decrease
disease transmission, prevent unfavorable outcomes and reduce case fatality. The
national TB Program(NTP) recommend using WHO rapid diagnostic tests (Xpert
and others) to diagnose tuberculosis. Patient diagnosed for TB using rapid
diagnostic test should be recorded and reported to the NTP on a monthly basis.

Disaggregation Age:< 5, 5-14,>15yrs

Sex: M/F

Sources TB unit register

Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.1.13. TB_DST:Drug Susceptibility testing (DST) coverage for TB patients

Definition Percentage of TB patients with Drug susceptibility testing (DST) results for at least
rifampicin among bacteriological confirmed new and retreatment TB patients
Formula Number of notified bacteriologically confirmed TB cases with drug
susceptibility testing results for at least rifampicin during the reporting
X 100
period
Number of notified bacteriologically confirmed TB cases
Interpretation Testing for drug susceptibility for WHO-recommended drugs is essential to
provide the right treatment for every person diagnosed with TB.Early detection of
resistance is intended to ensure an appropriate drug regimen from the start and
presumably increase the likelihood of success and alleviate amplification of
resistance patterns. This indicator measures the availability and access to drug
susceptibility testing for at least rifampicin for TB patients.

Disaggregation Registration group:

 New
 Previously treated including relapse and;
 Unknown treatment history
Sources TB unit register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

Definition Proportion of bacteriologically confirmed DR-TB cases that are notified during the
reporting period among the total number of estimated DR-TB cases
Formula Number of bacteriologically confirmed DR-TB cases that are notified
during the reporting period
X 100
Total number of *estimated DR-TB incident cases among notified TB cases
during the same specified period
Interpretation Culture and Drug susceptibility tests (DST) for at least rifampicin are indicated in
patients presumed to harbor drug-resistant TB strains. This indicator is useful to
determine the burden of DR-TB in the country. Furthermore, it helps national TB
control program for planning of DR-TB treatment expansion, forecasting,
quantification and procurement of second line drugs (SLDs) and reagents.

NB: All detected DR-TB cases are expected to be reported by health facilities
including DR TB Treatment initiating centers where they were first detected. The
detection could be completed within the facility or with the support of external
laboratory facility (after sample is sent for detection). In order to avoid double
reporting of detected cases, treatmentinitiating centers (TICs) should not include
DR-TB cases detected and referred by other facilities for DR-TB treatment in their
DR detection report.
NB: *The denominator is provided by annual WHO-Estimates for the country.
Disaggregation Sex: Male ,Female,
Type: Hr-TB, RR only, MDR ,Pre-XDR, XDR
Age: <15, >= 15
Sources DR-TB register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.1.14. TB_DR_TD:Drug Resistant (DR) TB case detection rate

2.1.15. TB_DR_TX:DR TB treatment coverage

Definition Percentage of DR-TB cases that are registered and started treatment on the
national recommended regimen in the reporting period among total number of
notified in the same reporting period
Formula Number of DR-TB cases that are registered and started on Second line
drugs (SLD) treatment regimen in the reporting period X 100
Total number of DR-TB patients notified during the same reporting
period
Interpretation This indicator measures the capacity of programs to enroll DR-TB cases on
appropriate treatment. The program manager is responsible for ensuring that
all cases in which DR-TB is detected are placed on appropriate treatment in the
shortest time possible. Early detection of resistance is intended to ensure a
correct drug regimen from the start and lower risks of further amplification of
drug resistance.

A comparison of the number of enrolled DR-TB cases to those detected

indicates access to care. It is a crude indicator given that patients started on
treatment during a given period may have been detected prior to the period of
assessment.
Disaggregation HIV status: Positive, Negative , Unknown HIV Status
Registration group: New, Previously Treated with first-line anti TB drug
(FLD), Previously treated with second-line anti TB drug (SLD),Unknown
treatment history
Diagnosis: Bacteriologically confirmed pulmonary, bacteriologically
confirmed extra pulmonary and clinically diagnosed (Pulmonary and EPTB),
Type of Regimen : Shorter regimen, Longer Regimen, Individualized
Regimens

Sources DR-TB register

Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.2.16. TB_DR_TXO:Final Outcome of RR/MDR-TB Cases
Definition A cohort of DR-TB cases for whom final outcome has been determined among those
enrolled on DR -TB treatment during the year of assessment

Formula Number of cohort of RR/MDR-TB cases enrolled on RR/MDR-TB treatment

regimen during reporting period for whom final outcome has been
determined X 100
Total number of RR/MDR-TB cases enrolled on RR/MDR-TB treatment
regimen during the same cohort period
Interpretation This indicator shows the final treatment outcomes for patients enrolled to DR-TB
treatment. The final treatment outcome of cohort of DR-TB patients report should
be reported based on the timeline recommended for specific regimen type.
Generally, final outcome of the patient both in short and long term regimen should
be compiled at 24 months after the last patient in the cohort starts treatment. Most
of the patients will finished their treatment within the first evaluation periods.
However there are patients who will continue their treatment longer than the
majority group especially patient enrolled to long term regimen. Therefore, the
final outcome of these cohort cases are compiled and monitored twice at 24 and
36 months. Thus written document of the final outcome of DR-TB patients on long
term regimen should be recorded in DR-TB Register and reported once again to
the National TB program at 36 months.

Disaggregation Final Outcome: Cured, Completed, Failed, Died, Lost to follow up, Not evaluated
Regimen type: Short term, Long term

Sources DR-TB register

Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.17. TB_MN:Proportion of all forms of TB and DR-TB patients with malnutrition

Definition Percentage of notified all forms of TB and DR-TB patients with Malnutrition in the
reported period among all registered TB/DR-TB cases screened for malnutrition

Formula Number of notified all forms of TB and DR-TB patients with Malnutrition
in the reported period
X 100
Total number of notified and treated all forms of TB and DR- TB cases
screened for Malnutrition
Interpretation Malnutrition is an important co-morbid condition among TB/DR-TB patients with
significant impact on treatment outcomes. This indicator will help measure the
magnitude of malnutrition among notified TB/DR-TB patients and will help in
proper planning for nutritional care needs of TB/DR-TB patients.

Disaggregation Nutritional Status: Normal, MAM, SAM

Sources Unit TB Register; DR-TB register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.2.18. TB_HIV:Proportion of registered new and relapse TB patients with documented HIV
status
Definition Number of new and relapse TB and DR-TB patients who had an HIV test result
recorded in the TB register expressed as a percentage of the number registered
during the reporting period
Formula Number of (new and relapse )TB and DR-TB patients registered during X100
the reporting period who had an HIV test result recorded in the TB
register
Total number of new and relapse TB and DR-TB patients registered in the
TB register during the reporting period
Interpretation This indicator measures the HIV status among TB patients. TB is the leading
cause of morbidity and mortality among people living with HIV. Ensuring that
TB patients receive HIV testing and counseling services should be a high
priority. Knowledge of HIV status enables HIV-positive TB patients to access
the most appropriate HIV prevention, treatment, care and support services.
Ideally, all TB patients with unknown HIV status should be offered an HIV test,
and preferably within the context of the TB service provider, in which case the
HIV test can be recorded in the patient record and the TB register. Patient
confidentiality must be maintained. The following point are crucial for effective
HIV Screening of TB patients. 1. Where HIV counseling and testing is carried
out in a different part of the same facility or even at a distant site, the TB
program needs to record when a TB patient is referred for an HIV test and
receives the result. 2. TB patients should preferably be tested at the start of TB
treatment so that they can benefit from appropriate care throughout TB
treatment. 3. The numerator should include all TB patients who were
previously known to be HIV-positive (documented evidence of enrolment in
HIV care) or their negative documented HIV result from previous testing
acceptable to the health care provider (such as performed in the past 3–6
months from a reliable laboratory). This indicator measures the combined
services’ ability to ensure that TB patients know their HIV status under
program conditions.
Disaggregation Type of TB: DS TB (All forms); DR TB
Sex: male , female,
HIV status: HIV positive, HIV Negative , Unknown
Sources Unit TB register, DR TB register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.2.19. TB_ART:Proportion of HIV-positive new and relapse TB patients on ART during TB

treatment
Definition Number of HIV-positive new and relapse TB patients who receive ART during TB
treatment expressed as a percentage of those registered HIV positive TB cases during
the reporting period
Formula Number of TB cases with documented HIV-positive status who start or
continue ART during the reporting period
X 100
Number of registered TB cases with documented HIV-positive status
during the reporting period
Interpretation This indicator measure the extent to which programs effectively link HIV-infected
TB patients to appropriate HIV treatment. The HIV status of TB patients is often
determined at the TB clinics, but ART for TB cases is frequently provided by the
HIV program. Therefore, provision of ART for this population often implies
successful linkage between the TB and HIV program. Therefore, reconciliation of
the information between the TB and ART registers at facility level should be done
regularly. It is an outcome indicator to measure commitment and capacity of TB
services to ensure that HIV-positive TB patients are able to access ART. Limitation:
this indicator may miss patients diagnosed towards the end of reporting period
whose ART treatment status may not be updated in the TB registers.

The information on outcome of the referral should be recorded in the TB register

(TB/HIV columns). This is important not only for Program management but also
for individual patient care. TB Program personnel need to be aware of a TB patient
starting on ART so that they can manage drug reactions and interactions
appropriately. Note that irrespective of the CD4 cell count, ART should be provided
as soon as possible to HIV positive TB patients and no later than eight weeks after
TB treatment begins. It should be given as a matter of emergency within the first
two weeks of TB treatment among HIV-positive TB and DR-TB patients with
profound immune-suppression (i.e.CD4 count < 50 cells/mm3). ART significantly
improves the quality of life, reduces morbidity, and enhances the survival of
people with advanced HIV infection or AIDS. HIV-positive TB patients are one of
the largest groups who are likely to benefit from ART, and efforts should be made
to identify and treat those who are eligible.

Disaggregation Sex: Male , Female

Age: 0-4, 5-14, 15+
Previously known HIV Positive; newly tested HIV-positive
Sources Unit TB Register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.2.20. LEP_NOT:Leprosy notification per 10,000 population
Definition Proportion of leprosy cases detected among estimated number of leprosy cases in the
population

Formula Total number of leprosy cases notified during the reporting period
X 100
Estimated number of population in the catchment area
Interpretation The number of leprosy cases reflects the performance of the leprosy prevention
and control program. This indicator is a proxy for leprosy incidence in a given
area. It has to be calculated at national and subnational level up to population size
of 10,000. It has also been shown that the number of cases detected increases with
the frequency of examinations: very frequent examinations will identify a number
of self-healing cases that would otherwise never have come forward. The indicator
should be compared with leprosy estimates, which are updated annually by the
Ministry of Health and mapping data of the respective administrative level. Having
the total number of relapse cases will reflect the quality of treatment service
provided and the number rises, it indicates magnitude of transmission of leprosy
and circulation of drug resistant strain of leprosy.
Disaggregation Age: <15, >=15, Sex: Male, Female
Type; Paucibacillary, Multibacillary
Registration group :New, Relapse , other retreatment (defaulters, others)
Sources Leprosy register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

Definition The proportion of new cases of leprosy with disability grade II at the time of
diagnosis

Formula Total number of new leprosy cases having disability grade II at time of
diagnosis during reporting period X 100
Total number of new leprosy cases detected during the same period
Interpretation This indicator measures the quality and effectiveness of the case-finding activities.
A high disability rate among new cases signals that cases are detected late during
the course of the disease. If the rate is high, it is essential to strengthen case-
finding activities and develop health education in order to encourage the
population to seek treatment before disabilities appear.
Disaggregation Age :<15 ;>=15
Sex: Male, Female

Sources Leprosy register

Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency
2.2.21. LEP_DIS:Grade II disability rate among new cases of leprosy

2.2.22. LEP_TX:Leprosy treatment completion rate

Definition Percentage of a cohort of leprosy cases registered in a specified period that

successfully completed treatment

Formula The number of leprosy cases who completed treatment successfully during
specified cohort period X 100
The total number of leprosy cases registered during the same cohort period
Interpretation Treatment completion rate (both for PB and MB types of leprosy) measures the
program’s capacity to retain leprosy patients through a complete course of
chemotherapy with a favorable clinical result. The duration of treatment for PB
and MB is different; hence, treatment completion rate should be done for PB and
MB cases separately.
Disaggregation Type: PB, MB
Sources Leprosy register
Reporting level Heath center /Hospital/Clinic
Reporting Monthly
Frequency

2.3. Malaria Prevention and Control

2.3.1. MAL_DX:Morbidity attributed to malaria

Definition Malaria cases per 1000 population at risk population
Formula Number of new malaria OPD + IPD cases (All malaria cases, of any
species – whether clinical or laboratory (Microscopy & RDT) diagnosis X 1,000
Total population at risk of malaria in the catchment area
Interpretation Malaria case counts are quite sensitive and specific indicators for probability of
an epidemic. According to Epidemic Prevention and control guideline, malaria
cases should be plotted and reviewed weekly. When the epidemic threshold is
reached, the higher level should be notified and more frequently monitoring may
be required. Followed over years, the trends in morbidity should show the effects
of improved prevention and control efforts. Compared across geographic
locations, malaria morbidity can help identify priority areas for intervention.
Disaggregated by species, the morbidity patterns can suggest the emergence of
increasing drug resistance.
Disaggregation Age: 0-4, 5-14 >=15;
Sex: Male, Female
Diagnosis: clinical, laboratory confirmed (P. falciparum /P. vivax/Mixed), Travel
 History
Data source OPD register, IPD register, Emergency register, disease tally (for HPs)
Reporting level Heath Post /health center /Hospital/Clinic
Reporting Monthly
Frequency

2.3.2. MAL_DEATH:Facility based death attributed to malaria

Definition Proportion of all inpatient & emergency deaths due to lab confirmed malaria from
the total deaths in the facility
Formula The total number of all inpatient & Emergency deaths due to laboratory
confirmed malaria X 100
Total number of deaths reported in the health facilities during the
reporting period
Interpretation This indicator indicates the contribution of malaria to the total deaths in the
facility. Further investigation should be done if the percentage of malaria deaths
among the total deaths is increasing.
Disaggregation Age: 0-4, 5-14 >=15
Sex: Male, Female, Pregnant
Data Source IPD register and Emergency registers
Reporting level Heath Post /health center / Hospital/Clinic
Reporting Monthly
Frequency

2.3.3. MAL_POS:Malaria positivity rate

Definition Percentage of slides/ RDT found positive among all slides/RDT tests performed
Formula Number of slides/RDT positive for malaria
Total number of slides/RDT performed for malaria diagnosis X 100
Interpretation The slides / RDT positivity rate assesses the proportion of slides/RDT positive for
malaria among tested patients with fever/malaria symptoms. The slide or RDT
positivity rate is usually computed for a specified period of case detection
activities. In areas with unstable malaria, an increasing slide or RDT positivity
rate by 50% is one of the warning signs of a possible epidemic.
Disaggregation Age: 0-4, 5-14 >=15
Sex: Male, Female, Pregnant
Data source Laboratory register for Health center and Hospital, Service delivery tally (for HPs)
Reporting level Heath Post /health center /Hospital/Clinic
Reporting Monthly
Frequency
2.3.4. MAL_FULL:Proportion of confirmed malaria cases fully investigated and classified

Definition Proportion of confirmed malaria cases fully investigated and classified from the
total malaria cases
Formula Total number of malaria cases fully investigated and classified X100
Total number of malaria cases in elimination targeted Woredas
Interpretation Case classification becomes important during the last stage of malaria elimination
and is a primary reason for case investigation. This indicator shows the effort to
investigate additional cases from the community following the index case within
70-meter radius and contribute identification of the presence of malaria cases in
the community.

Disaggregation None
Data Source Malaria notification, screening and registration
Reporting level Heath Post /health center
Reporting Monthly
Frequency

2.3.5. MAL_FOCI:Proportion of foci fully investigated and classified

Definition It is the proportion of foci in elimination targeted Woredas where foci were fully
investigated and classified from the total new potential and active foci
Formula Total number of new potential and active foci that were fully investigated X100
Total number of foci in elimination targeted Woredas
Interpretation A foci investigation is conducted to identify the main features of a location,
including the population at greatest risk, the rate of infection of disease, the
distribution of vectors responsible for malaria transmission and the underlying
condition that support it. This indicator helps to measure from the identified foci
in the elimination districts with larva positive breading sites and adult mosquito
to take remedial actions (draining, filling, and larvicide, LLINs utilization and IRS).
Disaggregation None
Data Source Malaria notification, screening and registration
Reporting level Heath Post /health center
Reporting Monthly
Frequency

2.3.6. MAL_PAR:Annual parasite incidence

Definition Confirmed malaria cases (microscopy or RDT) per 1000 persons per year.
Formula Number of laboratory (microscopy or RDT) confirmed cases
Total Population within the catchment X 1000
Interpretation This indicator helps to see the transmission intensity in a given area and to
monitor the effectiveness of anti-malaria interventions.
Disaggregation None
Data Source Laboratory register
Reporting level Heath Post /health center /Hospital
Reporting Monthly
Frequency

2.3.7. MAL_IRS:Proportion of unit structures covered by Indoor residual spraying

Definition Proportion of unit structures in IRS targeted areas that were sprayed in the last 12
months.
Formula Number of unit structures sprayed
Total number of unit structures in the target area for IRS X 100
Interpretation This indicator is directly related to operations: It indicates the proportion of
houses sprayed with insecticide among targeted houses and is useful to increase
the level of prevention of malaria in the targeted population.
This indicator requires program-level data to be collected about each house
sprayed during each spraying event in the target area. Careful attention should be
given to identify houses not considered as part of the target area so that they can
be excluded from the calculation. Ideally, (1) all dwellings and relevant structures
in the target areas should be sprayed; (2) all spray able surfaces in the dwelling or
structure should be covered; (3) insecticide application should be uniform across
surfaces; and (4) spraying should be done at intervals consistent with the
manufacturer’s guidelines for specific insecticides. Collectively, these ideal
activities comprise the level of adequacy referred to above.
N.B on average one HH is equivalent to 1.5-unit structures.
Disaggregation None
Data Source Administrative records
Reporting level WorHO, ZHD/SHO
Reporting Annually
Frequency

2.3.8. MAL_EQA: Proportion of health facilities covered by External Quality Assurance

(EQA) for malaria diagnosis
Definition Health facilities (Public & Private) conducting malaria microscopy that are
participating in the quarterly national/regional/sub-regional EQA with blinded
rechecking, Panel and/or onsite evaluation method
Formula Number of health facilities participating in the quarterly blinded
rechecking EQA for malaria diagnosis X 100
Total number of health facilities conducting malaria laboratory diagnosis
(microscopy)
Interpretation This indicator helps to know the quality of malaria diagnosis in the health
facilities and it is calculated from the total health facilities conducting malaria
microscopy.
Disaggregation None
Data Source Administrative Record (Lab record)
Reporting level Heath Post /health center /Hospital
Reporting Annual
Frequency

3. Prevention and Control of Neglected Tropical Diseases

3.1. NTD_SCH: Proportion of individuals who swallowed MDA drug for Schistosomiasis
Definition Number of children who swallowed a drug to prevent schistosomiasis from the
expected eligible children
Formula Number of individuals who swallowed praziquantel drug for
Schistosomiasis X 100
Total children whose age is between 5-14 yr within specific cluster
Interpretation Mass drug administration is among the globally recommended strategies for NTD
prevention and control. This indicator monitors mainly the preventive
chemotherapy coverage for the prevention of schistosomiasis disease. This
indicator count the number of persons who are treated by MDA drugs at
community/school level. It also evaluate the number of children who swallowed
drug (praziquantel) among the total children who are eligible (5 years-14 years)
to take the drugs.
Disaggregation Sex: M/F
Age: 5-14yr; >=15
Data source Integrated MDA register
Reporting level Heath Post
Reporting Monthly
Frequency

3.2. NTD_STH: Proportion of individuals who swallowed drug for soil transmitted
helminthiasis (STH)
Definition Number of children who swallowed a drug to prevent soil transmitted helminthiasis
from the expected eligible children
Formula Number of individuals who swallowed Albendazole or albendazole drug
for STH X 100
Total children whose age is between 5-19 within the specific cluster
Interpretation Mass drug administration is among the globally recommended strategies for NTD
prevention and control. This indicator is used to monitor program
implementation for the prevention and STH worm intensity reduction among
children whose age is 5 years-19 years. The program uses anti helmintiasis drug
either Albendazole or Mebendazole for mass drug administration campaigns
conducted in the community or at school level.
Disaggregation Sex, age: 5-14, 15-19, >=20
Data source Integrated MDA register
Reporting level Heath Post
Reporting Monthly
Frequency
3.3. NTD_LF:Proportion of individuals who swallowed drug for lymphatic filariasis(LF)
Definition Number of people who swallowed a drug to prevent lymphatic filariasis from the
expected eligible population
Formula Number of individuals who swallowed ivermectin or Albendazole drug for
LF X 100
Total population whose age is above 5 years within the specific cluster or
endemic district
Interpretation Mass drug administration is among the globally recommended strategies for NTD
prevention and control. This indicator is among the five preventive chemotherapy
neglected tropical disease program which is used to monitor the lymphatic
filariasis program implementation for the prevention of lymphatic filariasis
infection by administering ivermectin or Albedazole for the eligible population
group whose age is above 5 yr. This indicator is used also to evaluate the
elimination program of LF in Ethiopia by 2025.
Disaggregation Sex: M/F
age: 5-14, >=15 years
Data source Integrated MDA register
Reporting level Heath Post
Reporting Monthly
Frequency

3.4. NTD_ONCH:Proportion of individuals who swallowed drug for onchocerciasis

Definition Number of who swallowed ivermectin to prevent onchocerciasis from the expected
eligible population
Formula Number of individuals who swallowed ivermectin drug for onchocerciasis
Total population whose age is above 5 years within the specific cluster or X 100
endemic district
Interpretation Mass drug administration is among the globally recommended strategies for NTD
prevention and control. This indicator is among the five preventive chemotherapy
neglected tropical disease program which is used to monitor the onchocerciasis
program implementation for the prevention of onchocerciasis infection by
administering ivermectin for the eligible population group whose age is above 5
yr. This indicator is used also to evaluate the elimination program of
onchocerciasis in Ethiopia by 2025.
Disaggregation Sex: M/F
Age:5-14, >=15
Data source Integrated MDA register
Reporting level Heath Post
Reporting Monthly
Frequency
3.5. NTD_TR:Proportion of individuals who swallowed drug for trachoma
Definition Number of people who swallowed azithromycin or took tetracycline eye ointment
to prevent trachoma from the expected eligible population
Formula Number of individuals who swallowed azithromycin drug for trachoma
Total population who are eligible for the trachoma MDA within the specific X 100
cluster or endemic district
Interpretation Mass drug administration is among the globally recommended strategies for NTD
prevention and control. Trachoma is known to be one of the major causes of
blindness in Ethiopia. The demand for trachoma mass treatment is enormous.
This indicator is among the five preventive chemotherapy neglected tropical
disease program which is used to monitor the trachoma program implementation
for the prevention of trachoma infection by administering azithromycin or
tetracycline eye ointment for the eligible population. This indicator is used also to
evaluate the elimination program of trachoma in Ethiopia by 2025.
Disaggregation Sex: M/F
Age:0-6 months, 6 months- 7 yrs; 7yr-14 yrs; >=15 yrs
Data source Integrated MDA register
Reporting level Heath Post
Reporting Monthly
Frequency

3.6. NTD_VL: Number of visceral Leishmaniasis (VL) cases treated

Definition Number of patients who are diagnosed and treated for visceral leishmaniasis
using leishmaniasis drugs
Formula Number of individuals who are diagnosed and treated for visceral leshmaniasis
Interpretation This indicator is used to monitor the visceral leishmaniasis control program in
the country. This disease is fatal form of leishmaniasis that should be targeted for
elimination. The objective of this indicator will tell about the progress of the
program implementation. The disease incidence per annual is between 2,500-
4,000 cases in the country. Therefore, this indicator is used to monitor how many
of the cases are investigated and managed.
Disaggregation Sex: M/F
Age:<5; 5-14; 15+ yrs
VL type: Primary, relapse, Post Kalazar Dermal (PKD)
HIV status: Positive, Negative
Treatment outcome:cure, defaulted, death, treatment failure, transfer out
Data source Leishmaniasis register
Reporting level Health center/Hospital
Reporting Monthly
Frequency
3.7. NTD_CL: Number of cutaneous Leishmaniasis (CL) cases treated
Definition Number of patients who are diagnosed as cutaneous Leishmaniasis by confirming
parasite leishmania and treated by anti leishmaniasis
Formula Number of cutaneous leishmaniasis cases diagnosed and treated
Interpretation This indicator is used to monitor the cutaneous leishmaniasis control program in
the country. This disease causes disfigurement and stigma. And the objective of
this indicator will tell about the progress of the program implementation. The
disease incidence per annual is between 20,000- 30,000 cases in the country.
Therefore this indicator will monitor how many of the cases have been reached
and are managed.
Disaggregation Sex: M/F
Age:<5; 5-14; 15+ yrs
CL type: Primary, relapse
Treatment outcome: improved, not improved
Data source Leishmaniasis register
Reporting level Health center/Hospital
Reporting Monthly
Frequency

3.8. NTD_TT: Proportion of Trachomatous Trichiasis (TT) cases who received corrective
TT surgery
Definition Proportion of individuals with confirmed trichiasis for whome trichiasis corrective
surgery was performed among all confirmed TT cases in the specific cluster
Formula Number of individuals who have confirmed eyelid inversion or trichiasis
Total number of confirmed TT cases in the specific geography or X100
population

Interpretation Trachoma is the most common infectious cause of blindness worldwide. It causes
trichiasis (in turning of the eyelash to touch the eye) which can cause visual loss.
Surgery is the main treatment for trichiasis. In Ethiopia, there are backlogs of TT
cases, which require an intensive TT surgical intervention. This indicator
monitors the TT backlog clearance and used to evaluate the program’s
implementation status in reducing blindness due to prevenatable trachoma.

Disaggregation Sex: M/F

Age: <15; >=15 yrs
Data source TT surgery register
Reporting level Health center/Hospital
Reporting Monthly
Frequency
4. Prevention and Control of Non-Communicable Diseases and Mental Health

4.1. NCD_HTNDX: Number of hypertensive patients enrolled to care

Definition Number of confirmed hypertension cases registered for treatment(enrolled to
care)
Formula Number of hypertensive patients enrolled to care
Interpretation All individuals with confirmed hypertension are eligible to be enrolled to
hypertensive care. Drug therapy is defined as taking medication for
management of raised blood pressure or hypertension. Non-pharmacological
management or healthy life style counseling is defined as giving advice by
health workers to quit using tobacco, reduce excess alcohol intake, reduce salt
in diet, eat at least five servings of fruit and/or vegetables per day, reduce fat in
diet, start or do more physical activity, maintain a healthy body weight or lose
weight.

The global action plan on the prevention and control of NCDs suggests at least
50% of eligible people receive drug therapy and counseling to prevent heart
attack and stroke. This indicator permits monitoring trends in the number of
patients with hypertension who received treatment for hypertension.
Moreover, it shows health seeking behavior of the community. Furthermore, it
helps to design prevention, counseling and treatment interventions at health
facilities, which further contribute to avoid cardiovascular complications.
Treating hypertensive patients is associated with a decrease in cardiovascular
complications. WHO recommends drug therapy for prevention and control of
heart attacks and strokes because it is feasible, has high impact and affordable,
even in low- and middle-income countries such as Ethiopia.
Disaggregation Age: 18-29; 30-39; 40-65; >=70
Sex: Male, female
Type of Care:
 Health lifestyle Counselling only (HLC)
 Pharmacological management and HLC
Timing of enrollment:
 Newly enrolled to care
 Previously in care
Data source HTN/DM Treatment Register
Reporting Heath center / Hospital/Clinic
level
Reporting Monthly
Frequency

4.2. NCD_HTNTX: Six-monthly control of blood pressure among people treated for
hypertension
Definition Proportion of patients registered for hypertensive treatment at the health facility
 whose blood pressure is controlled 6 months after treatment initiation
Formula Number of patients with controlled blood pressure at the last clinical
visit
Number of the cohort of patients registered for the treatment of X 100
hypertension during the month that ended 6 months previously
Interpretation Controlled hypertension is an indication of the quality of care for hypertension
patients. Controlled hypertension means Systolic blood pressure (SBP) of less
than 140mmHg and Diastolic Blood Pressure (DBP) of less than 90 mmHg. Lost
to follow-up means when hypertension patients do not report to the health
center or hospital for more than 28 days after last appointment. Therefore,
calculating hypertension control rate is an important indicator to measure the
effectiveness of clinical services in the program.
Disaggregation Treatment Outcome after 6 months:
 Controlled, uncontrolled, lost to follow up, died, transferred out
Age: 18-29; 30-39; 40-65; >=70
Sex: Male, female
Data source HTN/DM Treatment Cohort Register
Reporting Heath center / Hospital/Clinic
level
Reporting Monthly
Frequency

4.3. NCD_CVD: Proportion of patients with high CVD risk who received treatment
Definition It is the proportion of patients with high CVD risk (among those with HPN and
DM) and received treatment for CVD risk reduction
Formula Number of patients with high CVD risk that received treatment
Total number of patients with high CVD risk X 100
Interpretation CV risk, according to WHO risk assessment, refers to the chance of having fatal
or non-fatal heart attack/stroke in the next 10 years with the current risk
profile of the patient. CVD risk factors are any biologic or environmental
conditions known to increase the inherent risk of having CV event. Risk factor
can be preventable. Primary Prevention from CVD is control of risk factors
before cardiovascular disease develops while Secondary Prevention is
Prevention of further occurrence or progression of previous cardiovascular
disease.

There are two types of WHO risk charts based on availability of laboratory to
measure blood glucose and cholesterol levels. These are CVD risk charts that
include measurements of total cholesterol and information on diabetes mellitus.
The laboratory-based CVD risk charts should be used for treatment decisions.
The variables needed for using this chart are as follows: History; Age (between
40 to 74 years); smoking history: current smoking; and sex.
 Individuals with >=20% of lab based risk category and >=10% of non-lab based
category are considered to be at high risk of CVD.
Disaggregation Type of treatment: With Statin , Without Statin
Age: 40-59; 60-74
Sex: Male, female
Data source HTN/DM Treatment Register
Reporting Health Center/Hospital
level
Reporting Monthly
Frequency

4.4. NCD_DMDX: Number of new diabetic patients enrolled to care

Definition Number of confirmed diabetes cases registered for treatment (enrolled to care)
Formula Number of new diabetic patients enrolled to care
Interpretation WHO recommends glycemic control for prevention and control of heart attacks
and strokes because it is feasible, high impact and affordable, even in low- and
middle-income countries. This indicator allows monitoring trends in the
number of patients with diabetes who received treatment. Monitoring
treatment of diabetes at health facilities shows health seeking behavior of the
community. Further, it helps to design prevention, counseling and treatment
interventions, which further contribute to avoid macro vascular and micro
vascular complications. Those patients newly enrolled to care after
confirmation of diagnosis and those patients that were previously in care that
are self-referred, referred from OPD, NCD screening corner or other
units/health facilities will be included in the numerator. Those individuals
found to have raised blood sugar after screening will be included in the
denominator.
Disaggregation Type of treatment:
 Health lifestyle Counselling only (HLC)
 Pharmacological management and HLC
Timing of enrollment:
 Newly enrolled to care
 Previously in care
Age: <15, 15-29, 30-39, >=40
Sex: Male, Female
Data source HTN/DM Treatment Register
Reporting Heath center/Hospital/ Clinic
level
Reporting Monthly
Frequency

4.5. NCD_DMTX: Six-monthly control of diabetes among individuals treated for diabetes
Definition Proportion of newly enrolled diabetic individuals with controlled blood glucose at
6 months after initiating treatment
Formula Number of patients with controlled diabetes at the last clinical visit
Number of cohort of patients registered for treatment of diabetes during X 100
the month that ended 6 months previously
Interpretation This indicator allows monitoring of diabetes control among newly enrolled
diabetic patients 6 months after initiating treatment. Monitoring this indicator
shows the quality and effectiveness of the program. It is a quality indicator,
which helps to design prevention, counseling and treatment interventions to
further contribute to avoid macro vascular and micro vascular complications.

Diabetes is labelled as controlled when fasting blood glucose (FBG) level is

below 130mg/dl at the last clinical visit in the most recent month just before
the reporting period.
Disaggregation Treatment outcome:
 Controlled, uncontrolled, Lost to follow up, Died and Transfer out
Age: <15, 15-29, 30-39, >=40
Sex: Male, Female
Data source HTN/DM Treatment Cohort Register
Reporting Heath center/ Hospital/ Clinic
level
Reporting Monthly
Frequency

4.6. NCD_CV_SCRN: Proportion of women aged 30–49 years screened for cervical Ca
Definition The proportion of women between ages 30 – 49 screened either with Visual
Inspection with Acetic Acid (VIA) or Human Papilloma Virus (HPV) DNA test for
cervical cancer
Formula Number of women aged 30–49 years who have been screened for cervical
cancer in the reporting period X 100
Estimated number of women aged 30–49 years in the catchment
Interpretation This indicator is intended to monitor trends in the provision of counseling and
screening services for cervical cancer. Data should be generated by counting the
total number of individuals who received screening service at service delivery
points (usually in family planning clinics) from health facilities providing the
service. Recent developments in technologies adapted to low-resource settings
make screening and treatment of cervical pre-cancer lesions feasible and highly
cost-effective for all countries. Additionally Ethiopia has also introduced the HPV
DNA test as an additional screening test in addition to the VIA screening test
previously in use.

Early detection and treatment of precancerous lesions can result in massive

improvements in the chance of survival, and are especially important in
 developing countries where access to expensive cancer treatment is limited.
There is sufficient evidence that cervical cancer screening can reduce cervical
cancer mortality by 80 per cent or more among screened women.

The service is provided integrated with family planning service and during the
service; cervical in-take form will be used to document the required information
during screening. HPV DNA test positive only tells us the presence of human
papilloma virus infection. Therefore, women whose HPV DNA test turned positive
should undergo VIA screening to identify presence of lesion.
Disaggregation Screening type: VIA, HPV DNA
Result for VIA:
 Normal cervix,
 Precancerous lesion
 Suspicious for cervical cancer
Result for HPV DNA test: Positive, negative
Data source Cervical Cancer Screening and Treatment Register
Reporting level Health Center/Hospital/Clinic
Reporting Monthly
frequency

4.7. NCD_CV_TX: Proportion of eligible women who received treatment for cervical
lesion
Definition Percentage of women with a precancerous lesion on VIA test who received
treatment
Formula Number of women 30 - 49 years with cervical lesion treated
Number of women 30 - 49 years with identified pre-cancerous cervical X 100
lesion
Interpretation This indicator is intended to monitor the proportion of women with precancerous
cervical lesions who received treatment of precancerous lesions with treatment
approaches such as cryotherapy, LEEP or thermal ablation. This can result in
massive improvements of survival, and are especially important in developing
countries where access to expensive cancer treatment is limited.
Disaggregation Treatment type:
 Cryotherapy
 LEEP
 Thermal Ablation/Thermo-coagulation
Data source Cervical Cancer Screening and Treatment Register
Reporting level Health Center/Hospital/Clinic
Reporting Monthly
Frequency

4.8. NCD_CSR: Cataract surgical rate (CSR)

Definition Number of cataract operations performed per million population
Formula Number of Cataract surgeries performed
Total population in the catchment area X 1,000,000
Interpretation The CSR is a performance indicator that indicates the extent of the effort to
control cataract blindness and it allows easy comparison between countries and
regions. It is also an indicator for the availability, accessibility and affordability of
cataract services. The CSR does not address the quality of surgery nor the
proportion of the cataract problem covered. This Indicator should help us to
improve training and influence policy. It is simple to collect output indicator
recommended by WHO, it show the performance in relation to the country's need
to do cataract surgeries. It helps decision makers to allocate resources based on
the performance and workload of the facilities and regions.
Disaggregation None
Data source Operation Register
Reporting level Health Center/Hospital/Clinic
Reporting Monthly
Frequency

Mental Health

4.9. MH_TX: Proportion of individuals treated for priority mental health disorders
Definition It is the proportion of individuals who were diagnosed and treated for priority
mental health disorders, including depression, psychosis, bipolar, epilepsy and
substance use disorders
Formula 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤ℎ𝑜 𝑤𝑒𝑟𝑒 𝑡𝑟𝑒𝑎𝑡𝑒𝑑 𝑓𝑜𝑟 𝑑𝑒𝑝𝑟𝑒𝑠𝑠𝑖𝑜𝑛
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤𝑖𝑡ℎ 𝐷𝑒𝑝𝑟𝑒𝑠𝑠𝑖𝑜𝑛
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤ℎ𝑜 𝑤𝑒𝑟𝑒 𝑡𝑟𝑒𝑎𝑡𝑒𝑑 𝑓𝑜𝑟 𝑝𝑠𝑦𝑐ℎ𝑜𝑠𝑖𝑠
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤𝑖𝑡ℎ 𝑝𝑠𝑦𝑐ℎ𝑜𝑠𝑖𝑠
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤ℎ𝑜 𝑤𝑒𝑟𝑒 𝑡𝑟𝑒𝑎𝑡𝑒𝑑 𝑓𝑜𝑟 𝑏𝑖𝑝𝑜𝑙𝑎𝑟 𝑑𝑖𝑠𝑜𝑟𝑑𝑒𝑟 X 100
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤𝑖𝑡ℎ 𝑏𝑖𝑝𝑜𝑙𝑎𝑟 𝑑𝑖𝑠𝑜𝑟𝑑𝑒𝑟
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤ℎ𝑜 𝑤𝑒𝑟𝑒 𝑡𝑟𝑒𝑎𝑡𝑒𝑑 𝑓𝑜𝑟 𝑒𝑝𝑖𝑙𝑒𝑝𝑠𝑦
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤𝑖𝑡ℎ 𝑒𝑝𝑖𝑙𝑒𝑝𝑠𝑦
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤ℎ𝑜 𝑤𝑒𝑟𝑒 𝑡𝑟𝑒𝑎𝑡𝑒𝑑 𝑓𝑜𝑟 𝑠𝑢𝑏𝑠𝑡𝑎𝑛𝑒 𝑢𝑠𝑒 𝑑𝑖𝑠𝑜𝑟𝑑𝑒𝑟
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑤𝑖𝑡ℎ 𝑠𝑢𝑏𝑠𝑡𝑎𝑛𝑐𝑒 𝑢𝑠𝑒 𝑑𝑖𝑠𝑜𝑟𝑑𝑒𝑟
Interpretation This indicator measures coverage of services for priority mental health disorders
that includes Depression, Psychosis, Bipolar, and epilepsy and substance use
disorder. The numerator is the number of people that received mental health
service and the denominator is the expected number of people with priority
mental health disorders in the catchment area. For each priority mental health
disorders, the estimate can be taken from national or subnational studies.
Disaggregation Type of disorder:
- Depression,
- Psychosis,
 - Bipolar,
- epilepsy
- Substance use disorder)
Age: <15, 15-24, 25-49, 50+
Sex: Male, Female
Data source OPD and IPD registers; Mental Health Follow up register
Reporting Heath center /Hospital/ Clinic
level
Reporting Monthly
Frequency

4.10. NCD_CDBD: Proportion of children (<18) diagnosed and treated for childhood
developmental and behavioral disorders
Definition It is the proportion of children under 18 years of age who have been diagnosed and
treated for childhood developmental and behavioral disorders, from the estimated
number of children with the disorders
Formula Number of children treated for childhood and behavioral disorders
Estimated number of children with childhood developmental and X 100
behavioral disorders
Interpretation This indicator measures access to services targeting childhood and
developmental disorders. It measures the proportion of children who are
diagnosed and treated for major childhood and developmental disorders such as
autistic disorders, intellectual disability, learning and developmental problems,
attention deficit hyperactivity disorder (ADHD), Conduct and Oppositional
Disorders down’s syndrome, and others.

For each childhood developmental and behavioral disorder, the estimate can be
taken from national or subnational studies.
Disaggregation Sex: M/F
Type of disorder
Data source OPD and IPD registers; IMNCI register; Mental Health Follow up register
Reporting level Heath center /Clinic/ Hospital
Reporting Monthly
Frequency

5. Hygiene and Environmental Health

5.1. HEH_HHLW: Proportion of HHs with liquid waste management

Definition Proportion of HH having safe liquid waste disposal site

Formula Number of households having liquid waste disposal site X100
Total number of households
Interpretation This indicator measures availability of liquid waste management system at
 household level. Liquid wastes at household level should be managed by
preparing seepage pit, septic tanks, connected to sewer lines and latrines. Thus,
this indicator measures the status of liquid waste management by the
households.

Limitations: Health extension workers may not visit all household in one
quarter. So, the indicator may not represent the actual status of the kebele
quarterly.
Dis- None
aggregation
Source Hygiene & Sanitation card (FF)/eCHIS
Reporting level Heath Post
Reporting Quarterly
Frequency

5.2. HEH_HHSW: Proportion of HHs with safe solid waste management

Definition Proportion of HH having safe solid waste disposal site
Formula Number of households having solid waste disposal site X100
Total number of households
Interpretation This indicator measures availability of solid waste management system at
household level. Safe solid waste disposal at HH level includes burial,
composting, providing household wastes to authorized collectors, disposing in
municipal containers by households.
Limitations: Health extension workers may not visit all household in one
quarter. So, the indicator may not represent the actual status of the a kebele
quarterly
Dis- None
aggregation
Source Hygiene & Sanitation card (FF)/eCHIS
Reporting level Heath Post
Reporting Quarterly
Frequency

5.3. HEH_HHSF: Proportion of households having sanitation facilities

Definition Proportion of households having sanitation facilities disaggregated by basic,

limited and unimproved facilities
Formula Number of households having sanitation facilities X100
Total number of households
This indicator measuresProportion of households having sanitation facilities
Interpretation disaggregated by basic, limited and unimproved facilities. These facilities are
classified into three categories that include:
Basic sanitation Facilities: Use of improved sanitation facilities that are
not shared with other households.
 (Improved sanitation facilities are Sanitation facilities that are designed
to hygienically separate human excreta from human contact. These
include wet sanitation technologies such as flush and pour flush toilets
connected to sewers, septic tanks or pit latrines, and dry sanitation
technologies such as dry pit latrines with slabs and composting toilets.)

Limited sanitation Facilities: Use of improved sanitation facilities shared

between two or more households.

Unimproved sanitation Facilities: Use of unimproved sanitation facilities.

(Unimproved sanitation facilities are Sanitation facilities that do not
hygienically separate human excreta from human contact. This includes
dry pit latrines without slabs, hanging latrines, bucket latrines, and flush
and pour-flush toilets discharging to an open drain.)

No sanitation facility: no sanitation facility in the household

Limitations: Health extension workers may not visit all household in one
quarter. So, the indicator may not represent the actual status of the kebele
quarterly.
Dis- Basic, limited, unimproved Sanitation Facilities, No facility
aggregation
Source Hygiene & Sanitation card (FF)/eCHIS
Reporting level Heath Post
Reporting Quarterly
Frequency

5.4. HEH_HHHWF: Proportion of households having hand washing facilities at the premises
Definition Proportion of households having hand washing facilities at the premises
disaggregated by basic & limited hand washing facilities
Formula Number of Households having hand washing facilities at the premises X100
Total number of Households
Interpretation This indicator measures Proportion of households having hand washing
facilities at the premises disaggregated by basic & limited hand washing
facilities Hand washing facility: may be fixed or mobile, and include sinks
with tap water, buckets with taps, tippy-taps, and jugs or basins designated for
hand washing. Soap includes bar soap, liquid soap, powder detergent, and
soapy water but does not include ash, soil, sand or other traditional hand
washing agents.
Basic hand washing service: availability of a hand washing facility on
premises with soap and water.
Limited hand washing service: availability of hand washing facility on
premises but without soap or water.
No hand washing facility: no hand washing facility of any kind on premises.
 Limitations: Health extension workers may not visit all household in one
quarter. So, the indicator may not represent the actual status of the kebele
quarterly.
Dis- Basic, limited, No facility
aggregation
Source Hygiene & Sanitation card (FF)/eCHIS
Reporting level Heath Post
Reporting Quarterly
Frequency

5.5. HEH_HHHH: Proportion of households with healthy housing

Definition Proportion of households with healthy housing disaggregated by separate animal
house, smokeless stove and separate Kitchen
Formula Number of households with healthy housing X100
Total number of households
Interpretation This indicator measures the Proportion of households with healthy housing.
Healthy housing is one of the health extensions packages that is implemented
at household level. The package is intended for the prevention of diseases
related with indoor air pollution, zoonotic diseases. For the house to be
Healthy, it should fulfill at least Separate kitchen, Smokeless stove and separate
animal house. Healthy housing can be disaggregated as, a house with
Separate kitchen,
Smokeless stove,
separate animal house

Limitations: Health extension workers may not visit all household in one
quarter. So, the indicator may not represent the actual status of the kebele
quarterly.
Dis- Separate kitchen, Smokeless stove, separate animal house
aggregation
Source Hygiene & Sanitation card (FF)/eCHIS,
Reporting level Heath Post
Reporting Quarterly
Frequency

5.6. HEH_ODF: Proportion of kebeles declared ODF

Definition Proportion of kebeles declared ODF registered as new and existing among total
number of Kebeles
Formula Number of kebeles that have been declared open defecation free X100
[Existing + New]
Total number of Kebeles
Interpretation This indicator measures the number of Kebeles which have declared open
 defecation free and verified and certified by Woreda ODF verification Team
based ODF verification and certification protocol.
Existing: number of ODF kebeles declared in previous quarter and still
sustained ODF until reporting quarter
New: Number of ODF Kebeles declared in reporting quarter

Limitations: The kebele status may be changed over time.

Dis- Existing, New
aggregation
Source Hygiene & Sanitation card (FF)/eCHIS
Reporting level Heath Post
Reporting Quarterly
Frequency

5.7. HEH_WSTST: Proportion of water schemes for which water quality test conducted
Definition Proportion of water schemes for which water quality test conducted
Formula Number of water schemes tested for water quality X100
Total number of water schemes
Interpretation This indicator measures Proportion of water schemes for which water quality
test conducted. Water quality test includes test of drinking water sources for
physical, microbiological, chemical parameters which is conducted by woreda
health Offices using portable water test kits and should be conducted
biannually in regular basis and occasionally based on rumors indicated
suspicion of contaminated water.
Positive for Micro biological test result means E.coli count equals to or more
than 1.

Limitations: The woreda may not visit all water schemes in one quarter. So,
the indicator may not represent the actual status of the Woreda quarterly.
Dis- Total water quality test, Positive for Microbiological test
aggregation
Source Admin record
Reporting level Woreda Health Office
Reporting Quarterly
Frequency

5.8. HEH_HFWATER: Proportion of health facility with water service

Definition Proportion of health facility with water service disaggregated by basic, limited
& No services
Formula Number of health facilities with water services X100
Total number of Health facilities
Interpretation This indicator measures the Proportion of health facility with water service.
Availability of water service can be reported with disaggregation as;
 Basic water service: Water is available from piped water, boreholes or tube
wells, protected dug wells, protected springs, rainwater, and packaged or
delivered water in which their nature of design and construction have the
potential to deliver safe water on the premises. The water source should be
within the premises of the health facility.

Limited water services: Water is available from piped water, boreholes or

tube wells, protected dug wells, protected springs, rainwater, and packaged or
delivered water in which their nature of design and construction have the
potential to deliver safe water within 500 meters of the premises, but not all
requirements for basic service are met. The water source is not in the health
facility but is within 500m from the health facility.

No water services: Water is taken from unprotected dug wells or springs, or

surface water sources; or an improved source that is more than 500 meters
from the premises; or there is no water source.

Limitations: Needs continuous supervision of water facilities in Health

facilities, training and capacity building of woreda health office staffs.
Dis-aggregation Basic, limited or No Service
Source Admin
Reporting level Health post/ Health center/Hospital
Reporting Quarterly
Frequency

5.9. HEH_HFSAN: Proportion of health facility with sanitation facilities

Definition Proportion of health facility with sanitation facilities disaggregated by basic,
limited & no sanitation service
Formula Number of health facility with sanitation facilities X100
Total number of Health facilities
Interpretation This indicator measures Proportion of health facility with sanitation facilities.
Availability of sanitation facilities can be reported with disaggregation as;
Basic sanitation service: Access and use of wet sanitation technologies – such
as flush and pour flush toilets connecting to sewers, septic tanks or pit latrines
– and dry sanitation technologies – such as dry pit latrines with slabs, and
composting toilets designed to hygienically separate human excreta from
human contact, with at least one toilet dedicated for staff, at least one sex-
separated toilet with menstrual hygiene facilities, and at least one toilet
accessible for people with limited mobility.
Limited sanitation services: At least one wet sanitation technologies – such
as flush and pour flush toilets connecting to sewers, septic tanks or pit latrines
– and dry sanitation technologies – such as dry pit latrines with slabs, and
composting toilets is available, but not all requirements for basic service are
met.
No sanitation services: Toilet facilities are unimproved (e.g. pit latrines
without a slab or platform, hanging latrines, bucket latrines) or there are no
 toilets.
Dis- Basic, limited or No sanitation Service
aggregation
Source Admin
Reporting level Health Post/Health center/Hospital
Reporting Quarterly
Frequency

5.10. HEH_HFWASTE: Proportion of health facilities with healthcare waste management

services
Definition Proportion of health facilities with healthcare waste management services
Formula Number of health facilities with healthcare waste management X100
services
Total number of Health facilities
Interpretation This indicator measures Proportion of health facility with waste management
services. Availability of waste management services can be reported with
disaggregation as;
Basic waste management service: Waste is safely segregated into at least
three categories: bins, sharps and infectious wastes, and are treated and
disposed safely.
Limited waste management services: There is limited separation and/or
treatment and disposal of sharps and infectious waste, but not all requirements
for basic service are met.
No waste management services: There are no separate bins for sharps or
infectious waste, and sharps and/or infectious waste are not treated/disposed
of safely.
Dis- Basic, limited or No Service
aggregation
Source Admin
Reporting Health post/Health center/Hospital
level
Reporting Quarter
Frequency

6. Health Extension and Primary Health Care

6.1. HEPHC_MODEL_H: Model Households

Definition Proportion of households that are currently model based on model household
criteria
Formula Number of currently model households in the catchment X100
Total number of households in the catchment area
Interpretation This indicator measures the extent to which households are producing their
health by implementing the health extension program components. It is about
 transfer ownership and responsibility of maintaining their health to individual
households.

Households that put at least 75% of the HEP packages into practice are
considered as Model. Currently Model Households = (Previously model and
sustained + Newly model)

Limitation: Health extension workers may not visit all household in one
quarter. So, the indicator may not represent the actual status of the kebele
quarterly.
Dis- None
aggregation
Data Source Family Folder (eCHIS)
Reporting level Heath Post
Reporting Quarterly
Frequency

6.2. HEPHC_HPPHCU: Proportion of high performing PHCUs

Definition Proportion of primary health care unit that score 85% & above in average based
on agreed criteria
Formula Number of high performing PHCUs X100
Total Number of PHCUs
Interpretation This indicator measures high performing PHCUs based on the criteria. A PHCU
will be considered as high performing if it scored an average weight of more
>85%. All the criteria need not to be fulfilled independently. Primary health
care unit encompass one health center with in average 5 satellite health post.

Producing high performing PHCUs is a critical component of to achieving

woreda transformation, which is currently measured by 80% of model kebele,
85% by 18 KPI indicators and 80% of EHCRIG.
Dis- None
aggregation
Source Admin record
Reporting level WoHO
Reporting Quarterly
Frequency

6.3. HEPHC_COMP_HP: Proportion of health posts providing comprehensive health services

Definition Proportion of health posts that provide comprehensive health services
Formula Number of health posts providing comprehensive health services X100
Total Number of health posts
Interpretation This indicator measures the number of comprehensive health posts in the
woreda. The type of service, HR and other criteria to become comprehensive
health post are defined in HEP optimization roadmap, which guides the HEP
program for the coming 15 years. The roadmap categorizes health posts in to
three, namely: comprehensive health post, basic health post and integrated
 health post based on different criteria. In the coming five years 10% of current
health posts are expected to be changed to comprehensive health post.

If a health post’s status changes from one to another, then their HR, service
delivery and logistic system also changes. Therefore, monitoring this change is
a very important aspect during the HSTP-2 period.
Dis- Basic and Comprehensive
aggregation
Source Admin Record
Reporting level Woreda HO
Reporting Annually
Frequency

6.4. HEPHC_MODEL_K: Model Kebele

Definition Proportion of model kebele among total Kebeles
Formula Number of graduated Model Kebeles X100
Total number of Kebeles
Interpretation This indicator measures the number of model kebeles in the catchment area. A
Kebele is labeled as model based on preset criteria and which is further
verified by woreda verification team.

Sum of point scores achieved by the kebeles in all four criteria (that is the
performance of a kebele in the above four indicators multiplied by the
maximum weight and divided by the maximum cut off point for each indicator)

It can be calculated as (Proportion of model households*25%/85%) +

(Proportion of SBA*25%/85%) + (Proportion of HHs with Improved latrine
access*25%/85%) + (Model school status*25%/98.6%)
Disaggregation None
Source Admin Record
Reporting level Health center
Reporting Quarterly
Frequency

7. Medical services

7.1. MS_OPD: Out-Patient Attendance Per-Capita

Definition Number of outpatient department visits (days) per person per year.
Formula Total number of outpatient visits
Total catchment population
Interpretation Outpatient attendance shows the level of utilization of and access to outpatient
health care services1[2]. It reflects the interaction between demand and supply
1
https://www.measureevaluation.org/prh/rh_indicators/health-systems/hss/number-of-outpatient-department-
visits-per-10-000
 of outpatient care. The use of outpatient services is inversely related to certain
barriers that may be physical (distance), economic (cost to patient), cultural
(low awareness and health care seeking behavior) or technical (poor quality of
health care). It has been demonstrated that OPD attendance visit goes-up when
such barriers are removed through bringing services closer to people and
reducing user fees [3]. It is used to examine trends, variations, and use of
service by type of facility and health care services by the type of facility and
health care services, geographic districts, and urban rural locations2.

Every patient or client who visited any health facility including public, private,
non-governmental, and community-based health facilities for any service
should be included in OPD attendance report. Patients who attend the
following services should be INCLUDED in the outpatient count and should be
counted once a day:
• General outpatient clinics
• Specialty outpatient clinics (including Dental, Ophthalmic and
Psychiatry)
• TB clinics
• ART clinics
• VCT clinics
• MCH clinics (EPI, IMCI, well baby clinics, ANC, PNC, family planning etc)
• Private wing clinics
• Patients attending the emergency department
Patients who attended services at dressing and injection room
Dis-aggregation Age, sex
Source Service delivery tally (for HP)/Central Card Room Register and OPD
attendance tally
Reporting level Health Post/Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.2. MS_BOR: Bed Occupancy Rate

Definition Percentage of available beds that have been occupied over a given period
Formula Sum-total of the length of stay (in days) in the reporting period X100
(Number of beds available)X(Number of days in the period)
Interpretation Bed occupancy rate (BOR) is calculated as a percentage of the number of beds
effectively occupied (bed-days) for curative care divided by the number of
beds available for curative care multiplied by the number of days in the period.
It is a measure of the efficiency of inpatient services. Hospitals are most
efficient at a BOR of about 85%. If the BOR is lower, resources may be wasted.
If the BOR is higher than 85% there is a danger of staff burnout, over-
crowding, and shortage of beds during sudden increases in demand for in-
patient services during epidemics or emergency situations. Higher BOR is
usually associated with reduced patient safety and privacy and is associated
with an increase in rates of in-hospital mortality [4, 5]. BOR could be sharply
increased during epidemics or emergency situations. In resource-limited

2
https://www.measureevaluation.org/prh/rh_indicators/health-systems/hss/number-of-outpatient-department-
visits-per-10-000
 situations, hospitals may admit patients beyond their capacities and treat them
by keeping them on the floor, trolleys and stretchers and BOR could be raised
beyond 100%. Measuring BOR helps hospitals to determine inefficiencies or
stresses in service delivery to investigate and take action to address it, and also
to plan for the future staff or other resource requirements.

An operational (in-patient) bed includes beds for all components of curative

care of illnesses (including both physical and mental or psychiatric illnesses)
or treatment of injury), diagnostic, therapeutic, and surgical procedures; and
obstetric services. It EXCLUDES beds in emergency room or emergency
gynecology departments, beds in day units or day surgery, temporary beds
(stretchers or trolleys, observation or recovery beds in the emergency
department, operating room or outpatient department, labor suite beds,
delivery beds or couches, examination beds for non-patients (e.g. beds for
mothers accompanying children), beds or cots for healthy babies who are born
in the hospital or visiting the facility as accompany. Beds for rehabilitative care,
long term and palliative care should also be excluded.

The length of stay should ONLY be counted for the actual reporting period. If a
patient was admitted during a previous reporting period, their length of stay
during that previous reporting period should not be counted for the current
period [6]. During calculation, INCLUDE patients admitted to both public and
private facilities.

Limitation: Comparing the performance of hospitals of the same level but with
different number of beds using BOR may be misleading. Hospitals with fewer
beds (fewer than the standard) can have higher BOR than hospital of the same
level (in the tier system) with higher number of hospitals
Dis-aggregation None
Source Inpatient admission/discharge (IPD) register
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.3. MS_ALOS: Average Length of Stay (in days)

Definition The average length of stay (in days) of patients in an inpatient facility during a
given period of time
Formula Total length of stay (in days)
Number of in-patient discharges
Interpretation Average length of stay [7] is a measure of health service quality and efficiency
[2, 3]. It reflects the appropriate utilization of inpatient services. By monitoring
length of stay, hospitals can assess if patients remain in hospital for longer than
what is necessary, perhaps due to non-clinical reasons, and investigate further
if required. The longer the patient stays at hospital, the greater the risk of
developing health facility-acquired infection, lower patient capacity of
hospitals and increased costs3. Decreased ALOS has been associated with

3
https://centrak.com/blog-decreasing-patient-length-of-
stay/#:~:text=The%20national%20average%20for%20a,cost%20of%20%2410%2C400%20per%20day.
 decreased risks of nosocomial infections and side effects of medication rates,
reduced burden of medical fees and increase the bed turnover rate and
lowered social costs [8].

NB: If the patient is directly discharged or transferred to home or other facility

from ICU the length stay should be counted.

During calculation, discharge includes discharge due to any possible reasons

including death, referral, terminal, absconded, or death. Analysis by type of
ward is more informative for facility level analysis and pinpoint area of
improvement.

Limitations: Regional or national level aggregation of ALOS may be less

informative to identify types of disease and wards with increased or lower
ALOS.
Dis-aggregation None
Source Inpatient admission/discharge register
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.4. MS_HBD: Hospital Bed Density

Definition Total number of hospital beds per 10 000 population
Formula Sum total length of stay in ICU (in days) X10,000
Total population
Interpretation The indicator contributes to the measurement of facility infrastructure
management, such as physical availability and accessibility of health services.
It is a measure of access to hospital service, equity in access and plan for
possible expansion of hospital service. It excludes labor and delivery beds
[2].The total population should consider all population that need to have
access to hospital service.

Limitations: the indicator shows access at a point in time. Because of

catchment population overlap at the lower level, the indicator could be
exaggerated.
Dis-aggregation None
Source Tally sheet/register at liaison/ward to capture the number of beds
Reporting level Hospital
Reporting Annually
Frequency

7.5. MS_ASSTECH: Assistive Technology Service Coverage

Definition Percentage of clients received AT service among those who sought AT service
Formula Total number of clients received AT service X100
Total number of clients registered to receive AT service
Interpretation Assistive technology (AT) service coverage measures the demand satisfied for
AT by people with different types of disability. It shows the inclusiveness of the
 health service to provide technology services to the disabled to improve their
quality of life.
Dis-aggregation Category of disabilities (Physical, mobility, hearing, others)
Age, sex
Source AT service register (New)
Reporting level Hospital
Reporting Quarterly
Frequency
7.6. MS_LaBT: Essential laboratory test availability

Definition The number of days in which all health center or hospital specific essential
laboratory tests were available in the reporting period
Formula Total number of days each essential laboratory tests are available in X100
the facility during the reporting period
(Total number of facility specific essential tests) X (Total number of
days in the reporting period)
Interpretation Hospitals and health centers are required to avail the minimum laboratory
tests recommended by Food and Drug Administration standards at all times.
The availability of health facility specific essential laboratory tests is a measure
of service availability. Essential tests should ALWAYS be available at the health
facility. If one of these tests is unavailable at any time, the health facility should
take action to identify and address the cause. For the RHB, knowledge of the
availability of health facility specific essential laboratory tests in hospitals
helps to assess the adequacy of access to laboratory tests and helps to address
issues of good governance. The list of essential laboratory tests at each level is
annexed.
Dis-aggregation None
Source Log sheet or tally sheet
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.7. MS_RoR: Referral-out Rate

Definition Proportion of patients who are referred to another health facility
Formula Number of referred patients (emergency + non- emergency) X100
Total number of patients or clients seen in the health facility
Interpretation A referral is the process in which a health worker at one level of the health
system, having insufficient resources (drugs, equipment, skills) to manage a
clinical condition, seeks the assistance of a better or differently resourced
facility at the same or higher level to assist in, or take over the management of
the case. An effective referral system ensures a close relationship between all
levels of the health system and helps to ensure people to receive the best
possible care closest to home.

Referral rate is an indicator of quality of health care. Referrals are systems that
are important for clients to receive the proper care they need in another health
 facility. A high number and proportion of referrals made from a health facility
to another health facility may indicate that the health facility is not providing
all services required, whereas a low number and proportion of referrals might
indicate that the health facility is not following referral guidelines and is
treating patients beyond their capacity. Knowing the rate of referrals helps to
plan for future service provision.

A referral rate of a facility ranges from 10-20% and it should be interpreted

cautiously by taking expert’s suggestion into consideration. When referral rate
is below 10%, it indicates the need to conduct audit on professional scope of
practice to discern if the health facility is practicing health care delivery
beyond its scope. If the referral rate is above 20%, it signifies the need to
identify the top-five reasons for referral and consider expanding service.
Limitation: The indicator is more informative at the facility level and doesn't
indicate reasons for referral-out.
Dis-aggregation Emergency and non- emergency
Source Referral register/Liaison register, OPD tally sheet
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.8. MS_AMBU: Ambulance service utilization for referral service

Definition Percentage of referral-in with ambulance among the emergency referral-ins

Formula Total number of emergency referral-in with ambulance X100
Total number of all emergency referral-in the reporting period
Interpretation This indicator shows the percentage of emergency referrals that used
ambulance to travel to the health facility and roughly measures the utilization
ambulance service. Because this indicator doesn’t show the service quality, it
should be interpreted along with ambulance response rate, which shows the
use of EMT or nurse accompanying the emergency case. When calculating this
indicator, all referrals including referral-ins should be included in the
denominator.
Dis-aggregation Pre-facility, between facility
Source Emergency register (needs box at the bottom)
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.9. MS_AMBUR: Ambulance service response rate

Definition Percentage of community ambulance requests for whom ambulance was

dispatched
Formula Number of ambulance requests for whom ambulance was dispatched Formula
Total number of community requests made for ambulance service
Interpretation Pre-facility emergency care and ambulances service is an emergency care
outside of a health facility or at the scene and continuing care during
 transportation with ambulance and ends with proper hand over of patient or
victim to respective health facility. When it is accessible to the community, it
contributes for reduction of deaths and disability due to acute illness and
severe injuries. A high response rate indicates the services the system’s
responsiveness and availability of services, and adequacy of the number of
ambulances. Low response shows demand and capacity gap. The target is more
than 90% of actual emergency call has to get ambulance dispatch for the
service. The dispatch center where the register will be put could be different
and it should be placed in all centers where there are call and dispatching of
ambulances.
Limitation: This indicator doesn’t show the community demand for
ambulance service, as the community members who have awareness about the
service and who have the capability to make a call request ambulance services.
Dis- • Number of Ambulance dispatched (With EMT/nurse, Without
aggregation EMT/nurse)
With case (labor and delivery , Road Traffic Accident and other)
Source Ambulance service register
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.10. MS_EMERG_MR: Facility emergency department mortality rate

Definition Percentage of patients died at the emergency department within 24 hours among
all emergency attendances
Formula Total number of deaths in emergency unit within 24 hours X100
Total number of emergency room attendances
Interpretation The emergency department mortality is a measure of the quality of care
provided by the emergency department of the health facility within 24 hours of
arrival at the emergency room. A high mortality could indicate that the facility
is providing poor quality emergency care with unnecessary patient deaths
against national target. Nationally emergency room mortality should be less
than 0.6 %. The number of deaths within the facility in places other than
emergency room should be captured as absolute number can be used to see
the trend.

N.B. A Patient who is already dead on arrival should be excluded in the

indicator.

Dead on arrival means when the patient arrives to the triage area and
confirmed dead by the physician.
Dis-aggregation Sex: Male/Female
Age <15 years, 15+ years
< 24 hours, >=24 hrs
Source Emergency register (column to capture death within 24 hours)
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.11. MS_EMERG24: Emergency room attendances with length of stay > 24 hours
Definition The proportion of all emergency room admissions who remain in the emergency
room for > 24 hours
Formula Total number of admissions who remain in emergency room for more X100
than 24 hours
Total number of emergency room discharges
Interpretation Hospitals have emergency room beds where patients can stay for a short
period of time to receive emergency treatment. However, the length of stay in
the emergency room should always be less than 24 hours. If a patient requires
treatment for longer than 24 hours, the patient should be transferred to a
ward. If emergency room beds are occupied by patients for more than 24
hours, then the emergency room will become congested and there is a danger
that the emergency room will not have the capacity to receive any NEW
emergency attendances.

The indicator includes all patients registered in the emergency room (of both
sexes and all ages) and excludes patients who were already dead (i.e. no vital
signs present) on arrival.
Dis-aggregation None
Source Emergency register (modification to capture stay beyond 24 hours)
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.12. MS_VAP: Percentage of ventilator associated pneumonia

Definition The percentage of ICU clients who have developed ventilator associated
pneumonia among those who were intubated for mechanical ventilation
Formula Total number of clients developed ventilator associated pneumonia X100
Total number of ICU clients on ventilator
Interpretation Ventilator associated pneumonia is one of the common complications that
affects the clients in the ICU. The probability of developing VAP of a patient in
the ICU depends on the skills of ICU staff to provide mechanical ventilation to
patients and it measures the quality of ICU service and determines the
outcome of the patient.
Dis-aggregation None
Source ICU register
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

7.13. MS_ICU_MR: Mortality rate in Intensive Care Unit

Definition Percentage of patients who died in the ICU among those admitted to ICU
Formula Number of deaths in ICU X100
Total number of discharges from ICU
Interpretation Intensive Care Unit (ICU) service is an initiative to enhance critical care in the
Ethiopian health care delivery system. The ICU has to have at least 4-6 bed,
along with cardiac monitors for each of the beds, and mechanical ventilators.
The ICU mortality rate helps to monitor the quality of care in the ICU. Even
though the number of beds in ICU of hospitals is few, it consumes 8% to 20% of
the hospital’s budget.

The mechanical ventilator machine, without appropriate monitoring and

evaluation, has its own side effects including machine related baro-trauma,
infections, machine failure which is associated with serious effect to the
patient. Death with mechanical ventilation means death of a patient after
mechanical ventilation was provided with endotracheal intubation. Death
without mechanical ventilation is death of a patient without being provided
with a mechanical ventilation using endo-tracheal intubation.

Though there is no known data about specific death related to conditions

associated with use of mechanical ventilator, according to WHO
recommendation, total mortality rate in ICU for developing countries lie
between 30% and 35%. If the general mortality rate is more than 35 %, it
needs investigation.

NB. This indicator doesn’t include Neonatal ICU death. In addition, discharge
should include the deaths as denominator. It should also exclude death at high
dependency units.

Limitation: the indicator could underestimate the mortality in the ICU as

patients who are not actually eligible for ICU may be admitted to the ICU
Dis-aggregation With vent, without vent,
<24 hours, >=24 hours
Source Emergency register
Reporting level Hospital
Reporting Monthly
Frequency

7.14. MS_PO_MR: Perioperative mortality rate

Definition All-cause death rate prior to discharge among patients having one or more
procedures for a major surgery in an operating theatre during relevant
admission for a major surgery
Formula Number of deaths among patients having one or more procedures in an
operating theatre admitted for major surgery X100
Total number of patients for whom major surgery has been conducted
Interpretation This indicator is rough measure of quality and safety of surgical service in the
facility. It includes all death that happen after anesthesia was provided to the
patient until discharge. The denominator for this indicator, which is the
number of major surgical procedures done per year is an indicator of met need
for surgical services. Ethiopia had the least surgical volume in the world [9].
 With the high surgical need of the population, this indicator will show progress
across time towards meeting demand for surgical care services. It informs
policy and planning regarding met and unmet need for surgical service. It is a
rough indicator of access to service [2]. Hospital procedure volume is assumed
to be a proxy measure of experience of doing surgeries repeatedly over long
period of time. There is a relation between volume and outcome of surgeries,
when the surgical volume of a hospital is very high and surgeries are
concentrated in high volume centers, it has been associated with better
outcomes. [10]. WHO estimates about 6495 operations per 100,000
populations per year are required in sub-Saharan Africa in which 95% of those
requiring surgical care do not have access to the service [11, 12].

NB: Major surgery is defined as a procedure performed under general

anesthesia, regional anesthesia or profound sedation in an operation theatre.
Dis-aggregation Elective, emergency
Source OR register, IPD register
Reporting level Hospital
Reporting Monthly
Frequency

7.15. MS_ICU_LOS: ICU length of stay

Definition The average length of stay (in days) of patients in the ICU during a given period
of time
Formula Sum total length of stay in ICU (in days) X100
Number of ICU discharges
Interpretation The duration of ICU stays for clients that received care at ICU indicates the
quality of care at the ICU. Bed rest is considered as part the treatment for
admitted patients with critical illnesses. An average of 3.3 days of stay in an
ICU bed is considered adequate to provide adequate rest and treatment for
critical patients. A critical patient is expected to spend an additional 1.5 days in
non-IUC bed [13].
Dis-aggregation None
Source ICU register
Reporting level Hospital
Reporting Monthly
Frequency

7.16. MS_PO_MEAN: Mean duration of in-hospital pre-elective operative stay

Definition The mean duration of in-hospital pre-elective operative stay in days
Formula Total number of in-hospital pre-elective operative stay in days X100
Total number of elective surgeries conducted in the period
Interpretation The mean duration of in-hospital pre-elective operative stay shows the length
of duration a patient spends in the hospital from admission to operation. It
shows the readiness of the surgical team and the facility within the acceptable
duration. It is a proxy measure of cancellation of surgeries in that if there a
higher cancelation rate, the mean duration of in-hospital pre-elective operative
 stay will be higher.
Dis-aggregation None
Source Register at liaison (schedule) Additional registration at OR
Reporting level Hospital
Reporting Monthly
Frequency
7.17. MS_SURG_WAIT: Number of clients in the waiting list for elective surgical service
Definition The number of clients in the waiting list for elective surgery
Formula The absolute number of clients in the waiting list for elective surgery
Interpretation In countries where the access to surgical services is limited, hospitals usually
tend to have long list of clients waiting for surgical procedures [12]. The
number of clients in the waiting list for surgery roughly measures access to
surgical services and can help to inform allocation of resources and finalize the
plan. It shows the backlog, demand for elective surgeries and the need for
expanding surgical services.
Dis-aggregation Age, <15 years, >=15 years
General surgery, Urology , Neurology , Orthopedics, Plastic, Pediatrics,
Gynecology, Opthalmology, ENT, Others
Source Register at liaison to capture
Reporting level Hospital
Reporting Monthly
Frequency

7.18. MS_SURG_DELAY: Delay for electivesurgical admission

Definition The average number of days that patients who underwent elective surgery
during the reporting period waited for admission
Formula Sum total of number of days between date added to surgical waiting
list to date of admission for surgery X100
Number of patients who were admitted for elective surgery
Interpretation It is the average number of days between the dates each patient was added to
the waiting list to their date of admission for surgery. Delays in surgery for
different conditions are associated with a significant increase in morbidity and
mortality. The Government has set a stretch objective that any outpatient who
requires a bed should receive the service within 2 weeks. By monitoring the
waiting time for surgical admission, hospitals can assess the adequacy of
surgical capacity and identify the need for improved efficiency in systems and
processes, and/or the need for additional surgical staff and/or resources
EXCLUDE:
 Elective Caesarean Sections
 Emergency Surgery
 Ophthalmic Surgery
NB: If a cold case patient is admitted on the same day (the same calendar date)
that the decision for surgery is made, then their number of days on the waiting
list should be counted as zero.
Dis-aggregation None
Source Liaison registration book
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency
7.19. MS_IPMR: Inpatient mortality rate

Definition Inpatient deaths before discharge per 100 patients discharged

Formula Number of inpatient deaths
Total number of discharges X100
Interpretation Provides rough evidence regarding quality of care when compared with other
facilities. Care should be exercised, however. The level and location of a facility
may affect its case mix. The inpatient mortality rate is calculated as the number
of IPD deaths divided by the number of IPD discharges in the facility during a
given time period. The number of deaths can be known from the monthly totals
of IPD deaths reported. The inpatient mortality rate can be estimated at all
levels except Health Post.
Dis-aggregation Age: 0-4, 5-10, 11-19, 20-29, 30-45, 46-65, >=66
Sex: Male, Female
Source In-patient registers.
Reporting level HC/Clinic, Hospital
Reporting Monthly
Frequency

7.20. MS_MORB10: Top 10 causes of morbidity

Definition The ten leading causes of morbidity per 1000 population
Formula Number of new OPD + IPD Cases from specific diseases X100
Total population in the catchment area
Interpretation Provides evidence regarding priorities for planning and resource allocation.
The top ten causes should be listed, from highest to lowest. The total number
of cases seen at OPD and IPD and the cases per 1,000 should also be included
for comparison. This indicator may show the burden of specify diseases in the
community.

Note:-The numerator should include only those who are new cases so that a
person will not be counted more than once for the same illness/disease.
Dis-aggregation Age: 0-4, 5-10, 11-19, 20-29, 30-45, 46-65, >=66
Sex: Male, Female
Source Outpatient (OPD) registers, Inpatient register, Emergency register; Disease
information tally (HP)
Reporting level Not to be reported but to be analyzed
Reporting Analysis Frequency (Any time)
Frequency

7.21. MS_MORT10: Top ten causes of institutional mortality

Definition The ten leading causes of mortality
Formula Number of deaths in a health facility from specific disease X100
Total number of discharge
Interpretation
The top ten causes can be known from the annual totals of monthly IPD deaths
reported. Provides evidence regarding priorities for planning and resource
allocation. The top ten causes should be listed, from highest to lowest. The total
number of IPD deaths and the case fatality rate should also be included for
comparison with other locations. While deaths are reported monthly, the top ten
are calculated annually, based on the sum of monthly totals. IPD death is death
of a patient who was alive when he/she came to the health facility and died
afterwards. Note that patients who died at arrival before admission/at
emergency should not be counted and include deaths from OPD, emergency, IPD,
ICU and NICU.
Dis- Age: 0-4, 5-10, 11-19, 20-29, 30-45, 46-65, >=66
aggregation Sex: Male, Female
Source Outpatient (OPD) registers, Inpatient register, Emergency register; Disease
information tally (HP)
Reporting Not to be reported but to be analyzed
level
Reporting Analysis Frequency (Any time)
Frequency

8. Pharmaceuticals and medical devices and their rational and proper use

8.1. PMS_SUP_FILL: Supplier fill rate

Definition Supplier fill rate is the percentage of correctly filled items (at least 80%) by
quantity by supplier (EPSA, or other private supplier who have agreement to
supply) of total order made by a health facility over a given period.
Formula Number of line item delivered at least 80% of the requested amount X100
Total number of line item requested
Interpretation This indicator measures supplier’s ability to fill orders completely in terms of
items and quantity during a definite period of time.

An item in an order is considered completely filled if at least 80% of the request

is filled in the correct quantities with the correct products.

This indicator also helps health facilities to identify which items are causing the
most problems and find another mechanism for obtaining those items
Disaggregation By type of supplier: (EPSA, others),
By category: RDF, Program
Sources RRF report, Receiving voucher of HF, approved procurement request by DTC or
HF head
Reporting Health center/Hospital/
level
Reporting Quarterly
Frequency
8.2. PMS_AVAIL: Essential Drugs Availability

Definition The number of months in which a tracer drug was available averaged over all
tracer drugs during the month
Formula Σ (tracer drugs x months available)
X 100
Σ tracer drugs x Σ total number of months in time period
Interpretation Essential drugs should always be available. Essential drug availability is the
proportion of months in the time period under consideration for which a
given tracer drug was available when needed. The availability can be averaged
over several tracer drugs to give a general picture of availability. The type of
essential drug that needs to be available differs by type of health facility. The
following drugs are those essential drugs that are selected as tracers for
essential drug availability:
For Health Posts:
 Amoxicillin dispersible tablet
 Oral Rehydration Salts
 Zinc dispersible tablet
 Gentamycin Sulphate injection
 Medroxyprogesterone Injection
 Arthmeter + Lumfanthrine (Coartem) tablet (any packing)
 Ferrous sulphate + folic acid
 Albendazole tablet/suspension
For health centers and hospitals:
 Medroxyprogesterone Injection
 Pentavalent vaccine
 Magnesium Sulphate injection
 Oxytocine inj
 Gentamycin injection
 ORS+/- Zinc sulphate
 Amoxcillin dispersable/suspension/capsule
 Iron + folic acid
 Albendazole/Mebendazole tablet/suspension
 TTC eye ointment
 RHZE/RH
 TDF/3TC/DTG
 Co-trimoxazole 240mg/5ml suspension
 Arthmeter + Lumfanthrine tablet
 Amlodipine tablet
 Frusamide tablets
 Metformin tablet
 Normal Saline 0.9%
 40% glucose
 Adrenaline injection
 Tetanus Anti Toxin (TAT) injection
 Omeprazole capsule
 Metronidazole capsule
 Ciprofloxcaxillin tablet
 Hydralizine injection
Any month in which a drug unavailability is experienced, even for only 1 day,
 is reported as a month in which the drug was unavailable when needed
Disaggregation No disaggregation
Sources This information is available from records kept at the facility drug dispensary
Reporting level Health post /Health center/Clinic/Hospital/
Reporting Monthly
Frequency

8.3. PMS_ABIOTIC: Percentage of encounters with an antibiotic prescribed

Definition The percentage of encounters with one or more antibiotics prescribed per
individual patient
Total number of encounter with one or more antibiotics
X 100
Formula Total number of encounter
Interpretation This indicator measures the overall level of antibiotics use. Imprudent use of
antibiotics leads to antimicrobial resistance. The emergence and spread of
Antimicrobial resistance (AMR) continues to threaten the ability to treat
common infections and is becoming ever-growing concern in the healthcare
community. AMR can lead to treatments becoming ineffective and accelerate the
spread of infections. The cost of AMR to national economies and their health
systems is significant as it affects productivity of patients or their caretakers
through prolonged hospital stays and the need for more expensive and intensive
care.

One of the major preventive intervention to curb antimicrobial resistance is

proper antibiotic prescription and utilization. Globally, only 20-30% of the
prescription for patient encounter should have antibiotic.

Encounter refers to every patient’s or client’s visit to the health facility. Whether
a patient is given one or more prescription papers per visit, all is considered as
one encounter.

Limitation: Those clients that are sent home with counseling and advice i.e.
without a prescription are missed

Disaggregation No disaggregation

Data Sources Drug dispensing Register

Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

8.4. PMS_FILL100: Percentage of client with 100% prescribed drug filled

Definition Percentage of clients who get all the prescribed medicines (100%) from the health
facility dispensary among all the clients who received prescriptions in a given
time period.
Formula Number of client who received all prescribed drug
X 100
Total number of client who received prescription
Interpretation This indicator measures proportion of clients who get all the prescribed drugs
within the facility. It is one of the indicators that tell about continuous
availability of medicines. Getting prescribed drugs within the facility pharmacy
improves patient satisfaction and overall trust and confidence in the health
sector.
It is expected that all clients should get all the prescribed drugs (100%) from
the health facility dispensary.
Disaggregation No disaggregation
Sources Drug dispensing Register
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency

8.5. PMS_FSML: Percentage of medicines prescribed from the facility’s medicines list

Definition The percentage of medicines that are prescribed from the health facility
medicine list out of the total number of medicines prescribed
Formula Total number of medicines prescribed from Health facility medicine X100
list
Total number of medicine prescribed
Interpretation Every health facility is expected to have a medicine list specific to the facility
based on its history of disease burden. This facility medicine list is revised
periodically to address emergence of new needs and change in disease
pattern in the facility.

Accordingly, health care workers are expected to prescribe medicine that

are listed in the health facility. The more health care workers prescribe
medicines from the health facility list, the better chance that patients
/clients get the medicine and the more likely that patients get them for
cheaper price. It also prevents clients from frustration and improves
satisfaction.

Monitoring this indicator regularly and taking corrective actions for any gap
identified should be a major activity of health facilities

Disaggregation No disaggregation
Sources Drug dispensing Register
Reporting level Health center/Clinic/Hospital/
Reporting Monthly
Frequency
8.6. PMS_WAST: Pharmaceuticals wastage rate

Definition The percentage of the stock of products, in value, that are unusable because of
expiration or damage during a period to the total value of the products
received during the same period plus the quantity of the products found
during the beginning of the period
Formula Unusable stock of products during a period in monetary value X100
Beginning stock+ received stock during the same period in monetary
value
Interpretation This indicator can be calculated for any facility that manages
pharmaceutical of interest. It can be measured over any period but it is
preferable to be calculated for unusable stock with in a quarter. It is usually
calculated after a physical inventory is taken. Unusable stock that has been
accumulated for long period and were not disposed previously (expired and
damaged items that were transferred from previous quarter) should not be
included during calculation of this indicator. In addition, items that were
unusable during the quarter reviewed but were disposed with in the
quarter should be taken in to consideration during calculation. This
indicator is one of the performance indicators to have efficiency gain, which
is one of the HSTP priorities. The target in HSTP is to reduce wastage of
pharmaceuticals to less than 2%.
Disaggregation By: RDF, Program
Sources Bin cards/stock cards
Reporting level Health center/Clinic/Hospital
Reporting Quarterly
Frequency

8.7. PMS_EQUIP: Functionality of medical equipment

Definition Percentage of functional medical equipment from the health facility’s updated
medical equipment inventory list
Formula Number of functional medical equipment in the health facility
Total number of available medical equipment in the health facility from X 100
updated medical equipment inventory list
Interpretation This indicator measures percentage of functional medical equipment in the
health facility at the time of reporting. Functional medical equipment are
instruments which are giving the expected services. To monitor and evaluate
this indicator, the health facility should establish computer based or manual
medical equipment inventory system and also should update the inventory
whenever additions or omissions of medical equipment occur to the health
facility. Health facilities should use the Medical Equipment Inventory Form to
register medical equipment that is available in the health facility.

Medical equipment refers to a capital medical device used for specific

purpose of diagnosis and treatment of disease or rehabilitation following
disease or injury it can be used alone or in combination with any accessory
consumable or other devices requiring professional installation, user training,
 commissioning, maintenance, calibration, decommissioning.
Disaggregation No disaggregation
Sources Facility medical equipment inventory
Reporting level Health center/Clinic/Hospital/
Reporting Annual
Frequency

9. Regulatory systems

8.8. RS_STAN: Proportion of health facilities that met Ethiopian health facility
requirements

Definition Proportion of all types of public, private and non-governmental health facilities that
met of Ethiopian health facility requirements according to their respective level.

Formula Number of health facilities that met Ethiopian health facility requirements
at least 75% (Green Level) X 100
Total number of health facilities
Interpretation To improve quality health service, emphasis will be given to improve standards of
health facilities and enforce the implementation of the national health facility
requirements by health facilities. The purpose of this indicator is to track the
provision of quality health service to the public in standardized health facilities.

In order to enable health facilities to deliver quality health services, it will be

applied strong regulation to fully implement the national health facility
requirements to ensure their competence so that the public will receive quality
health service.

This is very important to assess the capacity of the Health facilities on the quality
and safety of healthcare services provided at each level of care. Since the indicator
will be applied equally to healthcare facilities, it will provide valuable information
about the number of healthcare facilities in the country that fulfill the minimum
standards that ensure the quality and safety of service delivery. This again helps
the government in order to plan for the expansion of the standardized healthcare
services to meet the access and quality targets in the country.

Disaggregation Private and Public

Data Sources Inspection/Supervision report
Reporting level WorHO/ZHD/RHB/MOH
Reporting Annually
Frequency
8.9. RS_FOOD: Proportion of food and drinking service establishments that met
Ethiopian hygiene and environmental health requirements

Definition Proportion of food and drinking service establishments that met Ethiopian
hygiene and environmental health requirements

Formula Number of food and drinking service establishments that met Ethiopian
hygiene and environmental health requirements X 100
All food and drinking service establishments
Interpretation Despite the effort of health regulatory bodies there are gaps in implementation
of hygiene and environmental health requirements of food and drinking service
establishments. To improve hygiene and environmental health of food and
drinking service establishments, national requirements are being developed.
Therefore, food and drinking service establishments will be enforced to
implement national hygiene and environmental health requirements. This will
help food and drinking service establishments to improve hygiene and
environmental health. It is very important to assess the hygiene and
environmental health of food and drinking service establishments at each level.
The measurement of this indicator will help the government to design effective
strategies to enforce food and drinking service establishments to implement
national hygiene and environmental health requirements and to reduce hygiene
and environmental health related diseases.

Disaggregation No disaggregation
Sources Inspection report
Reporting level WorHO/ZHD/RHB/MOH
Reporting Annually
Frequency

10. Human resource development and management

8.10. HR_HCW2P: Health care worker to Population ration by Category

Definition This refers to the health Staff to population ratio by category:

Physician (Specialist, sub-specialists and all types of Doctors), Health officers, all
types of nurses, Midwives, ESO and Level IV health extension worker etc).
Formula Total Population
1: Total number of health care workers at the end of the year (by
category)
Interpretation Adequate staffing indicates appropriateness and regularity in service
provision and also suggests access to services. It can suggest priority areas
for increasing staff according to equity standards. However, interpretation
should be done cautiously; population densities and geographic conditions are
also powerful influences on staffing needs. Staffs who left for training should be
counted.

According to the World health organization (WHO), the expected Physician to

population density is 1 per 10,000, 1 to 5,000 population for Nurse and 1
midwife to 5,000 population. Altogether (Doctors, Nurses and midwife) 2.3 per
1,000 population.

Disaggregation By profession category:

Physician (Doctor, health officer, All types of Nurse, Midwife, ESO and Health
extension worker etc)

Sex: Male/ Female

Sources Facility personnel records, Administrative records, HRIS
Reporting level Health post/Health center/Clinic/Hospital
Reporting Annually
Frequency

8.11. HR_STAFF_STAND: Proportion health Facility staffed as per the standard

Definition The Proportion of health facilities (Hospital, Health Center & Health post) staffed as
per the Ethiopian facility staffing standards
Formula Number of health facilities meeting staffing standard for particular
category X 100
Total number of health facilities
Interpretation Monitoring the recruitment of newly trained health workers into the national
health labor market is critical in order to reduce inefficiencies in the hiring
system, identify potential gaps between supply and demand for health workers,
and monitor achievements in health workforce planning.
There is an Ethiopian facility staffing standard that clearly indicates the staff
required for each level of the health system, including the number of each type of
professional.

Disaggregation By Profession category: Physician (Physicians, health officer, All types of Nurse,
Midwives, and ESO)

Sources Administrative report

Reporting level Health post/Health center/Clinic/Hospital
Reporting Annually
Frequency
8.12. HR_LICENS: Percentage of health professionals with an active professional license

Definition The Proportion of health professionals that have active/renewed professional

license
Formula Number of health professionals that have active/renewed professional
license in each professional category X 100
Total number of health professionals in each category (at the end of the
year)
Interpretation All health professionals should have active/renewed professional license to
practice in the health system of Ethiopia. In addition, professionals with an active
license are supposed to have contemporary knowledge and skill to deliver
quality service thereby improving the health status of the population. So all
health institutions should check the license status of health professionals and
follow license renewal accordingly.

An active license is defined as a professional license within the range of the

allowed period/time of practice (i.e not expired). The professional category
includes physicians (General Practitioners, Dental Medicines and all Specialties
under medical Doctor) and all types of Nurses (include all Nursing specialties
(Comprehensive Nurse, Neonatal Nurse, Mental Health Nurse, Ophthalmic
Nurses etc), midwives, health officer, other

Disaggregation By professional category: Physicians, all types of Nurses, Health Officer,

Midwives, Others

Sources Facility record/Personnel record

Reporting level Health center/Clinic/Hospital
Reporting Annually
Frequency

11. Enhance informed decision making and innovations

8.13. EIDM_RCOMP:Reporting Completeness

Definition Proportion of routine reports that were received by the health institution & health
administrative level

Formula Total number of reports received during a given time period X

The number of reports expected 100
Interpretation The more complete the reporting, the better it reflects the services provided in
the catchment area. Ideally, 100% reporting completeness is the standard. This
standard is not impossible and has been achieved by several regions. The
minimum acceptable level of report completeness is 90%.
A lower level of completeness compromises the reliability of data. This indicator
shows representative completeness (reports received from the total number of
reports expected), it does not show content completeness. For now, health
facilities are advised to conduct content completeness for selected data
elements. In the future the electronic reporting platforms will be designed to
generate content completeness.
Reporting completeness should be done for each type of report that includes
Service report (monthly, quarterly and annually), OPD morbidity report
(monthly) and IPD morbidity and mortality report (Monthly) and other data
sets.
Reporting completeness can also be averaged mainly for service and disease
reports.
Disaggregation Type of report: Service report, OPD report, IPD report and other data sets
Data Sources Data quality and performance monitoring log book/ DHIS-2
Reporting level Health post/Health center/Clinic/Hospital
Reporting Monthly
Frequency

8.14. EIDM_RTIME: Reporting Timeliness

Definition Proportion of routine health and administrative reports that were received within
the specified time.

Formula Number of reports received according to schedule

X 100
The number of reports expected
Interpretation Timeliness refers to the reports received within a defined schedule of a given
reporting period. As with completeness, 90% is a minimum level of acceptable
timeliness. Late data is of little value in making prompt decisions that really
affect performance.

Reporting timeliness should be done for each type of report that includes
Service report (monthly, quarterly and annually), OPD morbidity report
(monthly) and IPD morbidity and mortality report (Monthly) and other data
sets.
Disaggregation Type of report: Service report, OPD report, IPD report and other data sets

Sources Data quality and performance monitoring log book/ DHIS-2

Reporting level Health post/Health center/Clinic/Hospital
Reporting Monthly
Frequency

8.15. EIDM_LQAS: Proportion of health facilities that conduct reporting consistency check
using LQAS

Definition The Proportion of health facilities that conduct data quality (reporting
consistency) checks using LQAS
Formula Number of health facilities that conducted LQAS
X 100
Total number of health facilities
Discrepancies between data compiled, reported and events recorded in patient /
client records are a major source of error and poor quality data.

LQAS provide a quick and reliable method for comparing compiled, recorded
and reported data. Methodology of tacking LQAS is a standard methodology of
12 samples from registers/ records for comparison with reports. Compiled,
recorded and reported data should correspond with LQAS results above 90%.
LQAS is relevant to facilities only, where it is used for self-assessment. IT is
repeated by supervising institution to corporate the results. The quality
HMIS data can be estimated using a sample of 12 data elements and comparing
the results with a standard LQAS table. Selected data elements from the report
to be submitted to the next reporting level is compared with the record on
registers and tally sheets.
Interpretation
Health facilities are expected to conduct LQAS before submitting their report to
the next level. If the LQAS score is completed in the reporting format, the
receiving administrative health unit can consider that the health facility has
conducted the LQAS in that reporting period. Based on this, the administrative
health unit can identify the number and proportion of health facilities that are
performing data quality checks. However, we need to check this during
supervisions in order to verify whether the health facilities are doing the right
way of doing LQAS and whether they are taking actions accordingly.

Additionally, the first and the last LQAS score will be reported. If the first LQAS
score is greater than 90%, there will be no last score.
Disaggregation Type of report: Service report, OPD morbidity report, IPD morbidity and
mortality report

Sources LQAS Minute log book

Reporting level Health post/Health center/Clinic/Hospital
Reporting Monthly
Frequency
8.16. EIDM_LB_NOTI: Proportion of live births notified by the health facility

Definition This refers to the proportion of live births notified by the health facility among the
total expected live birth in that specific period

Formula Total number of births notified

X 100
Expected live births in that specific period
Interpretation The health sector is mandated to notify births and deaths happen in the facility
and in the community. There is joint monitoring & evaluation procedure
between the health sector (health extension worker) and civil registrar office to
assess and evaluate the number of births notified by the health sector Versus the
number of births registered by the civil registrar office. One of the major reasons
raised by the civil registrar office for poor birth registration is poor notification
practice by the health sector

Birth notification is a crucial intervention which is currently the prime source of

data for birth registration. The data from this is vital for national planning. It is
necessary to compile accurate, complete and timely vital statistics, which is
central to estimating population size and composition at all levels.
Disaggregation None

Sources Integrated maternal and child health care card (health post), delivery register
Reporting level Health post/Health center/Clinic/Hospital
Reporting Monthly
Frequency

8.17. EIDM_D_NOTI: Proportion of deaths notified by the health facility

Definition This refers to the Proportion of death notified to the health facility among the
total expected deaths in that specific period
Formula Total number of deaths notified x100
Expected number of deaths in that specific period
Interpretation This is the proportion of deaths notified by the health facility. This
information is very important to further capture causes of death at different
age and sex group. These data are vital for pinpointing the diseases and
injuries that are cutting lives short and for planning preventive services to
avoid premature mortality. Cause of death data are also useful to inform
governments about outbreaks of fatal disease. In Ethiopia, more than 90% of
death happen outside of the health facility. Notifying them and knowing the
probable causes of death for them will give the real time data on the most
common causes of death aggregated by different variable.
Disaggregation None
Sources Emergency register, NICU, ICU, PNC. Delivery register, inpatient register
For community level: Death notification pad
Reporting level Health post/Health center/Clinic/Hospital
Reporting Monthly
Frequency
8.18. EIDM_INF_SCOR: Information use score

Definition The average score of information use as measured by the information use parameters
of the IR model woredas assessment measurement tool.

Formula (Data use score*100%)/40%

Interpretation Information revolution remains to be one of the transformation agenda during

HSTP II as well. The major pillars continue to be transformation in data use culture,
digitization and HIS governance.

The data use cultural transformation encompasses improving data capturing,

availability, accessibility of quality data and use for action. Measuring information
use is a challenging concept globally, however Ethiopia practiced measured data
use though its IR model woreda strategy and mainly the measurement tool.

Information use is one of the section in this assessment tool which has clearly
defined parameters that are weighted. All facilities and administrative units are
expected to self-assess their IR status regularly, develop tailored action plan
according to the gap, and implement for the action plan for improvement.

Benchmark: Facilities that scored >=90% can be considered as model for data use
score and those that scored between 65% and 90% can be considered as candidate
facilities. However while those that scored <65% are emerging for data use and
need critical attention.

Facilities will conduct the IR assessment on a quarterly basis and send their
aggregate report.

Disaggregation HIS structure and resources score (30):

Data quality score (30%):
Data use score (40%):
Total IR score (100%):
Sources IR Model woreda measurement tool
Reporting level Health post/Health center/Hospital
Reporting Quarterly
Frequency
12. Health financing

8.19. HCF_ALLOC: Proportion of government health budget allocated to the health sector
in the fiscal year

Definition This refers to the total government budget on health as a percentage of total
government budget
Formula Total government budget allocated to health
X 100
Total Government budget
Interpretation This indicates the share of government health budget as a proportion of total
government budget as it is indicated in the annual government’s budget
proclamation (note that in the calculation it is important to take the adjusted
budget figure as that is the final figure known by finance offices at all levels of
administration).This indicator shows the relative share of health sector budget
to the total budget. It illustrates the commitment of the government to the
health sector.

Moreover, the data from this indicator can be analyzed to see the share of
health sector budget as a proportion of total government budget disaggregated
by Domestic sources (Government treasury, internal revenue) and external
sources (AID) in the fiscal year.

(Note that the Internal revenue is the total amount of resource mobilized locally
at health facility from clinical and non-clinical services and appropriated by
respective legal framework).

Disaggregation Government treasury, Internal revenue appropriated and Aid

Sources The financial data from MOF/BOFED/WoFED
Reporting level WorHo/ZHD/RHB/MOH
Reporting Annually
Frequency

8.20. HCF_UTIL: Health budget Utilization

Definition The proportion of Health budget utilization to allocation

Formula Total Health budget Utilized
X 100
Total health budget allocated (appropriated)
Interpretation This indicates that the capacity of the health sectors to utilize the budget
allocated disaggregated by source of budget compared with the total allocated
budget in the fiscal year. It is calculated for total budget utilized compared with
total budget allocated and also by disaggregation for each budget category
(Government, aid and internal revenue).

Note that the budget utilization of internal revenue is calculated from the total
amount of appropriated budget. Total amount of internal revenue generated
will also be collected as data element for this indicator. Therefore, the share of
internal revenue generated to the total health budget can also be analyzed here.
This shows the availability of locally generated revenue that can be used to
supplement government resources for quality improvement. Locally generated
revenue is not intended to replace government funds, but to supplement them.

In addition, reviewing the total amount of revenue generated measures the

revenue collection potential of the health facility and helps to measure the gaps
between what is actually collected and appropriated. If this sum of the bank
balance at the end of the previous year and the actual collection is less than the
appropriated budget for RRU, the health facility will be constrained to spend as
per the plan; if this sum is in excess of the appropriated budget the health
facility need to submit additional expenditure plan and use the available
amount effectively.

Disaggregation Internal revenue generated:

Budget Utilized by source: Government treasury, Internal revenue and Aid
Sources Administrative and financial Records
Reporting level Health center/Hospital /WorHo/ZHD/RHB/MOH
Reporting Annually
Frequency

8.21. HCF_REIMB: Proportion of reimbursed amount from the total spent

Definition This refers to the proportion of reimbursed amount of money to health facilities
from total spent on Government, Insurance beneficiaries and other 3rd party, for
fee waived, exempted health services, and other health services
Formula Total reimbursed amount of money to health facilities X
Total amount of money spent 100
Interpretation There is no health care service provided for free. In one way or another the
amount of money that the health facility spent on beneficiaries should be
reimbursed. This indicators measures the reimbursed amount of budget for
services provided for fee waived beneficiaries, insured members, exempted
health services, 3rd party payment and other health services based on the
respective legal framework.

To total number of beneficiaries as fee waived, insurance, exempted health

services and 3rd party payment will be collected from central medical record unit
and finance unit of the health facility.

Disaggregation By:
o Fee waived beneficiaries:
o Insurance beneficiaries:
o Exempted health services:
o 3rd party payment:

Sources Financial records at health centers and hospitals and Administrative reports
Reporting level Health center/Hospital
Reporting Quarterly
Frequency

8.22. HCF_CBHI: Membership Enrollment Rate for CBHI

Definition Proportion of HHs enrolled in CBHI woreda from those eligible

Formula Number of HHs enrolled in CBHI Woreda X 100
Total number of eligible households for CBHI membership in the woreda

Interpretation This indicator deals with the proportion of households enrolled as CBHI members
in a woreda for a given year from the eligible ones. CBHI membership in Ethiopia
is on voluntary basis and households who reside in the woreda and engaged in the
informal sector are eligible for membership.

Formal sector employees who reside in the woreda are not eligible for
membership. Currently CBHI is mainly implemented in rural areas with few
startups in urban settings. Higher enrollment rate is always desired as it means
more members in the CBHI scheme and larger risk pooling. Larger risk pooling is
very important for the financial sustainability of the insurance scheme.
Disaggregation By type of member:
• Indigent member
• Paying member
Sources Administrative records / Woreda CBHI scheme
Reporting level WorHO/ZHD/RHB/MOH
Reporting Quarterly
Frequency
13. Strengthen leadership and governance

8.23. LG_CSC: Proportion of Primary health Care facilities implementing Community

Scorecard (CSC)

Definition The proportion of Primary health Care facilities with a community Score Card
(CSC) value of >=80%

Formula Number of Primary health Care facilities with a community Score Card
(CSC) of >=80% X 100
Total number of Primary health Care facilities
Interpretation This means the number of primary health care facilities who undergo
Community Score Card (CSC) and gets the score 80% and greater than 80%
based on the stated six measurements of primary health service delivery, from
all facility that already started the program. This Indicator is vital for improving
the health service delivery by engaging the institutions and the community to
solve the public grievance related to services. So far the indicator not only
evaluates the status of the service and it also measures the primary health
service Good Governance through creating accountability on leadership.

Note: Primary health care facilities that did not report their community score
card score or that did not conduct the assessment will be considered as having
a CSC value of less than 80%.

Disaggregation No disaggregation

Sources Community score card checklist and template

Reporting level Health center
Reporting Quarterly
Frequency

8.24. LG_GGI: Proportion of hospitals with Good Governance Index (GGI) of >=80%

Definition The proportion of hospitals with a Good Governance Index (GGI) of >=80%
Formula Number of hospitals with a Good Governance Index (GGI) of >=80%
X 100
Total number of hospitals
Interpretation It measures the status of the Good Governance (GG) of the Hospital by the
national stated standards and reviewing those standards against the eight good
governance principles so that the system of health service delivery on the
Hospital are measured on every quarter bases. Implementing GGI on the
hospital changes the service quality in remarkable way through creating
accountability and engaging all health care service stakeholders and actors.

Note: Hospitals that did not report their Good Governance Index (GGI) score or
that did not conduct the assessment will be considered as having a GGI value of
less than 80%.

Disaggregation No disaggregation
Sources Good governance index measurement checklist and template
Reporting level Hospital
Reporting Bi-Annual (Will be reported in the quarter when the GGI is conducted)
Frequency

8.25. LG_FEM: Proportion of leadership positions in health facilities that are held by
females

Definition This is the proportion of leadership positions in health facilities that are held by
women
Formula Number of leadership positions held by women at health facility level
X 100
Total number of leadership positions in health facilities
Interpretation In Ethiopia, despite their capabilities, women are deprived of chances and are
socially challenged to play their role as leader. Currently, there are bold
initiatives to mainstream gender in all health programs and operations, and
empower women by ensuring their representation at all levels. A special
attention will be given to the development, creation of conducive environment
and engagement of women in leadership positions during HSTP II.
Leadership position at health facility level is operationally defined as the Head/
Vice head/ Department heads.

Disaggregation No disaggregation

Sources Administrative records

Reporting level Health center/Clinic/Hospital
Reporting Annually
Frequency

8.26. LG_GBV: Number of Gender based violence (GBV) survivors who received health care
services
Definition This refers to the number of GBV survivors who received health care services
Formula The number of GBV survivors who received health care services
Interpretation According to EDHS 2016, among women age 15-49, 23% have experienced
physical violence and 10% have experienced sexual violence. Regarding Injuries
due to spousal violence, 22% of ever-married women who experienced spousal,
physical, or sexual violence reported injuries such as cuts, bruises, or aches and
deep wounds and other serious injuries.

Astonishingly, only about one-quarter of women who have experienced physical

or sexual violence has sought help. The Ministry of health in collaboration with
other sectors, is now working on prevention of GBV and expansion of health
care services for GBV survivors which include as one-stop service.

This indicator includes individuals (Both male and female) who survive any
form of gender based violence (sexual, physical, psychological or mixed)

At each level, this indicator should be analyzed by looking at trends over time.
Disaggregation By Type: Sexual, Physical, psychological and mixed
Sex: Male and Female
Sources GBV register
Reporting level Health center/Clinic/Hospital

Reporting Monthly
Frequency

14. Health infrastructure

8.27. HI_HF2P: Functional health facility to population ratio

Definition The ratio of functional facility to total population

Formula 1: Total Population
Total number of functional public facilities by type
Interpretation Functional facility to population ratio is calculated as the total population in
the catchment area divided by the total number of facilities (by type during a
given time period) (usually one year). Functional facility to population ratio
is an important indicator of equity; it can highlight priority areas.

In addition, newly constructed or upgraded health facilities should be

reported for further analysis. Newly constructed health facilities considers
new construction of health facilities within the respective woreda or higher
level at a given period of time. Upgrading refers to some level of expanding
existing health facility to upgrade the level of service. It indicates upgrading
previously existing health facility from one type to another. Both new
construction and upgrading indicates the level of investment in health
physical infrastructure.

Disaggregation By Facility Type: health post (Basic and Comprehensive), health center,
primary hospital, general hospital and specialized hospital
Sources Administrative report
Reporting level WoHO/ZHD/RHB/MOH
Reporting Annually
Frequency

8.28. HI_FUNC_INFR: Proportion health facilities with functional infrastructure

Definition Proportion of health institutions with electricity, water supply, functional sanitation
facilities and functional Network infrastructure

Formula A. # of health facilities with electricity *100

Total number of health facilities

B. # of health facilities with full functional Network infrastructure *100

Total number of health facilities
Interpretation Health institutions need electricity, water supply, functional sanitation facilities
and functional network infrastructure to optimally carry out service. Absence of
any of electricity, water and sanitation limits the facility’s scope for diagnosis and
treatment.

Availability of water supply and functional sanitation facilities in health facilities

is addressed under hygiene and sanitation section.
Disaggregation None
Sources Administrative records
Reporting level Health post/Health center/Clinic/Hospital
Reporting Annually
Frequency
Reference
 Annex 1: List of HMIS Indicators by reporting level and Frequency
Indicators by reporting level and Frequency
Code Indicator Monthly Quarterly Annually
HP HC Clinic HOSP WoHO+ HP HC Clinic HOSP WoH HP HC Clinic HOSP WoHO
O+ +
Reproductive and Maternal
MAT_CAR Contraceptive Acceptance Rate (CAR) X X X X
MAT_IPPCAR Immediate postpartum contraceptive acceptance rate X X X X
(IPPCAR)
MAT_ANC1 Antenatal Care (ANC) coverage – First visit X X X X
MAT_ANC4+ Antenatal Care (ANC) coverage – Four visits X X X X
MAT_ANC8+ Antenatal Care (ANC) coverage – Eight or more contact X X X X
MAT_SYPH Proportion of pregnant women tested for syphilis X X X X
MAT_SBA Skilled delivery attendance X X X X
MAT_SBR Stillbirth Rate X X X X
MAT_EPNC Early Postnatal care (PNC) coverage X X X X
MAT_CS Caesarean Section (C/S) Rate X X X
MAT_ABOR Women receiving comprehensive abortion care services X X X
MAT_IMD Institutional maternal deaths X X X
MAT_CMD Number of maternal deaths in the community X
MAT_PPH Women who developed Post-partum Hemorrhage (PPH) X X X X
MAT_UTER Delivered women who received Uterotonics X X X X
PMTCT
MTCT_TST Percentage of pregnant, laboring and lactating women X X X
who were tested for HIV and who know their results
MTCT_ART Percentage of HIV-positive pregnant women who X X X
received ART to reduce the risk of mother-to child-
transmission during pregnancy, labor & delivery (L&D)
and postpartum
MTCT_HEI_EID Proportion of HIV exposed infants with virological test X X X
MTCT_HEI_COTR Percentage of exposed infants born to HIV-infected X X X
women who were started on co-trimoxazole prophylaxis
within two months of birth
MTCT_HEI_ARV Percentage of infants born to HIV-infected women X X X
receiving antiretroviral (ARV) prophylaxis for prevention
of mother-to-child transmission (PMTCT)
MTCT_HEI_ABTST Percentage of HIV exposed infants receiving HIV X X X
confirmatory (antibody test) test by 18 months
Expanded Program on Immunization (EPI)
EPI_HepB-BD HepatitisB -Birth dose(BD) immunization coverage X X X X
EPI_DPT3 DPT3-HepB3-Hib3 (Pentavalent third dose) immunization X X X X
coverage (< 1 year)
EPI_OPV3 OPV 3 (Oral Polio Vaccine third dose) Immunization X X X X
Coverage (< 1 year)
EPI_PCV3 Pneumococcal conjugated vaccine (PCV3) immunization X X X X
coverage (< 1 year)
EPI_Rota2 Rotavirus vaccine 2nd dose (Rota2) immunization X X X X
coverage (< 1 year)
EPI_IPV IPV (Inactivated Polio Vaccine) Immunization Coverage (< X X X X
1 year)
EPI_MCV1 Measles (MCV1) immunization coverage (< 1year) X X X X
EPI_MCV2 Measles second dose (MCV2) immunization coverage X X X X
(15-24 months)
EPI_FULLY Full immunization coverage (< 1 year) X X X X
EPI_PAB Proportion of infants protected at birth against neonatal X X X X
tetanus
EPI_HPV2 HPV 2 (Human Papilloma Virus vaccine (2nd dose) X X X X
Immunization coverage (14 years old girls)
EPI_VWR Vaccine wastage rate X X X X
Child Health
CH_IND Institutional Neonatal Death Rate X X X
CH_CND Number of Neonatal death at community X
CH_TX_PNEU Proportion of under-five children with pneumonia X X X X
received antibiotic treatment
CH_TX_SYI Proportion of Sick Young infant treated for Newborn X X X X
infection
CH_TX_DIAR Proportion of children with diarrhea who are treated by X X X X
both ORS and Zinc at community and facility level
CH_KMC Proportion of low birth weight or premature newborns X X X
for whom Kangaroo Mother Care (KMC) was initiated
after delivery
CH_ASPH Proportion of asphyxiated neonates who were X X X X
resuscitated (with bag & mask)
CH_TX_NICU Treatment outcome of neonates admitted to NICU X X
CH_CHX Proportion of newborns that received at least one dose X X X X
of Chlorhexidine Digluconate (CHX) to the cord on the
first day after birth
CH_CHDM Proportion of under-five children monitored for child X X X X
development
Nutrition
NUT_LBW Percentage of live births that weigh less than 2,500gm X X X X
out of the total live births weighed
NUT_GMP Proportion of children under two years who participated X X X X
in Growth Monitoring and Promotion
NUT_VITA Proportion of children aged 6–59 months who received X X X X
two doses of vitamin A supplement
NUT_DeW Proportion of children 24-59 months de-wormed X X X X
NUT_IFA Proportion of pregnant women received IFA 90 plus X X X X
NUT_PreSMN Proportion of Pregnant and lactating women screened X X X X
for malnutrition
NUT_U5SMN Proportion of children under five years screened for X X X X
malnutrition
NUT_TX-U5MN Treatment outcomes for management of complicated X X X X
severe acute malnutrition in children 0-59 months
HIV Prevention and Control Indicators
HIV_HTS_TST Percentage of people living with HIV who know their X X X X
 status
HIV_TX_CURR Percentage of people living with HIV currently receiving X X X
ART
HIV_TX_NEW Number of adults and children with HIV infection newly X X X
started on ART
HIV_ART_RET ART retention rate X X X
HIV_ART_INTR Number of ART Clients that interrupted Treatment X X X
HIV_TX_PVLS Viral load Suppression X X X
HIV_PrEP Number of individuals receiving Pre-Exposure Prophylaxis X X X

HIV_PEP Number of persons provided with Post-Exposure X X X

prophylaxis
HIV_PLHV_TSP Proportion of clinically undernourished PLHIV who X X X
received therapeutic or supplementary food
HIV_STI_SCRN Proportion of STI cases tested for HIV X X X
HIV_ART_FP Percentage of non-pregnant women in the reproductive X X X
age living with HIV on ART using a modern family
planning method
HIV_TB_SCRN Proportion of patients enrolled in HIV care who were X X X
screened for TB
HIV_CXCA_SCRN Proportion of HIV positive women (15+) on ART screened X X X
for Cervical Ca
HIV_HeP_TST Number of individuals tested for Hepatitis X X X
HIV_HeP_TX Proportion of diagnosed Hepatitis B and C patients who X X X
received treatment
TB Treatment coverage
TB_TX TB Treatment coverage X X X
TB_RETX Tuberculosis Re-treatment Rate X X X
TB_CR Cure Rate for bacteriologically confirmed Pulmonary TB X X X
cases
TB_TSR TB Treatment Success rate (TSR) among all forms of TB X X X
cases
TB_UTX Unsuccessful treatment outcome among all forms of TB X X X
TB_COMM Proportion of all forms of TB cases notified and treated X X X
from community referral
TB_CBTSR Community based TB Treatment success rate X X X
TB_DX_PRIV Proportion of notified TB cases (all forms) contributed by X X X
other governmental and private facilities
TB_CI Contact investigation coverage X X X
TB_TPT TB Preventive Therapy (TPT) Coverage X X X
TB_IPT TPT Completion Rate X X X
TB_TST-WHO Percentage of new and relapse TB patients tested using a X X X
WHO recommended rapid tests at the time of diagnosis

TB_DST Drug Susceptibility testing (DST) coverage for TB patients X X X

TB_DR_TD Drug Resistant (DR) TB case detection rate X X X
TB_DR_TX DR TB treatment coverage X X X
TB_DR_TxO Final Outcome of RR/MDR-TB Cases X X X
TB_MN Proportion of all forms of TB and DR-TB patients with X X X
malnutrition
TB_HIV Proportion of registered new and relapse TB patients X X X
with documented HIV status
TB_ART Proportion of HIV-positive new and relapse TB patients X X X
on ART during TB treatment
LEP_NOT Leprosy notification per 10,000 population X X X
LEP_DIS Grade II disability rate among new cases of leprosy X X X
LEP_TX Leprosy treatment completion rate X X X
Malaria Prevention and Control
MAL_DX Morbidity attributed to malaria X X X X

MAL_DEATH Facility based death attributed to malaria X X X X

MAL_POS Malaria positivity rate X X X X
MAL_FULL Proportion of confirmed malaria cases fully investigated X X X X
and classified
MAL_FOCI Proportion of foci fully investigated and classified X X X X
MAL_PAR Annual parasite incidence X X X X
MAL_IRS Proportion of unit structures covered by Indoor residual X
spraying
MAL_EQA Proportion of health facilities covered by External Quality X X X X
Assurance (EQA) for malaria diagnosis
Prevention and Control of Neglected Tropical Diseases
NTD_SCH Proportion of individuals who swallowed MDA drug for X
Schistosomiasis
NTD_STH Proportion of individuals who swallowed drug for soil X
transmitted helminthiasis (STH))
NTD_LF Proportion of individuals who swallowed drug for X
lymphatic filariasis(LF)
NTD_ONCH Proportion of individuals who swallowed drug for X
onchocerciasis
NTD_TR Proportion of individuals who swallowed drug for X
trachoma
NTD_VL Number of visceral Leishmaniasis (VL) cases treated X X
NTD_CL Number of cutaneous Leishmaniasis (CL) cases treated X X
NTD_TT Proportion of Trachomatous Trichiasis (TT) cases who X X
received corrective TT surgery
Prevention and Control of Non-Communicable Diseases and Mental Health
NCD_HTNDX Number of hypertensive patients enrolled to cares X X X
NCD_HTNTX Six-monthly control of blood pressure among people X X X
treated for hypertension
NCD_CVD Proportion of patients with high CVD risk who received X X X
treatment
NCD_DMDX Number of new diabetic patients enrolled to care X X X
NCD_DMTX Six-monthly control of diabetes among individuals X X X
treated for diabetes
NCD_CV_SCRN Proportion of women aged 30–49 years screened for X X X
cervical Ca
NCD_CV_TX Proportion of eligible women who received treatment for X X X
cervical lesion
NCD_CSR Cataract surgical rate (CSR) X X X
Mental Health
MH_TX Proportion of individuals treated for priority mental X X X
health disorders
MH_CDBD Proportion of children (<18) diagnosed and treated for X X X
childhood developmental and behavioral disorders
Hygiene and Environmental Health
HEH_HHLW Proportion of HHs with liquid waste management X
HEH_HHSW Proportion of HHs with safe solid waste management X
HEH_ODF Proportion of kebeles declared ODF X
HEH_HHSF Proportion of households having sanitation facilities X
HEH_HHHWF Proportion of households having hand washing facilities X
at the premises
HEH_HHHH Proportion of households with healthy housing X
HEH_WSTST Proportion of water schemes for which water quality test X
conducted
HEH_HFWATER Proportion of health facility with water service X X X
HEH_HFSAN Proportion of health facility with sanitation facilities X X X
HEH_HFWASTE Proportion of health facilities with healthcare waste X X X
management services
HEP and Primary Health Care
HEPHC_MODEL_ Model Households X
H
HEPHC_HPPHCU Proportion of high performing PHCUs X
HEPHC_COMP_H Proportion of health posts providing comprehensive X
P health services
HEPHC_MODEL_K Model Kebele X
Medical Service
MS_OPD Out-Patient Attendance Per-Capita X X X X
MS_BOR Bed Occupancy Rate X X X
MS_ALOS Average Length of Stay (in days) X X X
MS_HBD Hospital Bed Density X
MS_ASSTECH Assistive Technology Service Coverage X
MS_LaBT Essential laboratory test availability X X X
MS_RoR Referral-out Rate X X X
MS_AMBU Ambulance service utilization for referral service X X X
MS_AMBUR Ambulance service response rate X X X
MS_EMERG_MR Facility emergency department mortality rate X X X
MS_EMERG24 Emergency room attendances with length of stay > 24 X X X
hours
MS_VAP Percentage of ventilator associated pneumonia X X X
MS_ICU_MR Mortality rate in Intensive Care Unit X
MS_PO_MR Perioperative mortality rate X
MS_ICU_LOS ICU length of stay X
MS_PO_MEAN Mean duration of in-hospital pre-elective operative stay X
MS_SURG_WAIT Number of clients in the waiting list for elective surgical X
service
MS_SURG_DELAY Delay for elective surgical admission X
MS_IPMR Inpatient mortality rate X X X
MS_MORB10 Top 10 causes of morbidity
MS_MORT10 Top ten causes of institutional mortality
Pharmaceuticals and medical devices and their rational and proper use
PMS_SUPP_FILL Supplier fill rate X X X X X
PMS_AVAIL Essential Drugs Availability X X X X
PMS_ABIOTIC Percentage of encounters with an antibiotic prescribed X X X
PMS_FILL100 Percentage of client with 100% prescribed drug filled X X X
PMS_FSML: Percentage of medicines prescribed from the facility’s X X X
medicines list
PMS_WAST Pharmaceuticals wastage rate X X X
PMS_EQUIP Functionality of medical equipment X X X
Regulatory systems
RS_STAN Proportion of health facilities that met Ethiopian health X
facility requirements
RS_FOOD Proportion of food and drinking service establishments X
that met Ethiopian hygiene and environmental health
requirements
Human resource development and management
HR_HCW2P Health care worker to Population ration by Category X X X X X
HR_STAFF_STAND Proportion health Facility staffed as per the standard X X X X X
HR_LICENS Percentage of health professionals with an active X X X
professional license
Enhance informed decision making and innovations
EIDM_RCOMP Reporting Completeness X X X X X
EIDM_RTIME Reporting Timeliness X X X X X
EIDM_LQAS Proportion of health facilities that conduct reporting X X X X X
consistency check using LQAS
EIDM_LB_NOTI Proportion of live births notified by the health facility X X X X
EIDM_D_NOTI Proportion of deaths notified by the health facility X X X X
EIDM_INF_SCOR Information use scores X X X X X
Health financing
HCF_ALLOC Proportion of health budget allocated to the health X
sector in the fiscal years
HCF_UTIL Health budget Utilization X X
HCF_REIMB Proportion of reimbursed amount from the total spent X X
HCF_CBHI Membership Enrollment Rate for CBHI X
Strengthen governance and leadership
LG_CSC Proportion of Primary health Care facilities implementing X
Community Scorecard (CSC)
LG_GGI Proportion of hospitals with Good Governance Index X
(GGI) of >=80%
LG_FEM Proportion of leadership positions in health facilities that X X X
are held by females
LG_GBV Number of Gender based violence (GBV) survivors X X X
(Physical and sexual) who received health care services
Health infrastructure
HI_HF2P Functional health facility to population ratio X
HI_FUNC_INFR Proportion health facilities with functional infrastructure X X X X