WEEKLY REPORTING TEMPLATE

GBV & SRH SERVICES

Name of Parner:

Reporting Period:

Name of Region*(Select from t

Name of Health Facility: mandura gm health center

S.n Thematic Area

10
Maternal and Newborn
11 Health

12

13
14

15

16

17

18

19

20

21

22

23
GBV Response

24

25

26

27 Comprehensive
Abortion Care
28

29

30

31

32

33
34

35

36

37

38

39

40

41

42

43

44

Nutrition
45

46

Awareness Sessions
47

48
KITS DISTRIBUTION
49
 WEEKLY REPORTING TEMPLATE
GBV & SRH SERVICES

Ethiopian Midwives Association

November 2-8 /2024

Benishangul Gumuz

Health Facility: mandura gm health center

Female
Indicators Disaggregate by age) (0-14)

# of normal deliveries assisted by skilled birth attendant in health facility 0.00

# of assisted (instrumental) deliveries in health facility 0.00

# of caesarean section deliveries 0.00

# of live births 0.00

# of stillbirths 0.00

# of early Institutional neonatal death during the first 0-24hr (day) 0.00

# of early Institutional neonatal death during 1 -7 days (week) 0.00

# of low birth weight new-borns 0.00

# of pregnant women who received ANC first visit during the current pregnancy, 0.00
Period: <16 weeks
# of pregnant women who received ANC first visit during the current pregnancy, 0.00
Period: >=16 weeks

# of pregnant women who have 4 or more contact during the current pregnancy. 0.00

# of pregnant women who have 8 or more contact during the current pregnancy. 0.00

# of women/girls and their babies who receive early Postnatal care (PNC) during 0.00
0-24 hours( 1st day)
 # of women/girls and their babies who receive early Postnatal care (PNC) during 0.00
25-48 hours
# of women/girls and their babies who receive early Postnatal care (PNC) during 0.00
49-72 hours
# of women/girls and their babies who receive early Postnatal care (PNC) during 0.00
73 hrs- 7days

# of referrals from the community to EmONC 0.00

# of institutional maternal deaths. (i.e. at health facility) 0.00

Number of maternal deaths in the community(i.e. at home, on the way to health 0.00
facility, HP)
# of women and girls living with obstetric fistula receiving surgical repair with 0.00
financial support from UNFPA
# of obstetric fistula and Public organ prolapse (POP) patient supported with 0.00
transport cost (Cost covered)

# of incidents of sexual violence reported to health services 0.00

# of rape survivors receiving HIV post-exposure prophylaxis (PEP) within 72 0.00

hours of incident
# of female rape survivors receiving emergency contraception (EC) within 120 0.00
hours of incident

# of survivors of sexual violence referred to facilities with CMR services 0.00

# of women and girls receiving post abortion care (PAC) 0.00

# of women and girls receiving CAC 0.00

# of women and girls receiving SAC 0.00

# of women and girls who received post abortion contraception (modern method) 0.00

# of patients with STI/RTI managed according to protocols 0.00

# of pregnant women attending antenatal care tested for syphilis 0.00

# of pregnant women attending antenatal care offered testing for HIV 0.00

# of pregnant women who were tested and know their HIV status 0.00
# of patients on ART who receive continuation therapy 0.00

# of HIV+ pregnant women who received ART to EMTCT as per protocol 0.00

# of pregnant women provided with HIV and STI care services 0.00

# of women and girls accepting modern SHORT term effect contraceptive 0.00
methods for the first time. (i.e. no double counting)
# of women and girls accepting modern LONG term effect contraceptive methods 0.00
for the first time. (i.e. no double counting)
# of women and girls accepting modern SHORT term effect contraceptive 0.00
methods. (i.e. total revisits)
# of women and girls accepting modern LONG term effect contraceptive methods. 0.00
(i.e. total revisits)
# of women who accepted a modern contraceptive method immediately after 0.00
delivery (0-48hours)

# of women and girls receiving emergency contraception (i.e. excluding CMR) 0.00

# of women and girls accepting a modern contraceptive method. (i.e. excludes 0.00
condoms)
# of pregnant women attending antenatal care who receive iron & folic acid 0.00
supplements

# of pregnant and lactating women (PLW) screened for acute malnutrition 0.00

# of PLW who are linked/managed. 0.00

# of people attending SRH and GBV awareness raising activities, information and 0.00
education and community conversation sessions.

# condoms distributed (in units, not in number of kits) 0.00

# of clean delivery kits distributed

 November
week one

Female Female Female Female Female Male Male Male Male

(15-17) (18-24) (25-49) (50-65) (65+) (0-14) (15-17) (18-24) (25-49)

0.00 1.00 3.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 1.00 3.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 6.00 6.00 0.00 0.00

0.00 4.00 10.00 0.00 0.00

0.00 2.00 3.00 0.00 0.00

0.00 1.00 1.00 0.00 0.00

0.00 1.00 3.00 0.00 0.00

0.00 1.00 1.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 15.00 14.00 0.00 0.00

0.00 6.00 6.00 0.00 0.00

0.00 6.00 6.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 4.00 7.00 0.00 0.00

0.00 1.00 2.00 0.00 0.00

0.00 2.00 2.00 0.00 0.00

0.00 0.00 1.00 0.00 0.00

0.00 1.00 2.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 7.00 12.00 0.00 0.00

0.00 13.00 20.00 0.00 0.00

0.00 10.00 12.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 1.00 3.00 4.00
0.00 3.00 5.00 3.00 0.00
0.00 0.00 20.00 25.00
0.00 0.00 0.00 0.00 0.00
Male Male Persons with Female Male TOTAL
(50-65) (65+) disability [Total #] [Total #] [Individuals #]

0.00 4 0 4

0.00 0 0 0

0.00 0 0 0

0.00 4 0 4

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 12 0 12

0.00 14 0 14

0.00 5 0 5

0.00 2 0 2

0.00 4 0 4
0.00 2 0 2

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 29 0 29

0.00 12 0 12

0.00 12 0 12
 0.00 0 0 0

0.00 0 0 0

0.00 0 0 0

0.00 11 0 11

0.00 3 0 3

0.00 4 0 4

0.00 1 0 1

0.00 3 0 3

0.00 0 0 0

0.00 19 0 19

0.00 33 0 33

0.00 22 0 22

0.00 0 0 0
0.00 0.00
0.00 11 8 19
0.00 0.00
0.00 0 45 45

0 0 0