Polio Eradication Toolkit

Community Mobilizer Reporting Formats (Templates)

Size: A4
Year: 2011
Organization: CGPP/Ethiopia
Country: Ethiopia
Languages: English

Health facility staff collect and record data from each CV on monthly activities and are submitted to CGPP field assistants, who review them for quality, provide feedback to the CVs, and compile them into a summary form (see Project Field Staff Monthly Reporting). The tool contains three reporting formats: case report format ; CV activity report form; and registration of pregnant women and newborns for polio doses at birth. The case report form collects data on cases of acute flaccid paralysis (AFP), measles, and neonatal tetanus detected in the community, with details on name, age and onset of illness. The CV activity report collects data on: health education; house-to-house visits; community mobilization for RI; and community mobilization for Supplementary National Immunization Days (SNIDs).

Health facility staff use the data to monitor and support the work of CVs, monitor and respond to occurrence of key diseases, and reach out to pregnant women and newborns for appropriate care and vaccination.