MONITORING AND EVALUATION PLAN - TBC India

ANNEXURE C: Reporting Templates for Program and Finance
Tool 1: District Level Monthly Activity Reporting Form
SSR Name:
Sub Recipient Name:
Name of District:
Report for the month of:
Sl .
No.
Indicator Achievement
1 Number of NGOs sensitised at District level on community
mobilisation and RNTCP schemes
2 Number of people trained and retrained on interpersonal skills
and soft skills for District level health staff at District level
3 BCC toolkit roll out
4 Number of community volunteers oriented in use of BCC toolkit
5 Number of local NGOs trained to participate in RNTCP
schemes
6 Number of trained NGOs who applied for RNTCP schemes
7 Number of NGO's sanctioned RNTCP schemes
8 Number of community meetings held to address myths and
misconceptions
9 Number of meetings with District and Sub District Health staff to
address service delivery gaps
10 World TB Day and International Women's Day celebration
11 Number of Patients' Charter brochures distributed
12 Number of NGOs sanctioned with Sputum collection / transport
schemes
13 Number of DMCs established through Civil Society participation
14 Number of Rural Health care providers sensitized on referrals,
DOTS provision and eligible RNTCP schemes
15 Number of sputum positive initial defaulters successfully retraced
and enrolled in DOTS
16 District level TB forums functional
17 Number of CBOs trained in leadership and organizational
management skills
18 Number of grass root advocates identified
19 Number of CBOs who participated in quarterly review meeting
with DTO
© World Vision India, Axshya India Project
Monitoring and Evaluation Plan, October 2010 Page No 70