Annex: Report Template for Catchment based mentorship
Region/ Zone/Woreda
Name of hospital conducted the mentorship:
Name of health center provided the mentorship:
The team combination 1. The MNH mentorship done by Name- 2. CH mentorship done by Name- 3. Nutrition, mentorship done by Name- 4. RH/FPs mentorship done by Name- 5. AYHD/YFS mentorship done by Name- 6. GVB mentorship done by Name-- 7. Pharmacy mentorship done by Name- 8. Iaboratory mentorship done by Name- 9. QI coaching done by Name-- 10. HSS coaching done by Name-
organization--
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Reporting Month
A. MNH Service
Total score from ---- Strength .
Areas to be improved
Actions taken/solved by the mentorship team
Challenges RHB/ZHD/WrHO/others should solve
B.
CHILD HeaIth: IMNCI
Total score from ----/-- Strength
-%
.
.
. .
Areas to be improved
Actions taken/solved by the mentorship team
Challenges RHB/ZHD/WrHO/others should solve
C. Family planning/RH
Total score from -- Strength .
.
Areas to be improved
Actions taken/solved by the mentorship team
Challenges RHB/ZHD/WrHO/others should solve
D. AYHD Service
Total score from ---- Strength
-%
.
Areas to be improved
.
Actions taken/solved by the mentorship team
Challenges RHB/ZHD/WrHO/others should solve
E. Gender/GBV Service
Total score from ----/-- Strength .
.
Areas to be improved
Actions taken/solved by the mentorship t