2023 revised edition
LWALA SUPPORTED OUTREACH SUMMARY TOOL
SUB-COUNTY: ……………………….
LINK FACILITY NAME: ……………………………………… MFL code: …………………………………………..
IN-CHARGE’S NAME: …………………………………… CONTACTS………………
Name of Outreach site: ………………………. DATE (of o u t r e a c h ):……………..
MONTH: …………………………………………. YEAR: ……………………………………….
NAMES OF THOSE CONDUCTING
OUTREACHES.
Supervisors; CHWs
1. 1.
2. 2.
3. 3.
4.
Health Workers/Service Providers: LOCATION OF OUTREACH (Indicate the
villages served)
1. 1.
2. 2.
3. 3.
4.
Fill in the table below:
No Reached No Reached Total No
Reached
Service(s) provided < 1 year >1 year
a) Immunization services M F M F M F
Total Immunization Defaulters
reached
BCG
OPV 0
OPV 1
OPV 2
OPV 3
IPV
Penta 1
Penta 2
Penta 3
PCV 1
PCV 2
PCV 3
Rota 1
Rota 2
Rota 3
Malaria 1
Malaria 2
Malaria 3
Malaria 4
Measles < 1 year
Fully Immunized at 1 year
Measles 1 1/2 years
2023 revised edition
Fully immunized at 2 years
b) Vitamin A supplementation M F TOTAL
Vitamin A at 6 months (100,000 IU)
Vitamin A at 1 year (200,000IU)
Vitamin A at 1 ½ years (200,000IU)
VitaminA at 2-5 years (200,000IU)
c) ANC services M F
Total ANC clients served
Total ANC Defaulters Reached
ANC 1
ANC Revisits
ANC 4
Number of ANC clients issued
with combined
IFAS
Number of ANC clients issued with
Iron
Number of women issued with Folate
Number of ANC clients receiving IPTp
1
Number of ANC clients receiving IPTp
2
Number of ANC clients receiving IPTp
3
Number of ANC clients receiving
>IPTp 3
HIV C&T in Pregnancy
No. of adolescents (10-14
years) presenting with
pregnancy
No. of adolescents (15-19
years) presenting with
pregnancy
d) Family Planning services New Revisits TOTAL REMOVALS
COCs
POPs
Injectable DMPA IM
Injectables-DMPA SC
Implants
Implanon/NXT
Jadelle
IUCD
Non-Hormonal (Copper T)
Hormonal (LNG IUS)
Voluntary Surgical Contraception
(VSC)
BTL
Vasectomy
Male condoms
Female condoms
Total adolescent clients (10-
14yrs) receiving FP
Services
Total adolescent clients (15-
19yrs) receiving FP
Services
Total youth clients (20-
2023 revised edition
24yrs) receiving FP
Services
Above 24 yrs.
2023 revised edition
ECD Services
e) Management of < 5 years cases M F TOTAL
Total cases of diarrhea in under 5
years
Cases of Diarrhea in U5 treated with
ORS and
Zinc
Cases of Pneumonia in U5s treated
with antibiotics
Cases of Pneumonia in U5s treated
with Amoxicillin
f) Nutrition M F TOTAL
Total number of children 0 - 6 months
weighed
Total number of children 6 – 23
weighed
Total number of children 24 – 59
months weighed
Number of children under 5
who are underweight
Number of children under 5 who are
wasted
Number of severely malnourished
children under
five (MUAC RED) <115mm
Number of moderately
malnourished children
under five (MUAC Yellow)115mm-
125mm
Number of moderately
malnourished children
under five (MUAC Green) >125mm
Number of children dewormed
0-< 6months on exclusive breast feeding
g) Other ECD focused activities
Births registered
# caregivers registered on NHIF
# of Children registered on NHIF
# caregivers registered on UHC
h) Sessions/health talks
Play and communication with children
Children rights
Responsive parenting and
development milestones
Treatments Done Male Female Total
Referrals Done
Presbyopia: No of Glasses distributed
Disability inclusion: Person with Disability served/reached
2023 revised edition
2023 revised edition
CLIENT INFORMATION AND EDUCATION
Male Female Total
<20 >20 <20 >20 <20 >20
Clients reached with information and education on RH/FP
Clients reached with information and education on
MNCAH
Clients reached with information and education on
Nutrition
Clients reached with information and education on WASH
Clients reached with ECD messages
Clients with Disability reached
TOTAL
Challenges faced during the Outreach
1.
2.
3.
4.
5.
Number of water guard distributed.
No. Of Aqua tabs distributed
Number of pur sachets distributed
Action points for the next Outreach
1.
2.
3.
4.
Pictures of the outreach
