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District Health Society, MadhubaniMONTHLY PHYSICAL DATA OF ASHA PROGRAMME FOR THE MONTH OF ………………….
Name of BCM/HM- Name of Month- Block-
SN
Blo
ck C
omm
unity
Mob
ilize
r in
Plac
e
No
Of A
SHA
' S B
ank
A/C
Ope
ned
No
Of A
SHA
Hav
ing
Icar
d
No
Of A
SHA
with
HB
NC
Kit
No
Of A
SHA
with
Sar
ies
Targ
et
Ach
ieve
men
t
Targ
et
Ach
ieve
men
t
No.
of D
rug
Kit
Rep
lishe
d
Targ
et A
SHA
Dis
trict
Tra
iner
Tea
m
Targ
et
Ach
ieve
men
t
Targ
et
Ach
ieve
men
t
1 Andhrathadhi2 Babubarhi3 Basopatti4 Benipatti5 Bisfi6 Ghoghardiha7 Harlakhi8 Jaynagar9 Jhanjharpur
10 Khajauli11 Khutauna12 Ladania13 Laukahi
14
15 Madhwapur16 Pandaul17 Rahika18 Rajnagar19 Kaluahi20 Phulpras
Total-
Name Of Block
ASHA Selectio
n
ASHA Fecilitat
or Selectio
n
Drug Kit Status
ASHA Diwas
Status of ASHA Traning Module 5, 6 & 7
Capacity Building Academic Support Programme No. of
ASHA's Enrolled into 10th grade of
Bachelor’sPreparatory Programme touch open
Schools or IGNOU
Best performance award of Rs. 1000/-, Rs. 500/- Rs.300/-
Candidate of ASHA as per District Level
No.
of N
ew A
SHA
with
D
rug
Kit
No.
of A
SHA
Pre
sent
in
ASH
A D
iwas
No.
of A
SHA
's Tr
aine
d in
Ph
ase-
I
No.
of A
SHA
's Tr
aine
d in
Ph
ase-
II
No.
of A
SHA
's Tr
aine
d in
Ph
ase-
III
No.
of A
SHA
's Tr
aine
d in
Ph
ase-
IV
Madhepur & Lakhnaur
Signature of BCM/HM Signature of MO-IC
District Health Society, MadhubaniMONTHLY FINANCIAL DATA/REPORT OF ASHA PROGRAMME FOR THE MONTH OF …………………….
Name of BCM/HM- Name of Month- Block-
SN
No.
of D
rug
kit R
eplis
ed
Am
ount
Pai
d fo
r Dru
g K
it R
eplis
hmen
t
No.
of N
ew D
rug
Kit
Proc
ured
Am
ount
Pai
d fo
r New
Dru
g K
it
No.
of H
BN
C k
it Pr
ocur
ed
Am
ount
pai
d fo
r H
BN
C k
it Pr
ocur
emen
t
No.
of S
aree
rece
ived
Am
ount
pai
d fo
r Sar
ee
No.
of A
SHA
Diw
as O
rgan
iaed
No.
of A
SHA
Pre
sent
in A
SHA
Diw
as
Am
mou
nt p
aid
to A
SHA
's on
Ash
a D
iwas
1 Andhrathadhi2 Babubarhi3 Basopatti4 Benipatti5 Bisfi6 Ghoghardiha7 Harlakhi8 Jaynagar9 Jhanjharpur
10 Khajauli11 Khutauna12 Ladania13 Laukahi
14
15 Madhwapur16 Pandaul17 Rahika18 Rajnagar19 Kaluahi20 Phulpras
Total-
Name of Block
Am
ount
ot b
e pa
id to
ASH
A in
Mod
ule
5,6
& 7
Tra
inin
g (T
A+D
A)
Am
ount
pai
d to
ASH
A in
Mod
ule
5,6
& 7
Tr
aini
ng (T
A+D
A)
Amount spent under the head of Capacity Building/
Academic Support Programme No. of ASHAs Enrolled into 10th grade or
Bachelor's Preparatory Programme through open
Schools or IGNOU.
Best performanceAward
to ASHA's
No.
of A
SHA
En
rolle
d
Am
ount
to b
e pa
id fo
r en
rollm
ent
Am
ount
pai
d fo
r en
rollm
ent
Am
ount
pai
d to
ASH
A
Rs.1
000/
-A
mou
nt p
aid
to A
SHA
R
s.500
/-A
mou
nt p
aid
to A
SHA
R
s.300
/-
Madhepur & Lakhnaur
Signature of BCM/HM Signature of MO-IC
District Health Society, MadhubaniInsentive Details of ASHA Programme
Name of BCM/HM- Block- Name of Month-
Programme & Related Work
Insentives in Rs.
Back dues By Cash By Whom Remarks
1 600 400
a. 100 1002nd ANC3rd ANC4th ANC
b.IFA 1st
100
100
IFA 2ndIFA 3rd
c.TT-1
100TT-2IFA 3rd
d. 300 200
2
Immunization5 to 10 Child 5011 to 15 Child 10016 to 20 Child 15021 and above 21 Child 200
For full immunization (within 1 year) 100
For full immunization (12-24 months) 50
Polio Round
Vitamin -A Round
For ASHA
For Facilitators
3 ASHA Diwas 100
Sl. No.
No. of Cases Where
ASHA is involved
Incentive to be paid
Incentive Paid in this
month
Cumulative Dues if not
paid
By Cheque
Rural Area
Urban Area
Janani Evam Bal Surkchha Yojnafor Institutional Delivery and full
Immunization of the new born1st ANC (Registration within 12 weeks)
Institutional Deliveries (after BCG Immunization)
75/- per day
100/- per day
150/- per day
4
Pariwar NiyojanSterilization 150
Vasectomy '/ NSV 200
IUD
5
Adarsh Dampati Yojana
500
500
1000
6 DOTs (After full treatment) 250
7Laprocy P.B. Case 300Laprocy M.B. Case 500
8 Kalazar (After full treatment) 100
9 175
10During TrainingDaily Allowance 100Travel Alloance 100
11 250
12 Social Marketing of Sanitary napkins
13
14
As per Guideline
For Ensuring spacing of 2 years after marriage
For Ensuring spacing of 3 years after the birth of 1st child
For Encouraging couple opts for a permanent limiting method up to 2
children
Cataract Operation (Motiyabind) under National Blindness Control
Programme
Home visit under HBNC and IMNCI (After 6 visits in institutional deliveries and 7 visit in home
deliveries)
Rs. 1 per pack
Reporting death of women (15 to 40 years) and children (0-1 Years) by
ASHA to the Block PHC, MO/ANM within 24 hours of death to Block PHC MO/ANM under maternal
Death Review Programme
200/- per registration
Facilitating monthly meeting with adolescent at village for 9 Mensural
Hygine districts only.
50 per meeting
Signature of BCM/HM Signature of MO-IC
District Health Society, MadhubaniVHSNC Monthly Status
Name of Block- Name of Month-
Sl. No. Name of Block Remarks
1Total-
BCM/BHM MO-IC
Total no. of Panchayat
Total No. of VHSNC consitituted with Bank Account
Total No. of VHSNC meeting conducted in the reporting month
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1
Signature of MO-IC
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iz[k.Mksa dk uke
vk'kk dh la0
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'kknh ds ckn igys cPps ds
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djus okys ¼;ksX; nEifr dh la[;k½
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varjky lqfuf'pr
djus okys ¼;ksX; nEifr dh la[;k½
;kstuk ds vUrxZr ,d larku ds
ckn ca/;kdj.k
pquusokys nEifr;ksa dh la0½
;kstuk ds vUrxZr
nwljs cPps ds ckn
ca/;kdj.k pquus okys
nEifr;ksa dh la0
vH;qfDr
fcuk larku okys ;kX; nEifr
,d cPps okys ;ksX; nEifr
nks cPps okys ;ksX; nEifr
Signature of BCM/HMMadhubani
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izkIr LVkWd dh la0 forj.k dh la0
Condom OCP ECP Condom OCP ECP Condom OCP ECP1
lkekftd foi.ku laca/kh izfrosnuizkFkfed LokLF; dsUnz dk uke& ekg dk
uke&
dz0la0
LokLF; laLFkku dk uke
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BCM/HM MO-IC
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http://115.112.230.29/dhis
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Any Problem Please Contact- 9031870700
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