2. Sustainability and impact Important for our funders and Rotary International Establish the link to care Form the base line study for further evaluations by RFHA and CDC/NDOH

6. PROCESS FORM 1: REGISTRATION FORM FORM 2: SERVICES TALLY SHEET  Printed in triplicate book format  A3 size  Colour coded  Have campaign logos to indicate RFHD Campaign  Quantity per site: Catering for 1500 people per site  Delivered to distribution points 1 st week of March REGISTRATION FORM Rotary responsibility at registration desk Sheet will tally up to 228 Clients then move onto sheet number 2,3,4, etc End of the day: copy 1 - retained by Rotary Site Champion copy 2 - given to NDOH copy 3 - given to CDC/USAID NGO (if no representation then save and give to Club Champion) Rotary Club Champion to transpose data onto electronic capturing template supplied Hard copy of Registration Form to be retained by Club Champion and sent through to Regional Representative at end of campaign.

7. Required Information All Shaded areas

8. Headings 1.Person = Line number 2.Gender = Grouping of Family, male, female and children 3.Family = Any family grouping – father+Mother+children, grandmother or siblings 4.Male = (single arrival) or male (part of family group) 5.Female = (same as male in 4) 6.Child = between 5 – 15 years old 7.Child = younger than 5 years

9. Bottom of Registration Sheet Required Information Areas in Grey

10. Club Electronic Reporting Sheet

11. PROCESS SERVICES TALLY SHEET Standard Government reporting tool RFHD Campaign Logos to identify services throughout campaign Printed in triplicate, colour coded, booklet format, Delivered to Rotary Distribution points 1st week March Pack will contain a letter of instruction to DOH, NGO workers from NDOH to assist Rotary to communicate at site level Distributed to each service station by Rotary Champion – tear off Each sheet will record up to 50 Clients. Filled in by Government/NGO workers Responsibility of Club Site Champion to get a Rotary copy from each service station at the end of each day Responsibility of Club Site Champion to transpose data onto an electronic data collection template supplied each day

12. PROCESS SERVICES TALLY SHEET

13. Services Rendered

14. Required Information All orange and blue shaded areas

15. Service Headings Type of Service Rendered T = Tested R = Referred

16. Registration Total for the day as per category Manual Input Total services, Auto calculation Total per service per day

17. TIMELINES Club Champion report to Steering Committee Head: 11 th April Steering Committee report to Programme Director: 18 th April Final report to RFHA Board: 30 th April

18. HELP! General Information Steering Committee Heads Process and Content Sue Paget: 083 456 3923 Electronic Templates Steve du Plessis: 082 893 4211 steve@newdawn.org.za