Survey Text

Benin 2001
Ghana 2008
Ghana 2014
Kenya 2008
Kenya 2014
Niger 2012
top
Benin 2001
Survey form view entire document:  text 
817F) Where can you go for this test?
RECORD ALL MENTIONED.

817FX) Where did you go for this test?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MATERNITY D
MOBILE CLINIC E
FIELDWORKER F
OTHER (SPECIFY)_____ G
PRIVATE MEDICAL SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
ADBC/MATRON/MIDWIFE/NURSE'S AIDE O
PARA-PUBLIC SECTOR
INFORMATION AND ADVICE CENTER P
PNLS (NATIONAL PROGRAM AGAINST AIDS) Q
OTHER (SPECIFY)_____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL PRACTITIONER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) _____ X

top
Ghana 2008
Survey form view entire document:  text 
928. Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ________________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER/OUTREACH/PEER EDUCATOR G
OTHER PUBLIC (SPECIFY) _____
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL (SPECIFY) ____ O
OTHER SOURCE
SHOP/MARKET P
CHURCH Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ______ X

top
Ghana 2014
Survey form view entire document:  text 
931) Where is that?
Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER/CLINIC B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER/OUTREACH/PEER EDUCATOR G
OTHER PUBLIC (SPECIFY) _____ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ O
OTHER SOURCE
HOME P
CORRECTIONAL FACILITY Q
OTHER (SPECIFY) _____ X

top
Kenya 2008
Survey form view entire document:  text 
916F. Where is that? Any other place?

IF SOURCE IS HOSPITAL, HEALTH CENTRE OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ___________

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE 'E'.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
MISSIONARY/CHURCH HOSP./CLINIC E
FPAK HEALTH CENTER/CLINIC F
PRIVATE HOSPITAL/CLINIC G
VCT CENTRE H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL (SPECIFY) ___________ K
OTHER (SPECIFY) _______________________ X

top
Kenya 2014
Survey form view entire document:  text 
931) Where is that?

Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF THE PLACE_________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) ________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/MISSIONARY/CHURCH HOSPITAL/CLINIC E
FAMILY OPTIONS/FHOK CLINIC G
VCT CENTER H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________ K
OTHER (SPECIFY) __________ X

top
Niger 2012
Survey form view entire document:  text 
931) Where is that?

Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
(NAME OF PLACE) ______________

PUBLIC SECTOR
A NATIONAL HOSPITAL
B REGIONAL HOSPITAL
C HD C
D MATERNITY
E INTEGRATED HEALTH CENTER
F CARITAS DÉVELOPPEMENT F
G AMBULATORY TREATMENT CENTER
H SCHOOL BASED CLINIC
I OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
J PRIVATE HOSPITAL/CLINIC
K PRIVATE LABORATORY
L SCHOOL BASED CLINIC
M CLINIC/ NIGERIEN ASSOCIATION FOR FAMILIAL WELL-BEING
N OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
X OTHER (SPECIFY)