Survey Text

Afghanistan 2015 Guinea 2012 Namibia 2013 Uganda 2016
Benin 2001 India 2015 Nigeria 2008 Zambia 2007
Benin 2006 Lesotho 2009 Nigeria 2013 Zambia 2013
Burundi 2010 Lesotho 2014 Senegal 2005
Cameroon 2011 Madagascar 2003 Tanzania 1996
Cote d'Ivoire 2011 Mali 2012 Uganda 1995
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Afghanistan 2015
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 (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
STAND-ALONE VCT CENTER F
FAMILY PLANNING CLINIC G
MOBILE CLINIC H
COMMUNITY HEALTH WORKER I
OTHER PUBLIC SECTOR______J
NON-GOVERNMENT SECTOR
MARIE STOPES K
RED CROSS SOCIETY L
AFGA M
OTHER NGO SECTOR________N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR O
STAND-ALONE VCT CENTER P
PHARMACY Q
MOBILE CLINIC R
FIELDWORKER S
OTHER PRIVATE MEDICAL SECTOR_______T
OTHER SOURCE
HOME U
CHARITY/FOUNDATIONS V
REFUGEE CAMP W
OTHER___________X

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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

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Benin 2006
Survey form view entire document:  text 
830) Where is that? Any other place?
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.
RECORD ALL MENTIONED.

NAME OF PLACE _________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
SCREENING CENTER D
STRAT AV HEALTH WORKER/MOBILE CLINIC E
HEALTH WORKER F
OTHER PUBLIC (SPECIFY) ________ G
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE H
PHARMACY I
PRIVATE DOCTOR J
HEALTH AGENT K
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER (SPECIFY) ________ X

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Burundi 2010
Survey form view entire document:  text 
929) Where was the test done? (4)

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER 12
STAND-ALONE VCT CENTER 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER 16
SCHOOL BASED CLINIC 17
OTHER PUBLIC SECTOR (SPECIFY)______ 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 21
STAND ALONE VCT CENTER 22
PHARMACY 23
MOBILE CLINIC 24
FIELDWORKER 25
SCHOOL BASED CLINIC 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ 27
OTHER SOURCE
HOME 31
CORRECTIONAL FACILITY 32
OTHER (SPECIFY)____ 96

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Cameroon 2011
Survey form view entire document:  text 
1235) Where is that?

Anywhere else?

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

IF UNABLE TO DETERMINE IF THE HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY/
MOTHER AND CHILD CARE CENTER B
HEALTH WORKER C
HIV PREVENTION AND VOLUNTARY TESTING CENTER D
MOBILE CLINIC E
OTHER PUBLIC (SPECIFY): ___ F
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL G
PRIVATE SECULAR HOSPITAL/CLINIC H
HEALTH CENTER/RELIGIOUS DISPENSARY/MISSION I
MEDICAL OFFICE J
PHARMACY K
HEALTH WORKER L
HIV PREVENTION AND VOLUNTARY TESTING CENTER M
MOBILE CLINIC N
OTHER PRIVATE MEDICAL (SPECIFY): ___ O
OTHER SOURCE (SPECIFY): ___ X

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Cote d'Ivoire 2011
Survey form view entire document:  text 
931) Where is that? (4)

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ M
OTHER (SPECIFY)____ X

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Guinea 2012
Survey form view entire document:  text 
931) Where is that? (4)

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ M
OTHER (SPECIFY)____ X

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India 2015
Survey form view entire document:  text 
1038. Where is that? Any other place?

RECORD ALL PLACES MENTIONED. IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF FACILITY/PLACE(S))_______________
PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTRE B
STAND-ALONE ICTC C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
SCHOOL BASED CLINIC G
OTHER PUBLIC SECTOR (SPECIFY)________H
NGO OR TRUST HOSPITAL/CLINIC I
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC PRIVATE DOCTOR J
STAND-ALONE ICTC K
PHARMACY L
MOBILE CLINIC M
FIELDWORKER N
SCHOOL BASED CLINIC O
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______P
OTHER SOURCE
HOME Q
CORRECTIONAL FACILITY R
OTHER (SPECIFY) ________X

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Lesotho 2009
Survey form view entire document:  text 
928 Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PVT HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PVT DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
COMMUNITY HEALTH WORKER/SUPPORT GROUPS K
OTHER X

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Lesotho 2014
Survey form view entire document:  text 
930) Do you know of a place where people can go to get tested for HIV?

YES 1
NO 2 (GO TO 931A)

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 ____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
FAMILY PLANNING CLINIC D
OTHER PUBLIC SECTOR (SPECIFY) ____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
LESOTHO PLANNED PARENTHOOD I
PSI/NEW START CENTER J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ K
CHAL
CHAL HOSPITAL L
CHAL HEALTH CENTER M
CHAL HEALTH POST N
RED CROSS HEALTH CENTER O
VILLAGE HEALTH WORKER P
SUPPORT GROUPS Q
FACILITY OUTSIDE OF LESOTHO R
OTHER (SPECIFY) ____ X

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Madagascar 2003
Survey form view entire document:  text 
816F. Where can you go for this test?
816FX. Where did you go for this test?
RECORD ALL MENTIONED.

IF IT'S A HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE_________
PUBLIC SECTOR
DISTRICT HOSPITAL II [FACILITY EQUIPPED FOR SURGERIES] A
DISTRICT HOSPITAL I [NON-SURGICAL MEDICAL CAPABILITIES] B
BASIC HEALTH CENTER II [BASIC HEALTH CARE, PHYSICIAN-RUN] C
BASIC HEALTH CENTER I [BASIC HEALTH CARE, RUN BY PARA-MEDICAL OFFICER] D
OTHER PUBLIC (SPECIFY) _____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PIF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER LOCATION
VBC AGENT L
STORE M
KIOSK N
TRADITIONAL HEALER O
OTHER (SPECIFY) _____ X

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Mali 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
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERRAL HEALTH CENTER (CSREF) C
FREE CLINIC/MATERNITY D
COMMUNITY HEALTH CENTER (CSCOM) E
PUBLIC VOLUNTEER TESTING CENTER F
SCHOOL BASED CLINIC G
OTHER PUBLIC_______ (SPECIFY) H
PRIVATE SECTOR
PRIVATE CLINIC/HOSPITAL I
PRIVATE HEALTH CARE PRACTICE J
TREATMENT ROOM K
INDEPENDENT VOLUNTEER TESTING CENTER L
PHARMACY M
COMMUNITY BASED AGENT N
SCHOOL BASED CLINIC O
OTHER PRIVATE______ (SPECIFY) P
OTHER SOURCE
HOME (RESPONDENT'S HOME) Q
MILITARY CAMP R
OTHER_________ (SPECIFY) X

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Namibia 2013
Survey form view entire document:  text 
931) Where is that? (4)

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ M
OTHER (SPECIFY)____ X

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Nigeria 2008
Survey form view entire document:  text 
928 Where is that? (4)
Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC (SPECIFY) _________ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER 2I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
OTHER (SPECIFY) ___________ X

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Nigeria 2013
Survey form view entire document:  text 
931) Where is that? (4)

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ M
OTHER (SPECIFY)____ X

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Senegal 2005
Survey form view entire document:  text 
830. Where is this?
Is there another place?
RECORD ALL PLACES MENTIONED.

IF THE PLACE IS A HOSPITAL, HEALTH CENTER OR CLINIC, RECORD 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
PLANNING FAMILY CENTER C
TESTING CENTER D
STRAT. AVANCÉE/EQU. MOBLI E
HEALTH CARE WORKER F
OTHER PUBLIC (SPECIFY) _____G
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE H
PHARMACY I
PRIVATE DOCTOR J
HEALTH CARE WORKER K
OTHER PRIVATE (SPECIFY) _____L
OTHER (SPECIFY) _____X

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Tanzania 1996
Survey form view entire document:  text 
841. Where could you go?
841A. Where did you go?

GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTRE C
DISPENSARY/PARASTATAL FACILITY D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY F
PRIV. DOCTOR/CLINIC/HOSPITAL G
PHARMACY/MEDICAL STORE H
CBD WORKER I
OTHER PRIVATE SECTOR
SHOP J
CHURCH K
FRIENDS/RELATIVES/NEIGHBORS L
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

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Uganda 1995
Survey form view entire document:  text 
835) Where could you go?

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
DISPENSARY/HEALTH UNIT C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ________ L
OTHER PRIVATE SECTOR
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _________ X
DOES NOT KNOW Z

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Uganda 2016
Survey form view entire document:  text 
1032) Where is that? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIBATE SECTOR, WRITE THE NAME OF THE PALCE.

(NAME OF PLACE) ___________

PUBLIC SETOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE VCT SERICES D
COMMUNITY HEALTH WORKER/VH E
OTHER PUBLIC SECTOR (SPECIFY)_______F
PRIVATE MEDICAL SECTOR
PRIVATE GISOURAK/CLINIC/PRIVATE DOCTOR G
PHARMACY/DRUG SHOP H
MEBILE VCT SERVICES I
COMMUNITY HEALTH WORKER J
OTHER PRIVAT MEDICAL SECTOR (SPECIFY) _____K
OTHER (SPECIFY) ______X

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Zambia 2007
Survey form view entire document:  text 
928. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). 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(S)) ___________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
COMMUNITY/FIELDWORKER F
OTHER PUBLIC (SPECIFY) ______ G

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
MISSION HOSPITA/CLINIC I
STAND-ALONE VCT CENTER J
MOBILE CLINIC K
COMMUNITY/FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER (SPECIFY) _______________ X

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Zambia 2013
Survey form view entire document:  text 
930) Do you know of a place where people can go to get tested for the AIDS virus?

YES 1
NO 2 (GO TO 932)

931) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT CENTER/POST B
STAND-ALONE VCT CENTRE C
FAMILY PLANNING CLINIC D
MOBILE HOSPITAL/CLINIC E
COMMUNITY BASED AGENT/FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY) __________________G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
MISSION HOSPITAL/CLINIC I
STAND-ALONE VCT CENTRE J
MOBILE HOSPITAL/CLINIC K
COMMUNITY BASED AGENT/FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________________ M
OTHER SOURCE
PRISON N
OTHER (SPECIFY) _________________________X