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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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Angola 2015

Survey form view entire document: text

1031) Do you know of any place where people can go to get an HIV test done?

YES 1
NO 2 (GO TO 1033)

1032) Where?
Any other place?
MULTIPLE CHOICES
PROBE TO IDENTIFY THE PLACE.
IF IT IS NOT POSSIBLE TO DETERMINE IF THE PLACE IS PUBLIC OR PRIVATE, RECORD THE NAME OF THE PLACE.

(NAME OF PLACE)____

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
REGIONAL HOSPITAL B
MUNICIPAL HOSPITAL C
CATV (Office for Advice and Voluntary Testing of HIV/AIDS) D
HEALTH CENTER E
PTV F
OTHER PUBLIC: (SPECIFY)____ G

PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
CATV I
PHARMACY J
OTHER PRIVATE: (SPECIFY)____ K

OTHER: (SPECIFY)____ 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

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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Benin 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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Benin 2017

Survey form view entire document: text

1032) 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

Govt. Hospital A
Govt. Health Center B
Stand-Alone HTC Center C
Family planning clinic D
Mobile HTC Services E

Other public sector (specify) F

Private medical sector

Private hospital/clinic G
Stand-Alone HTC Center H
Pharmacy I
Mobile HTC Services J

Other private medical (specify) K

Other (specify) X

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Burkina Faso 2010

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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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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Burundi 2016

Survey form view entire document: text

1032) 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 GOVERNMENT HOSPITAL A
REGIONAL GOVERNMENT HOSPITAL B
DISTRICT HOSPITAL C
GOVERNMENT HEALTH CENTER D
INDEPENDENT TESTING CENTER E
MOBILE TESTING SERVICE F
SCHOOL CLINIC G
OTHER_____________H

CERTIFIED MEDICAL SECTOR

CERTIFIED HOSPITAL I
CERTIFIED HEALTH CENTER J
OTHER PRIVATE MEDICAL___________K

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/DOCTOR L
PRIVATE HEALTH CARE CENTER M
SCHOOL CLINIC N
INDEPENDENT TESTING CENTER O
PHARMACY P
MOBILE TESTING SERVICE Q
OTHER PRIVATE MEDICAL__________ R

OTHER___________X

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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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Chad 2004

Survey form view entire document: text

816l) Where can you go for this test?
ANYWHERE ELSE?
RECORD ALL MENTIONED

PUBLIC SECTOR

TESTING CENTER A [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC/GARRISON D
NATIONAL PROGRAM FIGHTING AIDS (PNLS) E [##TRANSLATOR NOTE: THIS IS AN OFFICIAL LOCATION NAME]
POLYCLINIC F
HOSPITAL/HEALTH CENTER PHARMACY G
OTHER PUBLIC H

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL I
CLINIC/OFFICE J
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING K
PRIVATE HEALTH CENTER L
COMPANY HEALTH CENTER M
CARE OFFICE/NURSE N
PHARMACY/PHARMACY DEPOT O
OTHER PRIVATE MEDICAL P

PUBLIC/PRIVATE SECTOR

VILLAGE PHARMACY/HEALTH CENTER Q

OTHER PLACE X

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Chad 2014

Survey form view entire document: text

931) Where is that?
PROBE TO IDENTIFY THE TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE
ANY OTHER PLACE?
RECORD ALL MENTIONED

NAME OF PLACE(S)___________

PUBLIC SECTOR

VOLUNTARY TESTING CENTER A
HOSPITAL/MATERNITY B
MILITARY HOSPITAL/GARRISON C
HEALTH CENTER/FREE CLINIC D
SECTOR-SPECIFIC PROGRAM FOR THE FIGHT AGAINST AIDS E
POLYCLINIC F
PHARMACY OF HOSPITAL/HEALTH CENTER G
AL NADJMA CENTER [##TRANSLATOR NOTE: HIV/AIDS TESTING CENTER] H
OTHER PUBLIC SECTOR (SPECIFY) I

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL J
CLINIC/DOCTOR'S OFFICE K
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING L
PRIVATE HEALTH CENTER M
BUSINESS HEALTH CENTER N
CARE OFFICE/INFIRMARY O
PHARMACY/PHARMACY DEPOT P
CHADIAN SOCIAL MARKETING ASSOCIATION Q
DIOCESAN CENTER FOR MEDICAL ACTION (CEDIAM) R
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) S

PUBLIC/PRIVATE SECTOR

PHARMACY/VILLAGE HEALTH CENTER T
COMMUNITY VOLUNTEER TESTING CENTER U
OTHER (SPECIFY) X

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Congo (Democratic Republic) 2007

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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Congo (Democratic Republic) 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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Congo Brazzaville 2005

Survey form view entire document: text

830) Where is that? Any other place?
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR

HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
NATIONAL LABORATORY C
ANONYMOUS VOLUNTEER SCREENING CENTER D

PRIVATE MEDICAL SECTOR

CLINIC E
PRIVATE DOCTOR'S OFFICE F
LABORATORY G
MEDICAL-SOCIAL CENTER H
CONGOLESE ASSOCIATION FOR FAMILY WELL-BEING I

OTHER PLACE X

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Congo Brazzaville 2011

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.

PUBLIC SECTOR

HOSPITAL A
INTEGRATED HEALTH CENTER B
NATIONAL LABORATORY C
VOLUNTARY ANONYMOUS TESTING CENTER D

PRIVATE MEDICAL SECTOR

CLINIC E
DOCTOR'S OFFICE F
LABORATORY G

OTHER PLACE (SPECIFY) _____ X

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Cote d'Ivoire 1994

Survey form view entire document: text

914) Where can one go to get tested for AIDS?
RECORD ALL MENTIONED.

PUBLIC SECTOR

PUBLIC HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B

PRIVATE MEDICAL SECTOR

CLINIC/PRIVATE NURSE C
PHARMACY D

OTHER (SPECIFY)____ E
DON'T KNOW F

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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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Egypt 2005

Survey form view entire document: text

1120) Where is that?

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

Any other place?
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) _______________________

GOVERNMENT

GOVERNMENT HOSPITAL A
GOVT. HEALTH UNIT B
VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
OTHER GOVT (SPECIFY) __________ F

NON GOVERNMENTAL (SPECIFY) ___________ G

PRIVATE MEDICAL

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY) _________ J

OTHER NON-MEDICAL (SPECIFY) __________ X

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Egypt 2014

Survey form view entire document: text

1011. Do you know of place where people can go to get tested for the virus that causes AIDS?

YES 1
NO 2
DON'T KNOW 8

1012. Where is that?

IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND ADDRESS OF THE PLACE. PROBE

GOVERNMENT

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH UNIT B
VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
STANDALONE GOVERNMENT LABORATORY F
OTHER GOVERNMENT (SPECIFY)_____________G
NON GOVERNMENTAL (SPECIFY)______________H

PRIVATE MEDICAL

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
PHARMACY J
STANDALONE PRIVATE LABORATORY K
OTHER PRIVATE MEDICAL (SPECIFY)______________L

OTHER NON-MEDICAL (SPECIFY)_________________X

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Eswatini (Swaziland) 2006

Survey form view entire document: text

930) 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)__________

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
PHU/CLINIC D
MOBILE CLINIC E
OTHER PUBLIC (SPECIFY) ________F

PRIVATE SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR G
STAND-ALONE VCT CENTER H
MOBILE CLINIC I
OTHER PRIVATE (SPECIFY) _________J

MISSION

HOSPITAL K
CLINIC L
OTHER (SPECIFY) ________M

NGO

FLAS N
TASC O
OTHER NGO P
(SPECIFY)_________X

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Ethiopia 2005

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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Ethiopia 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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Ghana 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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Ghana 2014

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

top

Guinea 2005

Survey form view entire document: text

830. Where is that?
Any other place?
RECORD ALL PLACES MENTIONED.

IF SOURCE IS HOSPITAL 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

NATIONAL REFERENCE LAB A
CHU B [note: some type of public health facility, meaning unclear]
REGIONAL HOSPITAL C
HOSPITAL D [note: the original shows "hospital pref.", the "pref." portion may mean preferential or preferred; again, this is some type of public hospital]
CMC F [note: some type of public health facility, meaning unclear]
OTHER PUBLIC (SPECIFY) _____ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE LABORATORY I
OTHER PRIVATE MEDICAL (SPECIFY) _____ J

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

top

Guinea 2018

Survey form view entire document: text

1032) 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
PREFECTURAL HOSPITAL/COMMUNAL MEDICAL CENTER C
HEALTH CENTER D
HEALTH POST/CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
PRIVATE HEALTH CLINIC J
FAMILY PLANNING CLINIC/GUINEAN ASSOCIATION FOR FAMILY WELL-BEING K

OTHER PRIVATE MEDICAL (SPECIFY) L

OTHER (SPECIFY) X

top

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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Jordan 2007

Survey form view entire document: text

911) 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, VOLUNTARY COUNSELING AND TESTING CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _______________________

PUBLIC MEDICAL SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT MOTHER AND CHILD HEALTH CENTER C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNSELING CENTER F
OTHER PUBLIC (SPECIFY)_____________ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
JORDANIAN ASSOCIATION OF FAMILY PLANNING AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOVERNMENT ORGANIZATION L
OTHER PRIVATE MEDICAL (SPECIFY)________ M

OTHER (SPECIFY)________________ X

Survey form view entire document: text

911) 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, VOLUNTARY COUNSELING AND TESTING CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _______________________

PUBLIC MEDICAL SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT MOTHER AND CHILD HEALTH CENTER C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNSELING CENTER F
OTHER PUBLIC (SPECIFY)_____________ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
JORDANIAN ASSOCIATION OF FAMILY PLANNING AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOVERNMENT ORGANIZATION L
OTHER PRIVATE MEDICAL (SPECIFY)________ M

OTHER (SPECIFY)________________ X

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Jordan 2012

Survey form view entire document: text

911. 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 MEDICAL SECTOR

GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNCELING CENTER F
OTHER PUBLIC (SPECIFY) _____ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOV. ORGANIZATION L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M

OTHER (SPECIFY) _____ X

Survey form view entire document: text

911. 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 MEDICAL SECTOR

GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNCELING CENTER F
OTHER PUBLIC (SPECIFY) _____ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOV. ORGANIZATION L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M

OTHER (SPECIFY) _____ X

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Jordan 2017

Survey form view entire document: text

1032) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURSE.
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 MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNCELING CENTER F
OTHER PUBLIC SECTOR (SPECIFY) ______________G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOV. ORGANIZATION L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________________ M

OTHER (SPECIFY) ___________________ X

Survey form view entire document: text

1032) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURSE.
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 MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
TESTING AND COUNCELING CENTER F
OTHER PUBLIC SECTOR (SPECIFY) ______________G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
PRIVATE LABORATORY K
OTHER NON GOV. ORGANIZATION L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ___________________ M

OTHER (SPECIFY) ___________________ X

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Kenya 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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Kenya 2014

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

top

Liberia 2007

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

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
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
STAND-ALONE VCT CENTER D
NACP E
OTHER PUBLIC (SPECIFY) ____________ F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
FAMILY PLANNING ASSN. LIBERIA K
MOBILE CLINIC L
OTHER PRIVATE MEDICAL (SPECIFY) _____________ M

OTHER SOURCE

SHOP N
OTHER (SPECIFY) ________ X

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Liberia 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

Survey form view entire document: text

931. Where is that? (4)
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

GOVERNMENT HOSPITAL A
GOVERNMENT 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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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

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

top

Madagascar 2008

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 A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _____

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 PLACE (SPECIFY) ______ E

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K

OTHER (SPECIFY) ______ X

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 A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _____

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 PLACE (SPECIFY) ______ E

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PF/FISA CENTER J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K

OTHER (SPECIFY) ______ X

top

Malawi 2010

Survey form view entire document: text

1333. 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
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
HSA D
DOOR TO DOOR E
OTHER PUBLIC F

CHAM/MISSION

HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
DOOR TO DOOR J

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
PRIVATE COMPANY HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL M

BLM N
MACRO O
OTHER X

THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS.

top

Malawi 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 PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
HSA D
DOOR TO DOOR E
OTHER PUBLIC SECTOR (SPECIFY) F

CHAM/MISSION

HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
DOOR TO DOOR J

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR K
PHARMACY L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M

BLM N
MACRO O

OTHER SOURCE

HOME P
WORKPLACE Q
CORRECTIONAL FACILITY R

OTHER (SPECIFY) X

top

Mali 2006

Survey form view entire document: text

830. Where is this?
Is there another place?

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

RECORD ALL PLACES MENTIONED.

PLACE NAME___

PUBLIC SECTOR

NATIONAL REF LAB A
NATIONAL HOSPITAL B
REGIONAL HOSPITAL C
CSREF (heath referral center) D
CSCOM (Centre de Santé Communitaire) Community Health Center F
OTHER PUBLIC (SPECIFY) __G

PRIVATE MEDICAL SECTOR

CESAC (AIDS treatment center in Mali) H
VCT I
OTHER PRIVATE MEDICAL (SPECIFY) __J

OTHER (SPECIFY) __X

top

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

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

top

Mali 2018

Survey form view entire document: text

1032) 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

GOVT. HOSPITAL 11
GOVT. HEALTH CENTER 12
STAND-ALONE HTC CENTER 13
MOBILE HTC SERVICES 14
OTHER PUBLIC SECTOR (SPECIFY) 16

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/DOCTOR 21
STAND-ALONE HTC CENTER 22
MOBILE HTC SERVICES 23
OTHER PRIVATE MEDICAL (SPECIFY) 26

OTHER (SPECIFY) 96

top

Myanmar 2015

Survey form view entire document: text

929) Where was the test done? 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 (RHC) 12
GOVT. HEALTH POST (SUB-CENTER) 13
STAND-ALONE VCT CENTER 14
FAMILY PLANNING CLINIC 15
MOBILE CLINIC 16
FIELDWORKER 17
SCHOOL BASED CLINIC 18
OTHER PUBLIC SECTOR____(SPECIFY) 19

NGO

MARIE STOPES 21
MYANMAR RED CROSS SOCIETY 22
PSI/M (SUN) 23
MMA 24
OTHER NGO SECTOR___(SPECIFY) 26

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR 31
STAND-ALONE VCT CENTER 32
PHARMACY 33
MOBILE CLINIC 34
DIAGNOSTIC LABORATORY 35
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) 36

OTHER SOURCE

HOME 41
CORRECTIONAL FACILITY 42

OTHER___(SPECIFY) 96

top

Namibia 2006

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/CLINIC B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
PHC CLINIC (MOBILE) E
COMM. HEALTH WORKER F
OTHER PUBLIC (SPECIFY) _____ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K

OTHER (SPECIFY) ____ X

top

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

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) __________

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
STAND-ALONE VCT CENTER C
GVT. PRIMARY HEALTH CARE CLINIC D
OUTREACH POINT E
MOBILE CLINIC F
SCHOOL BASED CLINIC G
OTHER PUBLIC SECTOR (SPECIFY __________) H

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLNIC/PRIVATE DOCTOR I
STAND-ALONE VCT CENTER J
PHARMACY K
MOBILE CLNIC L
FIELDWORKER M
SCHOOL BASED CLINIC N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY __________) O

OTHER SOURCE

HOME P
CORRECTIONAL FACILITY Q

OTHER (SPECIFY __________) X

top

Nepal 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 PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE __

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE CENTER B
OTHER PUBLIC FACILITIES (SPECIFY) ___ D

NON-GOVT. (NGO) SECTOR

FPAN E
MARIE STOPES F
OTHER NGO FACILITIES (SPECIFY) ___ G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
PRIVATE CLINIC I
STAND-ALONE HTC/VCT CENTER J
PHARMACY K
MOBILE HTC/VCT SERVICES L
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ M

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)

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)

top

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

top

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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Pakistan 2012

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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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Pakistan 2017

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1032) Where is that? Any other place?
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
GOVERNMENT HEALTH CENTER B
STAND-ALONE HTC CENTER C
OTHER PUBLIC SECTOR (SPECIFY) _________ D

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR E
STAND-ALONE HTC CENTER F
PHARMACY G
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______ H

OTHER (SPECIFY) _______ X

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Rwanda 2000

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817F. Where can you go for this test?
817FX. Where did you go for this test?

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

RECORD ALL MENTIONED

NAME OF PLACE____

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)_____F

PRIVATE MEDICAL SECTOR

PRIVATE CLINIC/HOSPITAL G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)_____ L

OTHER SOURCE

SHOP M
CHURCH N
RELATIVES/FRIENDS O

OTHER (SPECIFY)_____ X

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Rwanda 2005

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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Rwanda 2010

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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/AGREE SECTOR

REFERAL HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) G

PRIVATE MEDICAL SECTOR

POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) M

OTHER SOURCE

KIOSK N
TRADITIONAL BIRTH ATTENDANT O
FRIEND/RELATIVE P
CORRECTIONAL FACILITY Q

OTHER (SPECIFY) X

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Rwanda 2014

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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/AGREE SECTOR

REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G

PRIVATE MEDICAL SECTOR

POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M

OTHER SOURCES

KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
CORRECTIONAL FACILITY R

OTHER (SPECIFY) ____ X

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Senegal 2017

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1017) Where was the test done?

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

GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
VOLUNTARY TESTING CENTER 18
MOBILE CLINIC 19
OTHER PUBLIC SECTOR (SPECIFY) _____ 20

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
PRIVATE DOCTOR 23
RELIGIOUS FREE CLINIC 24
PRIVATE LABORATORY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26

OTHER SOURCE

SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____ 96

Survey form view entire document: text

1017) Where was the test done?

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

GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
VOLUNTARY TESTING CENTER 18
MOBILE CLINIC 19
OTHER PUBLIC SECTOR (SPECIFY) _____ 20

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/OFFICE 21
PHARMACY 22
PRIVATE DOCTOR 23
RELIGIOUS FREE CLINIC 24
PRIVATE LABORATORY 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 26

OTHER SOURCE

SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____ 96

top

South Africa 2016

Survey form view entire document: text

1032) Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO IDENTIFY IF PUBLIC OR PRIVATE SECTOR, RECORD 'X' AND WRITE THE NAME OF THE PLACE(S).

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT CLINIC/COMMUNITY HEALTH CENTRE B
MOBILE/TEMPORARY HCT SERVICES C
OTHER PUBLIC SECTOR (SPECIFY) _________ D

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR E
NEW START CENTRE F
CHEMIST/PHARMACY G
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ H

OTHER (SPECIFY) _________ X

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Tanzania 1996

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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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Tanzania 2010

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 SECTOR, WRITE THE NAME OF THE PLACE. WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ___________

GOVERNMENT/PARASTATAL

REFERAL/SPEC. HOSPITAL A
REGIONAL HOSPITAL B
DISTRICT HOSPITAL C
HEALTH CENTRE D
DISPENSARY E
VILLAGE HEALTH POST F
CBD WORKER G

RELIGIOUS/VOLUNTARY

REFERAL/SPEC. HOSPITAL H
DISTRICT HOSPITAL I
GOVT. HEALTH CENTRE J
DISPENSARY K

PRIVATE

HOSPITAL L
HEALTH CENTRE M
DISPENSARY N

OTHER

PRIVATE PHARMACY O
NGO P
VCT CENTRE Q

OTHER (SPECIFY) ________________________ X

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Togo 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- (SKIP TO 932)

931) Where is that?
Any other place?

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
STAND-ALONE VCT CENTER B
HEALTH CENTER C
DISPENSARY D
MOTHER-INFANT PROTECTION E
MOBILE CLINIC F
SCHOOL BASED CLINIC G
OTHER PUBLIC SECTOR_______ (SPECIFY) H

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC I
PRIVATE DOCTOR'S OFFICE J
PHARMACY K
SCHOOL BASED CLINIC L
NGO/ASSOCIATION M
OTHER PRIVATE MEDICAL SECTOR________ (SPECIFY) N

OTHER__________ (SPECIFY) X

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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

top

Uganda 2006

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

top

Uganda 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

top

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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Yemen 2013

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 THE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____

GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E

PRIVATE SECTOR

(PRIVATE HOSPITAL/CLINIC/DISPENSARY/DOCTOR'S OFFICE) F

NON GOVERNMENT ORGANIZATIONS

(HOSPITAL/CLINIC/DISPENSARY/PRIVATE DOCTOR'S OFFICE, MOBILE CLINIC) G

OTHER (SPECIFY) ____ X

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 THE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____

GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E

PRIVATE SECTOR

(PRIVATE HOSPITAL/CLINIC/DISPENSARY/DOCTOR'S OFFICE) F

NON GOVERNMENT ORGANIZATIONS

(HOSPITAL/CLINIC/DISPENSARY/PRIVATE DOCTOR'S OFFICE, MOBILE CLINIC) G

OTHER (SPECIFY) ____ X

top

Zambia 2007

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

top

Zambia 2018

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 PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) _____________________

PUBLIC SECTOR

GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES E
OTHER PUBLIC SECTOR (SPECIFY) __________________________ F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/ PRIVATE DOCTOR G
MISSION HOSPITAL/CLINIC H
STAND-ALONE HTC CENTER I
PHARMACY J
MOBILE HTC SERVICES K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________________ L
OTHER (SPECIFY) __________________ X

top

Zimbabwe 2005

Survey form view entire document: text

935) Where is that?

RECORD ALL SOURCES MENTIONED

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(S) __________

Any other places?

PUBLIC SECTOR

CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT/RURAL HOSPITAL C
RURAL HEALTH CENTER D
MUNICIPAL CLINIC E
OTHER PUBLIC (SPECIFY) __________ F

MISSION FACILITY G

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC H
NEW START CENTER I
OTHER PRIVATE VCT CENTER (SPECIFY) __________ J
OTHER PRIVATE DOCTOR (SPECIFY) __________ K

OTHER (SPECIFY) __________ X

top

Zimbabwe 2010

Survey form view entire document: text

931) Where is that? Any other place?

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

CENTRAL HOSPITAL A
PROVINCIAL HOSPITAL B
DISTRICT HOSPITAL C
RURAL HOSPITAL D
RURAL HEALTH CENTER/COUNCIL CLINIC E
URBAN MUNICIPAL CLINIC F
FAMILY PLANNING CLINIC G
OTHER PUBLIC SECTOR (SPECIFY) H

MISSION HOSPITAL/CLINIC I

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR J
NEW START CENTRE K
OTHER PRIVATE VCT CENTRE (SPECIFY) L

OTHER SOURCE

MOBILE VCT M

OTHER (SPECIFY) X

top

Zimbabwe 2015

Survey form view entire document: text

1031. Do you know of a place where people can go to get an HIV test?

YES 1
NO 2 (GO TO 1033)

Afghanistan 2015	Egypt 2005	Madagascar 2003	Rwanda 2010
Angola 2015	Egypt 2014	Madagascar 2008	Rwanda 2014
Benin 2001	Eswatini (Swaziland) 2006	Malawi 2010	Senegal 2017
Benin 2006	Ethiopia 2005	Malawi 2016	South Africa 2016
Benin 2011	Ethiopia 2011	Mali 2006	Tanzania 1996
Benin 2017	Ghana 2008	Mali 2012	Tanzania 2010
Burkina Faso 2010	Ghana 2014	Mali 2018	Togo 2013
Burundi 2010	Guinea 2005	Myanmar 2015	Uganda 1995
Burundi 2016	Guinea 2012	Namibia 2006	Uganda 2006
Cameroon 2011	Guinea 2018	Namibia 2013	Uganda 2011
Chad 2004	India 2015	Nepal 2016	Uganda 2016
Chad 2014	Jordan 2007	Niger 2012	Yemen 2013
Congo (Democratic Republic) 2007	Jordan 2012	Nigeria 2008	Zambia 2007
Congo (Democratic Republic) 2013	Jordan 2017	Nigeria 2013	Zambia 2018
Congo Brazzaville 2005	Kenya 2008	Pakistan 2012	Zimbabwe 2005
Congo Brazzaville 2011	Kenya 2014	Pakistan 2017	Zimbabwe 2010
Cote d'Ivoire 1994	Liberia 2007	Rwanda 2000	Zimbabwe 2015
Cote d'Ivoire 2011	Liberia 2013	Rwanda 2005

Survey Text