Survey Text

Ghana 2003 Malawi 2000 Namibia 2000 Zambia 2001
Kenya 2003 Malawi 2004 Nigeria 2003
Lesotho 2004 Mali 2001 Rwanda 2000
Madagascar 2003 Mozambique 2003 Tanzania 2004
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Ghana 2003
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816F. Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.

816FX Where did you go for the 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
GOVT. HOSPITAL/POLYCLINIC 11
GOVT. HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PRIVATE DOCTOR 22
PHARMACY/CHEMIST/DRUG STORE 23
MOBILE CLINIC 24
FIELDWORKER 25
FP/PPAG CLINIC 26
MATERNITY HOME 27
OTHER PRIVATE MEDICAL (SPECIFY) ____ 28
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) _____ 96

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Kenya 2003
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816F. Where can you go for the test?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTRE/CLINIC 12
GOVERNMENT DISPENSARY 13
OTHER PUBLIC (SPECIFY) ______ 16
PRIVATE MEDICAL SECTOR
MISSION/CHURCH HOSP. CLINIC 21
FPAK HEALTH CENTRE/CLINIC 22
PRIVATE HOSPITAL/CLINIC 23
VCT CENTRE 24
NURSING/MATERNITY HOME 26
BLOOD TRANSFUSION SERVICE 31
OTHER (SPECIFY) ______ 96

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Lesotho 2004
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826 Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.
826A Where did you go for the 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 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
OTHER PUBLIC __________(SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL _____________(SPECIFY) 26
CHAL
CHAL HOSPITAL 31
CHAL HEALTH CENTER 32
CBD 41
COMMUNITY HEALTH WORKER 42
SUPPORT GROUPS 43
OTHER SOURCE
SHOP 51
CHURCH 52
FRIENDS/RELATIVES 53
OTHER ______________(SPECIFY) 96

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Madagascar 2003
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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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Malawi 2000
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817F. Where can you go for the test?
817FX. Where did you go for the 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 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) _____ 16
MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PRIVATE DOCTOR 32
MOBILE CLINIC 33
OTHER PRIVATE MEDICAL (SPECIFY) ____ 36
BLM 41
MACRO 51
OTHER (SPECIFY) _____ 96

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Malawi 2004
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816M. Where can you go for the test?

RECORD ONLY FIRST RESPONSE GIVEN.

816MX. Where did you go for the 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 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELDWORKER 35
OTHER PRIVATE MEDICAL (SPECIFY) ____________ 36
BLM 41
MACRO 51
OTHER (SPECIFY) _____ 96

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Mali 2001
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817F. Where can you go for a test for the AIDS virus?
817X Where did you go for this test?

RECORD EVERYTHING MENTIONED.

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

NAME(S) OF PLACE(S) ____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
PMI (protection maternelle et infantile) /MATERNITY D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC (SPECIFY) _____ G
MEDICAL PRIVATE SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
ADBC/DOULA/BIRTH ASSISTANT/HEALTH AIDE O
PARA-PUBLIC SECTOR
INPS/CMIE (NATIONAL INSTITUTE OF SOCIAL FUNDS/INTER-ENTERPRISE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) ____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) ___ X

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Mozambique 2003
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816F. Where is that?

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

NAME OF PLACE__________
PUBLIC SECTOR
CENTRAL HOSPITAL 11
PROVINCIAL/GENERAL HOSPITAL 12
HOSPITAL IN RURAL AREA 13
HEALTH CENTER 14
GATV (Office for Advice and Voluntary Testing of HIV/AIDS) 15
OTHER (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL 21
PRIVATE CLINIC 22
PRIVATE DOCTOR 23
PRIVATE NURSE 24
PRIVATE PHARMACY 25
OTHER PRIVATE MEDICAL (SPECIFY) ____26
OTHER (SPECIFY) ______ 96

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Namibia 2000
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814G. Where can you go for the test?

814H. Where did you go for the test?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THEAPPROPRIATE CODE.
(NAME OF PLACE)

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVT. HEALTH CENTER/CLINIC 12
OTHER PUBLIC (SPECIFY) ____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER SOURCE
BLOOD TRANSFUSION SERVICE 31
OTHER (SPECIFY) ____ 96

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Nigeria 2003
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816F. Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.
816FX. Where did you go for the 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 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
DISPENSARY 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PATENT MEDICINE STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) _______________ 96

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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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Tanzania 2004
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830. Where is that? (3) 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.
RECORD ALL SOURCES MENTIONED.

(NAME OF PLACE) ________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
VILLAGE HEALTH POST (W G
CBD WORKER H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSPITAL J
GOVT. HEALTH CENTRE K
DISPENSARY L
PRIVATE
DISTRICT HOSPITAL M
HEALTH CENTRE N
DISPENSARY O
OTHER
NGO P
VCT CENTRE Q
OTHER (SPECIFY) _______ X

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Zambia 2001
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816K. Where can you go for the test?
RECORD ONLY FIRST RESPONSE GIVEN.
816KX. Where did you go for the 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 11
GOVERNMENT HEALTH CENTER 12
GOVERNMENT HEALTH POST 13
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY 21
MISSION HOSPITAL 22
PHARMACY 23
PRIVATE DOCTOR 24
WORK PLACE 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26