Survey Text

Burkina Faso 2003
Chad 2014
Congo (Democratic Republic) 2007
Madagascar 2003
Madagascar 2008
Mali 2006
Tanzania 2010
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Burkina Faso 2003
Survey form view entire document:  text 
330. Where is that?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL 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
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
MEDICAL POST D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PRIVATE HEALTH CENTER F
PHARMACY/MEDICINE DISPENSARY G
PRIVATE DOCTOR H
PF/FISA CENTER I
OTHER SOURCE
DBC AGENT J
STORE K
KIOSK L
CHURCH M
RELATIVES/FRIENDS N
OTHER (SPECIFY) ______ X

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Chad 2014
Survey form view entire document:  text 
325) WHERE IS THAT?
ANY OTHER PLACE?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))_______________
PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/DOCTOR'S OFFICE H
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING I
PRIVATE HEALTH CENTER J
BUSINESS HEALTH CENTER K
CARE OFFICE/INFIRMARY L
PHARMACY/PHARMACY DEPOT M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
PUBLIC/PRIVATE SECTOR
PHARMACY/VILLAGE HEALTH CENTER O
OTHER
SHOP/BAR/MARKET P
FIRST AID WORKER Q
TRAVELING VENDOR R
FRIENDS/NEIGHBORS/RELATIVES S
OTHER (SPECIFY) X

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Congo (Democratic Republic) 2007
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329) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 331)

330) Where is this?

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) __________

Another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
CLINIC B
HEALTH OUTPOST/CENTER C
MATERNITY CENTER D
OTHER PUBLIC (SPECIFY) ____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/POLYCLINIC G
PHARMACY H
AMO-CONGO I
HEALTH CENTER J
MEDICAL OFFICE K
PRIVATE DOCTOR L
TRAVELLING NURSE M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) ____ 0
OTHER SOURCE
SHOP P
CHURCH Q
RELATIVES/FRIENDS R
OTHER (SPECIFY) ____ X

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Madagascar 2003
Survey form view entire document:  text 
330. Where is that?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL 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
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PRIVATE HEALTH CENTER F
PHARMACY/MEDICINE DISPENSARY G
PRIVATE DOCTOR H
PF/FISA CENTER I
OTHER SOURCE
VBC AGENT J
STORE K
KIOSK L
CHURCH M
RELATIVES/FRIENDS N
OTHER (SPECIFY) ______ X

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Madagascar 2008
Survey form view entire document:  text 
333. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 335)

334. 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 OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

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
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PRIVATE MOBILE CLINIC F
PHARMACY G
PRIVATE DOCTOR H
FAMILY PLANNING CENTER I
OTHER SOURCE
FIELDWORKER J
STORE K
KIOSK L
CHURCH M
FRIEND/RELATIVE N
OTHER (SPECIFY) ______ X

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Mali 2006
Survey form view entire document:  text 
330. Where is this place? Any other place?

IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

RECORD ALL PLACES MENTIONED.

NAME OF ESTABLISHMENT__
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
MATERNITY D
CSCOM (Centre de Santé Communitaire) Community Health Center E
OTHER PUBLIC (SPECIFY)__F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
DOCTOR'S OFFICE H
HEALTH WARD I
PHARMACY J
MOBILE CLINIC K
OTHER PRIVATE (SPECIFY)__L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
AMBULENT SALESPERSON P
ADBC AGENTS DE DISTRIBUTION À BASE COMMUNAUTAIRE (MOBILE COMMUNITY HEALTH DISTRIBUTION Q
FRIEND/ACQUAINTANCE/RELATIVE R
OTHER (SPECIFY)__X

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Tanzania 2010
Survey form view entire document:  text 
324. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 326)

325. 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) _________
GOVERNMENT/PARASTATAL
REFERRAL/SPEC.HOSPITAL A
REGIONALHOSPITAL B
DISTRICTHOSPITAL C
HEALTHCENTRE D
DISPENSARY E
VILLAGEHEALTHPOST F
CBDWORKER G
RELIGIOUS/VOLUNTARY
REFERAL/SPEC.HOSPITAL H
DISTRICTHOSPITAL I
HEALTHCENTRE J
DISPENSARY K
PRIVATE
HOSPITAL L
HEALTHCENTRE M
DISPENSARY N
OTHER
PHARMACY O
NGO P
VCTCENTRE Q
SHOP/KIOSK R
BAR S
GUESTHOUSE/HOTEL T
FRIEND/RELATIVE/NEIGHBOUR U
OTHER (SPECIFY) __________ X