Survey Text

Bangladesh 2004
Bangladesh 2007
India 2005
Mali 2001
Morocco 2003
Mozambique 2011
Namibia 2000
Namibia 2006
Pakistan 2006
Pakistan 2012
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Bangladesh 2004
Survey form view entire document:  text 
330) Where is that?

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.

Any other place?

RECORD ALL PLACES MENTIONED.

NAME OF PLACE: _________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY): ___________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY): __________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY): __________ X

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Bangladesh 2007
Survey form view entire document:  text 
323) 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 OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____
PUBLIC SECTOR
HOSPITAL/MEDICAL COLLEGE A
FAMILY WELFARE CENTRE B
UPAZILA HEALTH COMPLEX C
SATELLITE CLINIC/EPI OUTREACH D
MATERNAL AND CHILD WELFARE CENTRE (MCWC) E
GOVERNMENT FIELD WORKER (FWA) F
COMMUNITY CLINIC G
OTHER (SPECIFY)____ H
NGO SECTOR
NGO STATIC CLINIC I
NGO SATELLITE CLINIC J
NGO DEPOT HOLDER K
NGO FIELD WORKER (FWA) L
OTHER (SPECIFY)____ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC N
QUALIFIED DOCTOR O
TRADITIONAL DOCTOR P
PHARMACY Q
OTHER PRIVATE MEDICAL (SPECIFY)____ R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
OTHER (SPECIFY)____ X

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India 2005
Survey form view entire document:  text 
355. Where is that?
Any other place?

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

NAME OF PLACE(S) ________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSPITAL/PHC D
SUB-CENTRE/ANM E
GOVT. MOBILE CLINIC F
CAMP G
ANGANWADI/ICDS CENTRE H
ASHA I
OTHER COMMUNITY-BASED WORKER J
OTHER PUBLIC MEDICAL SECTOR K
NGO OR TRUST HOSPITAL/CLINIC L
PRIVATE MEDICAL SECTOR
PVT. HOSPITAL M
PVT. DOCTOR/CLINIC N
PVT. MOBILE CLINIC O
VAIDYA/HAKIM/HOMEOPATH P
TRADITIONAL HEALER Q
PHARMACY/DRUGSTORE R
DAI (TBA) S
OTHER PRIVATE MEDICAL SECTOR T
OTHER SOURCE
SHOP U
FRIEND/RELATIVE V
OTHER (SPECIFY) _______ X

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Mali 2001
Survey form view entire document:  text 
330. Where is this place?
Anywhere else?
RECORD ALL MENTIONED.

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

NAME OF ESTABLISHMENT _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) _____F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELD WORKER K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH N
RELATIVES/FRIENDS O
OTHER (SPECIFY) _____ X

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Morocco 2003
Survey form view entire document:  text 
330) Where is that?
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
MATERNITY B
HEALTH CENTER C
DISPENSARY D
HOME VISIT E
MOBILE UNIT F
OTHER PUBLIC (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PHARMACY I
DOCTOR/MID-WIFE J
MOROCCAN ASSOCIATION FOR FAMILY PLANNING K
OTHER PRIVATE MEDICAL (SPECIFY) L _______
OTHER SOURCE
RELATIVE/FRIEND M
MIDWIFE N
OTHER (SPECIFY) X _________

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Mozambique 2011
Survey form view entire document:  text 
325. Where is that? Any other place?

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

RECORD ALL PLACES MENTIONED.

(NAME OF PLACE(S))_________
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER/POST D
MOBILE CLINIC E
PHARMACY F
OTHER (SPECIFY)____G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
SHOP L
GAS STATION M
BAR/DISCOTHEQUE N
INFORMATION STAND/BOOTH O
OTHER (SPECIFY)___ P
OTHER SOURCE
SCHOOL Q
MARKET/STORE R
CHURCH S
FRIEND/RELATIVE T
TRADITIONAL HEALER U
ADOLESCENT SPECIAL SERVICES V
OTHER (SPECIFY)____X

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Namibia 2000
Survey form view entire document:  text 
323) Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 401)

324) Where is that?
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.
Any other places?
RECORD ALL MENTIONED.

(NAME OF PLACE) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTRE/CLINIC B
PHC CLINIC (MOBILE) C
COMMUNITY HEALTH WORKER D
OTHER PUBLIC (SPECIFY)____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY)____ I
OTHER SOURCE
SHOP J
CHURCH/SCHOOL K
FRIEND/RELATIVE L
TRAD. BIRTH ATTENDANT M
TRADITIONAL HEALER N
OTHER (SPECIFY) _____ O

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Namibia 2006
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 EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER/CLINIC B
PHC CLINIC (MOBILE) C
COMMUNITY HEALTH WORKER D
OTHER PUBLIC (SPECIFY)____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY)____ I
OTHER SOURCE
SHOP J
CHURCH K
FRIEND/RELATIVE L
TRAD. BIRTH ATTENDANT M
TRAD. HEALER N
OTHER (SPECIFY) _____ X

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 EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER/CLINIC B
PHC CLINIC (MOBILE) C
COMMUNITY HEALTH WORKER D
OTHER PUBLIC (SPECIFY)____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY)____ I
OTHER SOURCE
SHOP J
CHURCH K
FRIEND/RELATIVE L
TRAD. BIRTH ATTENDANT M
TRAD. HEALER N
OTHER (SPECIFY) _____ X

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Pakistan 2006
Survey form view entire document:  text 
323) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
________(NAME OF PLACE)
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11
RURAL HEALTH CENTRE, MCH 12
FAMILY WELFARE CENTRE 13
MOBILE SERVICE CAMP 14
LADY HEALTH WORKER 15
LH VISITOR 16
BASIC HEALTH UNIT 17
MALE MOBILIZER 18
OTHER PUBLIC (SPECIFY) ____ 19
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
PHARMACY, CHEMISTS 22
PRIVATE DOCTOR 23
HOMEOPATH 24
DISPENSER/COMPOUNDER 25
OTHER PRVATE MEDICAL (SPECIFY) __ 26
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 31
FRIEND/RELATIVE 32
HAKIM 32
DAI, TRAD, BIRTH ATTENDANT 34
PUSHCART 35
OTHER (SPECIFY) ___ 96

Survey form view entire document:  text 
323) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
________(NAME OF PLACE)
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11
RURAL HEALTH CENTRE, MCH 12
FAMILY WELFARE CENTRE 13
MOBILE SERVICE CAMP 14
LADY HEALTH WORKER 15
LH VISITOR 16
BASIC HEALTH UNIT 17
MALE MOBILIZER 18
OTHER PUBLIC (SPECIFY) ____ 19
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
PHARMACY, CHEMISTS 22
PRIVATE DOCTOR 23
HOMEOPATH 24
DISPENSER/COMPOUNDER 25
OTHER PRVATE MEDICAL (SPECIFY) __ 26
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 31
FRIEND/RELATIVE 32
HAKIM 32
DAI, TRAD, BIRTH ATTENDANT 34
PUSHCART 35
OTHER (SPECIFY) ___ 96

Survey form view entire document:  text 
323) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR FWC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
________(NAME OF PLACE)
RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC 11
RURAL HEALTH CENTRE, MCH 12
FAMILY WELFARE CENTRE 13
MOBILE SERVICE CAMP 14
LADY HEALTH WORKER 15
LH VISITOR 16
BASIC HEALTH UNIT 17
MALE MOBILIZER 18
OTHER PUBLIC (SPECIFY) ____ 19
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC 21
PHARMACY, CHEMISTS 22
PRIVATE DOCTOR 23
HOMEOPATH 24
DISPENSER/COMPOUNDER 25
OTHER PRVATE MEDICAL (SPECIFY) __ 26
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) 31
FRIEND/RELATIVE 32
HAKIM 32
DAI, TRAD, BIRTH ATTENDANT 34
PUSHCART 35
OTHER (SPECIFY) ___ 96

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Pakistan 2012
Survey form view entire document:  text 
334) 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
______

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC A
RURAL HEALTH CENTRE, MCH B
MCH C
FAMILY WELFARE CENTRE/FWW D
MOBILE SERVICE CAMP E
LADY HEALTH WORKER F
LH VISITOR G
BASIC HEALTH UNIT H
MALE MOBILIZER I
FWA J
OTHER PUBLIC (SPECIFY) ____ K
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC L
PHARMACY, CHEMISTS M
PRIVATE DOCTOR N
HOMEOPATH O
DISPENSER/COMPOUNDER P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) R
FRIEND/RELATIVE S
HAKIM T
DAI, TRAD, BIRTH ATTENDANT U
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 
334) 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
______

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC A
RURAL HEALTH CENTRE, MCH B
MCH C
FAMILY WELFARE CENTRE/FWW D
MOBILE SERVICE CAMP E
LADY HEALTH WORKER F
LH VISITOR G
BASIC HEALTH UNIT H
MALE MOBILIZER I
FWA J
OTHER PUBLIC (SPECIFY) ____ K
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC L
PHARMACY, CHEMISTS M
PRIVATE DOCTOR N
HOMEOPATH O
DISPENSER/COMPOUNDER P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) R
FRIEND/RELATIVE S
HAKIM T
DAI, TRAD, BIRTH ATTENDANT U
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 
334) 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
______

PUBLIC SECTOR
GOVT. HOSPITAL/RHSC A
RURAL HEALTH CENTRE, MCH B
MCH C
FAMILY WELFARE CENTRE/FWW D
MOBILE SERVICE CAMP E
LADY HEALTH WORKER F
LH VISITOR G
BASIC HEALTH UNIT H
MALE MOBILIZER I
FWA J
OTHER PUBLIC (SPECIFY) ____ K
PRIVATE/NGO MEDICAL SECTOR
PRIVATE/NGO HOSPITAL/CLINIC L
PHARMACY, CHEMISTS M
PRIVATE DOCTOR N
HOMEOPATH O
DISPENSER/COMPOUNDER P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP (NOT PHARMACY/CHEMIST) R
FRIEND/RELATIVE S
HAKIM T
DAI, TRAD, BIRTH ATTENDANT U
OTHER (SPECIFY) ___ X