Survey Text

Burkina Faso 2003 Kenya 2008 Senegal 2010 Senegal 2017
Chad 2014 Kenya 2014 Senegal 2012 Tanzania 2004
India 2005 Mali 2012 Senegal 2014 Togo 2013
India 2015 Mozambique 2011 Senegal 2015
Kenya 2003 Niger 2012 Senegal 2016
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Burkina Faso 2003
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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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India 2005
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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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India 2015
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352. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 354)

353. 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(S).

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

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Kenya 2003
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330. Where is that? Any other place? RECORD ALL PLACES MENTIONED.

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.

(NAME OF PLACE) _________

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE 'F'.

PUBLIC SECTOR
GOVERNMENT HOSPITAL B
GOVERNMENT HEALTH CENTRE C
GOVERNMENT DISPENSARY D
OTHER PUBLIC (SPECIFY) ________ E
PRIVATE MEDICAL SECTOR
MISSION, CHURCH HOSP./CLINIC F
FPAK HEALTH CENTRE/CLINIC G
PRIVATE HOSPITAL OR CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME K
OTHER PRIV. MEDICAL (SPECIFY) _____ L
OTHER SOURCE
MOBILE CLINIC M
COMMUNITY-BASED DISTRIBUTOR N
SHOP O
FRIEND/RELATIVE P
OTHER (SPECIFY) _________ X

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Kenya 2008
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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
GOVERNMENT HOSPITAL B
GOVT. HEALTH CENTER C
GOVERNMENT DISPENSARY D
OTHER PUBLIC (SPECIFY) ____________ E
PRIVATE MEDICAL SECTOR
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC F
FHOK/FPAK HEALTH CENTER/CLINIC G
PRIVATE HOSPITAL/CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME J
OTHER PRIV. MEDICAL (SPECIFY) ________ K
OTHER SOURCE
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
SHOP N
FRIEND/RELATIVE P
OTHER (SPECIFY) __________________ X

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Kenya 2014
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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) __________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
OTHER (SPECIFY) _______ X

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Mali 2012
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
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERRAL HEALTH CENTER (CSREF) 13
FREE CLINIC/MATERNITY 14
COMMUNITY HEALTH CENTER (CSCOM) 15
OTHER PUBLIC_______ (SPECIFY) 16
PRIVATE SECTOR
PRIVATE CLINIC/OFFICE 21
PRIVATE HEALTH CARE OFFICE 22
TREATMENT ROOM 23
PHARMACY 24
COMMUNITY BASED AGENT 25
OTHER PRIVATE______ (SPECIFY) 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK/APRON 33
TRAVELING VENDOR 34
FRIEND/ACQUAINTANCE/RELATIVES 35
OTHER___________ (SPECIFY) 96

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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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Niger 2012
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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
PHARMACY 11
MATERNITY REFERENCE CENTER 12
MATERNITY IN REGIONAL HOSPITAL 13
MATERNITY IN HD 14
INTEGRATED HEALTH CENTER 15
HEALTH HUT 16
MOBILE CLINIC 17
OTHER PUBLIC (SPECIFY) 18
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
MOBILE CLINIC 24
NIGERIEN ASSOCIATION FOR FAMILIAL WELL-BEING 25
ROAD KIOSK 26
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) 28
OTHER SOURCE
SHOP 31
RELIGIOUS INSTITUTION 32
FRIENDS/RELATIVES 33
TRAVELLING PHARMACY/PEDDLER 34
COMMUNITY LIAISON 35
OTHER (SPECIFY) 96

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Senegal 2010
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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
HEALTH HUT/RURAL MATERNITY E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
RELATIVES/FRIENDS Q
BAR R
OTHER (SPECIFY) _____ X

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Senegal 2012
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
A GOVT. HOSPITAL
B GOVT. HEALTH CENTER
C HEALTH POST
D GOVT. FAMILY PLANNING CENTER
E RURAL MATERNITY
F HEALTH HUT
G COMMUNITY PHARMACY
H MOBILE CLINIC
I OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
J PRIVATE HOSPITAL/CLINIC/OFFICE
K PHARMACY
L PRIVATE DOCTOR
M RELIGIOUS FREE CLINIC
N OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
O SHOP
P CHURCH
Q FRIENDS/RELATIVES
R BAR
X OTHER (SPECIFY)

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Senegal 2014
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 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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) X

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Senegal 2015
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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____X

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Senegal 2016
Survey form view entire document:  text 
327) 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(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

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Senegal 2017
Survey form view entire document:  text 
327) 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(S)) ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) _____ X

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Tanzania 2004
Survey form view entire document:  text 
329. Do you know of a place where a person can obtain a method of family planning?

YES 1
NO 2 (GO TO 331)

330. Where is that? 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 PLACES MENTIONED.

(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
GOVT.HEALTHCENTRE J
DISPENSARY K
PRIVATE
DISTRICTHOSPITAL 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

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Togo 2013
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- (SKIP TO 326)

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
GOVERNMENT HOSPITAL A
HEALTH CENTER B
DISPENSARY C
MOTHER-INFANT PROTECTION D
HEALTH HUT E
MOBILE CLINIC F
OTHER PUBLIC SECTOR______ (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
NGO/ASSOCIATION K
OTHER PRIVATE MEDICAL SECTOR________ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
OTHER________ (SPECIFY) X