Survey Text

Afghanistan 2015 Ghana 2014 Myanmar 2015 Rwanda 2005
Bangladesh 2004 Guinea 2005 Namibia 2000 Rwanda 2010
Bangladesh 2007 Guinea 2012 Namibia 2006 Rwanda 2014
Bangladesh 2011 Kenya 2014 Namibia 2013 Senegal 2005
Bangladesh 2014 Lesotho 2004 Nepal 2001 Tanzania 2004
Benin 2001 Lesotho 2009 Nepal 2006 Tanzania 2010
Benin 2006 Liberia 2013 Nepal 2011 Uganda 2001
Benin 2011 Malawi 2000 Niger 2006 Uganda 2006
Cote d'Ivoire 2011 Malawi 2004 Nigeria 2003 Uganda 2011
Eswatini (Swaziland) 2006 Malawi 2010 Nigeria 2008 Zambia 2007
Ethiopia 2005 Mali 2001 Nigeria 2013 Zambia 2013
Ghana 2003 Morocco 2003 Pakistan 2006 Zimbabwe 2005
Ghana 2008 Mozambique 2003 Pakistan 2012 Zimbabwe 2010
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Afghanistan 2015
Survey form view entire document:  text 
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(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
COMMUNITY HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR__________H
NON-GOVERNMENT SECTOR
MARIE STOPES I
RED CROSS SOCIETY J
AFGA K
OTHER NGO SECTOR_________L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
FIELDWORKER P
OTHER PRIVATE MEDICAL SECTOR_____________Q
OTHER SOURCE
CHARITY FOUNDATION R
REFUGEE CAMP S
SHOP T
FRIEND/RELATIVE U
OTHER__________X

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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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Bangladesh 2011
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 325A)

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 THE PLACE(S)) _____________________
PUBLIC SECTOR
MEDICAL COLLEGE HOSPITAL A
SPECIALISED GOVT. HOSPITAL
HOSPITAL (SPECIFY) ________________ B
DISTRICT HOSPITAL C
MCWC D
UPAZILLA HEALTH COMPLEX E
H and FWC F
SAT. CLINIC/EPI OUTREACH G
COMMUNITY CLINIC H
GOVT. FIELD WORKER (FWA) I
OTHER PUBLIC SECTOR (SPECIFY) ______________ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER NGO SECTOR (SPECIFY) _____________ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC P
QUALIFIED DOCTOR'S CHAMBER Q
NON-QUALIFIED DOCTOR'S CHAMBER R
PHARMACY S
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) ______________ T
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________ U
OTHER SOURCE
GROCERY V
FRIENDS/RELATIVES W
OTHER (SPECIFY) _____________ X

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Bangladesh 2014
Survey form view entire document:  text 
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(S)) ___________
PUBLIC SECTOR
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPITAL B
MCWC C
UPAZILLA HEALTH COMPLEX D
UH AND FWC E
SAT. CLINIC/EPI OUTREACH F
COMMUNITY CLINIC G
GOVT. FIELD WORKER (FWA) H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER NGO SECTOR (SPECIFY) _____ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
QUALIFIED DOCTOR'S CHAMBER P
NON-QUALIFIED DOCTOR'S CHAMBER Q
PHARMACY/DRUG STORE R
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ S
OTHER SOURCE
SHOP V
FRIENDS/RELATIVES W
OTHER (SPECIFY) _____ X

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Benin 2001
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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Benin 2006
Survey form view entire document:  text 
330) Where is that?
330A) Where did you learn to use the lactational amenorrhea method (LAM)?
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.
RECORD ALL MENTIONED.

NAME OF PLACE ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
FIELDWORKER D
COMMUNITY CENTER E
STRAT AV HEALTH WORKER F
HEALTH WORKER/ COMMUNITY LIAISON G
VENDING MACHINE H
OTHER PUBLIC (SPECIFY) ________ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
RELIGIOUS HOSPITAL K
PHARMACY L
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) M
DOCTOR'S OFFICE N
HEALTH AGENT (NON-GOVERNMENTAL ORGANIZATION) O
OTHER PRIVATE MEDICAL (SPECIFY) ________ P
OTHER SOURCE
SHOP/MARKET Q
CHURCH/MOSQUE R
RELATIVES/FRIENDS S
BAR/SALOON T
OTHER (SPECIFY) ________ X

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Benin 2011
Survey form view entire document:  text 
325) Where is that? (5)

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

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Cote d'Ivoire 2011
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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
HEALTH WORKER E
OTHER______ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL_________ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTIONS N
FRIEND/RELATIVES O
OTHER__________ (SPECIFY) X

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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
332) 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)__________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
PHU/CLINIC C
MOBILE CLINIC D
RHM/CBD E
OTHER PUBLIC (SPECIFY)_________F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
CBD K
OTHER PRIVATE (SPECIFY)______L
MISSION
HOSPITAL M
CLINIC N
OTHER MISSION (SPECIFY)_____O
NGO
FLAS P
OTHER NGO (SPECIFY)____Q
OTHER SOURCE
SHOP R
CHURCH S
FRIEND/RELATIVE T
OTHER (SPECIFY)______X

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Ethiopia 2005
Survey form view entire document:  text 
332. Where is that? Any other place?
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.
RECORD ALL PLACES MENTIONED.

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
CBD/CBRHA H
OTHER NGO ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER SOURCE
DRUG VENDOR M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) _____________ X

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Ghana 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.

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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Ghana 2008
Survey form view entire document:  text 
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) ___________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHIPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR ______ F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____ N
OTHER SOURCE
SHOP/MARKET O
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ____ X

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Ghana 2014
Survey form view entire document:  text 
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(S)) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
OTHER SOURCE
SHOP/MARKET O
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
OTHER (SPECIFY) ______ X

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Guinea 2005
Survey form view entire document:  text 
334 Where is that? (4)
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) ____________
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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Guinea 2012
Survey form view entire document:  text 
325) Where is that? (5)

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

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Kenya 2014
Survey form view entire document:  text 
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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Lesotho 2004
Survey form view entire document:  text 
319 Where is that? Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC ______(SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL _______ (SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
PEER EDUCATORS P
FRIENDS/RELATIVES Q
OTHER _____________(SPECIFY) X

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Lesotho 2009
Survey form view entire document:  text 
334 Where is that? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) _____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
OTHER PUBLIC SECTOR C
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC D
LPPA E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
CBD L
COMMUNITY HEALTH WORKER M
SUPPORT GROUPS N
OTHER SOURCE
SHOP O
CHURCH P
PEER EDUCATORS Q
FRIEND/RELATIVE R
OTHER X

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Liberia 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 (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(S))____
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. CLINIC C
COMMUNITY HEALTH VOL/gCHV D
OTHER PUBLIC SECTOR (SPECIFY) E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
PLANNED PARENTHOOD ASSN. LIB. I
MOBILE CLINIC J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
OTHER SOURCE
SHOP L
CHURCH M
FRIENDS/RELATIVES N
OTHER (SPECIFY) X

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Malawi 2000
Survey form view entire document:  text 
329. Where is that? Any other place?

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.
RECORD ALL MENTIONED.

NAME OF PLACE_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
CBDA/FIELD WORKER E
OTHER PUBLIC (SPECIFY) ____ F
MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
CBDA/FIELD WORKER N
OTHER PRIVATE MEDICAL (SPECIFY) _____ O
BLM P
OTHER SOURCE
SHOP Q
CHURCH R
FRIEND/RELATIVE S
OTHER (SPECIFY) _____ X

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Malawi 2004
Survey form view entire document:  text 
330. Where is that? Any other place?

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.
RECORD ALL PLACES MENTIONED.

NAME OF PLACE(S) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
CBDA/FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
CBDA/FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
BLM P
OTHER SOURCE
SHOP Q
CHURCH R
FRIEND/RELATIVE S
OTHER (SPECIFY) _____ X

top
Malawi 2010
Survey form view entire document:  text 
334. Where is that? Any other place?
PROBE TO IDENTIFY THE 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 A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST/OUTREACH C
MOBILE CLINIC D
HSA E
CBDA/DOOR TO DOOR F
OTHER PUBLIC G
CHAM/MISSION
HOSPITAL H
HEALTH CENTER I
MOBILE CLINIC J
DOOR TO DOOR K
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR L
PHARMACY M
MOBILE CLINIC N
CBDA/DOOR TO DOOR O
OTHER PRIVATE MEDICAL P
BLM Q
MACRO R
YOUTH DROP IN CENTRE S
OTHER SOURCE
SHOP T
CHURCH U
FRIEND/RELATIVE V
OTHER X

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Mali 2001
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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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 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.

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

top
Myanmar 2015
Survey form view entire document:  text 
325) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE WHETHER PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.___(NAME OF PLACE(S))

PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR___(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR___(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) R
OTHER SOURCE
SHOP S
FRIEND/RELATIVE T
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

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Namibia 2013
Survey form view entire document:  text 
325) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OF PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________
PUBLIC SECTOR
GOVT HOSPITAL A
GOVT HEALTH CENTER B
GVT PRIMARY HEALTH CARE CLINIC C
OUTREACH POINT D
MOBILE CLINIC E
FIELDWORKER/COMMUNITY HEALTH CARE PROVIDER F
OTHER PUBLIC SECTOR (SPECIFY __________) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PHARMACY J
PRIVATE DOCTOR K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY __________) L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
SCHOOL P
OTHER (SPECIFY __________) X

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Nepal 2001
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 _______________

Any other place?
RECORD ALL PLACES MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOVT. (SPECIFY) ____________ H
NON-GOVT. (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) ___________ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) _______ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R

OTHER (SPECIFY) ______________ X

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Nepal 2006
Survey form view entire document:  text 
345. Do you know of a place where you can obtain a method of family planning?

YES 1
NO 2 (GO TO 347)

346. 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/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
CONDOM BOX H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. (NGO) SECTOR
FPAN J
MARIE STOPES K
ADRA L
NEPAL RED CROSS M
UMN N
OTHER NGO. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME P
PHARMACY Q
PRIVATE DOCTOR R
OTHER PRIVATE MEDICAL (SPECIFY) __ S
OTHER SOURCE
SHOP T
FRIEND/RELATIVE U
OTHER (SPECIFY) __ X

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Nepal 2011
Survey form view entire document:  text 
315) You first started using (CURRENT METHOD) in (DATE FROM 308/308A). Where did you get it at that time?

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC 11
PHC CENTER 12
HEALTH POST 13
SUB-HEALTH POST 14
PHC OUTREACH 15
MOBILE CLINIC 17
FCHV 18
CONDOM BOX 19
OTHER GOVT. (SPECIFY) ___________ 16
NON-GOVT. (NGO) SECTOR
FPAN 21
MARIE STOPES 22
ADRA 23
NEPAL RED CROSS 24
UMN 25
OTHER NGO. (SPECIFY) __________ 26
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME 31
PHARMACY 32
SANGINI OUTLET 33
OTHER PRIVATE MEDICAL (SPECIFY) ___________ 36
OTHER SOURCE
SHOP 41
FRIEND/RELATIVE 42
OTHER (SPECIFY) ___________ 96

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Niger 2006
Survey form view entire document:  text 
334 Where is that? (4)
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) ____________
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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Nigeria 2003
Survey form view entire document:  text 
330. Where is that? Any other place?
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.
RECORD ALL PLACES MENTIONED

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
COMMUNITY HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ______ F

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/PATENT MEDICINE STORE H
PRIVATE DOCTOR I
MOBILE CLINIC J
COMMUNITY HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
NGO P
OTHER (SPECIFY) _______________ X

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Nigeria 2008
Survey form view entire document:  text 
334 Where is that? (4)
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) ____________
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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Nigeria 2013
Survey form view entire document:  text 
325) Where is that? (5)

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

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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

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Rwanda 2005
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) ______

RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH HOSPITAL B
AGENT DBC C
OTHER PUBLIC (SPECIFY)_____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
INFIRMARY I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP K
CHURCH L
PARENTS/FRIEND M
OTHER (SPECIFY) _____ X

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Rwanda 2010
Survey form view entire document:  text 
325) 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
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
FAMLIY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) M
OTHER SOURCES
KIOSK N
CHURCH O
FRIEND/RELATIVE P
OTHER (SPECIFY) X

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Rwanda 2014
Survey form view entire document:  text 
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(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
CHURCH O
FRIEND/RELATIVE P
YOUTH CENTER Q
OTHER (SPECIFY) ____ X

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Senegal 2005
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
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURALE MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
STRAT. AVANCÉE/EQU. MOBILE H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
RELIGIOUS FREE CLINIC N
HEALTH CARE WORKER O
OTHER PRIVATE (SPECIFY) _____P
OTHER SOURCE
SHOP Q
CHURCH R
RELATIVES/FRIENDS S
BAR T
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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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

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Uganda 2001
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 __________

ANY OTHER PLACE?
RECORD ALL MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED DISTRIBUTOR E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIEND/RELATIVE O
OTHER (SPECIFY) __________ X

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Uganda 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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED DISTRIBUTOR E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIEND/RELATIVE O
OTHER (SPECIFY) X

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Uganda 2011
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(S)) ________________________

PUBLIC SECTOR
GOVT HOSPITAL A
GOVT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUT REACH D
FIELDWORKER/VHT E
OTHER PUBLIC SECTOR (SPECIFY) _______________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
OUT REACH J
FIELDWORKER/VHT K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY) _______________ X

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Zambia 2007
Survey form view entire document:  text 
334 Where is that? (4)
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) ____________
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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Zambia 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 (GO TO 326)

325) 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
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
FAMILY PLANNING CLINIC D
COMMUNITY BASED AGENT/FIELDWORKER E
OTHER PUBLIC SECTOR F (SPECIFY) __________________________
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY BASED AGENT/FIELD WORKER K
MOBILE HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL SECTOR M (SPECIFY) ____________________
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
OTHER X (SPECIFY) _________________________

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Zimbabwe 2005
Survey form view entire document:  text 
331) 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 __________

Any other place?

RECORD ALL PLACES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC (SPECIFY) __________ G
MISSION FACILITY H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE DOCTOR (SPECIFY) __________ M
RETAIL OUTLET
GENERAL DEALER N
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) __________ R
OTHER PRIVATE SOURCE
CHURCH S
FRIEND/RELATIVE T
OTHER (SPECIFY) __________ X

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Zimbabwe 2010
Survey form view entire document:  text 
325) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SCETOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNFCP CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
OTHER PUBLIC SECTOR (SPECIFY) G
MISSION HOSPITAL/CLINIC H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PHARMACY J
PRIVATE DOCTOR K
CBD L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
RETAIL OUTLET
GENERAL DEALER N
SUPERMARKET O
TUCK SHOP P
SERVICE STATION Q
OTHER RETAIL (SPECIFY) R
OTHER PRIVATE SOURCE
CHURCH S
FRIENDS/RELATIVE T
OTHER (SPECIFY) X