Survey Text

Benin 2011
Congo Brazzaville 2011
Mali 2012
Tanzania 2010
Zambia 2001
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Benin 2011
Survey form view entire document:  text 
633) 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
FIELDWORKER D
SOCIAL CENTER E
STRAT AV HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
VENDING MACHINE H
OTHER PUBLIC SECTOR________ (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
RELIGIOUS HOSPITAL K
PRIVATE DOCTOR'S OFFICE L
PHARMACY M
BENINESE FAMILY PLANNING ASSOCIATION (ABPF) N
FIELDWORKER (NGO) O
OTHER PRIVATE MEDICAL ________(SPECIFY) P
OTHER SOURCE
SHOP/MARKET Q
CHURCH/MOSQUE R
FRIEND/RELATIVES S
BAR/REFRESHMENT AREA T
OTHER________ (SPECIFY) X

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Congo Brazzaville 2011
Survey form view entire document:  text 
633) Where is that? Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.

PUBLIC SECTOR
HOSPITAL A
INTEGRATED HEALTH CENTER B
HEALTH POST C
PRIVATE MEDICAL SECTOR
CLINIC D
DOCTOR'S OFFICE E
CONGOLESE ASSOCIATION FOR FAMILY WELL-BEING F
PHARMACY G
OTHER PRIVATE SECTOR
PEDDLER/TRAVELING PHARMACY I
SHOP/MARKET J
BAR/NIGHTCLUB/HOTEL K
FRIENDS/RELATIVES L
OTHER PLACE (SPECIFY) ______ X

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Mali 2012
Survey form view entire document:  text 
633) 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 A
REGIONAL HOSPITAL B
REFERRAL HEALTH CENTER (CSREF) C
FREE CLINIC/MATERNITY D
COMMUNITY HEALTH CENTER (CSCOM) E
OTHER PUBLIC_______ (SPECIFY) F
PRIVATE SECTOR
PRIVATE CLINIC/HOSPITAL G
PRIVATE HEALTH CARE OFFICE H
TREATMENT ROOM I
PHARMACY J
COMMUNITY BASED AGENT K
OTHER PRIVATE________ (SPECIFY) L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
TRAVELING VENDOR P
FRIEND/ACQUAINTANCE/RELATIVES Q
OTHER_________ (SPECIFY) X

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Tanzania 2010
Survey form view entire document:  text 
642. 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)) ___________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL A
REGIONAL HOSPITAL B
DISTRICT HOSPITAL C
HEALTH CENTRE D
DISPENSARY E
VILLAGE HEALTH POST (WORKER) F
CBD WORKER G
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL H
DISTRICT HOSPITAL I
GOVT. HEALTH CENTRE J
DISPENSARY K
PRIVATE
DISTRICT HOSPITAL L
HEALTH CENTRE M
DISPENSARY N
OTHER
PHARMACY O
NGO P
VCT CENTRE Q
SHOP/KIOSK R
BAR S
GUEST HOUSE/HOTEL T
FRIEND/RELATIVE/NEIGHBOUR U
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

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Zambia 2001
Survey form view entire document:  text 
528. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 530)

529. 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 SOURCES MENTIONED.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) ______ I
OTHER SOURCE
SHOP J
COMMUNITY-BASED AGENT/HEALTH WORKER K
FRIEND/RELATIVE L
SCHOOL M
BAR, HOTEL N
OTHER (SPECIFY) _______________ X