Survey Text

Benin 2011 Ghana 2003 Malawi 2000 Senegal 2015
Burkina Faso 2003 Ghana 2014 Nigeria 2003 Senegal 2016
Burkina Faso 2010 Guinea 2012 Nigeria 2008 Uganda 2001
Burundi 2010 Lesotho 2004 Nigeria 2013 Zambia 2013
Congo (Democratic Republic) 2013 Lesotho 2014 Senegal 2010 Zimbabwe 2005
Cote d'Ivoire 2011 Madagascar 2003 Senegal 2012 Zimbabwe 2010
Eswatini (Swaziland) 2006 Madagascar 2008 Senegal 2014 Zimbabwe 2015
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Benin 2011
Survey form view entire document:  text 
633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Burkina Faso 2003
Survey form view entire document:  text 
528) 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 SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Burkina Faso 2010
Survey form view entire document:  text 
633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Burundi 2010
Survey form view entire document:  text 
632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

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
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 SECTOR (SPECIFY) ______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY) ______ X

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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

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
FAMILY PLANNING CLINIC B
GOVERNMENT HEALTH CENTER C
FAMILY PLANNING CLINIC D
COMMUNITY LIAISON E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
NGO I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
TABLIER P
FRIEND/ACQUAINTANCE/RELATIVES Q
OTHER (SPECIFY) X

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Cote d'Ivoire 2011
Survey form view entire document:  text 
633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
646) 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
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
OTHER MISSION (SPECIFY)________O
NGO
FLAS P
OTHER NGO (SPECIFY)__________Q
OTHER SOURCE
SHOP R
CHURCH S
FRIENDS/RELATIVES T
OTHER (SPECIFY)_______X

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Ghana 2003
Survey form view entire document:  text 
528) 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 SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Ghana 2014
Survey form view entire document:  text 
633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Guinea 2012
Survey form view entire document:  text 
633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Lesotho 2004
Survey form view entire document:  text 
528) 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 SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Lesotho 2014
Survey form view entire document:  text 
632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

633) 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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
FAMILY PLANNING CLINIC D
OTHER PUBLIC SECTOR (SPECIFY) ____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE DOCTOR H
LESOTHO PLANNED PARENTHOOD I
PSI/NEW START CENTER J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ K
CHAL
CHAL HOSPITAL L
CHAL HEALTH CENTER M
CHAL HEALTH POST N
RED CROSS HEALTH CENTER O
CBD P
VILLAGE HEALTH WORKER Q
SUPPORT GROUPS R
FACILITY OUTSIDE OF LESOTHO S
OTHER SOURCE
SHOP T
CHURCH U
PEER EDUCATORS V
FRIEND/RELATIVE W
OTHER (SPECIFY) ____ X

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Madagascar 2003
Survey form view entire document:  text 
528) 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 SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Madagascar 2008
Survey form view entire document:  text 
644. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

645. Where is that?
Any other place?

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

NAME OF PLACE(S) _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
PF CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC PLACE (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) _______ L
OTHER LOCATION
STORE M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _______ X

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Malawi 2000
Survey form view entire document:  text 
528. Where is that?
RECORD FIRST RESPONSE ONLY.

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 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) _____ 16
MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELD WORKER 35
OTHER PRIVATE MEDICAL (SPECIFY) ____ 36
BLM 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIEND/RELATIVE 53
OTHER (SPECIFY) _____ 96

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Nigeria 2003
Survey form view entire document:  text 
528) 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 SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Nigeria 2008
Survey form view entire document:  text 
645 Where is that? (5)
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 
633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Senegal 2010
Survey form view entire document:  text 
632. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

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

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Senegal 2012
Survey form view entire document:  text 
632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

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
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 
632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

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
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 
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
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 
316) You first started using (CURRENT METHOD) in (DATE FROM 309). Where did you get it at that time?
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) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
HEALTH POST 13
GOVERNMENT FAMILY PLANNING CENTER 14
RURAL MATERNITY 15
HEALTH HUT 16
COMMUNITY PHARMACY 17
MOBILE CLINIC 18
OTHER PUBLIC SECTOR (SPECIFY) ____ 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE 21/22
PHARMACY 23
PRIVATE DOCTOR 24
RELIGIOUS FREE CLINIC 25
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
BAR 34
OTHER (SPECIFY) _____ 96

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Uganda 2001
Survey form view entire document:  text 
528) 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 SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Zambia 2013
Survey form view entire document:  text 
632) (4) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 701)

633) (4)
Where is that? (3)

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
GOVERNMENT 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
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

top
Zimbabwe 2005
Survey form view entire document:  text 
653) 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 places?

RECORD ALL SOURCES 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 F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
MISSION FACILITY I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
OTHER PRIVATE SOURCE
CHURCH T
FRIEND/RELATIVE U
OTHER (SPECIFY) __________ X

Survey form view entire document:  text 
653) 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 places?

RECORD ALL SOURCES 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 F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
MISSION FACILITY I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
OTHER PRIVATE SOURCE
CHURCH T
FRIEND/RELATIVE U
OTHER (SPECIFY) __________ X

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Zimbabwe 2010
Survey form view entire document:  text 
633) 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
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNPFC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) S
OTHER PRIVATE SOURCE
CHURCH T
BAR U
FRIENDS/RELATIVES V
PUBLIC TOILET W
OTHER (SPECIFY) X

Survey form view entire document:  text 
633) 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
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNPFC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) S
OTHER PRIVATE SOURCE
CHURCH T
BAR U
FRIENDS/RELATIVES V
PUBLIC TOILET W
OTHER (SPECIFY) X

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Zimbabwe 2015
Survey form view entire document:  text 
730D. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 731)

Survey form view entire document:  text 
730D. Do you know of a place where a person can get female condoms?

YES 1
NO 2 (GO TO 731)