Survey Text

Benin 2011 Ghana 2014 Namibia 2006 Tanzania 2004
Burkina Faso 2003 Guinea 2012 Namibia 2013 Tanzania 2010
Burkina Faso 2010 Lesotho 2004 Niger 2012 Uganda 2001
Burundi 2010 Madagascar 2003 Nigeria 2003 Zambia 2013
Congo (Democratic Republic) 2013 Madagascar 2008 Nigeria 2008 Zimbabwe 2005
Cote d'Ivoire 2011 Malawi 2000 Nigeria 2013 Zimbabwe 2010
Eswatini (Swaziland) 2006 Malawi 2010 Rwanda 2010 Zimbabwe 2015
Ghana 2003 Myanmar 2015 Rwanda 2014
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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

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

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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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. 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
OTHER PUBLIC (SPECIFY) ______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
MOBILE CLINIC I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
COMMUNITY/VILLAGE FIELDWORKER K
SHOP L
CHURCH M
FRIEND/RELATIVES N
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) 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 PUBLIC SECTOR_______ (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 
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 
533 Where is that? Any other place?
RECORD ALL SOURCES 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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Madagascar 2003
Survey form view entire document:  text 
528. Where is that?
Any other place?
RECORD ALL MENTIONED

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

NAME OF PLACE _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
GROUND AGENT E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
GROUND AGENT K
OTHER PRIVATE (SPECIFY) ____L
OTHER LOCATION
STORE/KIOSK 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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Malawi 2010
Survey form view entire document:  text 
645. Where is that? Anywhere else?
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
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

Survey form view entire document:  text 
645. Where is that? Anywhere else?
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
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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Myanmar 2015
Survey form view entire document:  text 
632) Do you know of a place where a person can get female condoms?

YES 1
NO 2 (SKIP TO 701)

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Namibia 2006
Survey form view entire document:  text 
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 HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE
THE NAME OF THE PLACE.

(NAME OF PLACE(S))___________
PUBLIC SECTOR
GVT. HOSPITAL A
GOVT. HEALTH CENTER/CLINIC B
PHC CLINIC (MOBILE) C
COMM. 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
FRIENDS/RELATIVES L
TRAD. BIRTH ATTENDANT M
TRAD. HEALER N
OTHER _____ X

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Namibia 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 701A)

633) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE HTE NAME OF THE PLACE.

(NAME OF PLACE(S)) __________
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 CENTER
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PHARMACY J
PRIVATE DOCTOR K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY __________) L
OTHER SOURCE
SHOP M
FRIEND/RELATIVE N
SCHOOL O
OTHER (SPECIFY __________) X

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Niger 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
A NATIONAL HOSPITAL
B REGIONAL HOSPITAL
C HD
D INTEGRATED HEALTH CENTER
E HEALTH HUT
F PHARMACY
G OTHER PUBLIC (SPECIFY)
PRIVATE MEDICAL SECTOR
H PRIVATE HOSPITAL/CLINIC
I PHARMACY
J ROAD KIOSK
K NIGERIEN ASSOCIATION FOR FAMILIAL WELL-BEING
L OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
M SHOP
N RELIGIOUS INSTITUTION
O FRIENDS/RELATIVES
P TRAVELLING PHARMACY/PEDDLER
Q SHELTER/DAY CAMP
X OTHER (SPECIFY)

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Nigeria 2003
Survey form view entire document:  text 
528. 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
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
FRIENDS/RELATIVES O
NGO P
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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Rwanda 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
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
FAMILY PLANNING CLINIC L
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) M
OTHER SOURCE
KIOSK N
TRADITIONAL BIRTH ATTENDANT O
FRIEND/RELATIVE P
OTHER (SPECIFY) X

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Rwanda 2014
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/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
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
OTHER (SPECIFY) ____ X

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Tanzania 2004

No questionnaire text is available for this sample.


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Tanzania 2010
Survey form view entire document:  text 
645. 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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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.

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
Friends/relatives O
Street vendor P
Lodge Q
Other (specify) __________ X

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Zambia 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 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/POST B
MOBILE HOSPITAL/CLINIC C
FAMILY PLANNING CLINIC D
COMMUNITY BASED AGENT/FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY BASED AGENT/FIELDWORKER K
MOBILE HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______________________ M
OTHER SOURCE
SHOP N
CHURCH M
FRIENDS/RELATIVES P
OTHER (SPECIFY) ________________________ X

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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

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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

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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)