Survey Text

Benin 2006 Congo Brazzaville 2011 Guinea 2012 Niger 2006
Benin 2011 Cote d'Ivoire 1994 Mali 2006 Tanzania 2004
Cameroon 1998 Cote d'Ivoire 1998 Mali 2012 Tanzania 2010
Cameroon 2004 Ghana 2008 Mali 2018 Togo 1998
Cameroon 2011 Guinea 1999 Mozambique 2003 Zambia 2001
Congo Brazzaville 2005 Guinea 2005 Mozambique 2011 Zimbabwe 2010
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Benin 2006
Survey form view entire document:  text 
545) 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
MATERNITY CENTER D
COMMUNITY PHARMACY E
STRAT AV HEALTH WORKER F
HEALTH WORKER G
OTHER PUBLIC (SPECIFY) ________ I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) L
DOCTOR'S OFFICE M
HEALTH AGENT (NON-GOVERNMENTAL ORGANIZATION) N
OTHER PRIVATE MEDICAL (SPECIFY) ________ O
OTHER SOURCE
SHOP/MARKET P
CHURCH/MOSQUE Q
SCHOOL R
RELATIVES/FRIENDS S
OTHER (SPECIFY) ________ X

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Benin 2011
Survey form view entire document:  text 
630) 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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Cameroon 1998
Survey form view entire document:  text 
518) Where is that?

RECORD ALL MENTIONED.

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PUBLIC/SEMIPUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
OTHER PUBLIC (SPECIFY): ___ C
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL D
SECULAR HOSPITAL/CLINIC E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION F
DOCTOR'S OFFICE G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
OTHER PRIVATE SECTOR
SHOP/MARKET J
BAR/NIGHTCLUB K
KIOSK L
INFORMAL COMMERCIAL DISTRIBUTION M
RELATIVES/FRIENDS N
OTHER (SPECIFY): ___ X

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Cameroon 2004
Survey form view entire document:  text 
524) Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 601)

525) 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/SEMIPUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
OTHER PUBLIC (SPECIFY): ___ C
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL D
SECULAR HOSPITAL/CLINIC E
HEALTH CENTER/RELIGIOUS CLINIC/MISSION F
DOCTOR'S OFFICE G
PHARMACY H
OTHER PRIVATE MEDICAL (SPECIFY): ___ I
OTHER PRIVATE SECTOR
SHOP/MARKET J
BAR/NIGHTCLUB K
KIOSK L
INFORMAL COMMERCIAL DISTRIBUTION M
RELATIVES/FRIENDS N
PARTNER HAD CONDOM O
OTHER (SPECIFY): ___ X

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Cameroon 2011
Survey form view entire document:  text 
641) Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 701)

642) Where is that?

Any other place?

PROBE TO DETERMINE EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

IF UNABLE TO DETERMINE IF THE HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE, RECORD THE NAME OF THE SOURCE.

NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY/
MOTHER AND CHILD CARE CENTER B
HEALTH WORKER C
OTHER PUBLIC (SPECIFY): ___ D
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL F
HEALTH CENTER/RELIGIOUS DISPENSARY/MISSION G
MEDICAL OFFICE H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY): ___ J
OTHER SOURCE
SHOP K
KIOSK/CASH REGISTER L
TRAVELING SALESMAN M
BAR/NIGHTCLUB N
PARTNER HAD CONDOM O
FRIENDS/RELATIVES P
OTHER (SPECIFY): ___ X

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Congo Brazzaville 2005
Survey form view entire document:  text 
545) Where is that? Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
HEALTH POST C
PRIVATE MEDICAL SECTOR
CLINIC D
PRIVATE DOCTOR'S OFFICE E
NURSE'S OFFICE F
MEDICAL-SOCIAL CENTER G
CONGOLESE ASSOCIATION FOR FAMILY WELL-BEING H
PHARMACY I
OTHER PRIVATE SECTOR
TRADITIONAL THERAPIST J
SPIRITUAL MEDICAL CENTER K
TRAVELLING SALESMAN/UNOFFICIAL PHARMACY L
SHOP/MARKET M
BAR/NIGHTCLUB/HOTEL N
RELATIVES/FRIENDS O
OTHER PLACE X

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Congo Brazzaville 2011
Survey form view entire document:  text 
630) 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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Cote d'Ivoire 1994
Survey form view entire document:  text 
919) Where did you or your husband/partner, get the condoms?

PUBLIC SECTOR
PUBLIC HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
PRIVATE MEDICAL SECTOR
CLINIC/PRIVATE NURSE 21
PHARMACY 22
OTHER PRIVATE SECTOR
SHOP/MINI-MART/SUPERMARKET 31
HOTEL/BAR/DANCE CLUB 32
FRIENDS/RELATIVES/PARTNERS 33
OTHER (SPECIFY)____ 41
DON'T KNOW 98

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Cote d'Ivoire 1998
Survey form view entire document:  text 
517) Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 518A)

518) Where is that?

RECORD ALL MENTIONED

IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER/MOTHER-INFANT CENTER 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE HOSPITAL/CLINIC 22
FAMILY PLANNING CENTER 23
PHARMACY/PHARMACY DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY): ___ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
CHURCH 35
ACQUAINTANCES/RELATIVES 36
TRADITIONAL PRACTITIONER 37
OTHER (SPECIFY): ___ 96

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Ghana 2008
Survey form view entire document:  text 
642. 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/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 1999
Survey form view entire document:  text 
517. Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 518A)

518. 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
HOSPITAL 11
FAMILY PLANNING CLINIC 12
FREE CLINIC 13
MEDICAL POST 14
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR 21
PRIVATE CLINIC/HOSPITAL 22
FAMILY PLANNING CENTER 23
PHARMACY/PHARMACEUTICAL DEPOT 24
OTHER PRIVATE MEDICAL (SPECIFY) _____ 26
OTHER PRIVATE SECTOR
SHOP/MARKET 31
BAR/NIGHTCLUB 32
KIOSK 33
INFORMAL COMMERCIAL DISTRIBUTION 34
CHURCH 35
FRIENDS/RELATIVES 36
TRADITIONAL PRACTITIONER 37
OTHER (SPECIFY) _____ 96

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Guinea 2005
Survey form view entire document:  text 
544. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 601)

545. Where is that?
Any other place?
RECORD ALL MENTIONED.

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
HOSPITAL A
HEALTH CENTER B
MEDICAL POST C
FAMILY PLANNING CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR G
PHARMACY H
FIELDWORKER J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
OTHER SOURCE
SHOP L
BAR/NIGHTCLUB M
KIOSK N
WORKPLACE O
FRIENDS/ACQUAINTANCES/RELATIVES P
OTHER (SPECIFY) _____ X

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Guinea 2012
Survey form view entire document:  text 
630) 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 GOVERNMENT HOSPITAL A
B GOVERNMENT HEALTH CENTER B
C FAMILY PLANNING CLINIC/AGBEF [##TRANSLATOR NOTE: GUINEAN ASSOCIATION FOR FAMILIAL WELL-BEING]

D FIELDWORKER
E OTHER (SPECIFY)
PRIVATE MEDICAL SECTOR
F PRIVATE HOSPITAL/CLINIC F
G PHARMACY G
H PRIVATE DOCTOR H
I FIELDWORKER I
J OTHER PRIVATE MEDICAL (SPECIFY) J
OTHER SOURCE
K SHOP K
L BAR/NIGHTCLUB/HOTEL L
M FRIEND/RELATIVES M
X OTHER (SPECIFY) X

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Mali 2006
Survey form view entire document:  text 
545. Where is this?
Any other place?

IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

RECORD ALL PLACES MENTIONED.

NAME OF PLACE__
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
PMI (protection maternelle et infantile-a program created in France to give free care to expecting/recent mothers) /MATERNITY D
CSCOM (Centre de Santé Communitaire) Community Health Center E
OTHER PUBLIC (SPECIFY) __F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
HEALTHCARE WORKER J
OTHER PRIVATE MEDICAL (SPECIFY) __K
OTHER SOURCE
SHOP L
BAR/NIGHTCLUB M
KIOSK N
AMBULANT SALESPERSON O
FRIEND/ACQUAINTANCE/RELATIVE P
OTHER (SPECIFY) __X

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Mali 2012
Survey form view entire document:  text 
630) 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 PRACTICE 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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Mali 2018
Survey form view entire document:  text 
730) From where did you obtain the condom the last 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
NATIONAL HOSPITAL 11
REGIONAL HOSPITAL 12
REFERENCE HEALTH CENTER 13
COMMUNITY HEALTH CENTER 14
DISPENSARY/MATERNITY 15
OTHER PUBLIC SECTOR (SPECIFY) 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
DOCTOR'S OFFICE 22
PRIVATE HEALTH CLINIC 23
PHARMACY 24
HEALTH POSTS 25
FAMILY PLANNING CLINIC 26
OTHER PRIVATE MEDICAL (SPECIFY) 28
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
BOOTH 36
TRAVELING PEDDLER 34
FRIENDS/RELATIVES 35
OTHER (SPECIFY) 96
DON'T KNOW 98

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Mozambique 2003
Survey form view entire document:  text 
525. Where is that?
Any other place?
RECORD ALL SOURCES MENTIONED.

IF SOURCE IS HOSPITAL, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE____
PUBLIC SECTOR
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
MOBILE CLINIC E
OTHER (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
SHOP M
CHURCH N
MEDICAL STAFF IN THE NEIGHBORHOOD O
STAND/BOOTH INFORMATION P
STORE Q
BAR/DISCOTHEQUE R
ADOLESCENTE SPECIAL SERVICES S
OTHER (SPECIFY) ____X

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Mozambique 2011
Survey form view entire document:  text 
630. 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
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER/POST D
MOBILE CLINIC E
PHARMACY F
OTHER (SPECIFY)____ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE DOCTOR I
PRIVATE NURSE J
PRIVATE PHARMACY K
SHOP L
GAS STATION M
BAR/ DISCOTHEQUE N
INFORMATION STAND/BOOTH O
OTHER (SPECIFY)____P
OTHER SOURCE
SCHOOL Q
MARKET/STORE R
CHURCH S
FRIEND/RELATIVE T
TRADITIONAL HEALER U
ADOLESCENT SPECIAL SERVICES V
OTHER (SPECIFY)____X

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Niger 2006
Survey form view entire document:  text 
545. Where is this?

IF THE PLACE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
HEALTH HUT C
FAMILY PLANNING CLINIC D
COMMUNITY HEALTH AGENT E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
DOCTOR'S OFFICE J
WALKING SALESMAN K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
WALKING SALESMAN/CART P
FRIEND/ACQUAINTANCE/RELATIVE Q
HOTEL/MOTEL R
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 
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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Togo 1998
Survey form view entire document:  text 
518) Where is that?

RECORD ALL MENTIONED

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
HOSPITAL 11
MEDICAL-SOCIAL CENTER 12
DISPENSARY/INFIRMARY 13
M.C.H. 14
HEALTH POST 15
STATE PHARMACY 16
OTHER PUBLIC (SPECIFY) __________ 17
PRIVATE MEDICAL SECTOR
HOSPITAL/PRIVATE CLINIC 21
PHARMACY 22
TOGOLESE ASSOCIATION FOR FAMILIAL WELL-BEING 23
DOCTOR'S OFFICE 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
MARKET/SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
GAS STATION 34
OTHER (SPECIFY) __________ 96

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

YES 1
NO 2 (GO TO 526B)

525. 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
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

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Zimbabwe 2010
Survey form view entire document:  text 
630) 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