Survey Text

Benin 2001 Lesotho 2004 Nigeria 1999 Tanzania 1999
Benin 2006 Lesotho 2009 Nigeria 2003 Togo 1998
Benin 2011 Lesotho 2014 Nigeria 2008 Togo 2013
Burkina Faso 2003 Liberia 2007 Nigeria 2013 Uganda 1995
Burkina Faso 2010 Liberia 2013 Rwanda 2000 Uganda 2001
Burundi 2010 Madagascar 2003 Rwanda 2005 Uganda 2006
Central African Republic 1995 Madagascar 2008 Senegal 1997 Uganda 2011
Chad 2014 Malawi 2000 Senegal 2005 Zambia 2013
Cote d'Ivoire 2011 Malawi 2004 Senegal 2010 Zimbabwe 1994
Eswatini (Swaziland) 2006 Malawi 2010 Senegal 2012 Zimbabwe 1999
Ghana 1998 Mali 2001 Senegal 2014 Zimbabwe 2005
Ghana 2003 Mozambique 2003 Senegal 2015 Zimbabwe 2010
Ghana 2008 Mozambique 2011 Senegal 2016 Zimbabwe 2015
Ghana 2014 Niger 2012 Tanzania 1996
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Benin 2001
Survey form view entire document:  text 
525) Where is that? Any other place?
IF SOURCE IF 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
OTHER PUBLIC (SPECIFY)____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
RELIGIOUS HOSPITAL H
PHARMACY I
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) J
DOCTOR'S OFFICE K
HEALTH AGENT L
OTHER PRIVATE MEDICAL (SPECIFY)____M
OTHER SOURCE
SHOP/MARKET N
CHURCH/MOSQUE O
RELATIVES/FRIENDS P
GAS STATION Q
OTHER (SPECIFY)____ X

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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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Burkina Faso 2003
Survey form view entire document:  text 
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 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 
630) Where is that? (3)

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

YES 1
NO 2 (GO TO 632)

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
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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Central African Republic 1995
Survey form view entire document:  text 
518) Where can you get a condom?

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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH SUB-CENTER C
HEALTH POST D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
HEALTH CENTER J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)____ L
OTHER SOURCE
MARKET M
CHURCH/RELIGIOUS CENTER N
FRIEND/RELATIVE O
OTHER (SPECIFY) X

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Chad 2014
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
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/DOCTOR'S OFFICE H
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING I
PRIVATE HEALTH CENTER J
BUSINESS HEALTH CENTER K
CARE OFFICE/INFIRMARY L
PHARMACY/PHARMACY DEPOT M
CHADIAN SOCIAL MARKETING ASSOCIATION N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
PUBLIC/PRIVATE SECTOR
PHARMACY/VILLAGE HEALTH CENTER P
OTHER
RELIGIOUS INSTITUTION Q
SHOP/BAR/MARKET R
FIRST AID WORKER S
TRAVELING VENDOR T
FRIENDS/NEIGHBORS/RELATIVES U
OTHER (SPECIFY) X

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

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 
643) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). 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
CLINIC N
OTHER MISSION (SPECIFY)_______O
NGO
FLAS P
OTHER NGO (SPECIFY)_________Q
OTHER SOURCE
SHOP R
CHURCH S
FRIEND/RELATIVES T
OTHER (SPECIFY)_______X

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Ghana 1998
Survey form view entire document:  text 
518. Where is that?

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELDWORKER 15
OTHER PUBLIC (SPECIFY) __________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) __________ 36

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 __________

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Ghana 2003
Survey form view entire document:  text 
525. Where is that? Any other place? RECORD ALL SOURCES 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
GOVT. HOSPITAL/CLINIC 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
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUG STORE I
MOBILE CLINIC J
FIELDWORKER K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
OTHER (SPECIFY) ____ X

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Ghana 2008
Survey form view entire document:  text 
642 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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Ghana 2014
Survey form view entire document:  text 
630) Where is that? (3)

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 
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 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 2009
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 HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ____________
PUBLIC SECTOR
GOVERNMENT 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 MEDICAL SECTOR H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CHAL HEALTH POST K
CBD L
COMMUNITY HEALTH WORKER/
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
PEER EDUCATORS Q
OTHER X

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

YES 1
NO 2 (GO TO 632)

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 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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Liberia 2007
Survey form view entire document:  text 
641) Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 701)

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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH CLINIC C
NACP D
OTHER PUBLIC (SPECIFY) _____________ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
FAMILY PLANNING ASSN. LIBERIA I
MOBILE CLINIC J
OTHER PRIVATE MEDICAL (SPECIFY) _______________ K
OTHER SOURCE
SHOP L
CHURCH M
FRIEND/RELATIVE N
OTHER (SPECIFY) ____________ X

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Liberia 2013
Survey form view entire document:  text 
629. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 632)

630. 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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Madagascar 2003
Survey form view entire document:  text 
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 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 
641. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 644)

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 A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ______
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) A
DISTRICT HOSPITAL I (non-surgical medical capabilities) B
BASIC HEALTH CENTER II (basic health care, physician-run) C
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PRIVATE HEALTH CENTER F
PHARMACY/MEDICINE DISPERSAL CENTER G
PRIVATE DOCTOR H
PF/FISA CENTER I
OTHER LOCATION
VBC AGENT J
STORE K
KIOSK L
CHURCH M
FRIENDS/RELATIVES N
MOTEL/HOTEL O
PEER EDUCATOR P
FIMAILO Q (NOTE: linked to a campaign to increase condom use in Madagascar)
OTHER (SPECIFY) _____ X

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Malawi 2000
Survey form view entire document:  text 
525. 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 2004
Survey form view entire document:  text 
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
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 (SPECIFY)___________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY)___________ X

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Malawi 2010
Survey form view entire document:  text 
642 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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Mali 2001
Survey form view entire document:  text 
525. Where is this?
Anywhere else?
RECORD ALL MENTIONED.

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

NAME OF PLACE_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MATERNITY/PMI D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC (SPECIFY) ____G
MEDICAL PRIVATE SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH CARE WORKER N
ADBC/DOULA/BIRTH ASSISTANT/HEALTH AIDE O
PARA-PUBLIC SECTOR
INPS/SMIE (NATIONAL INSTITUTE OF SOCIAL FUNDS/INTER-ENTERPRISE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) ___ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) ___ X

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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? (3)

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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Niger 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 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 1999
Survey form view entire document:  text 
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
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/PMS 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
COMMUNITY HEALTH WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) ______ 26
OTHER SOURCE
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
NGO 34
OTHER (SPECIFY) _______________ 36

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Nigeria 2003
Survey form view entire document:  text 
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 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 
642 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 
630) Where is that? (3)

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 2000
Survey form view entire document:  text 
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 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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Rwanda 2005
Survey form view entire document:  text 
642 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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Senegal 1997
Survey form view entire document:  text 
714. Which place(s) do you know of?
CIRCLE THE CODES CORRESPONDING TO RESPONSES GIVEN

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
HEALTH POST/ PMI (Protection Maternelle et Infantile) C
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC/HOSPITAL D
PHARMACY E
PRIVATE DOCTOR F
PRIVATE NURSE/CONFES G
OTHER SECTOR
ASBEF (Senegalese Association for Family Well-Being) H
CHURCH I
FRIEND/RELATIVE J
TRADITIONAL HEALER/WITCH DOCTOR K
OTHER (SPECIFY) _____L

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Senegal 2005
Survey form view entire document:  text 
545. Where is this?
Any other place?
RECORD EVERYTHING MENTIONED.

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

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CENTER C
HEALTH POST D
HEALTH HUT/ RURAL MATERNITY E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
HEALTH CARE WORKER M
OTHER PRIVATE (SPECIFY) _____N
OTHER SOURCE
SHOP O
BAR P
SCHOOL Q
RELIGIOUS INSTITUTION R
RELATIVES/FRIENDS S
OTHER (SPECIFY) _____X

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

YES 1
NO 2 (GO TO 632)

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
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
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) ____ X

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

YES 1
NO 2 (GO TO 632)

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 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 
629) Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 632)

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
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 
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
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 
731) 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
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
HOSPITAL/CLINIC/OFFICE 21
PRIVATE 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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Tanzania 1996
Survey form view entire document:  text 
805. Where can you get condoms?
CIRCLE ALL MENTIONED.
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

GOVERNMENT AND PARASTATAL
REGIONAL/CONSULTANT HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTRE C
DISPENSARY/PARASTATAL FACILITY D
VILLAGE HEALTH POST/WORKER E
MEDICAL PRIVATE SECTOR
RELIGIOUS ORG. FACILITY F
PRIV. DOCTOR/CLINIC/HOSPITAL G
PHARMACY/MEDICAL STORE H
CBD WORKER I
OTHER PRIVATE SECTOR
SHOP J
CHURCH K
FRIENDS/RELATIVES/NEIGHBORS L
OTHER (SPECIFY) ___________ X
DOES NOT KNOW Z

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Tanzania 1999
Survey form view entire document:  text 
524. Do you know of a place where one can get condoms?

YES 1
NO 2 (GO TO 526)

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.

NAME OF PLACE______
GOVERNMENT/PUBLIC SECTOR
REGIONAL/CONSULTANT HOSP 11
DISTRICT HOSPITAL 12
GOVT. HEALTH CENTER 13
DISPENSARY/PARASTATAL FACILITY 14
VILLAGE HEALTH POST/WORKER 15
PRIVATE MEDICAL SECTOR
RELIGIOUS ORGANIZATION FACILITY/MISSION HOSP 21
PRIVATE DOCTOR/CLINIC/HOSP 22
PHARMACY/MEDICAL STORE 23
CBD WORKER 24
OTHER PRIVATE SECTOR
SHOP/KIOSK 31
CHURCH 32
FRIEND/RELATIVE/NEIGHBOR 33
HEALTH EDUCATION/BAR GIRLS 34
OTHER (SPECIFY)_______________96
DON'T KNOW 98

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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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Togo 2013
Survey form view entire document:  text 
629) Do you know of a place where a person can get condoms?

YES 1
NO 2- (SKIP TO 632)

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
HEALTH CENTER B
DISPENSARY C
MOTHER-INFANT PROTECTION D
HEALTH HUT E
MOBILE CLINIC F
OTHER PUBLIC SECTOR__________ (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
NGO/ASSOCIATION K
OTHER PRIVATE MEDICAL SECTOR_______ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
OTHER_______ (SPECIFY) X

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Uganda 1995
Survey form view entire document:  text 
529) Do you know where you can get condoms?

YES 1
NO 2 (GO TO 532)

530) Where is that?

IF SOURCE IS HOSPITAL, HEALH 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
DISPENSARY/HEALTH UNIT 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELD WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) __________ 96

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Uganda 2001
Survey form view entire document:  text 
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.

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
Other (specify) __________ 96

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Uganda 2006
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
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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Uganda 2011
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 A
GOVT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUT REACH D
VILLAGE HEALTH TEAM E
OTHER PUBLIC SECTOR (SPECIFY) ___________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
OUT REACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL SECTOR (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 
629) Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 632)

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 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 1994
Survey form view entire document:  text 
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
GOVERNMENT HOSPITAL/CLINIC 10
RURAL/MUNICIPAL CLINIC 11
ZNFPC CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC MOBILE CLINIC 14
MOH MOBILE CLINIC 15
ZNFPC CBD 16
MOH CBD 17
OTHER PUBLIC (SPECIFY) __________ 18
MISSION FACILITY 19
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY 22
PRIVATE DOCTOR 23
CBD 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) __________ 96

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Zimbabwe 1999
Survey form view entire document:  text 
526) 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/CLINIC 11
RURAL/MUNICIPAL CLINIC 12
RURAL HEALTH CENTRE 13
ZNFPC (FIXED) CLINIC 14
ZNFPC MOBILE CLINIC 15
MOH MOBILE CLINIC 16
ZNFPC CBD 17
MOH CBD 18
OTHER PUBLIC (SPECIFY) __________ 19
MISSION FACILITY 21
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
CBD 34
OTHER PRIVATE MEDICAL (SPECIFY) __________ 36
OTHER SOURCE
SHOP 41
CHURCH 42
FRIENDS/RELATIVES 43
OTHER (SPECIFY) __________ 96

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Zimbabwe 2005
Survey form view entire document:  text 
642 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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Zimbabwe 2010
Survey form view entire document:  text 
630) Where is that? (3)

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

YES 1
NO 2 (GO TO 730D)