Survey Text

Benin 2006 Ghana 2008 Kenya 2008 Mali 2006
Ghana 1998 Ghana 2014 Kenya 2014 Mali 2012
Ghana 2003 Kenya 2003 Mali 2001 Niger 1998
top
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

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

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
GVT. HOSPITAL/POLYCLINIC A
GVT. HEALTH CENTRE B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PRIVATE SECTOR
HOSPITAL/CLINIC G
PHARMACY H
CHEMIST I
DRUG STORE J
MOBLIE CLINIC K
FIELD WORKER L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE (SPECIFY) ____O
OTHER SOURCE
CHURCH P
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _____ S

top
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

top
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

top
Ghana 2014
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
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER/CLINIC 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

top
Kenya 2003
Survey form view entire document:  text 
526. Where is that? Any other place? CIRCLE 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) ________

IF NURSING/MATERNITY HOME, ASK IF IT IS RUN BY A CHURCH OR MISSION. IF SO, CIRCLE CODE 'F'.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTRE B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) ____ D
PRIVATE MEDICAL SECTOR
MISSION, CHURCH HOSP./CLINIC F
FPAK HEALTH CENTRE/CLINIC G
PRIVATE HOSPITAL OR CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
MOBILE CLINIC M
COMMUNITY-BASED DISTRIBUTOR N
SHOP/KIOSK O
FRIENDS/RELATIVES Q
OTHER (SPECIFY) _______ X

top
Kenya 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 B
GOVT. HEALTH CENTER C
GOVERNMENT DISPENSARY D
OTHER PUBLIC (SPECIFY) ___________ E
PRIVATE MEDICAL SECTOR
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC F
FHOK/FPAK HEALTH CENTER/CLINIC G
PRIVATE HOSPITAL/CLINIC H
PHARMACY/CHEMIST I
NURSING/MATERNITY HOME J
OTHER PRIV. MEDICAL (SPECIFY) ________ K
OTHER SOURCE
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
SHOP N
FRIEND/RELATIVE P
OTHER (SPECIFY) ___________ X

top
Kenya 2014
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
GOVERNMENT HEALTH CENTER B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) ________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY/CHEMIST F
NURSING/MATERNITY HOME G
FAITH-BASED, CHURCH, MISSION HOSPITAL/CLINIC H
FAMILY OPTIONS/FHOK CLINIC I
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _________ J
OTHER SOURCE
SHOP K
MOBILE CLINIC L
COMMUNITY-BASED DISTRIBUTOR M
COMMUNITY HEALTH WORKER/CHW N
FRIEND/RELATIVE O
DISPENSER P
OTHER (SPECIFY) ___________ X

top
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

top
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

top
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

top
Niger 1998
Survey form view entire document:  text 
517) Do you know of a place where you could get condoms?

YES 1
NO 2 (GO TO 519)

518) 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 11
INTEGRATED HEALTH CENTER 12
MATERNITY WARD 13
HEALTH CHECK 14
CONSULTATION AT A FAIR 15
OTHER PUBLIC (SPECIFY): ___ 16
PRIVATE SECTOR
PRIVATE CLINIC 21
PHARMACY 22
PRIVATE DOCTOR'S OFFICE 23
HEALTHCARE WORKER 24
OTHER PRIVATE (SPECIFY): ___ 26
OTHER SOURCE
FIELD PHARMACY 31
TRADITIONAL HEALERS 32
FRIENDS/FAMILY 33
OTHER (SPECIFY): ___ 36