Survey Text

Afghanistan 2015 India 2015 Nepal 2001 Tanzania 2004
Eswatini (Swaziland) 2006 Jordan 2002 Nepal 2006 Tanzania 2010
Ethiopia 2000 Jordan 2007 Nepal 2011 Togo 2013
Ethiopia 2005 Jordan 2012 Nigeria 2003
Ethiopia 2011 Jordan 2017 Nigeria 2008
India 2005 Myanmar 2015 Nigeria 2013
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Afghanistan 2015
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 (NATIONAL, REGIONAL, PROVINCIAL OR DISTRICT) A
CHC/POLYCLINIC B
BASIC HEALTH CENTER C
HEALTH SUB-CENTER D
HEALTH POST/SUB-HEALTH POST E
COMMUNITY HEALTH WORKER F
MOBILE CLINIC G
OTHER PUBLIC SECTOR______H
NON-GOVERNMENT SECTOR
MARIE STOPES I
RED CROSS SOCIETY J
AFGA K
OTHER NGO SECTOR________L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
FIELDWORKER P
OTHER PRIVATE MEDICAL SECTOR_______Q
OTHER SOURCE
CHARITY/FOUNDATIONS R
REFUGEE CAMP S
SHOP T
FRIENDS/RELATIVES U
OTHER___________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

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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Ethiopia 2000
Survey form view entire document:  text 
1112. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME AND/OR LOCATION OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/OR LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________ 16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY)___________________ 26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) ________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) ________ 46

Survey form view entire document:  text 
1112. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME AND/OR LOCATION OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/OR LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________ 16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY)___________________ 26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) ________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) ________ 46

Survey form view entire document:  text 
1112. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME AND/OR LOCATION OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/OR LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________ 16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY)___________________ 26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) ________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) ________ 46

Survey form view entire document:  text 
1112. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME AND/OR LOCATION OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME AND/OR LOCATION OF PLACE____

GOVERNMENT
HOSPITAL 11
HEALTH CENTER 12
HEALTH STATION/CLINIC 13
HEALTH POST 14
COMMUNITY-BASED OUTLET 15
OTHER GOVERNMENT (SPECIFY)__________ 16
NONGOVERNMENTAL (NGO)
HEALTH FACILITY 21
COMMUNITY-BASED OUTLETS 22
OTHER NGO (SPECIFY)___________________ 26
PRIVATE MEDICAL
PRIVATE HOSPITAL 31
PRIVATE DOCTOR 32
PHARMACY 33
OTHER PRIVATE MEDICAL (SPECIFY) ________ 36
OTHER SOURCE
DRUG VENDOR 41
SHOP 42
FRIEND/RELATIVE 43
OTHER (SPECIFY) ________ 46

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Ethiopia 2005
Survey form view entire document:  text 
638. 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
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
CBD/CBRHA H
OTHER NGO ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER SOURCE
DRUG VENDOR M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 
638. 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
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
CBD/CBRHA H
OTHER NGO ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER SOURCE
DRUG VENDOR M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 
638. 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
GOVERNMENT HEALTH POST C
GOVERNMENT HEALTH STATION/CLINIC D
CBD E
OTHER PUBLIC (SPECIFY) ________F
NON-GOVERNMENT (NGO)
NGO HEALTH FACILITY G
CBD/CBRHA H
OTHER NGO ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
PHARMACY K
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ L
OTHER SOURCE
DRUG VENDOR M
SHOP N
FRIEND/RELATIVE O
OTHER (SPECIFY) _____________ X

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Ethiopia 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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) ______ E
NGO
NGO HEALTH FACILITY F
VOLUNTARY COMMUNITY HEALTH WORKERS G
OTHER NGO (SPECIFY) ______ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
PHARMACY K
ANTI-AIDS CLUB/ASSOCIATION L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
DRUG VENDOR/STORE N
SHOP/BAR/HOTEL/GROCERY O
FRIEND/RELATIVE P
OTHER (SPECIFY) ______ X

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 A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) ______ E
NGO
NGO HEALTH FACILITY F
VOLUNTARY COMMUNITY HEALTH WORKERS G
OTHER NGO (SPECIFY) ______ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
PHARMACY K
ANTI-AIDS CLUB/ASSOCIATION L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
DRUG VENDOR/STORE N
SHOP/BAR/HOTEL/GROCERY O
FRIEND/RELATIVE P
OTHER (SPECIFY) ______ X

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 A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) ______ E
NGO
NGO HEALTH FACILITY F
VOLUNTARY COMMUNITY HEALTH WORKERS G
OTHER NGO (SPECIFY) ______ H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL I
PRIVATE CLINIC J
PHARMACY K
ANTI-AIDS CLUB/ASSOCIATION L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
DRUG VENDOR/STORE N
SHOP/BAR/HOTEL/GROCERY O
FRIEND/RELATIVE P
OTHER (SPECIFY) ______ X

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India 2005
Survey form view entire document:  text 
619. Where is that? Any other place?

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S). RECORD ALL SOURCES MENTIONED.

NAME OF PLACE(S) __________
PUBLIC MEDICAL SECTOR
GOVT./MUNICIPAL HOSPITAL A
GOVT. DISPENSARY B
UHC/UHP/UFWC C
CHC/RURAL HOSPITAL/PHC D
SUB-CENTRE/ANM E
GOVT. MOBILE CLINIC F
CAMP G
ANGANWADI/ICDS CENTRE H
ASHA I
OTHER COMMUNITY BASED WORKER J
OTHER PUBLIC MEDICAL SECTOR (SPECIFY) _____ K
NGO OR TRUST HOSPITAL/CLINIC L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR M
PRIVATE PARAMEDIC N
VAIDYA/HAKIM/HOMEOPATH O
TRADITIONAL HEALER P
PHARMACY/DRUGSTORE Q
DAI (TBA) R
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ S
RATION SHOP T
OTHER SHOP U
VENDING MACHINE V
OTHER (SPECIFY) _______ X

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India 2015
Survey form view entire document:  text 
821. Where is that? Any other place?
RECORD ALL SOURCES MENTIONED.

IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE(S).

(NAME OF FACILITY/PLACE(S)) ______
PUBLIC HEALTH SECTOR
GOVERNMENT/MUNICIPAL HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
UHC/UHP/UFWC D
CHC/RURAL HOSPITAL/BLOCK PHC E
PHC/ADDITIONAL PHC F
SUB-CENTRE/ANM G
GOVERNMENT MOBILE CLINIC H
CAMP I
ANGANWADI/ICDS CENTRE J
ASHA K
OTHER COMMUNITY BASED WORKER L
OTHER PUBLIC HEALTH SECTOR (SPECIFY) ______M
NGO OR TRUST HOSPITAL/CLINIC N
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR O
PRIVATE PARAMEDIC P
PRIVATE MOBILE CLINIC Q
VAIDYA/HAKIM/HOMEOPATH (AYUSH) R
TRADITIONAL HEALER S
PHARMACY/DRUGSTORE T
DAI (TBA) U
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______V
OTHER SOURCE
RATION SHOP W
OTHER SHOP X
VENDING MACHINE Y
OTHER (SPECIFY) ________Z

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Jordan 2002
Survey form view entire document:  text 
525. Where is that? Any other place? (RECORD ALL SOURCES MENTIONED.)

IF SOURCE IS HOSPITAL, HEALTH CINTER, 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 A
GOVT. HEALTH CENTER B
GOVT. MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES (ARMED FORCES) E
MOBILE CLINIC F
OTHER PUBLIC____G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) K
UNRWA HEALTH CENTER L
OTHER NON GOV. ORGANIZATION M
OTHER PRIVATE MEDICAL_______N
OTHER SOURCE
FRIEND/RELATIVE O
OTHER________X

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Jordan 2007
Survey form view entire document:  text 
615) 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 PLACE.

(NAME OF PLACE(S)) ____________________________
PUBLIC MEDICAL SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT MOTHER AND CHILD HEALTH CENTER C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICES E
OTHER PUBLIC (SPECIFY)________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
JORDANIAN ASSOCIATION OF FAMILY PLANNING AND PROTECTION (JAFPP) J
UNITED NATIONS RELIEF AND WORKS AGENCY CLINIC K
OTHER NON-GOVERNMENT ORGANIZATION L
OTHER PRIVATE MEDICAL (SPECIFY)___________ M
OTHER SOURCE
FRIEND/ RELATIVE N
OTHER (SPECIFY)_____________ X

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Jordan 2012
Survey form view entire document:  text 
615. 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 MEDICAL SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. MCH C
UNIVERSITY HOSPITAL/CLINIC D
ROYAL MEDICAL SERVICES E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
UNRWA CLINIC K
OTHER NON-GOV ORGANIZATION L
OTHER PRIVATE MEDICAL (SPECIFY) _____ M
OTHER SOURCE
FRIEND/RELATIVE N
OTHER (SPECIFY) _____ X

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Jordan 2017
Survey form view entire document:  text 
714C) Where is that? Any other place?

PUBLIC MEDICAL SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICE E
OTHER PUBLIC (SPECIFY) _______________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
UNRWA HEALTH CENTER K
UNHCR/OTHER NON GOV. ORG. L
OTHER PRIVATE MEDICAL (SPECIFY) _____________ M
OTHER SOURCE
FRIEND/RELATIVE N
OTHER (SPECIFY) ___________________ X

Survey form view entire document:  text 
714C) Where is that? Any other place?

PUBLIC MEDICAL SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. MCH C
UNIVERSITY HOSPITAL D
ROYAL MEDICAL SERVICE E
OTHER PUBLIC (SPECIFY) _______________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY I
JORDANIAN AS. OF FP AND PROTECTION (JAFPP) J
UNRWA HEALTH CENTER K
UNHCR/OTHER NON GOV. ORG. L
OTHER PRIVATE MEDICAL (SPECIFY) _____________ M
OTHER SOURCE
FRIEND/RELATIVE N
OTHER (SPECIFY) ___________________ X

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Myanmar 2015
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 (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

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 (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

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 (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

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 (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

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 (RHC) B
GOVT. HEALTH POST (SUB-CENTER) C
VILLAGE HEALTH WORKER D
MOBILE CLINIC E
UHC/MCH CENTER F
OTHER PUBLIC SECTOR____(SPECIFY) G
NON-GOVERNMENT SECTOR
MARIE STOPES H
MYANMAR RED CROSS SOCIETY I
PSI/M (SUN) J
MMA K
OTHER NGO SECTOR____(SPECIFY) L
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC M
PHARMACY N
PRIVATE DOCTOR O
MOBILE CLINIC P
FIELDWORKER Q
OTHER PRIVATE MEDICAL SECTOR____(SPECIFY) R
OTHER SOURCE
SHOP S
BETELNUT SHOP T
FRIENDS/RELATIVES U
OTHER______(SPECIFY) X

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Nepal 2001
Survey form view entire document:  text 
714. Where is that?
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.

NAME OF PLACE _______________

Any other place?
RECORD ALL MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOV'T (SPECIFY) _______ H
NON-GOV'T (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) ________ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) ___________ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _______ X

Survey form view entire document:  text 
714. Where is that?
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.

NAME OF PLACE _______________

Any other place?
RECORD ALL MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOV'T (SPECIFY) _______ H
NON-GOV'T (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) ________ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) ___________ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _______ X

Survey form view entire document:  text 
714. Where is that?
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.

NAME OF PLACE _______________

Any other place?
RECORD ALL MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOV'T (SPECIFY) _______ H
NON-GOV'T (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) ________ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) ___________ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _______ X

Survey form view entire document:  text 
714. Where is that?
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.

NAME OF PLACE _______________

Any other place?
RECORD ALL MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOV'T (SPECIFY) _______ H
NON-GOV'T (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) ________ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) ___________ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _______ X

Survey form view entire document:  text 
714. Where is that?
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.

NAME OF PLACE _______________

Any other place?
RECORD ALL MENTIONED.

GOVERNMENT SECTOR
GOVT. HOSPITAL/CLINIC A
PRIMARY HEALTH CARE CENTER/HEALTH CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FCHV F
CONDOM BOX G
OTHER GOV'T (SPECIFY) _______ H
NON-GOV'T (NGO) SECTOR
FP ASSN. OF NEPAL I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
OTHER NGO (SPECIFY) ________ M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME N
PHARMACY O
OTHER PRIVATE (SPECIFY) ___________ P
OTHER SOURCE
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _______ X

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Nepal 2006
Survey form view entire document:  text 
617. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

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

YES 1
NO 2 (GO TO 701)

618. Where is that? Any other place? IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).

NAME OF PLACE __
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE LCINIC F
FCHV G
OTHER GOVT. (SPECIFY) __ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEAL REDCROSS L
UMN M
OTHER NGO. (SPECIFY) ___ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDCIAL (SPECIFY) ___ Q
OTHER SOURCE
SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___ T
OTHER (SPECIFY) ___ X

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Nepal 2011
Survey form view entire document:  text 
618) Where is that?
Any other place?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL SOURCES MENTIONED

(NAME OF PLACE(S)) _______________

.

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
OTHER GOVT. (SPECIFY) ___________ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) __________ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) ___________ Q
OTHER SOURCE SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___________ T
OTHER (SPECIFY) ___________ X

Survey form view entire document:  text 
618) Where is that?
Any other place?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL SOURCES MENTIONED

(NAME OF PLACE(S)) _______________

.

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
OTHER GOVT. (SPECIFY) ___________ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) __________ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) ___________ Q
OTHER SOURCE SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___________ T
OTHER (SPECIFY) ___________ X

Survey form view entire document:  text 
618) Where is that?
Any other place?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL SOURCES MENTIONED

(NAME OF PLACE(S)) _______________

.

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
OTHER GOVT. (SPECIFY) ___________ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) __________ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) ___________ Q
OTHER SOURCE SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___________ T
OTHER (SPECIFY) ___________ X

Survey form view entire document:  text 
618) Where is that?
Any other place?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL SOURCES MENTIONED

(NAME OF PLACE(S)) _______________

.

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
OTHER GOVT. (SPECIFY) ___________ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) __________ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) ___________ Q
OTHER SOURCE SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___________ T
OTHER (SPECIFY) ___________ X

Survey form view entire document:  text 
618) Where is that?
Any other place?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL SOURCES MENTIONED

(NAME OF PLACE(S)) _______________

.

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
OTHER GOVT. (SPECIFY) ___________ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) __________ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) ___________ Q
OTHER SOURCE SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___________ T
OTHER (SPECIFY) ___________ X

Survey form view entire document:  text 
618) Where is that?
Any other place?
IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL SECTOR, WRITE THE NAME OF THE PLACE(S).
RECORD ALL SOURCES MENTIONED

(NAME OF PLACE(S)) _______________

.

PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
MOBILE CLINIC F
FCHV G
OTHER GOVT. (SPECIFY) ___________ H
NON-GOVT. (NGO) SECTOR
FPAN I
MARIE STOPES J
ADRA K
NEPAL RED CROSS L
UMN M
OTHER NGO. (SPECIFY) __________ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/NURSING HOME O
PHARMACY P
OTHER PRIVATE MEDICAL (SPECIFY) ___________ Q
OTHER SOURCE SHOP R
FRIEND/RELATIVE S
OTHER (SPECIFY) ___________ T
OTHER (SPECIFY) ___________ X

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Nigeria 2003
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
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 
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) _________________
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
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) ______ M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
NGO Q
OTHER (SPECIFY) _______________ X

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Nigeria 2013
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
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY)____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
CHEMIST/PMS I
PRIVATE DOCTOR J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_____ M
OTHER SOURCE
SHOP N
CHURCH O
FRIENDS/RELATIVES P
NGO 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 
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 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