Survey Text

Cameroon 1998 Congo Brazzaville 2005 Mali 2006 Niger 1998
Cameroon 2004 Congo Brazzaville 2011 Mali 2012 Niger 2006
Cameroon 2011 Cote d'Ivoire 1998 Mali 2018 Niger 2012
Chad 1996 Ethiopia 2000 Mozambique 1997 Uganda 2001
Chad 2004 Ethiopia 2005 Mozambique 2003 Uganda 2006
Chad 2014 Ethiopia 2011 Mozambique 2011 Uganda 2011
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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 
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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Chad 1996
Survey form view entire document:  text 
517. Do you know of a place where you can get condoms?

YES 1
NO 2 (GO TO 519)

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Chad 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 MENTIONED.

(NAME OF PLACE)_______________
PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
AMASOT/MASOCOT F [##TRANSLATOR NOTE: BOTH ARE ACRONYMS FOR AGENCIES THAT ADVOCATE CONDOMS]
OTHER PUBLIC G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
CLINIC/OFFICE I
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING J
PRIVATE HEALTH CENTER K
COMPANY HEALTH CENTER L
CARE OFFICE/NURSE M
PHARMACY/PHARMACY DEPOT N
OTHER PRIVATE MEDICAL O
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER P
OTHER
SHOP/BAR/MARKET/HOTEL Q
FIRST AID WORKER R
MOBILE VENDOR S
FRIENDS/NEIGHBORS/RELATIVES T
OTHER PLACE_______________- 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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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 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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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

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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

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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

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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 1997
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
CENTRAL HOSPITAL A
PROVINCIAL/GENERAL HOSPITAL B
RURAL HOSPITAL C
HEALTH CENTER D
HEALTH POST E
MOBILE CLINIC F
OTHER (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE CLINIC H
PRIVATE PHARMACY I
PRIVATE DOCTOR J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
OTHER SOURCE
SHOP L
TRADITIONAL HEALER M
MEDICAL STAFF IN THE NEIGHBORHOOD N
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? 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 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

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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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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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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