Survey Text

Benin 1996 Ghana 2003 Kenya 2008 Malawi 2004
Benin 2001 Ghana 2008 Kenya 2014 Malawi 2010
Benin 2011 Ghana 2014 Lesotho 2004 Nepal 2011
Chad 1996 Guinea 1999 Lesotho 2009 Niger 2012
Chad 2004 Jordan 2002 Lesotho 2014 Rwanda 2000
Chad 2014 Jordan 2007 Liberia 2007 Rwanda 2005
Congo Brazzaville 2005 Jordan 2012 Liberia 2013 Rwanda 2010
Congo Brazzaville 2011 Jordan 2017 Madagascar 1997 Rwanda 2014
Cote d'Ivoire 1998 Kenya 1998 Madagascar 2008 Senegal 1997
Ghana 1998 Kenya 2003 Malawi 2000 Togo 1998
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Benin 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)

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
FIELDWORKER 14
COMMUNITY CENTER 15
OTHER PUBLIC (SPECIFY) ____________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
RELIGIOUS HOSPITAL 22
PHARMACY 23
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) 24
DOCTOR'S OFFICE 25
FIELDWORKER 26
OTHER PRIVATE MEDICAL (SPECIFY) _____________ 27
OTHER
SHOP/MARKET 31
CHURCH 32
FRIENDS/RELATIVES 33
GAS STATION 34
OTHER (SPECIFY) ___________ 96

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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 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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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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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

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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? Any other place?

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

IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______________
PUBLIC SECTOR
GOVT. HOSPITAL/POLYCLINIC A
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ______ N
OTHER SOURCE
SHOP/MARKET O
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
OTHER (SPECIFY)______ X

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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

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

YES 1
NO 2 (GO TO 518A)

518. Where is that?

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

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

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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

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Kenya 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 519)

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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

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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

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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

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Lesotho 2004
Survey form view entire document:  text 
530 Where is that? Any other place?
RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
OTHER PUBLIC ___________(SPECIFY) D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
OTHER PRIVATE MEDICAL ___________(SPECIFY) H
CHAL
CHAL HOSPITAL I
CHAL HEALTH CENTER J
CBD K
COMMUNITY HEALTH WORKER L
SUPPORT GROUPS M
OTHER SOURCE
SHOP N
CHURCH O
PEER EDUCATORS P
FRIENDS/RELATIVES Q
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 1997
Survey form view entire document:  text 
518. Where is that?

IF IT IS A PUBLIC HOSPITAL OR A PRIVATE HOSPITAL OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE PROPER TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______________
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
OTHER PUBLIC (SPECIFY) __________ X
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
DOCTOR G
PF/FISA CENTER H
OTHER PRIVATE (SPECIFY) ______ Y
OTHER SOURCE
STORE I
RELIGIOUS CENTER J
RELATIVES K
FRIENDS L
OTHER (SPECIFY) ____________ Z

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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?
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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F

MISSION
HOSPITAL G
HEALTH CENTER H
MOBILE CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
MOBILE CLINIC M
FIELDWORKER N
OTHER PRIVATE MEDICAL (SPECIFY) __________ O
BLM P
OTHER SOURCE
SHOP Q
CHURCH R
FRIENDS/RELATIVES S
OTHER (SPECIFY) _____ X

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Malawi 2010
Survey form view entire document:  text 
642. Where is that? Anywhere else?
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 POST/OUTREACH C
MOBILE CLINIC D
HSA E
CBDA/DOOR TO DOOR F
OTHER PUBLIC G
CHAM/MISSION
HOSPITAL H
HEALTH CENTER I
MOBILE CLINIC J
DOOR TO DOOR K

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR L
PHARMACY M
MOBILE CLINIC N
CBDA/DOOR TO DOOR O
OTHER PRIVATE MEDICAL P
BLM Q
MACRO R
YOUTH DROP IN CENTRE S
OTHER SOURCE
SHOP T
CHURCH U
FRIEND/RELATIVE V
OTHER 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

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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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Rwanda 2000
Survey form view entire document:  text 
525. Where is that? Anywhere else?

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

RECORD ALL MENTIONED

NAME OF PLACE____
PUBLIC SECTOR
GOVERNMENT/GOVERNMENT-APPROVED HOSPITAL A
GOVERNMENT/GOVERNMENT-APPROVED HEALTH CENTER B
FAMILY PLANNING CLINIC C
DBC AGENT D
OTHER PUBLIC (SPECIFY)_____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
ARBEF (RWANDAN ASSOCIATION FOR FAMILY WELFARE) CLINIC I
OTHER PRIVATE MEDICAL (SPECIFY)____ J
OTHER SOURCE
SHOP/KIOSK K
CHURCH L
RELATIVES/FRIENDS M
OTHER (SPECIFY)_____ X

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Rwanda 2005
Survey form view entire document:  text 
545. 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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
AGENT DBC C
OTHER PUBLIC (SPECIFY) _____ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
PRIVATE DOCTOR G
ARBEF CLINIC H
NURSE I
OTHER PRIVATE MEDICAL (SPECIFY) ____ J
OTHER SOURCE
SHOP/KIOSK/STREET K
CHURCH L
FRIENDS/RELATIVES M
OTHER (SPECIFY) ____ X

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Rwanda 2010
Survey form view entire document:  text 
630) Where is that? Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S)
PUBLIC SECTOR
REFERAL HOSPITAL A
DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) M
OTHER SOURCE
KIOSK N
TRADITIONAL BIRTH ATTENDANT O
FRIEND/RELATIVE P
OTHER (SPECIFY) X

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Rwanda 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/AGREE SECTOR
REFERRAL HOSPITAL A
PROVINCIAL/DISTRICT HOSPITAL B
HEALTH CENTER C
HEALTH POST D
OUTREACH E
COMMUNITY HEALTH WORKER F
OTHER PUBLIC HEALTH FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
POLYCLINIC H
CLINIC I
DISPENSARY J
PHARMACY K
FAMILY PLANNING CLINIC L
OTHER PRIVATE HEALTH FACILITY (SPECIFY) ____ M
OTHER SOURCES
KIOSK/SHOP/BAR N
TRADITIONAL HEALER O
FRIEND/RELATIVE P
YOUTH CENTER Q
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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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