Survey Text

Afghanistan 2015 Ghana 1998 Mali 1995 Uganda 2001
Benin 1996 Ghana 2003 Mali 2001 Uganda 2006
Benin 2001 Guinea 2005 Mali 2006 Uganda 2011
Benin 2006 Guinea 2012 Mali 2012 Zambia 2001
Benin 2011 Kenya 1998 Myanmar 2015 Zambia 2007
Burkina Faso 2003 Kenya 2003 Nigeria 1999 Zambia 2013
Burkina Faso 2010 Kenya 2008 Nigeria 2003 Zimbabwe 1994
Burundi 2010 Kenya 2014 Nigeria 2008 Zimbabwe 1999
Central African Republic 1995 Madagascar 2003 Nigeria 2013 Zimbabwe 2005
Congo (Democratic Republic) 2007 Madagascar 2008 Tanzania 1996 Zimbabwe 2010
Congo (Democratic Republic) 2013 Malawi 2000 Tanzania 1999 Zimbabwe 2015
Cote d'Ivoire 2011 Malawi 2004 Togo 1998
Eswatini (Swaziland) 2006 Malawi 2010 Uganda 1995
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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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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 2006
Survey form view entire document:  text 
545) Where is that? Any other place?

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

NAME OF PLACE ________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MATERNITY CENTER D
COMMUNITY PHARMACY E
STRAT AV HEALTH WORKER F
HEALTH WORKER G
OTHER PUBLIC (SPECIFY) ________ I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) L
DOCTOR'S OFFICE M
HEALTH AGENT (NON-GOVERNMENTAL ORGANIZATION) N
OTHER PRIVATE MEDICAL (SPECIFY) ________ O
OTHER SOURCE
SHOP/MARKET P
CHURCH/MOSQUE Q
SCHOOL R
RELATIVES/FRIENDS S
OTHER (SPECIFY) ________ X

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Benin 2011
Survey form view entire document:  text 
630) Where is that?
Any other place?

PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
FIELDWORKER D
SOCIAL CENTER E
STRAT AV HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
VENDING MACHINE H
OTHER PUBLIC SECTOR______ (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
RELIGIOUS HOSPITAL K
PRIVATE DOCTOR'S OFFICE L
PHARMACY M
BENINESE FAMILY PLANNING ASSOCIATION (ABPF) N
FIELDWORKER (NGO) O
OTHER PRIVATE MEDICAL_______ (SPECIFY) P
OTHER SOURCE
SHOP/MARKET Q
CHURCH/MOSQUE R
FRIEND/RELATIVES S
BAR/REFRESHMENT AREA T
OTHER________ (SPECIFY) X

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Burkina Faso 2003
Survey form view entire document:  text 
525) Where is that?

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

Any other place?

RECORD ALL SOURCES MENTIONED.

NAME OF PLACE: _____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY): __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY): ___________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY): ___________ X

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Burkina Faso 2010
Survey form view entire document:  text 
630. Where is that?
Any other place?

PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
OTHER (SPECIFY) _____ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
MOBILE CLINIC I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
COMMUNITY/VILLAGE FIELDWORKER K
SHOP L
CHURCH M
FRIEND/RELATIVES N
OTHER (SPECIFY) ______ X

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

YES 1
NO 2 (GO TO 632)

630) Where is that?
Any other place?

PROBE TO IDENTITY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY) ______ X

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

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

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

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Congo (Democratic Republic) 2007
Survey form view entire document:  text 
544) Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 601)

545) Where is that?
Any other place?
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 A
HEALTH CENTER B
HEALTH OUTPOST C
FAMILY PLANNING CLINIC D
COMMUNITY WORKER E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
AMO-CONGO I
HEALTH AGENT J
OTHER PRIVATE MEDICAL (SPECIFY) ____ K
OTHER SOURCE
SHOP L
BAR/NIGHTCLUB M
KIOSK N
TABLIER O
FRIENDS/ACQUAINTANCES/RELATIVES P
OTHER (SPECIFY) _____ X

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Congo (Democratic Republic) 2013
Survey form view entire document:  text 
629) Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 632)

630) Where is that? Any other place?
PROBE TO 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
FAMILY PLANNING CLINIC B
GOVERNMENT HEALTH CENTER C
FAMILY PLANNING CLINIC D
COMMUNITY LIAISON E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
NGO I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) L
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
TABLIER P
FRIEND/ACQUAINTANCE/RELATIVES Q
OTHER (SPECIFY) X

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Cote d'Ivoire 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
MOBILE CLINIC D
HEALTH WORKER E
OTHER PUBLIC SECTOR_________ (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
HEALTH AGENT K
OTHER PRIVATE MEDICAL__________ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTIONS N
FRIEND/RELATIVES O
OTHER______________ (SPECIFY) X

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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
643) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))__________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
PHU/CLINIC C
MOBILE CLINIC D
RHM/CBD E
OTHER PUBLIC (SPECIFY)_________F
PRIVATE SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
CBD K
OTHER PRIVATE (SPECIFY)________L
MISSION
HOSPITAL M
CLINIC N
OTHER MISSION (SPECIFY)_______O
NGO
FLAS P
OTHER NGO (SPECIFY)_________Q
OTHER SOURCE
SHOP R
CHURCH S
FRIEND/RELATIVES T
OTHER (SPECIFY)_______X

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

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

If source is hospital, health center, or clinic, write the name of the place. Probe to identify the type of source and circle the appropriate code.

NAME OF PLACE __________

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Ghana 2003
Survey form view entire document:  text 
525. Where is that? Any other place? RECORD ALL SOURCES MENTIONED?

IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) _____________
PUBLIC SECTOR
GOVT. HOSPITAL/CLINIC A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PRIVATE DOCTOR H
PHARMACY/CHEMIST/DRUG STORE I
MOBILE CLINIC J
FIELDWORKER K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) ____N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
OTHER (SPECIFY) ____ X

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Guinea 2005
Survey form view entire document:  text 
544. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 601)

545. Where is that?
Any other place?
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 A
HEALTH CENTER B
MEDICAL POST C
FAMILY PLANNING CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR G
PHARMACY H
FIELDWORKER J
OTHER PRIVATE MEDICAL (SPECIFY) _____ K
OTHER SOURCE
SHOP L
BAR/NIGHTCLUB M
KIOSK N
WORKPLACE O
FRIENDS/ACQUAINTANCES/RELATIVES P
OTHER (SPECIFY) _____ X

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Guinea 2012
Survey form view entire document:  text 
630) Where is that? (3)

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

(NAME OF PLACE(S))________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY)______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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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

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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Madagascar 2003
Survey form view entire document:  text 
525. Where is that?
Any other place?
RECORD ALL MENTIONED

IF IT IS A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).

NAME OF PLACE _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
GROUND AGENT E
OTHER PUBLIC (SPECIFY) _____ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
GROUND AGENT K
OTHER PRIVATE (SPECIFY) ____L
OTHER LOCATION
STORE M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _____ X

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Madagascar 2008
Survey form view entire document:  text 
641. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 644)

642. Where is that?
Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

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

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Malawi 2000
Survey form view entire document:  text 
525. Where is that?
RECORD FIRST RESPONSE ONLY.

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

NAME OF PLACE______
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) _____ 16
MISSION
HOSPITAL 21
HEALTH CENTER 22
MOBILE CLINIC 23
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 31
PHARMACY 32
PRIVATE DOCTOR 33
MOBILE CLINIC 34
FIELD WORKER 35
OTHER PRIVATE MEDICAL (SPECIFY) ____ 36
BLM 41
OTHER SOURCE
SHOP 51
CHURCH 52
FRIEND/RELATIVE 53
OTHER (SPECIFY) _____ 96

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Malawi 2004
Survey form view entire document:  text 
525) Where is that? Any other place?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
RECORD ALL SOURCES MENTIONED.

NAME OF PLACE_____________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY)__________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY)___________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY)___________ X

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Malawi 2010
Survey form view entire document:  text 
642. Where is that? 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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Mali 1995
Survey form view entire document:  text 
518. Where is this?

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

NAME OF PLACE__
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER/FREE CLINIC/CLINIC/MATERNITY 12
HEALTH AGENT 13
PRIVATE SECTOR
CLINIC 21
PRIVATE DOCTOR 22
PHARMACY 23
FIELD WORKER 24
COMMUNITY
HEALTH CENTER 31
HEALTH CARE WORKER 32
FAMILY PLANNING FIELDWORKER/DOULA/BIRTHER/HEALTH AID 33
PARA-PUBLIC
INPS/CMIE (NATIONAL INSTITUTE OF SOCIAL FUNDS/INTER-ENTREPRISE MEDIAL CENTER) 41
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) 42
NON GOVERNMENTAL
NGO/AMPPF (Malian Association of Family Protection and Promotion) 51
OTHER PRIVATE SECTOR
SHOP/MARKET 61
HEALER/TRADITIONAL PRACTITIONER/MARABOUT (a kind of spiritual healer/witch doctor) 62
FRIEND(S)/RELATIVE(S) 63
OTHER (SPECIFY)__96
DOESN'T KNOW 98

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

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

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

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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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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

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Nigeria 1999
Survey form view entire document:  text 
518. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

(NAME OF PLACE) __________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
COMMUNITY HEALTH WORKER 15
OTHER PUBLIC (SPECIFY) ______ 16

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

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Nigeria 2003
Survey form view entire document:  text 
525. Where is that? 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? (5)
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) ____________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC (SPECIFY) ____________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL (SPECIFY) __________ L
OTHER SOURCE
SHOP M
CHURCH N
FRIEND/RELATIVE O
OTHER (SPECIFY) __________ X

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Nigeria 2013
Survey form view entire document:  text 
630) Where is that? (3)

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

(NAME OF PLACE(S))________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTER B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY)______ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
MOBILE CLINIC J
FIELDWORKER K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)______ L
OTHER SOURCE
SHOP M
CHURCH N
FRIENDS/RELATIVES O
OTHER (SPECIFY)______ X

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Tanzania 1996
Survey form view entire document:  text 
805. Where can you get condoms?
CIRCLE ALL MENTIONED.
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

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

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

YES 1
NO 2 (GO TO 526)

525. Where is that?

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

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

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Togo 1998
Survey form view entire document:  text 
518) Where is that?

RECORD ALL MENTIONED

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

(NAME OF PLACE)_____________

PUBLIC SECTOR
HOSPITAL 11
MEDICAL-SOCIAL CENTER 12
DISPENSARY/INFIRMARY 13
M.C.H. 14
HEALTH POST 15
STATE PHARMACY 16
OTHER PUBLIC (SPECIFY) __________ 17
PRIVATE MEDICAL SECTOR
HOSPITAL/PRIVATE CLINIC 21
PHARMACY 22
TOGOLESE ASSOCIATION FOR FAMILIAL WELL-BEING 23
DOCTOR'S OFFICE 24
FIELDWORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
MARKET/SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
GAS STATION 34
OTHER (SPECIFY) __________ 96

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

YES 1
NO 2 (GO TO 532)

530) Where is that?

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

(NAME OF PLACE) __________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL 11
GOVERNMENT HEALTH CENTER 12
DISPENSARY/HEALTH UNIT 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ___________ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC 21
PHARMACY/DRUG STORE 22
PRIVATE DOCTOR 23
MOBILE CLINIC 24
FIELD WORKER 25
OTHER PRIVATE MEDICAL (SPECIFY) __________ 26
OTHER PRIVATE SECTOR
SHOP 31
CHURCH 32
FRIENDS/RELATIVES 33
OTHER (SPECIFY) __________ 96

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Uganda 2001
Survey form view entire document:  text 
525 Where is that?
If source is hospital, health center, or clinic, write the name of the place. Probe to identify the type of source and circle the appropriate code.

Name of place __________

Any other place?
Record all mentioned.

Public sector
Government hospital A
Government health center B
Family planning clinic C
Outreach D
Government community based distributor E
Other public (specify) __________ F
Private medical sector
Private hospital/clinic G
Pharmacy/drug shop H
Private doctor/nurse/midwife I
Outreach J
NGO community based distributor K
Other private medical (specify) __________ L
Other source
Shop M
Religious institution N
Friends/relatives O
Street vendor P
Lodge Q
Other (specify) __________ X
Other (specify) __________ 96

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Uganda 2006
Survey form view entire document:  text 
642) Where is that? Any other place?

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

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

NAME OF PLACE(S)_____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUTREACH D
GOVERNMENT COMMUNITY BASED DISTRIBUTOR E
OTHER PUBLIC (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY/DRUG SHOP H
PRIVATE DOCTOR/NURSE/MIDWIFE I
OUTREACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
STREET VENDOR P
LODGE Q
OTHER (SPECIFY) X

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Uganda 2011
Survey form view entire document:  text 
630) Where is that?
Any other place?

PROBE TO IDENTIFY EACH TYPE OF SOURCE.

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

(NAME OF PLACE(S)) _________________________

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT HEALTH CENTER B
FAMILY PLANNING CLINIC C
OUT REACH D
VILLAGE HEALTH TEAM E
OTHER PUBLIC SECTOR (SPECIFY) ___________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
OUT REACH J
NGO COMMUNITY BASED DISTRIBUTOR K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) __________ L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
STREET VENDOR P
LODGE Q
OTHER (SPECIFY) ___________ X

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Zambia 2001
Survey form view entire document:  text 
524. Do you know of a place where a person can get male condoms?

YES 1
NO 2 (GO TO 526B)

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
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PVT. HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) ______ I
OTHER SOURCE
SHOP J
COMMUNITY-BASED AGENT/HEALTH WORKER K
FRIEND/RELATIVE L
SCHOOL M
BAR, HOTEL N
OTHER (SPECIFY) _______________ X

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Zambia 2007
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
GOVT. HEALTH CENTER B
GOVT. HEALTH POST C
OTHER PUBLIC (SPECIFY) ______ D

PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/SURGERY E
MISSION HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
COMMUNITY BASED AGENT I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
SHOP K
FRIENDS/RELATIVES L
OTHER (SPECIFY) _______________ X

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

YES 1
NO 2 (GO TO 632)

630) Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___________________________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER/POST B
MOBILE HOSPITAL/CLINIC C
FAMILY PLANNING CLINIC D
COMMUNITY BASED AGENT/FIELDWORKER E
OTHER PUBLIC SECTOR (SPECIFY) ________________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC G
MISSION HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR J
COMMUNITY BASED AGENT/FIELDWORKER K
MOBILE HOSPITAL/CLINIC L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _______________________ M
OTHER SOURCE
SHOP N
CHURCH M
FRIENDS/RELATIVES P
OTHER (SPECIFY) ________________________ X

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Zimbabwe 1994
Survey form view entire document:  text 
518) Where is that?

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

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

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Zimbabwe 1999
Survey form view entire document:  text 
526) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE __________

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

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Zimbabwe 2005
Survey form view entire document:  text 
649) 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 PLACES __________

Any other places?

RECORD ALL SOURCES MENTIONED.

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTER C
ZNFPC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC (SPECIFY) __________ H
MISSION FACILITY I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE DOCTOR (SPECIFY) __________ N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) __________ S
OTHER PRIVATE SOURCE
CHURCH T
FRIEND/RELATIVE U
OTHER (SPECIFY) __________ X

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Zimbabwe 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
GOVERNMENT HOSPITAL/CLINIC A
RURAL/MUNICIPAL CLINIC B
RURAL HEALTH CENTRE C
ZNPFC CLINIC D
MOH MOBILE CLINIC E
ZNFPC CBD/DEPOT HOLDER F
VILLAGE/FARM HEALTH WORKER G
OTHER PUBLIC SECTOR (SPECIFY) H
MISSION HOSPITAL/CLINIC I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
PHARMACY K
PRIVATE DOCTOR L
CBD M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
RETAIL OUTLET
GENERAL DEALER O
SUPERMARKET P
TUCK SHOP Q
SERVICE STATION R
OTHER RETAIL (SPECIFY) S
OTHER PRIVATE SOURCE
CHURCH T
BAR U
FRIENDS/RELATIVES V
PUBLIC TOILET W
OTHER (SPECIFY) X

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

YES 1
NO 2 (GO TO 730D)