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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

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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India 2005

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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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Mali 2001

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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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Mozambique 1997

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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 2011

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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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Namibia 2000

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521. Do you know of a place where one can get condoms?

YES 1
NO 2 (GO TO 524)

522. 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
GOVT. HEALTH CENTER/CLINIC B
PHC CLINIC (MOBILE) C
COMMUN. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ F

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC G
PHARMACY H
PRIVATE DOCTOR I
OTHER PRIVATE MEDICAL (SPECIFY) _____ L

OTHER SOURCE

SHOP M
CHURCH N
FRIENDS/RELATIVES O
PRAD'L BIRTH ATTENDANT P
TRADITIONAL HEALER Q

OTHER (SPECIFY) ____ X

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Namibia 2006

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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 A
GOVT HEALTH CENTER/CLINIC B
PHC (MOBILE) C
COMM. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ E

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) ____ I

OTHER SOURCE

SHOP J
CHURCH K
FRIENDS/RELATIVES L
TRAD. BIRTH ATTENDANT M
TRAD. HEALER N
OTHER (SPECIFY) _____ X

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 A
GOVT HEALTH CENTER/CLINIC B
PHC (MOBILE) C
COMM. HEALTH WORKER D
OTHER PUBLIC (SPECIFY) ____ E

PRIVATE MEDICAL SECTOR

PRIVATE HOSPITAL/CLINIC F
PHARMACY G
PRIVATE DOCTOR H
OTHER PRIVATE MEDICAL (SPECIFY) ____ I

OTHER SOURCE

SHOP J
CHURCH K
FRIENDS/RELATIVES L
TRAD. BIRTH ATTENDANT M
TRAD. HEALER N
OTHER (SPECIFY) _____ X

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Niger 1998

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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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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

Survey Text