Survey Text

Afghanistan 2015 Ghana 2003 Namibia 2000 Senegal 2005
Benin 1996 Ghana 2008 Namibia 2006 Tanzania 1996
Benin 2001 Ghana 2014 Namibia 2013 Tanzania 1999
Benin 2006 Guinea 2005 Nepal 2001 Tanzania 2004
Benin 2011 Guinea 2012 Nepal 2006 Tanzania 2010
Burkina Faso 2003 India 2005 Nepal 2011 Uganda 1995
Burundi 2010 Lesotho 2004 Niger 2006 Uganda 2001
Cameroon 2011 Liberia 2013 Nigeria 1999 Uganda 2006
Central African Republic 1995 Madagascar 2003 Nigeria 2003 Uganda 2011
Congo (Democratic Republic) 2007 Malawi 2000 Nigeria 2008 Zambia 2013
Congo (Democratic Republic) 2013 Malawi 2004 Nigeria 2013 Zimbabwe 1994
Cote d'Ivoire 2011 Malawi 2010 Rwanda 2000 Zimbabwe 1999
Eswatini (Swaziland) 2006 Mali 1995 Rwanda 2005 Zimbabwe 2005
Ethiopia 2005 Mali 2001 Rwanda 2010 Zimbabwe 2010
Ghana 1998 Myanmar 2015 Rwanda 2014 Zimbabwe 2015
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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?

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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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

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? (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

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

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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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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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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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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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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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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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

No questionnaire text is available for this sample.


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

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

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

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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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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 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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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

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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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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Namibia 2000
Survey form view entire document:  text 
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
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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Namibia 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? 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
GVT PRIMARY HEALTH CARE CLINIC C
OUTREACH POINT D
MOBILE CLINIC E
FIELDWORKER/COMMUNITY HEALTH CARE PROVIDER F
OTHER PUBLIC SECTOR (SPECIFY __________) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PHARMACY J
PRIVATE DOCTOR K
OTHER PRIVATE MEDICAL SECTOR (SPECIFY __________) L
OTHER SOURCE
SHOP M
FRIEND/RELATIVE N
SCHOOL O
OTHER (SPECIFY __________) X

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Nepal 2001
Survey form view entire document:  text 
714. Where is that?
IF SOURCE IS A HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______________

Any other place?
RECORD ALL MENTIONED.

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

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

YES 1
NO 2 (GO TO 701)

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

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

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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 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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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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Rwanda 2000
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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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 2005
Survey form view entire document:  text 
545. Where is this?
Any other place?
RECORD EVERYTHING MENTIONED.

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

NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CENTER C
HEALTH POST D
HEALTH HUT/ RURAL MATERNITY E
COMMUNITY PHARMACY F
STRAT. AVANCÉE/EQU. MOBILE G
HEALTH CARE WORKER H
OTHER PUBLIC (SPECIFY) _____I
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
HEALTH CARE WORKER M
OTHER PRIVATE (SPECIFY) _____N
OTHER SOURCE
SHOP O
BAR P
SCHOOL Q
RELIGIOUS INSTITUTION R
RELATIVES/FRIENDS S
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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Tanzania 2004

No questionnaire text is available for this sample.


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Tanzania 2010
Survey form view entire document:  text 
642. Where is that? Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S)) ___________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL A
REGIONAL HOSPITAL B
DISTRICT HOSPITAL C
HEALTH CENTRE D
DISPENSARY E
VILLAGE HEALTH POST (WORKER) F
CBD WORKER G
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL H
DISTRICT HOSPITAL I
GOVT. HEALTH CENTRE J
DISPENSARY K
PRIVATE
DISTRICT HOSPITAL L
HEALTH CENTRE M
DISPENSARY N
OTHER
PHARMACY O
NGO P
VCT CENTRE Q
SHOP/KIOSK R
BAR S
GUEST HOUSE/HOTEL T
FRIEND/RELATIVE/NEIGHBOUR U
OTHER (SPECIFY) ___________ X
DON'T KNOW Z

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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 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)