Survey Text

Togo 1998
Togo 2013
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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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Togo 2013
Survey form view entire document:  text 
629) Do you know of a place where a person can get condoms?

YES 1
NO 2- (SKIP 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
HEALTH CENTER B
DISPENSARY C
MOTHER-INFANT PROTECTION D
HEALTH HUT E
MOBILE CLINIC F
OTHER PUBLIC SECTOR__________ (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC H
PHARMACY I
PRIVATE DOCTOR'S OFFICE J
NGO/ASSOCIATION K
OTHER PRIVATE MEDICAL SECTOR_______ (SPECIFY) L
OTHER SOURCE
SHOP M
RELIGIOUS INSTITUTION N
FRIENDS/RELATIVES O
OTHER_______ (SPECIFY) X