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

OTHER (SPECIFY) ____ X