Survey Text

Afghanistan 2015 Egypt 2008 India 2015 Tanzania 2004
Bangladesh 2011 Egypt 2014 Mali 1995 Tanzania 2010
Bangladesh 2014 Ethiopia 2005 Myanmar 2015 Yemen 2013
Benin 2006 Ethiopia 2011 Nepal 2006
Benin 2011 Ethiopia 2016 Nepal 2011
Egypt 2005 India 2005 Nepal 2016
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Afghanistan 2015
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945. Where did you go? 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
STAND-ALONE VCT CENTER F
FAMILY PLANNING CLINIC G
MOBILE CLINIC H
COMMUNITY HEALTH WORKER I
OTHER PUBLIC SECTOR______J
NON-GOVERNMENT SECTOR
MARIE STOPES K
RED CROSS SOCIETY L
AFGA M
OTHER NGO SECTOR________N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR O
STAND-ALONE VCT CENTER P
PHARMACY Q
MOBILE CLINIC R
FIELDWORKER S
OTHER PRIVATE MEDICAL SECTOR_______T
OTHER SOURCE
CHARITY/FOUNDATIONS U
REFUGEE CAMP V
SHOP W
OTHER___________X

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Bangladesh 2011
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944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 945A)

945) Where did you go?
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
MEDICAL COLLEGE HOSPITAL A
SPECIALISED GOVT. HOSPITAL
HOSPITAL (SPECIFY) ________________ B
DISTRICT HOSPITAL C
MCWC D
UHC E
H and FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASST. I
OTHER (SPECIFY) ______________ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER (SPECIFY) _____________ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC P
QUALIFIED DOCTOR Q
UNQUALIFIED DOCTOR R
PHARMACY/DRUG STORE S
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) ______________ T
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________ U
OTHER SOURCE (SPECIFY) _______________ X

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944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 945A)

945) Where did you go?
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
MEDICAL COLLEGE HOSPITAL A
SPECIALISED GOVT. HOSPITAL
HOSPITAL (SPECIFY) ________________ B
DISTRICT HOSPITAL C
MCWC D
UHC E
H and FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASST. I
OTHER (SPECIFY) ______________ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER (SPECIFY) _____________ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC P
QUALIFIED DOCTOR Q
UNQUALIFIED DOCTOR R
PHARMACY/DRUG STORE S
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) ______________ T
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________ U
OTHER SOURCE (SPECIFY) _______________ X

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944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 945A)

945) Where did you go?
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
MEDICAL COLLEGE HOSPITAL A
SPECIALISED GOVT. HOSPITAL
HOSPITAL (SPECIFY) ________________ B
DISTRICT HOSPITAL C
MCWC D
UHC E
H and FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASST. I
OTHER (SPECIFY) ______________ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER (SPECIFY) _____________ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC P
QUALIFIED DOCTOR Q
UNQUALIFIED DOCTOR R
PHARMACY/DRUG STORE S
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) ______________ T
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________ U
OTHER SOURCE (SPECIFY) _______________ X

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944) The last time you had (PROBLEM FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 945A)

945) Where did you go?
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
MEDICAL COLLEGE HOSPITAL A
SPECIALISED GOVT. HOSPITAL
HOSPITAL (SPECIFY) ________________ B
DISTRICT HOSPITAL C
MCWC D
UHC E
H and FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASST. I
OTHER (SPECIFY) ______________ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER (SPECIFY) _____________ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC P
QUALIFIED DOCTOR Q
UNQUALIFIED DOCTOR R
PHARMACY/DRUG STORE S
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) ______________ T
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________ U
OTHER SOURCE (SPECIFY) _______________ X

Survey form view entire document:  text 

945) Where did you go?
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
MEDICAL COLLEGE HOSPITAL A
SPECIALISED GOVT. HOSPITAL
HOSPITAL (SPECIFY) ________________ B
DISTRICT HOSPITAL C
MCWC D
UHC E
H and FWC F
SATELLITE CLINIC/EPI OUTREACH SITE G
COMMUNITY CLINIC H
FAMILY WELFARE ASST. I
OTHER (SPECIFY) ______________ J
NGO SECTOR
NGO STATIC CLINIC K
NGO SATELLITE CLINIC L
NGO DEPO HOLDER M
NGO FIELD WORKER N
OTHER (SPECIFY) _____________ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC P
QUALIFIED DOCTOR Q
UNQUALIFIED DOCTOR R
PHARMACY/DRUG STORE S
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) ______________ T
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____________ U
OTHER SOURCE (SPECIFY) _______________ X

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Bangladesh 2014
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945. Where did you go?
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
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPITAL B
MCWC C
UHC D
UH AND FWC E
SATELLITE CLINIC/EPI OUTREACH SITE F
COMMUNITY CLINIC G
FAMILY WELFARE ASST. H
OTHER (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER (SPECIFY) _____ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
QUALIFIED DOCTOR P
UNQUALIFIED DOCTOR Q
PHARMACY/DRUG STORE R
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) _____ S
OTHER SOURCE
OTHER (SPECIFY) _____ X

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945. Where did you go?
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
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPITAL B
MCWC C
UHC D
UH AND FWC E
SATELLITE CLINIC/EPI OUTREACH SITE F
COMMUNITY CLINIC G
FAMILY WELFARE ASST. H
OTHER (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER (SPECIFY) _____ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
QUALIFIED DOCTOR P
UNQUALIFIED DOCTOR Q
PHARMACY/DRUG STORE R
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) _____ S
OTHER SOURCE
OTHER (SPECIFY) _____ X

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945. Where did you go?
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
HOSP./MEDICAL COLLEGE/SPE. MED. COL A
DISTRICT HOSPITAL B
MCWC C
UHC D
UH AND FWC E
SATELLITE CLINIC/EPI OUTREACH SITE F
COMMUNITY CLINIC G
FAMILY WELFARE ASST. H
OTHER (SPECIFY) _____ I
NGO SECTOR
NGO STATIC CLINIC J
NGO SATELLITE CLINIC K
NGO DEPO HOLDER L
NGO FIELD WORKER M
OTHER (SPECIFY) _____ N
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC O
QUALIFIED DOCTOR P
UNQUALIFIED DOCTOR Q
PHARMACY/DRUG STORE R
PRIVATE MEDICAL COLLEGE HOSPITAL (SPECIFY) _____ S
OTHER SOURCE
OTHER (SPECIFY) _____ X

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Benin 2006
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860) Where did you go? Any other place?
CIRCLE ALL MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC
FIELDWORKER D
COMMUNITY CENTER E
HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
OTHER PUBLIC (SPECIFY) ________ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC J
RELIGIOUS HOSPITAL K
PHARMACY L
ABPF (BENIN FAMILY ADVOCACY ASSOCIATION) M
DOCTOR'S OFFICE N
HEALTH AGENT (NON-GOVERNMENTAL ORGANIZATION) O
OTHER PRIVATE MEDICAL (SPECIFY) ________ P
OTHER SOURCE
SHOP/MARKET Q
TRADITIONAL PRACTITIONER R
RELATIVES/FRIENDS/NEIGHBOR S
VENDOR T
OTHER (SPECIFY) ________ X

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Benin 2011
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945) Where did you go?
Any other place?

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

(NAME OF PLACE)_______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
FIELDWORKER E
STRAT AV HEALTH WORKER F
HEALTH WORKER/COMMUNITY LIAISON G
SCHOOL CLINIC H
OTHER ________(SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR J
RELIGIOUS HOSPITAL K
INDEPENDENT VCT CENTER L
PRIVATE DOCTOR'S OFFICE M
PHARMACY N
BENINESE FAMILY PLANNING ASSOCIATION (ABPF) O
FIELDWORKER (NOG) P
SCHOOL CLINIC Q
OTHER PRIVATE MEDICAL SECTOR________(SPECIFY) R
OTHER SOURCE
SHOP S
OTHER_______ (SPECIFY) X

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Egypt 2005
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1133) Where did you go?

Any other place?
RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH
URBAN HOSPITAL A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL H
TEACHING HOSPITAL I
HEALTH INSURANCE ORG J
CURATIVE CARE ORGANIZATION K
OTHER GOVERNMENTAL L
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOC. M
CSI PROJECT N
OTHER NON-GOVERNMENTAL O
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC P
PRIVATE DOCTOR Q
PHARMACY R
MOSQUE HEALTH UNIT S
CHURCH HEALTH UNIT T
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) U
FRIEND/RELATIVE V
OTHER (SPECIFY) _______________ X

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1133) Where did you go?

Any other place?
RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH
URBAN HOSPITAL A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL H
TEACHING HOSPITAL I
HEALTH INSURANCE ORG J
CURATIVE CARE ORGANIZATION K
OTHER GOVERNMENTAL L
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOC. M
CSI PROJECT N
OTHER NON-GOVERNMENTAL O
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC P
PRIVATE DOCTOR Q
PHARMACY R
MOSQUE HEALTH UNIT S
CHURCH HEALTH UNIT T
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) U
FRIEND/RELATIVE V
OTHER (SPECIFY) _______________ X

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Egypt 2008
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1008. Where did you go? Any other place? RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSPITAL (GNRL/DSTRCT) A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL (COMPl'TARY) D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL H
TEACHING HOSPITAL I
HEALTH INSURANCE ORG J
CURATIVE CARE ORGANIZATION K
OTHER GOVERNMENTAL L
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOC M
CSI PROJECT N
OTHER NON-GOVERNMENTAL O
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC P
PRIVATE DOCTOR Q
PHARMACY R
MOSQUE HEALTH UNIT S
CHURCH HEALTH UNIT T
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) U
FRIEND/RELATIVE V
OTHER (SPECIFY) ________________ X

Survey form view entire document:  text 

1008. Where did you go? Any other place? RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSPITAL (GNRL/DSTRCT) A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL (COMPl'TARY) D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL H
TEACHING HOSPITAL I
HEALTH INSURANCE ORG J
CURATIVE CARE ORGANIZATION K
OTHER GOVERNMENTAL L
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOC M
CSI PROJECT N
OTHER NON-GOVERNMENTAL O
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC P
PRIVATE DOCTOR Q
PHARMACY R
MOSQUE HEALTH UNIT S
CHURCH HEALTH UNIT T
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) U
FRIEND/RELATIVE V
OTHER (SPECIFY) ________________ X

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Egypt 2014
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1025. The last time you had (PROBLEM FROM 1021/1022/1023), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1100)

1026. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSPITAL (GENERAL/DISTRICT) A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL (CENTRAL) D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL H
HEALTH INSURANCE ORGANIZATION I
CURATIVE CARE ORGANIZATION J
OTHER GOVERNMENTAL K
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOCIATION L
CSI PROJECT M
OTHER NON-GOVERNMENTAL N
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC O
PRIVATE DOCTOR P
PHARMACY Q
MOSQUE HEALTH UNIT R
CHURCH HEALTH UNIT S
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ETC.) T
FRIEND/RELATIVE U
OTHER (SPECIFY)____________X

Survey form view entire document:  text 

1025. The last time you had (PROBLEM FROM 1021/1022/1023), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 1100)

1026. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED.

MINISTRY OF HEALTH AND POPULATION
URBAN HOSPITAL (GENERAL/DISTRICT) A
URBAN HEALTH UNIT B
HEALTH OFFICE C
RURAL HOSPITAL (CENTRAL) D
RURAL HEALTH UNIT E
MCH CENTER F
MOBILE UNIT G
OTHER GOVERNMENTAL
UNIVERSITY/TEACHING HOSPITAL H
HEALTH INSURANCE ORGANIZATION I
CURATIVE CARE ORGANIZATION J
OTHER GOVERNMENTAL K
NON-GOVERNMENTAL
EGYPT FAMILY PLANNING ASSOCIATION L
CSI PROJECT M
OTHER NON-GOVERNMENTAL N
PRIVATE MEDICAL
PRIVATE HOSPITAL/CLINIC O
PRIVATE DOCTOR P
PHARMACY Q
MOSQUE HEALTH UNIT R
CHURCH HEALTH UNIT S
OTHER NON-MEDICAL
VENDOR (SHOP, KIOSK, ETC.) T
FRIEND/RELATIVE U
OTHER (SPECIFY)____________X

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Ethiopia 2005
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925. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
VCT CENTER C
GOVERNMENT HEALTH POST D
FAMILY PLANNING CLINIC E
STAND ALONE VCT CENTER F
OTHER PUBLIC (SPECIFY) ________G

NON-GOVERNMENT (NGO) HEALTH FACILITY H
STANDALONE VCT CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/ CLINIC/DOCTOR J
STAND ALONE VCT CENTER K
PHARMACY L
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ M
OTHER SOURCE
DRUG VENDOR N
SHOP O
TRADITIONAL HEALER P
OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

925. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED

PUBLIC SECTOR
GOVERNMENT HOSPITAL/CLINIC A
GOVERNMENT HEALTH CENTER B
VCT CENTER C
GOVERNMENT HEALTH POST D
FAMILY PLANNING CLINIC E
STAND ALONE VCT CENTER F
OTHER PUBLIC (SPECIFY) ________G

NON-GOVERNMENT (NGO) HEALTH FACILITY H
STANDALONE VCT CENTER I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/ CLINIC/DOCTOR J
STAND ALONE VCT CENTER K
PHARMACY L
OTHER PRIVATE MEDICAL (SPECIFY) ___________________ M
OTHER SOURCE
DRUG VENDOR N
SHOP O
TRADITIONAL HEALER P
OTHER (SPECIFY) _____________ X

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Ethiopia 2011
Survey form view entire document:  text 

945. Where did you go? 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 THE PLACE(S) ________
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
GOVT. HEALTH STATION/CLINIC C
GOVT. HEALTH POST/HEW D
OTHER PUBLIC (SPECIFY) _______E
NGO HEALTH FACILITY F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
PRIVATE CLINIC H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY) ______ J
OTHER SOURCE
DRUG VENDOR/STORE K
SHOP L
TRADITIONAL HEALER M
OTHER (SPECIFY) ______ X

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Ethiopia 2016
Survey form view entire document:  text 

1050. Where did you go? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
PUBLIC PHARMACY D
OTHER PUBLIC SECTOR (SPECIFY) E
NGO
HEALTH FACILITY F
OTHER NGO MEDICAL SECTOR (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PRIVATE PHARMACY J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
OTHER SOURCE
SHOP/MARKET L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) X

Survey form view entire document:  text 

1050. Where did you go? Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

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

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
GOVERNMENT HEALTH POST C
PUBLIC PHARMACY D
OTHER PUBLIC SECTOR (SPECIFY) E
NGO
HEALTH FACILITY F
OTHER NGO MEDICAL SECTOR (SPECIFY) G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
PRIVATE CLINIC I
PRIVATE PHARMACY J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) K
OTHER SOURCE
SHOP/MARKET L
TRADITIONAL PRACTITIONER M
OTHER (SPECIFY) X

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India 2005
Survey form view entire document:  text 

935. Who did you see?
Anyone else?
RECORD ALL PERSONS SEEN.

PUBLIC MEDICAL SECTOR
GOVT. DOCTOR A
PUBLIC HEALTH NURSE B
ANM/LHV C
MALE MPW/SUPERVISOR D
ANGANWADI WORKER E
VILLAGE HEALTH GUIDE F
ASHA G
OTHER PUBLIC SECTOR HEALTH WORKER (SPECIFY) ______ H
NGO WORKER I
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR J
PRIVATE NURSE K
COMPOUNDER/PHARMACIST L
VAIDYA/HAKIM/HOMEOPATH M
DAI (TBA) N
TRADITIONAL HEALER O
OTHER PRIVATE SECTOR HEALTH WORKER P
OTHER (SPECIFY) ______ X

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India 2015
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1055. Where did you go?
Any other place?

RECORD ALL PLACES MENTIONED. IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTRE, OR CLINIC IS PUBLIC OR PRIVATE HEALTH SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF FACILITY/PLACE(S))_________________
PUBLIC HEALTH SECTOR
GOVERNMENT HOSPITAL A
VAIDYA/HAKIM/HOMEOPATH (AYUSH) B
GOVERNMENT HEALTH CENTRE C
STAND-ALONE ICTC D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
SCHOOL BASED CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) ________I
NGO OR TRUST HOSPITAL/CLINIC J
PRIVATE HEALTH SECTOR
PRIVATE HOSPITAL/CLINIC PRIVATE DOCTOR K
VAIDYA/HAKIM/HOMEOPATH (AYUSH) L
STAND-ALONE ICTC M
PHARMACY N
MOBILE CLINIC O
FIELDWORKER P
SCHOOL BASED CLINIC Q
OTHER PRIVATE HEALTH SECTOR (SPECIFY) _______R
OTHER SOURCE
HOME S
CORRECTIONAL FACILITY T
OTHER (SPECIFY) ___________X

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Mali 1995

No questionnaire text is available for this sample.


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Myanmar 2015
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945) Where did you go? 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
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
OTHER____(SPECIFY) X

Survey form view entire document:  text 

945) Where did you go? 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
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
OTHER____(SPECIFY) X

Survey form view entire document:  text 

945) Where did you go? 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
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
OTHER____(SPECIFY) X

Survey form view entire document:  text 

945) Where did you go? 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
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
OTHER____(SPECIFY) X

Survey form view entire document:  text 

945) Where did you go? 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
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER G
OTHER PUBLIC SECTOR___(SPECIFY) H
NGO
MARIE STOPES I
MYANMAR RED CROSS SOCIETY J
PSI/M (SUN) K
MMA L
OTHER NGO SECTOR___(SPECIFY) M
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR N
STAND-ALONE VCT CENTER O
PHARMACY P
MOBILE CLINIC Q
FIELDWORKER R
OTHER PRIVATE MEDICAL SECTOR___(SPECIFY) S
OTHER SOURCE
SHOP T
OTHER____(SPECIFY) X

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Nepal 2006
Survey form view entire document:  text 

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

922. The last time you had (PROBLEM FROM 918/919/920). Did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 924)

923. Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S). IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER VCT CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ___
GOVT. SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELD WORKER H
OTHER GOVT. (SPECIFY) ___ I
NON-GOVT. SECTOR
FPAN J
AMDA K
INF L
NEPAL RED CROSS M
UMN N
OTHER NON-GOVT. (SPECIFY) ___ O
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR P
OTHER PRIVATE MEDICAL (SPECIFY) ___ Q
OTHER SOURCE
OTHER (SPECIFY) ___ X

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Nepal 2011
Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

Survey form view entire document:  text 

929) Where did you go?
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)) _____________________
GOVT. SECTOR
GOVT. HOSPITAL/CLINIC A
PHC CENTER B
HEALTH POST C
SUB-HEALTH POST D
PHC OUTREACH CLINIC E
FAMILY PLANNING CLINIC F
MOBILE CLINIC G
FIELDWORKER H
OTHER GOVT. (SPECIFY) __________ I
NON-GOVT. (NGO)
FPAN J
AMDA K
ADRA L
INF M
NEPAL RED CROSS N
UMN O
OTHER NGO. (SPECIFY) __________ P
PRIVATE MED. SECTOR
PVT. HOSPITAL/CLINIC NURSING HOME Q
OTHER PRIVATE MED. (SPECIFY) ________ R
OTHER SOURCE OTHER (SPECIFY) _____________ X

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Nepal 2016
Survey form view entire document:  text 

1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
MOBILE CAMP E
SATELLITE CLINIC F
OTHER PUBLIC FACILITIES (SPECIFY) ___ G
NON-GOVT. (NGO) SECTOR
FPAN H
MARIE STOPES I
OTHER NGO FACILITIES (SPECIFY) __ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURISNG HOME K
PRIVATE CLINIC L
PHARMACY M
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ N
OTHER SOURCE
SHOP O
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
MOBILE CAMP E
SATELLITE CLINIC F
OTHER PUBLIC FACILITIES (SPECIFY) ___ G
NON-GOVT. (NGO) SECTOR
FPAN H
MARIE STOPES I
OTHER NGO FACILITIES (SPECIFY) __ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURISNG HOME K
PRIVATE CLINIC L
PHARMACY M
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ N
OTHER SOURCE
SHOP O
OTHER (SPECIFY) ___ X

Survey form view entire document:  text 

1050. Where did you go? Any other place? PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

NAME OF PLACE ___
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
PRIMARY HEALTH CARE CENTER B
HEALTH POST/SUB-HEALTH POST C
PHC OUTREACH CLINIC D
MOBILE CAMP E
SATELLITE CLINIC F
OTHER PUBLIC FACILITIES (SPECIFY) ___ G
NON-GOVT. (NGO) SECTOR
FPAN H
MARIE STOPES I
OTHER NGO FACILITIES (SPECIFY) __ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/NURISNG HOME K
PRIVATE CLINIC L
PHARMACY M
OTHER PRIVATE MEDICAL FACILITIES (SPECIFY) ___ N
OTHER SOURCE
SHOP O
OTHER (SPECIFY) ___ X

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Tanzania 2004
Survey form view entire document:  text 

860. Where did you go? Any other place?
RECORD ALL SOURCES MENTIONED.

GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL B
REGIONAL HOSPITAL C
DISTRICT HOSPITAL D
HEALTH CENTRE E
DISPENSARY F
VILLAGE HEALTH POST (W G
CBD WORKER H
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL I
DISTRICT HOSPITAL J
GOVT. HEALTH CENTRE K
DISPENSARY L
PRIVATE
DISTRICT HOSPITAL M
HEALTH CENTRE N
DISPENSARY O
OTHER
NGO P
VCT CENTRE Q
OTHER (SPECIFY) _______ X

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Tanzania 2010
Survey form view entire document:  text 

950. Where did you go? Any other place?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE) __________
GOVERNMENT/PARASTATAL
REFERAL/SPEC. HOSPITAL A
REGIONAL HOSPITAL B
DISTRICT HOSPITAL C
HEALTH CENTRE D
DISPENSARY E
VILLAGE HEALTH POST F
CBD WORKER G
RELIGIOUS/VOLUNTARY
REFERAL/SPEC. HOSPITAL H
DISTRICT HOSPITAL I
GOVT. HEALTH CENTRE J
DISPENSARY K
PRIVATE
HOSPITAL L
HEALTH CENTRE M
DISPENSARY N
OTHER
PRIVATE PHARMACY O
NGO P
VCT CENTRE Q
OTHER (SPECIFY) ________________________ X

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Yemen 2013
Survey form view entire document:  text 

945) Where did you go? Any other place? PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF THE SECTOR, WRITE THE NAME OF THE PLACE

(NAME OF PLACE(S))____
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
PRIMARY HEALTH CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
PRIVATE SECTOR
(PRIVATE HOSPITAL/CLINIC/DISPENSARY/DOCTOR'S OFFICE) F
NON GOVERNMENT ORGANIZATIONS
(HOSPITAL/CLINIC/DISPENSARY/PRIVATE DOCTOR'S OFFICE/MOBILE CLINIC) G
OTHER (SPECIFY) ____ X