Survey Text

Benin 2006 Chad 1996 Cote d'Ivoire 1998 Guinea 1999
Burkina Faso 1998 Congo Brazzaville 2005 Ethiopia 2005 Liberia 2013
Cameroon 2018 Congo Brazzaville 2011 Ethiopia 2011 Niger 2012
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Benin 2006
Survey form view entire document:  text 
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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Burkina Faso 1998
Survey form view entire document:  text 
801G. Where did you seek advice or treatment?
RECORD ALL MENTIONED.

PUBLIC/PARA-PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
CSPS C
SMI D
DISPENSARY/MATERNITY POST E
COMMUNITY PHARMACEUTICAL DEPOT F
OTHER PUBLIC (SPECIFY) _____ G
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR'S OFFICE H
FAMILY PLANNING CLINIC I
PHARMACY J
NURSE'S OFFICE K
OTHER PRIVATE (SPECIFY) _____ L
OTHER SOURCE
STORE/MARKET M
BAR/NIGHTCLUB N
KIOSK O
HOTEL/ROOM FOR RENT P
INFORMAL RETAIL CIRCUIT Q
FRIENDS/RELATIVES R
OTHER (SPECIFY) _____ X
OTHER (SPECIFY) _____ Y

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Cameroon 2018
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.

PUBLIC SECTOR
GOVERNMENT HOSPITAL A
SUB-DIVISIONAL MEDICAL CENTER / INTEGRATED HEALTH CENTER / DISPENSARY B
HEALTH / COMMUNITY WORKER C
STAND-ALONE HTC CENTER D
MOBILE HTC SERVICES / CNLS E
OTHER PUBLIC SECTOR (SPECIFY)_________F
PRIVATE MEDICAL SECTOR
CONFESSIONAL HOSPITAL / CLINIC G
PRIVATE LAY HOSPITAL / CLINIC H
CONFESSIONAL HEALTH CENTER / DISPENSARY I
DOCTOR'S OFFICE J
PHARMACY K
STAND-ALONE HTC CENTER L
MOBILE HTC SERVICES M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_________N
OTHER SOURCE
HOME O
WORKPLACE P
CORRECTIONAL FACILITY Q
SCHOOL / CULTURAL CENTER R
OTHER (SPECIFY)_________X

Survey form view entire document:  text 
1049. The last time you had (PROBLEM FROM 1045 / 1046 / 1047), did you seek any kind of advice or treatment?

YES 1
NO 2 (SKIP TO 1051)

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Chad 1996
Survey form view entire document:  text 
801G) Where did you seek advice or treatment?

Anywhere else? From anyone else?

RECORD ALL MENTIONED.

IF HOSPITAL, HEALTH CENTER, OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.

PLEASE NOTE:
IF RESPONSE IS 'MILITARY HOSPITAL/GARRISON,' CIRCLE 'B' FOR N'DJAMENA AND THE CODE 'C' FOR OTHER CITIES.

PLEASE NOTE:
IF THE RESPONSE IS 'NURSE,' PROBE TO DETERMINE IF A REAL NURSE (CODE 'K' "WORKPLACE HEALTH CENTER") OF IF A HOSPITAL OR A PUBLIC HEALTH CENTER.

PUBLIC SECTOR
PUBLIC HOSPITAL/MATERNITY CLINIC A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/DISPENSARY/GARRISON C
WALK-IN CLINIC D
HOSPITAL OR HEALTH CENTER PHARMACY E
OTHER PUBLIC (SPECIFY): ___ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/PRIVATE DOCTOR'S OFFICE H
CHADIAN FAMILY WELFARE ASSOCIATION I
PRIVATE HEALTH CENTER J
WORKPLACE HEALTH CENTER K
PHARMACY/PHARMACEUTICAL DEPOT L
OTHER PRIVATE MEDICAL (SPECIFY): ___ M
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER N
OTHER
SHOP/BAR/MARKET O
FIRST AID WORKER P
TRAVELING SALESMAN Q
FRIENDS/NEIGHBORS/RELATIVES R
HEALER S
OTHER (SPECIFY): ___ X

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Congo Brazzaville 2005
Survey form view entire document:  text 
860) Where did you go? Any other place?
CIRCLE 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
OTHER PLACE X

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Congo Brazzaville 2011
Survey form view entire document:  text 
945) Where did you go?
Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE.

PUBLIC SECTOR
HOSPITAL A
INTEGRATED HEALTH CENTER B
HEALTH POST C
PRIVATE MEDICAL SECTOR
CLINIC D
DOCTOR'S OFFICE E
PHARMACY F
OTHER PRIVATE SECTOR
TRADITIONAL THERAPIST G
PEDDLER/TRAVELING PHARMACY H
SHOP/MARKET I
OTHER PLACE (SPECIFY) _____ X

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Cote d'Ivoire 1998
Survey form view entire document:  text 
801G) Where did you seek advice or treatment?

Any other place?

CIRCLE ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/MOTHER-INFANT CENTER B
FREE CLINIC C
MEDICAL POST D
OTHER PUBLIC (SPECIFY): ___ E
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR F
PRIVATE HOSPITAL/CLINIC G
FAMILY PLANNING CENTER H
PHARMACY/PHARMACY DEPOT I
OTHER PRIVATE MEDICAL (SPECIFY): ___ J
OTHER PRIVATE SECTOR
SHOP/MARKET K
INFORMAL COMMERCIAL DISTRIBUTION L
CHURCH M
ACQUAINTANCES/RELATIVES N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY): ___ X
DON'T KNOW Z

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Ethiopia 2005
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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Guinea 1999
Survey form view entire document:  text 
801G. Where did you seek advice or treatment?
Any other place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
FAMILY PLANNING CLINIC B
FREE CLINIC C
MEDICAL POST D
OTHER PUBLIC (SPECIFY) _____ E
PRIVATE MEDICAL SECTOR
PRIVATE DOCTOR F
PRIVATE CLINIC/HOSPITAL G
FAMILY PLANNING CLINIC H
PHARMACY/PHARMACEUTICAL DEPOT I
OTHER PRIVATE MEDICAL (SPECIFY) _____ J
OTHER PRIVATE SECTOR
SHOP/MARKET K
INFORMAL COMMERCIAL DISTRIBUTION L
CHURCH M
FRIENDS/RELATIVES N
TRADITIONAL PRACTITIONER O
OTHER (SPECIFY) _____ X
DOESN'T KNOW Z

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Liberia 2013
Survey form view entire document:  text 
945. Where did you go? (4)
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 B
STAND-ALONE VCT CENTER C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER F
OTHER PUBLIC SECTOR (SPECIFY)____________G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR H
STAND-ALONE VCT CENTER I
PHARMACY J
MOBILE CLINIC K
FIELDWORKER L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY)_____________M
OTHER (SPECIFY)__________________X

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Niger 2012
Survey form view entire document:  text 
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(S))______________

PUBLIC SECTOR
A NATIONAL HOSPITAL
B MATERNITY REFERENCE CENTER
C REGIONAL HOSPITAL
D HD
E INTEGRATED HEALTH CENTER
F HEALTH HUT
G PHARMACY
H OTHER PUBLIC SECTOR (SPECIFY)
PRIVATE MEDICAL SECTOR
I PRIVATE HOSPITAL/CLINIC
J PHARMACY
K CLINIC/ NIGERIEN ASSOCIATION FOR FAMILIAL WELL-BEING
L RELIGIOUS INSTITUTION
M OTHER PRIVATE MEDICAL SECTOR (SPECIFY)
OTHER SOURCE
N SHOP
O TRAVELLING PHARMACY/PEDDLER
P TRADITIONAL PRACTITIONER
X OTHER (SPECIFY)