Survey Text

Central African Republic 1995
Chad 1996
Chad 2014
Congo Brazzaville 2005
Madagascar 2008
Tanzania 2004
Tanzania 2010
top
Central African Republic 1995
Survey form view entire document:  text 
808) Where did you seek advice or treatment?
Any other place?

CIRCLE ALL MENTIONED

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

top
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

top
Chad 2014
Survey form view entire document:  text 
945) Where did you go?

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))_______

ANY OTHER PLACE?
RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/DOCTOR'S OFFICE H
PRIVATE HEALTH CENTER I
BUSINESS HEALTH CENTER J
CARE OFFICE/INFIRMARY K
PHARMACY/PHARMACY DEPOT L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
PUBLIC/PRIVATE SECTOR
PHARMACY/VILLAGE HEALTH CENTER N
OTHER
SHOP/BAR/MARKET O
TRADITIONAL PRACTITIONER P
FIRST AID WORKER Q
FRIENDS/NEIGHBORS/RELATIVES R
OTHER (SPECIFY) X

Survey form view entire document:  text 
945) Where did you go?

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))_______

ANY OTHER PLACE?
RECORD ALL MENTIONED

PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/DOCTOR'S OFFICE H
PRIVATE HEALTH CENTER I
BUSINESS HEALTH CENTER J
CARE OFFICE/INFIRMARY K
PHARMACY/PHARMACY DEPOT L
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) M
PUBLIC/PRIVATE SECTOR
PHARMACY/VILLAGE HEALTH CENTER N
OTHER
SHOP/BAR/MARKET O
TRADITIONAL PRACTITIONER P
FIRST AID WORKER Q
FRIENDS/NEIGHBORS/RELATIVES R
OTHER (SPECIFY) X

top
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

top
Madagascar 2008
Survey form view entire document:  text 
950. 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 A HOSPITAL, HEALTH CENTER, OR CLINIC IS A PUBLIC OR PRIVATE INSTITUTION, WRITE THE NAME OF THE PLACE.

NAME OF PLACE(S) ______
PUBLIC SECTOR
DISTRICT HOSPITAL II (facility equipped for surgeries) A
DISTRICT HOSPITAL I (non-surgical medical capabilities) B
BASIC HEALTH CENTER II (basic health care, physician-run) C
BASIC HEALTH CENTER I (basic health care, run by para-medical officer) D
OTHER PUBLIC PLACE (SPECIFY) ______ E
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC F
PRIVATE HEALTH CENTER G
PHARMACY/MEDICINE DISPERSAL CENTER H
PRIVATE DOCTOR I
PF/FISA CENTER J
TOP NETWORK K
OTHER PRIVATE MEDICAL (SPECIFY) _____ L
OTHER SOURCE
VBC AGENT M
STORE N
KIOSK O
CHURCH P
TRADITIONAL HEALER Q
RELATIVES/FRIENDS R
OTHER (SPECIFY) ______ X

top
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

top
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