Survey Text

Benin 2011 Kenya 2008 Niger 2012 Tanzania 2004
Burkina Faso 1998 Kenya 2014 Senegal 2010 Tanzania 2010
Chad 1996 Madagascar 1997 Senegal 2014 Togo 1998
Chad 2014 Mali 2006 Senegal 2015 Togo 2013
Cote d'Ivoire 1998 Mali 2012 Senegal 2016
Ethiopia 2016 Mali 2018 Senegal 2017
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Benin 2011
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)_______
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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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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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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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

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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 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

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Kenya 2008
Survey form view entire document:  text 
919G. 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)) ______________
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVT. HEALTH CENTRE/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC (SPECIFY) _______ D
PRIVATE MEDICAL SECTOR
MISSIONARY/CHURCH HOSP./CLINIC E
FPAK HEALTH CENTER/CLINIC F
PRIVATE HOSPITAL/CLINIC G
VCT CENTRE H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL (SPECIFY) ___________ K
OTHER SOURCE
TRADITIONAL HEALER L
SHOP/PHARMACY M
FRIENDS OR RELATIVES N
OTHER (SPECIFY) _______________________ X

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Kenya 2014
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
GOVERNMENT HEALTH CENTER/CLINIC B
GOVERNMENT DISPENSARY C
OTHER PUBLIC SECTOR (SPECIFY) _________ D
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR E
MISSIONARY/CHURCH HOSPITAL/CLINIC F
FAMILY OPTIONS/FHOK CLINIC G
VCT CENTER H
NURSING/MATERNITY HOMES I
BLOOD TRANSFUSION SERVICES J
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) ________ K
OTHER SOURCE
SHOP/PHARMACY L
TRADITIONAL HEALER M
COMMUNITY HEALTH WORKER/CHW N
FRIENDS/RELATIVES O
OTHER (SPECIFY) _________ X

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Madagascar 1997
Survey form view entire document:  text 
801H. Where did you seek advice or treatment?
RECORD ALL MENTIONED.

PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER B
DISPENSARY C
LOCAL HEALTH POST D
OTHER PUBLIC (SPECIFY) __________ X
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC E
PHARMACY F
DOCTOR G
OTHER PRIVATE (SPECIFY) ______ Y
OTHER SOURCE
STORE I
RELIGIOUS CENTER J
RELATIVES K
FRIENDS L
HEALER M
OTHER (SPECIFY) ____________ Z

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Mali 2006
Survey form view entire document:  text 
860. Where did you go?
Was there another place?
RECORD ALL MENTIONED.

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
CSREF (heath referral center) C
PMI (protection maternelle et infantile - a program created in France to give free care to expecting/recent mothers) /MATERNITY D
CSCOM (Centre de Santé Communitaire) Community Health Center E
PHARMACY F
OTHER PUBLIC (SPECIFY) __G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR H
PHARMACY I
STI CENTER J
HEALTH WORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __M
OTHER SOURCE
TRADITIONAL HEALER N
SHOP O
OTHER (SPECIFY) __X

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Mali 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)__________
PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERRAL HEALTH CENTER (CSREF) C
FREE CLINIC/MATERNITY D
COMMUNITY HEALTH CENTER (CSCOM) E
PUBLIC VOLUNTEER TESTING CENTER F
SCHOOL BASED CLINIC G
OTHER PUBLIC H_______ (SPECIFY)
PRIVATE SECTOR
PRIVATE CLINIC/HOSPITAL I
PRIVATE HEALTH CARE PRACTICE J
TREATMENT ROOM K
INDEPENDENT VOLUNTEER TESTING CENTER L
PHARMACY M
COMMUNITY BASED AGENT N
SCHOOL BASED CLINIC O
OTHER PRIVATE_____ (SPECIFY) P
OTHER SOURCE
HOME (RESPONDENT'S HOME) Q
MILITARY CAMP R
SHOP S
OTHER_______ (SPECIFY) X

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Mali 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
(NAME OF PLACE)

PUBLIC SECTOR
NATIONAL HOSPITAL A
REGIONAL HOSPITAL B
REFERENCE HEALTH CENTER C
COMMUNITY HEALTH CENTER D
DISPENSARY/MATERNITY E
STAND-ALONE HTC CENTER F
MOBILE HTC SERVICES G
OTHER PUBLIC SECTOR (SPECIFY) H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/PRIVATE DOCTOR I
STAND-ALONE HTC CENTER J
PHARMACY K
MOBILE HTC SERVICES L
OTHER PRIVATE MEDICAL (SPECIFY) M
OTHER SOURCE
SHOP N
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)

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Senegal 2010
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
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
HEALTH POST C
GOVERNMENT FAMILY PLANNING CLINIC D
HEALTH HUT/RURAL MATERNITY E
BASIC HEALTH CARE CENTER F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC (SPECIFY) ______ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS DISPENSARY M
OTHER PRIVATE MEDICAL (SPECIFY) ______ N
OTHER SOURCE
SHOP O
CHURCH P
RELATIVES/FRIENDS Q
BAR R
OTHER (SPECIFY) ______ X

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Senegal 2014
Survey form view entire document:  text 
944) The last time you had (INFECTION FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 946)

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
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) X

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Senegal 2015
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) ______
PUBLIC SECTOR
GOVT. HOSPITAL A
GOVT. HEALTH CENTER B
HEALTH POST C
GOVT. FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
MOBILE CLINIC H
OTHER PUBLIC SECTOR (SPECIFY) _____ I
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE J
PHARMACY K
PRIVATE DOCTOR L
RELIGIOUS FREE CLINIC M
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ N
OTHER SOURCE
SHOP O
CHURCH P
FRIENDS/RELATIVES Q
BAR R
OTHER (SPECIFY) ____X

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Senegal 2016
Survey form view entire document:  text 
1050) Where did you go?

Any other place?

PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
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
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
VOLUNTARY TESTING CENTER H
MOBILE HTC SEVICES I
OTHER PUBLIC SECTOR (SPECIFY) _____ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
RELIGIOUS FREE CLINIC N
PRIVATE LABORATORY O
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ P
OTHER SOURCE
SHOP Q
CHURCH R
FRIENDS/RELATIVES S
BAR T
OTHER (SPECIFY) _____ X

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Senegal 2017
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
HEALTH POST C
GOVERNMENT FAMILY PLANNING CENTER D
RURAL MATERNITY E
HEALTH HUT F
COMMUNITY PHARMACY G
VOLUNTARY TESTING CENTER H
MOBILE HTC SEVICES I
OTHER PUBLIC SECTOR (SPECIFY) _____ J
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/OFFICE K
PHARMACY L
PRIVATE DOCTOR M
PRIVATE LABORATORY N
RELIGIOUS FREE CLINIC O
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ P
OTHER SOURCE
SHOP Q
CHURCH R
FRIENDS/RELATIVES S
BAR T
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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Togo 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
MEDICAL-SOCIAL CENTER B
DISPENSARY/INFIRMARY C
M.C.H. D
HEALTH POST E
STATE PHARMACY F
OTHER PUBLIC (SPECIFY) __________ G
PRIVATE MEDICAL SECTOR
HOSPITAL/PRIVATE CLINIC H
PHARMACY I
TOGOLESE ASSOCIATION FOR FAMILIAL WELL-BEING J
DOCTOR'S OFFICE K
FIELDWORKER L
OTHER PRIVATE MEDICAL (SPECIFY) __________ M
OTHER PRIVATE SECTOR
SHOP/MARKET N
FRIEND(S)/RELATIVES O
TRADITIONAL PRACTITIONER P
OTHER (SPECIFY) __________ X
DON'T KNOW Z

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Togo 2013
Survey form view entire document:  text 
944) The last time you had (INFECTION FROM 940/941/942), did you seek any kind of advice or treatment?

YES 1
NO 2- (SKIP TO 946)

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
GOVERNMENT HOSPITAL A
STAND-ALONE VCT CENTER B
HEALTH CENTER C
DISPENSARY D
MOTHER-INFANT PROTECTION E
MOBILE CLINIC F
SCHOOL BASED CLINIC G
OTHER PUBLIC SECTOR________ (SPECIFY) H
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC I
PRIVATE DOCTOR'S OFFICE J
PHARMACY K
SCHOOL BASED CLINIC L
NGO/ASSOCIATION M
OTHER PRIVATE MEDICAL SECTOR______ (SPECIFY) N
OTHER_____ (SPECIFY) X