Fed. Rep. of Nigeria - Impact evaluation of the Malaria Control Program P115036 Malaria DDI_NGA_2012_MCBPIE-B_v01_M Development Data Group Development Research Group 2014-02-10 Nesstar Publisher Pedro Carneiro Costas Meghir Edit V. Velenyi v01 Malaria Control Booster Project – Additional Financing Human Development Network (HDN) P115036 Health, Nutrition and Population (HE) Dinesh Nair Moriam Jagun Noel Chisaka Janet Adebo Marc Smitz Marcus Holmlund Qiao Wang M Abul Kalam Azad Malaria is a major public health problem in Nigeria, and both a cause and a consequence of poverty. The majority of cases are due to Plasmodium falciparum, the life-threatening form of the disease. The World Bank has been supporting seven states of the Nigerian Federation, representing more than 25 percent of the country’s population, in the fight against malaria through the Malaria Control Booster Project (MCBP). These States are: Akwa Ibom, Anambra, Bauchi, Gombe, Jigawa, Kano, and Rivers. Malaria Control Booster Program Impact Evaluation 2012-2013 Baseline Survey MCBPIE-B 2012-13 NGA_2012_MCBPIE-B_v01_M Pedro Carneiro Costas Meghir Edit V. Velenyi Marcus Holmlund M Abul Kalam Azad Qiao Wang Nesstar Publisher World Bank Qiao Wang Impact evaluation Nigeria Eleven local government areas in Gombe State Sample survey data [ssd] Hanovia Medical Limited Face-to-face [f2f] The sample size of household survey is 1,590 with 15 households within each health facility catchment area. The response rate is 100%. About 12 households (7.55%) declined biomedical tests. Community, primary health facility and health facility worker surveys were administered in all the 106 wards with 100% response rate. The response rate of the PMV survey is 83% (177 out of 212) because some selected communities did not have up to the number of PMVs envisaged. For the same reason, the response rate of the CDD survey is 98% (259 out of 265). The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses. CDD.NSDstat Community-Directed Distributer (CDD) survey data 259 392 Nesstar 200801 CS.NSDstat Community survey (CS) data 106 491 Nesstar 200801 HFW.NSDstat Health Facility Worker (HFW) survey data 106 493 Nesstar 200801 HS.NSDstat Household survey (HS) data 23820 608 Nesstar 200801 HS_SEC12.NSDstat Household survey (HS) data 23820 22 Nesstar 200801 PHF.NSDstat Primary Health Facility (PHF) survey data 106 1600 Nesstar 200801 PMV.NSDstat Patent Medicine Vendor (PMV) survey data 173 409 Nesstar 200801 CDD_ID StateCode LGACode 1 AKKO 2 BALANGA 3 BILLIRI 4 DUKKU 5 FUNAKAYE 6 GOMBE 7 KALTUNGO 8 KWAMI 9 NAFADA 10 SHONGOM 11 YAMALTU/DEBA WardCode 101 AKKO 102 GARKO 103 KALSHINGI 104 KASHERE 105 KUMO CENTRAL 106 KUMO EAST 107 KUMO NORTH 108 KUMO WEST 109 PINDIGA 110 TUMU 111 TUKULMA 201 BAMBAM 203 DADIYA 204 GELENGU/BALANGA 205 KINDIYO 206 KULANI/DEGRI/SIKKAM 207 MWONA 208 NYUWAR/JESSU 209 SWA/REF/GASI/W.WAJA 210 TALASEE/DONG/REME 301 BANGANJE NORTH 303 BARE 304 305 306 KALMAI 307 TAL 308 TANGLANG 309 TODI 310 401 GOMBE ABBA 402 HASHIDU 403 JAMARI 404 KUNDE 406 MALALA 407 WAZIRI NORTH 408 409 WURO TALE 410 ZANGE 411 ZAUNE 501 ASHAKA/MAGABA 502 BAGE 503 BAJOGA 504 BAJOGA 505 BODOR/TILDE 506 JILLAHI 507 kupto 508 RIBADU 509 TONGO 510 WAWA/WAKKALTU 603 604 605 DAWAKI 606 HERWA GANA 608 KUMBIYA KUMBIYA 609 NASARAWA 610 PANTAMI 611 SHAMAKI 701 AWAK 702 BULE/KALTIN 703 KALTUNGO WEST 704 KALTUNGO EAST 705 KAMO 707 TULA WANGE 708 TULA YIRI 709 TUNGO 710 TURE 801 BOJUDE 802 DABA FULANI 803 DOHO 804 DUKUL 805 GADAM 806 JURARA 807 KOMFULATA 808 KWAMI 809 MALAM-SIDI 810 MALLERI 901 BARWO NASARAWA 902 BARWO WINDE 903 BIRIN BOLEWA 904 BIRIN FULANI EAST 905 BIRIN FULANI WEST 906 GUDUKKU 907 JIGAWA 908 NAFADA CENTRAL 909 NAFADA EAST 910 NAFADA WEST 1001 BANGUNJI 1002 BOH 1003 BURAK 1004 FILIYA 1006 GWANDUM 1007 KULISHIM 1008 KUSHI 1009 LALIPIDO 1010 LAPAN 1101 DEBA 1102 DIFA/LUBO/KINAFA 1103 GWANI/SHINGA/WADE 1104 HINNA 1105 JAGALI NORTH 1106 JAGALI SOUTH 1107 KANAWA/WAJARI 1108 KURI/LANO/LAMBAM 1109 KWADON/LIJI/KURBA 1110 NONO/KUNUWA/W.BIRDEKA 1111 ZAMBUK/KWALI CodeOfNearestFacility SEA NUMBER 1 RURAL 2 PERI-URBAN 3 URBAN NAME OF VILLAGE INTERVIEWER NAME DATE OF FIRST INTERVIEW INTERVIEWER NAME DATE OF FINAL INTERVIEW RESULT OF INTERVIEW 1 COMPLETED 2 PARTIALLY COMPLETED 3 REFUSAL 4 CDD NOT PRESENT 96 OTHER (SPECIFY) LANGUAGE OF THE INTERVIEW 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) RESPONDENTS' LOCAL LANGUAGE 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER(SPECIFY) TRANSLATOR USED 1 NEVER 2 SOMETIMES 3 ALWAYS SUPERVISOR NAME DATE OF SUPERVISION DATA ENTRY OPERATOR DATA ENTRY DATE DATA ENTRY SUPERVISOR DATA ENTRY SUPERVISION DATE Do you agree to participate in this interview? 1 YES 2 NO GENDER OF RESPONDENT 1 MALE 2 FEMALE 1.01 :What is your current age, in years? 1.02: What is your marital status? 1.03: What is the highest grade you have completed in school? 21 JS1 22 JS2 23 JS3 24 SS1 25 SS2 26 SS3 32 VOCATIONAL 33 TECHNICAL 42 UNIVERSITY UNDERGRADUATE 43 UNIVERSITY GRADUATE 96 OTHER (SPECIFY) 1.04: What is your religion? 1 NONE 2 CHRISTIANITY 3 MUSLIM / ISLAM 4 TRADITIONAL 96 OTHER (SPECIFY 1.05: What is your ethnic group? 1.06: For how many years have you been resident in this community? 1.07: Have you previously been involved with volunteer and / or community/villag 1 YES, VOLUNTEER 2 YES, COMMUNITY 3 YES, VOLUNTEER AND COMMUNITY 4 NO 1.08: What kind of community and / or volunteer work were you involved in? 1 CAMPAIGNS FOR SPECIAL EVENTS (e.g. NATIONAL IMMUNIZATION DAYS, SAFE MOTHERHOOD DAY, LLIN DISTRIBUTION, WORLD MALARIA DAY, ETC.) 2 COMMUNITY DEVELOPMENT WORK (e.g. BUILDING BOREHOLES, ETC.) 3 PROVIDING COMMUNITY / NEIGHBORHOOD SECURITY 4 COMMUNITY HEALTH PROMOTION (e.g. FAMILY PLANNING, IMMUNIZATION, HIV, ETC.) 96 OTHER (SPECIFY) 2.01: Have you received any previous training for community health work? 1 YES 2 NO 2.02: Was this training specifically for CDD work? 1 YES 2 NO 2.03: Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 JHPIEGO 5 SOCIETY FOR FAMILY HEALTH (SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 2.05: Have you provided any health services in the past 3 months? 1 YES 2 NO 3.01: Do you or did you receive any fees or other incentives for your village he 1 YES 2 NO 3.02: What is (was) the primary source of these fees or other incentives? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 NGO 5 COMMUNITY/VILLAGE 6 PRIVATE ORGANIZATION 7 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 3.04: Do (did) you charge your patients fees? 1 YES 2 NO 3.05: On average, how much? 3.06: Do (did) you receive payment other than money from patients? 1 YES 2 NO 3.08: During the last 12 months, what has been your primary job (other than vill 1 PROFESSIONAL 2 TECHNICAL 3 SMALL BUSINESS OWNER 4 FARMER 5 LIVESTOCK KEEPER 6 FISHERMAN 7 LABORER 8 NO OTHER WORK / NOT APPLICABLE 96 OTHER (SPECIFY) 3.09: What sector is this job connected with? 1 AGRICULTURE 2 FISHING 3 FORESTRY, HUNTING, LIVESTOCK 4 MINING AND QUARRYING 5 MANUFACTURING 6 ELECTRICITY / GAS / WATER 7 CONSTRUCTION 8 TOURISM / HOTEL 9 TRADE AND COMMERCE 10 TRANSPORT AND COMMUNICATION 11 FINANCE AND INSURANCE 12 PUBLIC ADMINISTRATION 13 EDUCATION 14 HEALTH 96 OTHER (SPECIFY) 3.10: Who paid your wages? 1 SELF-EMPLOYED 2 EMPLOYER 3 FAMILY (PAID) 4 FAMILY (UNPAID) 5 OTHER (SPECIFY) 96 OTHER (SPECIFY) 3.11: During the past 12 months, how many months did you work at your primary jo 3.12: On average, how many hours per week did you work at your primary job? 3.13: What was your total cash income from your primary job during the past 12 m 3.14: What was your total value of in-kind payments you received for your primar 3.16: Does your household own any land? 1 YES 2 NO 3.17: What is the size of this land? 3.17A: Unit Code 1 SQUARE METER 2 HECTARE 3 PLOT 96 OTHER (SPECIFY) 3.17B: Number of Units 3.18: If you were to sell all of the land you own, how much do you think you wou 3.19: How much land did you cultivate during the past agricultural season? 3.19A: Unit Code 1 SQUARE METER 2 HECTARE 3 PLOT 96 OTHER (SPECIFY) 3.19B: Number of Units 4.01: Have you previously worked as a community directed distributor (CDD) 1 YES 2 NO 4.02: In your work as a CDD, how many households are you responsible for? 4.03: Do you feel that this is too few, too many, or just the right amount? 1 TOO FEW 2 TOO MANY 3 JUST RIGHT 4.04: How many households did you visit in the past month? 4.05: How much time in hours do you spend each week on CDD work? 4.06: Do you feel that this is too few, too many, or just the right amount? 1 TOO FEW 2 TOO MANY 3 JUST RIGHT 4.07:What is the distance from your village to your referral health facility, in 4.07A: UNIT CODE 1 KILOMETERS 2 POLES 4.07B : NUMBER OF UNITS 4.08: What mode of transport do you most often use to travel to the health facil 1 WALKING 2 MOTOR CYCLE 3 BICYCLE 4 MOTOR VEHICLE (TRUCK OR CAR) 5 BOAT 96 OTHER (SPECIFY) 4.09: How much time does it usually take you to travel to the health facility, i 4.09A: Hours 4.09B: Minutes 5.01: Do you have a supervisor? 1 YES 2 NO 5.02: Who is your supervisor? 1 HEALTH FACILITY WORKER (MANAGER) 2 HEALTH FACILITY WORKER (NURSE) 3 HEALTH FACILITY WORKER (CHEW) 4 HEALTH FACILITY WORKER (OTHER, SPECIFY) 96 OTHER (SPECIFY) 5.03: How many times did you meet your supervisor to discuss your work in a 3 mo 5.05: Do you keep regular records of your CDD work? 1 YES 2 NO 5.09: Do you receive any feedback on your records? 1 YES 2 NO 1 YES 2 NO 6.02: Do you receive any support from this committee in your work as a CDD? 1 YES 2 NO 6.05: How are you addressed in your community? 1 CDD 2 VHW (VILLAGE HEALTH WORKER) 3 HEALTH WORKER 4 NURSE 96 OTHER (SPECIFY) 7.01: Why do you think your community selected you to be a CDD? 1 PREVIOUS EXPERIENCE WITH HEALTH WORK 2 PREVIOUS EXPERIENCE SPECIFICALLY WITH CDD WORK 3 LONG-TIME, TRUSTED MEMBER OF KINDRED/COMMUNITY 4 LEVEL OF EDUCATION 96 OTHER (SPECIFY) 7.02: Why do you accept this job? 1 DESIRE TO SERVE COMMUNITY 2 STATUS 3 MONETARY COMPENSATION 4 HAD TO / FORCED TO ACCEPT 96 OTHER (SPECIFY) 7.07: Do you know of any CDDs who have dropped out or who have stopped working a 1 YES 2 NO 7.08: What is the reason they no longer provide CDD services? 1 MOVED OUT OF VILLAGE 2 DIED 3 FOUND ANOTHER JOB 4 DISSATISFIED DUE TO LACK OF SALARY OR PAY 5 DID NOT FEEL SUPPORTED BY COMMUNITY 6 DID NOT FEEL SUPPORTED BY HEALTH FACILITY OR SUPERVISOR 7 SECURITY FACTORS 96 OTHER (SPECIFY) 7.09: In the past 3 months, has there been any incidence that made you feel thre 1 YES 2 NO 7.10: What was the primary reason you felt threatened or afraid to continue prov 1 Danger from armed groups / militants 2 Danger from criminal activities like robbery 3 4 5 Problems with travel 6 Terrorism 96 OTHER (SPECIFY) 8.01: What is the main cause of malaria? 1 MOSQUITOES 2 DIRTY FOODS 3 DIRTY LIQUIDS 4 CLIMATE / WEATHER 5 OILY FOOD 6 SUN 7 WITCHCRAFT 96 OTHER (SPECIFY) 8.08: In the last two weeks, have you seen any patients with fever? 1 YES 2 NO 8.09: How many patients have you seen in the last two weeks? 8.1: When did you see your last patient with fever? 1 IN THE LAST 24 HOURS 2 IN THE LAST 7 DAYS (WEEK) 3 IN THE LAST 14 DAYS (2 WEEKS) 96 OTHER 8.11: Was this patient male or female? 1 MALE 2 FEMALE 8.12: How old was this patient? 1 12 MONTHS OR LESS 2 BETWEEN 1 AND 5 YEARS 3 OLDER THAN FIVE YEARS 4 DON'T KNOW / DON'T REMEMBER 8.14: How did you diagnose the patient? 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST 3 SEND TO LAB / HEALTH FACILITY FOR MICROSCOPY 96 OTHER (SPECIFY) 8.15: What was your initial diagnosis? 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 96 OTHER (SPECIFY) 8.16: What action did you take? 1 TEPID SPONGE CHILD AND PROVIDE TREATMENT WITH ARTEMISININ COMBINATION THERAPY 2 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 3 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 4 PROVIDE TREATMENT WITH OTHER MEDICINE 5 REFER TO HEALTH FACILITY 6 REFER TO HOSPITAL 7 NO ACTION 96 OTHER (SPECIFY) 8.17: Did you record details about this patient in your patient register? 1 YES 2 NO 8.18: Can I see this entry? 1 YES 2 NO 8.19: DO THESE MATCH THE ENTRY IN THE PATIENT REGISTER? 1 YES 2 NO (SPECIFY) 8.20: What was the outcome for the patient? 1 FULL RECOVERY 2 PARTIAL RECOVERY 3 STILL SICK 4 DEATH 5 ADVERSE REACTION TO MEDICINE 6 DON’T KNOW 96 OTHER (SPECIFY 8.21: Do you use RDTs for diagnosis? 1 YES 2 NO 8.22: Are there any community outlets or mini-labs that support malaria diagnosi 1 YES 2 NO 8.23: Do you ever refer patients to such community outlets or mini-labs for diag 1 YES 2 NO 8.24: Do you ever refer patients to such community outlets or mini-labs for diag 1 YES 2 NO 8.25: Do you keep records on patient diagnoses? 8.26: Can I see your records? 1 YES 2 NO 8.30: How would you diagnose the patient 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST (RDT) 3 SEND TO LAB / HEALTH FACILITY FOR MICROSCOPY 96 OTHER (SPECIFY) 8.31: What do you think would be your initial diagnosis? 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 96 OTHER (SPECIFY) 8.32: What action would you take next? 1 TEPID SPONGE CHILD AND PROVIDE TREATMENT WITH ARTEMISININ COMBINATION THERAPY 2 PROVIDE TREATMENT WITH ACT 3 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 4 PROVIDE TREATMENT WITH OTHER MEDICINE 5 REFER TO HEALTH FACILITY 6 REFER TO HOSPITAL 7 NO ACTION 96 OTHER (SPECIFY) 8.33: How would you advise the mother / parents to act in the future if they not 1 TAKE SIMILAR ACTION 2 COME TO SHOP IMMEDIATELY UPON NOTICING SYMPTOMS 3 GO TO HEALTH FACILITY / HOSPITAL IMMEDIATELY IF DAUGHTER'S CONDITION DETERIORATES 4 NO ADVICE TO GIVE 96 OTHER (SPECIFY) 8.34: How would you diagnose the patient? 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST 3 SEND TO LAB / HEALTH FACILITY FOR MICROSCOPY 96 OTHER (SPECIFY) 8.35: What do you think would be your initial diagnosis? 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 96 OTHER (SPECIFY) 8.36: What would you do next? 1 GIVE ANOTHER DOSE OF ACT 2 REFER TO PMV 3 REFER TO HEALTH FACILITY / HOSPITAL 4 ASK HIM TO WAIT, THE MEDICINE WILL WORK 96 OTHER (SPECIFY) 8.37: What advice would you offer to the man, in case a similar situation arises 1 COME BACK TO CDD IF NOT FEELING BETTER 1 DAY AFTER TAKING ACT 2 GO IMMEDIATELY TO HEALTH FACILITY OR HOSPITAL IF NOT FEELING BETTER 1 DAY AFTER TAKING ACT 3 NO ADVICE 96 OTHER (SPECIFY) 8.38: What would you do? 1 ADMINISTER IPT 1 2 ADMINISTER IPT 1 AND 2 3 ADMINISTER ACT 4 ADMINISTER ANOTHER ANTI-MALARIAL 5 REFER TO HEALTH FACILITY / HOSPITAL 6 DO NOTHING 96 OTHER (SPECIFY) 9.02: How frequently do you procure/order drugs and supplies? 1 WEEKLY 2 BI-WEEKLY 3 MONTHLY 96 OTHER (SPECIFY) 9.03: How long does it normally take between the time of your order and time tim 9.03A: Unit code 9.03B: Number of Units 1 DAY 2 WEEKLY 3 MONTHLY 96 OTHER (SPECIFY) 9.04: How do you store your drugs and supplies? 1 DRY & COOL PLACE AT HOME 2 DRY & COOL PLACE OUTSIDE HOME 3 IN DEDICATED DRAWER / CLOSET 4 IN BAG 5 AT HOME (IN OPEN SPACE) 6 ANYWHERE / NO PLACE IN PARTICULAR 7 NO STORAGE 96 OTHER (SPECIFY) 9.05: Is the storage space secured? 1 YES, WITH A LOCK 2 NO 96 YES, WITH OTHER (SPECIFY) 9.06: Do you keep a stock register? 1 YES 2 NO 9.07: Can I see this register? 1 YES(SEEN) 2 NO(NOT SEEN) 9.08: Do you currently have ACTs available? 1 YES 2 NO 9.09: How many doses of ACT do you have available right now? 9.10: How many ACT stockouts have you experienced in the last 3 months? 9.11: What was the number one reason for these stockouts? 1 LACK OF AVAILABILITY IN HEALTH FACILITY 2 UNEXPECTED HIGH DEMAND 3 LACK OF PLANNING 4 NOT APPLICABLE 96 OTHER (SPECIFY) 9.12: Do you currently have SP available? 1 YES 2 NO 9.13: How many doses of SP do you have available right now? 9.14: How many SP stockouts have you experienced in the last 6 months? 9.15: What was the number one reason for these stockouts? 1 LACK OF AVAILABILITY IN HEALTH FACILITY 2 UNEXPECTED HIGH DEMAND 3 LACK OF PLANNING 4 NOT APPLICABLE 96 OTHER (SPECIFY) 9.16: Do you currently have RDT kits available? 1 YES 2 NO 9.17: How many RDT kits do you have available right now? 9.18: How many RDT kit stockouts have you experienced in the last 3 months? 9.19: What was the number one reason for these stockouts? 1 LACK OF AVAILABILITY IN HEALTH FACILITY 2 UNEXPECTED HIGH DEMAND 3 LACK OF PLANNING 4 NOT APPLICABLE 96 OTHER (SPECIFY) 10.01: In the past year, have you had any other job, in addition to your CDD wor 1 YES 2 NO 10.03: At any time in the past, have you had any other job (other than this CDD 1 YES 2 NO 2.04: Was topic of childhood disease covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of family planning covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of antenatal and postnatal care covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of referral to facility for delivery or danger signs covered in 1 YES 2 NO 96 OTHERS 2.04: Was topic of newborn care covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of tuberculosis covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of vaccinations covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of record keeping/inventory management covered in these training 1 YES 2 NO 96 OTHERS 2.04: Was topic of malaria covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of nutrition covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of sanitation and home hygiene covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of mental health covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of disabilities covered in these trainings? 1 YES 2 NO 96 OTHERS 2.04: Was topic of other (specify) covered in these trainings? 1 YES 2 NO 96 OTHERS 2.06: Have you provided service of treating sick children within the past 3 mont 1 YES 2 NO 2.06: Have you provided service of referring very sick children within the past 1 YES 2 NO 2.06: Have you provided service of supporting outreach vacination campaigns with 1 YES 2 NO 2.06: Have you provided service of consultations for adults within the past 3 mo 1 YES 2 NO 2.06: Have you provided service of birth spacing methods within the past 3 month 1 YES 2 NO 2.06: Have you provided service of giving iron tablets and nutrition advice to p 1 YES 2 NO 2.06: Have you provided service of referring pregnant women for tetanus toxoid a 1 YES 2 NO 2.06: Have you provided service of supervising and advising TBA within the past 1 YES 2 NO 2.06: Have you provided service of supervising home deliveries within the past 3 1 YES 2 NO 2.06: Have you provided service of referring pregnant women with daner signs wit 1 YES 2 NO 2.06: Have you provided service of PNC within the past 3 months? 1 YES 2 NO 2.06: Have you provided service of supervising and advising traditional birth at 1 YES 2 NO 2.06: Have you provided service of supervising home deliveries within the past 3 1 YES 2 NO 2.06: Have you provided service of referring pregnant women with danger signs wi 1 YES 2 NO 2.06: Have you provided service of PNC within the past 3 months? 1 YES 2 NO 2.06: Have you provided service of newborn care within the past 3 months? 1 YES 2 NO 2.06: Have you provided service of referring for TB diagnosis within the past 3 1 YES 2 NO 2.06: Have you provided service of supervising DOTS treatment for TB within the 1 YES 2 NO 2.06: Have you provided service of malaria treatment within the past 3 months? 1 YES 2 NO 2.06: Have you provided service of distributing mosquito nets within the past 3 1 YES 2 NO 2.06: Have you provided service of advising and referring on mental health withi 1 YES 2 NO 2.06: Have you provided service of advising and referring on disabilities within 1 YES 2 NO 2.06: Have you provided service of health education for groups of people within 1 YES 2 NO 2.06: Have you provided service of other (specify) within the past 3 months? 1 YES 2 NO 3.03: Have you received regular salary or stipend? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received ad-hoc/irregular salary or stipend? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received transport money? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received money for referral? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received loan? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received bicycle? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received literacy training? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received food for work? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received computer training? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received cloth? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received festival bonus? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received shoes? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received food for training? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received other food? 1 YES 2 NO 96 OTHER (SPECIFY) 3.03: Have you received other (specify)? 1 YES 2 NO 96 OTHER (SPECIFY) 3.07: Have you received food as payment? 1 YES 2 NO 96 OTHERS 3.07: Have you received livestock as payment 1 YES 2 NO 96 OTHERS 3.07: Have you received other (specify) as payment 1 YES 2 NO 96 OTHERS 3.15: How many of radio/CD/casette player does your household own? 3.15: How many of television does your household own? 3.15: How many of perssing iron does your household own? 3.15: How many of electric stove does your household own? 3.15: How many of gas stove does your household own? 3.15: How many of lamp does your household own? 3.15: How many of bed does your household own? 3.15: How many of mattress/sleeping mat does your household own? 3.15: How many of refrigerator does your household own? 3.15: How many of paraffin stove does your household own? 3.15: How many of sewing machine does your household own? 3.15: How many of table does your household own? 3.15: How many of sofa does your household own? 3.15: How many of land line telephone does your household own? 3.15: How many of mobile telephone does your household own? 3.15: How many of motorcycle does your household own? 3.15: How many of bicycle does your household own? 3.15: How many of motor vehicle does your household own? 3.15: How many of wheelbarrow does your household own? 3.15: How many of boat does your household own? 3.15: How many of tractor does your household own? 3.15: How many of crop sprayer does your household own? 3.15: How many of irrigation equipment does your household own? 3.15: How many of ploughs/harrows does your household own? 3.15: How many of hoes/awes does your household own? 3.15: How many of fishing net/fishing equipment does your household own? 3.20: How many of goats does your household own? 3.20: How many of sheep does your household own? 3.20: How many of pigs does your household own? 3.20: How many of chicken does your household own? 3.20: How many of guinea fowl does your household own? 3.20: How many of ducks/geese does your household own? 3.20: How many of turkey does your household own? 3.20: How many of donkey/horse does your household own? 3.20: How many of cow does your household own? 3.20: How many of bull does your household own? 3.20: How many of oxen does your household own? 3.20: How many of calves does your household own? 3.20: How many of rabbits does your household own? 5.04: During your last visit with your supervisor, did your supervisor bring sup 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor check sup 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor check rec 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor observe c 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor ask knowl 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor provide m 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor visit hou 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor meet with 1 YES 2 NO 96 OTHERS 5.04: During your last visit with your supervisor, did your supervisor other (sp 1 YES 2 NO 96 OTHERS 5.06: Do you keep record daily? 1 YES 2 NO 96 OTHER 5.06: Do you keep record weekly 1 YES 2 NO 96 OTHER 5.06: Do you keep record monthly 1 YES 2 NO 96 OTHER 5.06: Do you keep record other (specify) 1 YES 2 NO 96 OTHER 5.07: Do these records contain patient details? 1 YES 2 NO 96 OTHER 5.07: Do these records contain diagnose? 1 YES 2 NO 96 OTHER 5.07: Do these records contain drug received? 1 YES 2 NO 96 OTHER 5.07: Do these records contain drug dispensed? 1 YES 2 NO 96 OTHER 5.07: Do these records contain patient referrals? 1 YES 2 NO 96 OTHER 5.07: Do these records contain BCC/IEX material distributed? 1 YES 2 NO 96 OTHER 5.07: Do these records contain number of persons councelled? 1 YES 2 NO 96 OTHER 5.07: Do these records contain other (specify)? 1 YES 2 NO 96 OTHER 5.07: Do these records contain ...? 1 YES 2 NO 96 OTHER 5.08: Do you submit your records to health facility worker (supervisor)? 1 YES 2 NO 96 OTHER 5.08: Do you submit your records to health facility worker (not supervisor)? 1 YES 2 NO 96 OTHER 5.08: Do you submit your records to nobody? 1 YES 2 NO 96 OTHER 5.08: Do you submit your records to other (specify)? 1 YES 2 NO 96 OTHER 5.10: Do you receive feedback of ways to improve record-keeping? 1 YES 2 NO 96 OTHER 5.10: Do you receive feedback of ways to improve work? 1 YES 2 NO 96 OTHER 5.10: Do you receive feedback of your performance? 1 YES 2 NO 96 OTHER 5.10: Do you receive feedback of special recognition for work well done? 1 YES 2 NO 96 OTHER 5.10: Do you receive feedback of criticism for work not done well? 1 YES 2 NO 96 OTHER 5.10: Do you receive feedback of other (specify)? 1 YES 2 NO 96 OTHER 6.03: Do you receive cash payment for services as a support from the committee? 1 YES 2 NO 96 OTHER 6.03: Do you receive other (in-kind) payment for services as a support from the 1 YES 2 NO 96 OTHER 6.03: Do you receive donations of supplies/equipment as a support from the commi 1 YES 2 NO 96 OTHER 6.03: Do you receive community mobilization to use health services as a support 1 YES 2 NO 96 OTHER 6.03: Do you receive appreciation/recognition as a support from the committee? 1 YES 2 NO 96 OTHER 6.03: Do you receive other (specify) as a support from the committee? 1 YES 2 NO 96 OTHER 6.04: Does the health facility support salary or stipend to your CDD work? 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support other in-kind payment to your CDD work? 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support sharing knowledge about disease preventio 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support community mobilization to use health serv 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support training to your CDD work? 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support help with record keeping to your CDD work 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support appreciation/recognition to your CDD work 1 YES 2 NO 96 OTHERS 6.04: Does the health facility support no support from health facility to your C 1 YES 2 NO 96 OTHERS 6.04: Does the health facility other (specify) to your CDD work? 1 YES 2 NO 96 OTHERS 7.03: Is lack of training/knowledge the biggest difficulty you face in doing you 1 YES 2 NO 96 OTHER 7.03: Is lack of supervision/feedback on performance the biggest difficulty you 1 YES 2 NO 96 OTHER 7.03: Is patients/caretakers seek advice too late the biggest difficulty you fac 1 YES 2 NO 96 OTHER 7.03: Is lack of time the biggest difficulty you face in doing your job? 1 YES 2 NO 96 OTHER 7.03: Is lack of motivation the biggest difficulty you face in doing your job? 1 YES 2 NO 96 OTHER 7.03: Is lack of support from community the biggest difficulty you face in doing 1 YES 2 NO 96 OTHER 7.03: Is lack of supplies and drugs the biggest difficulty you face in doing you 1 YES 2 NO 96 OTHER 7.03: Is inadequate compensation the biggest difficulty you face in doing your j 1 YES 2 NO 96 OTHER 7.03: Is lack of communication with health facility the biggest difficulty you f 1 YES 2 NO 96 OTHER 7.03: Is conducting household visits the biggest difficulty you face in doing yo 1 YES 2 NO 96 OTHER 7.03: Is other (specify) the biggest difficulty you face in doing your job? 1 YES 2 NO 96 OTHER 7.04: How would you rate 'your job makes your feel good about yourself'? 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'you are proud to be working in your community'? 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'you are glad that you are working for this community r 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'the community really inspires ou to do your very best 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'you always complete your tasks efficiently and effecti 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'you are a hard worker'? 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'you are punctual about coming to work'? 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'these days, you feel motivated to work as hard as you 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'overall you are very satisfied with your job'? 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.04: How would you rate 'you are satisfied with the opportunity to use your abi 1 Strongly disagree 2 Disagree 3 Agree 4 Strongly agree 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: working relationshi 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: working relationshi 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: relationship with c 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: community support 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: availability of med 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: your level of respe 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: your training oppor 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: your ability to mee 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: your incentives 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: other employment be 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: safety and security 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: living accommodatio 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: recognition of your 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.05: How would you rate the following aspects of your work: overall satisfactio 1 Very Unsatisfied 2 Unsatisfied 3 Satisfied 4 Very Satisfied 5 Not applicable 89 Don't know 7.06: What are the first top thing you would change about your work to improve y 1 WORKING RELATIONSHIP WITH OTHER CDDs 2 WORKING RELATIONSHIP WITH HEALTH FACILITY WORKERS 3 RELATONSHIP WITH COMMUNITY / COMMUNITY LEADERS 4 COMMUNITY SUPPORT (FINANCIAL / OTHER) 5 AVAILABILITY OF MEDICINES 6 YOUR LEVEL OF RESPECT IN THE COMMUNITY 7 TRAINING OPPORTUNITIES 8 YOUR ABILITY TO MEET THE NEEDS OF THE COMMUNITY 9 INCENTIVES 10 OTHER EMPLOYMENT BENEFITS 11 SAFETY AND SECURITY TO LIVE AND WORK IN YOUR COMMUNITY 12 LIVING ACCOMODATIONS FOR YOUR FAMILY 13 RECOGNITION OF YOUR GOOD WORK 14 OVERALL SATISFACTION WITH CDD WORK 96 OTHER (SPECIFY) 7.06: What are the second top thing you would change about your work to improve 1 WORKING RELATIONSHIP WITH OTHER CDDs 2 WORKING RELATIONSHIP WITH HEALTH FACILITY WORKERS 3 RELATONSHIP WITH COMMUNITY / COMMUNITY LEADERS 4 COMMUNITY SUPPORT (FINANCIAL / OTHER) 5 AVAILABILITY OF MEDICINES 6 YOUR LEVEL OF RESPECT IN THE COMMUNITY 7 TRAINING OPPORTUNITIES 8 YOUR ABILITY TO MEET THE NEEDS OF THE COMMUNITY 9 INCENTIVES 10 OTHER EMPLOYMENT BENEFITS 11 SAFETY AND SECURITY TO LIVE AND WORK IN YOUR COMMUNITY 12 LIVING ACCOMODATIONS FOR YOUR FAMILY 13 RECOGNITION OF YOUR GOOD WORK 14 OVERALL SATISFACTION WITH CDD WORK 96 OTHER (SPECIFY) 7.06: What are the third top thing you would change about your work to improve y 1 WORKING RELATIONSHIP WITH OTHER CDDs 2 WORKING RELATIONSHIP WITH HEALTH FACILITY WORKERS 3 RELATONSHIP WITH COMMUNITY / COMMUNITY LEADERS 4 COMMUNITY SUPPORT (FINANCIAL / OTHER) 5 AVAILABILITY OF MEDICINES 6 YOUR LEVEL OF RESPECT IN THE COMMUNITY 7 TRAINING OPPORTUNITIES 8 YOUR ABILITY TO MEET THE NEEDS OF THE COMMUNITY 9 INCENTIVES 10 OTHER EMPLOYMENT BENEFITS 11 SAFETY AND SECURITY TO LIVE AND WORK IN YOUR COMMUNITY 12 LIVING ACCOMODATIONS FOR YOUR FAMILY 13 RECOGNITION OF YOUR GOOD WORK 14 OVERALL SATISFACTION WITH CDD WORK 96 OTHER (SPECIFY) 8.02: What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACH 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.02: What are the danger signs or symptoms of malaria? (up to three 1 FEVER 2 HEADACH 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.02: What are the danger signs or symptoms of malaria? (up to three 1 FEVER 2 HEADACH 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.03: How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 8.03: How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 8.03: How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 8.04: Which of the following have members of your household done to protect them 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 8.04: Which of the following have members of your household done to protect them 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 8.04: Which of the following have members of your household done to protect them 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 8.05: What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 8.05: What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 8.05: What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 8.06: What drug does the government recommend for the treatment of malaria? (up 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 8.06: What drug does the government recommend for the treatment of malaria? (up 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 8.06: What drug does the government recommend for the treatment of malaria? (up 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 8.07: What is the primary source of knowledge about malaria in your community? ( 1 VILLAGE HEALTH WORKER (VHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 8.07: What is the primary source of knowledge about malaria in your community? ( 1 VILLAGE HEALTH WORKER (VHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 8.07: What is the primary source of knowledge about malaria in your community? ( 1 VILLAGE HEALTH WORKER (VHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 8.13: What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.13: What symtpoms did the patient have? (up to three 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.13: What symtpoms did the patient have? (up to three 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.27: RECORD THE NUMBER OF FEVER CASES IN LAST 2 WEEKS 8.27: RECORD THE NUMBER OF RDT POSITIVE CASES (IF APPLICABLE)IN LAST 2 WEEKS 8.27: RECORD NUMBER OF MINI-LAB POSITIVE CASES (IF APPLICABLE)IN LAST 2 WEEKS 8.27: RECORD NUMBER OF HEALTH FACILITY POSTITVE CASES (IF APPLICABLE) IN LAST 2 8.27: RECORD DOSES OF ACT DISPENSED IN LAST 2 WEEKS 8.28: What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 8.28: What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 8.28: What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 8.28: What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 8.28: What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 8.28: What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 8.29: How many times have you engaged in each of these activities in the last tw 8.29: How many times have you engaged in each of these activities in the last tw 8.29: How many times have you engaged in each of these activities in the last tw 8.29: How many times have you engaged in each of these activities in the last tw 8.29: How many times have you engaged in each of these activities in the last tw 8.29: How many times have you engaged in each of these activities in the last tw 9.01: From where do you procure your drugs and supplies? (up to four) 1 HEALTH FACILITY 2 MARKET 3 PMV 96 OTHER (SPECIFY) 9.01: From where do you procure your drugs and supplies? (up to four) 1 HEALTH FACILITY 2 MARKET 3 PMV 96 OTHER (SPECIFY) 9.01: From where do you procure your drugs and supplies? (up to four) 1 HEALTH FACILITY 2 MARKET 3 PMV 96 OTHER (SPECIFY) 9.01: From where do you procure your drugs and supplies? (up to four) 1 HEALTH FACILITY 2 MARKET 3 PMV 96 OTHER (SPECIFY) 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 10.02: How does opportunities for training in your CDD work compare to your othe 1 Worse 2 Same 3 Better 10.02: How does your level of respect in the community in your CDD work compare 1 Worse 2 Same 3 Better 10.02: How does availability of necessary equipment/commodities in your CDD work 1 Worse 2 Same 3 Better 10.02: How does adequate time availabel to perform tasks in your CDD work compar 1 Worse 2 Same 3 Better 10.02: How does supervision and feedback from supervisor in your CDD work compar 1 Worse 2 Same 3 Better 10.02: How does teamwork/relationships with other CDDs/co-workers in your CDD wo 1 Worse 2 Same 3 Better 10.02: How does motivation and satisfaction with work in your CDD work compare t 1 Worse 2 Same 3 Better 10.02: How does recognition of your good work in your CDD work compare to your o 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 10.04: How does other benefits in your CDD work compare to your previous work? 1 Worse 2 Same 3 Better 1 Worse 2 Same 3 Better 10.04: How does opportunities for training in your CDD work compare to your prev 1 Worse 2 Same 3 Better 10.04: How does your level of respect in the community in your CDD work compare 1 Worse 2 Same 3 Better 10.04: How does availability of necessary equipment/commodities in your CDD work 1 Worse 2 Same 3 Better 10.04: How does adequate time available to perform tasks in your CDD work compar 1 Worse 2 Same 3 Better 10.04: How does supervision and feedback from supervisor in your CDD work compar 1 Worse 2 Same 3 Better 10.04: How does teamwork/relationships with other CDDs/co-workers in your CDD wo 1 Worse 2 Same 3 Better 10.04: How does motivation and satisfaction with work in your CDD work compare t 1 Worse 2 Same 3 Better 10.04: How does recognition and satisfaction with work in your CDD work compare 1 Worse 2 Same 3 Better 10.04: How does other (specify) in your CDD work compare to your previous work? 1 Worse 2 Same 3 Better STATE NAME STATE CODE SENATORIAL DISTRICT LGA NAME LGA CODE WARD NAME TREATMENT PRIMARY HEALTH FACILITY NAME PRIMARY HEALTH FACILITY ID PRIMARY HEALTH FACILITY TYPE COMMUNITY NAME Town Type 1 RURAL 2 PERI-URBAN 3 URBAN CS_ID NAME OF STATE NAME OF LGA 1 AKKO 2 BALANGA 3 BILLIRI 4 DUKKU 5 FUNAKAYE 6 GOMBE 7 KALTUNGO 8 KWAMI 9 NAFADA 10 SHONGOM 11 YAMALTU/DEBA NAME OF WARD 101 AKKO 102 GARKO 103 KALSHINGI 104 KASHERE 105 KUMO CENTRAL 106 KUMO EAST 107 KUMO NORTH 108 KUMO WEST 109 PINDIGA 110 TUMU 111 TUKULMA 201 BAMBAM 203 DADIYA 204 GELENGU/BALANGA 205 KINDIYO 206 KULANI/DEGRI/SIKKAM 207 MWONA 208 NYUWAR/JESSU 209 SWA/REF/GASI/W.WAJA 210 TALASEE/DONG/REME 301 BANGANJE NORTH 303 BARE 304 305 306 KALMAI 307 TAL 308 TANGLANG 309 TODI 310 401 GOMBE ABBA 402 HASHIDU 403 JAMARI 404 KUNDE 406 MALALA 407 WAZIRI NORTH 408 409 WURO TALE 410 ZANGE 411 ZAUNE 501 ASHAKA/MAGABA 502 BAGE 503 BAJOGA 504 BAJOGA 505 BODOR/TILDE 506 JILLAHI 507 kupto 508 RIBADU 509 TONGO 510 WAWA/WAKKALTU 603 604 605 DAWAKI 606 HERWA GANA 608 KUMBIYA KUMBIYA 609 NASARAWA 610 PANTAMI 611 SHAMAKI 701 AWAK 702 BULE/KALTIN 703 KALTUNGO WEST 704 KALTUNGO EAST 705 KAMO 707 TULA WANGE 708 TULA YIRI 709 TUNGO 710 TURE 801 BOJUDE 802 DABA FULANI 803 DOHO 804 DUKUL 805 GADAM 806 JURARA 807 KOMFULATA 808 KWAMI 809 MALAM-SIDI 810 MALLERI 901 BARWO NASARAWA 902 BARWO WINDE 903 BIRIN BOLEWA 904 BIRIN FULANI EAST 905 BIRIN FULANI WEST 906 GUDUKKU 907 JIGAWA 908 NAFADA CENTRAL 909 NAFADA EAST 910 NAFADA WEST 1001 BANGUNJI 1002 BOH 1003 BURAK 1004 FILIYA 1006 GWANDUM 1007 KULISHIM 1008 KUSHI 1009 LALIPIDO 1010 LAPAN 1101 DEBA 1102 DIFA/LUBO/KINAFA 1103 GWANI/SHINGA/WADE 1104 HINNA 1105 JAGALI NORTH 1106 JAGALI SOUTH 1107 KANAWA/WAJARI 1108 KURI/LANO/LAMBAM 1109 KWADON/LIJI/KURBA 1110 NONO/KUNUWA/W.BIRDEKA 1111 ZAMBUK/KWALI Nearest Health Facility Code SEA Code Town Type 1 RURAL 2 PERI-URBAN 3 URBAN Name Of Village/Community Interviewer Name CS_INT_NAME_DATF Day Month Year Second Interviwer's Name CS_INT2_NAME_DAT Day Month Year Language spoken by respondent during interview 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Respondent Local Language Mother Tongue 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Translated Used 1 NEVER 2 SOMETIMES 3 ALWAYS Supervisor Name CS_SUP_NAME_DAU Day Month Year Data Entry Operator CS_SUP_NAME_DAV Day Month Year Data Entry Supervisor CS_SUP_NAME_DAW Day Month Year Consent 1 YES 2 NO CS_COMMDATA Comment (GPS) 1.01 : Do the children (under 12 years old) in this community typically wear sho 1 YES 2 NO 1.02 : Do the adult (12 years and older) inthis community typically wear shoes ( 1 YES 2 NO 1.03 : Do the houses in this community typically hav glass in their window? 1 YES 2 NO 1.04 : Are the houses surrounding in ths community swept clean? 1 YES 2 NO 1.05 : What materials are used for the outside walls of the houses in this commu 1 BRICKS/BLOCKS 2 ASBESTOS 3 IRON SHEETS 4 PLASTIC 5 POLES 6 TILES 7 GRASS/STRAW 8 WOOD 9 MUD 10 CONCRETE ONLY 11 COVERED CONCRETE 12 CARDBOARD 96 OTHER (SPECIFIED) 1.06 : What materials are used for the roofs? 1 BRICKS/BLOCKS 2 ASBESTOS 3 IRON SHEETS 4 PLASTIC 5 POLES 6 TILES 7 GRASS/STRAW 8 WOOD 9 MUD 10 CONCRETE ONLY 11 COVERED CONCRETE 12 CARDBOARD 96 OTHER (SPECIFIED) 1.07 : What materials are used for the Floors? 1 BRICKS/BLOCKS 2 ASBESTOS 3 IRON SHEETS 4 PLASTIC 5 POLES 6 TILES 7 GRASS/STRAW 8 WOOD 9 MUD 10 CONCRETE ONLY 11 COVERED CONCRETE 12 CARDBOARD 96 OTHER (SPECIFIED) 1.08 : Are there piles of exposed garbaged visible along the road/sheet/paths? 1 YES 2 NO 1.09 : Is animal dropping visible in the community? 1 YES 2 NO 1.10 : Are there obstructed sewers, gutters,or canals in this village? 1 YES 2 NO 1.11 : Are there standing stagnant pool of water (do not include marshes, lakes, 1 YES 2 NO 1.12 : Are there any livestock visible roaming around the house? 1 YES 2 NO 1.13 : What is the most common type of road surface in this community? 1 TAR/TARMAC(PAVED) 2 GRAVEL 3 DUST 96 OTHER (SPECIFY) 1.14 : What is the topography of this community? 1 INLAND PLANS 2 HILLS 3 MOUNTAINS 4 DESERT 5 OTHER 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.02 : What is your position in the community? 1 HEADMAN/WOMAN 2 SPOUSE TO HEADMAN/WOMAN 3 SCHOOL HEADTEACHER 4 TEACHER 5 AGRICULTURAL EXTENSION OFFICER 6 RELIGIOUS LEADER 7 MERCHANT/BUSINESS 8 HEALTH WORKER 9 NGO WORKER 96 OTHER (SPECIFY) 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.03 : What village do you come from? Enter name of the village. 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.04 : Please record gender. 1 MALE 2 FEMALE 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.05 : How old are you? (enter years) 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.06 : For how many years have you lived in this community? 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.07 : What ethnic group do you belong to? 1 TULA 2 TERA 3 TANGALE 4 FULANI 5 YORUBA 6 IGBO 96 OTHERS 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 2.08 : What is the highest level of education you have completed? 1 NONE / PRE-PRIMARY 2 FOR CLASSES IN PRIMARY / SECONDARY SCHOOL, RECORD CLASS 12 GRADE 12 GCE (O-LEVEL) 13 GRADE 12 GCE (A-LEVEL) 14 COLLEGE / UNIVERSITY 15 UNIVERSITY POSTGRADUATE 16 MASTER'S DEGREE 17 DOCTORAL LEVEL 3.01 : How many household are there in this community? 3.02 : How many people live in this community 3.03 : What are the first most common religions practised by residents of this c 1 CATHOLIC 2 PROTESTANT 3 MUSLIM/ISLAM 5 TRADITIONAL 6 OTHER CHRISTAIN 96 OTHER (SPECIFY) 3.03 : What are the second most common religions practised by residents of this 1 CATHOLIC 2 PROTESTANT 3 MUSLIM/ISLAM 5 TRADITIONAL 6 OTHER CHRISTAIN 96 OTHER (SPECIFY) 3.03 : What are the third most common religions practised by residents of this c 1 CATHOLIC 2 PROTESTANT 3 MUSLIM/ISLAM 5 TRADITIONAL 6 OTHER CHRISTAIN 96 OTHER (SPECIFY) 3.04 : What is the number of households that practice the first most common reli 3.04 : What is the number of households that practice the second most common rel 3.04 : What is the number of households that practice the third most common reli 3.05 : What are the first most common languages spoken in thier homes by residen 1 ENGLISH 2 HAUSA 3 FULFULDU 4 TANGALE 5 BOLEWA 6 KANURI 7 TERA 8 YORUBA 9 IGBO 96 OTHERS ( SPECIFY) 3.05 : What are the second most common languages spoken in thier homes by reside 1 ENGLISH 2 HAUSA 3 FULFULDU 4 TANGALE 5 BOLEWA 6 KANURI 7 TERA 8 YORUBA 9 IGBO 96 OTHERS ( SPECIFY) 3.05 : What are the third most common languages spoken in thier homes by residen 1 ENGLISH 2 HAUSA 3 FULFULDU 4 TANGALE 5 BOLEWA 6 KANURI 7 TERA 8 YORUBA 9 IGBO 96 OTHERS ( SPECIFY) 3.06 : What is the number of household thst speak the first most common language 3.06 : What is the number of household thst speak the first most common language 3.06 : What is the number of household thst speak the first most common language 3.07 : What is the first main ethnic group in this community? 1 TANGELE 2 TERA 3 TULA 4 FULANI 5 IGBO 6 YORUBA 96 OTHERS ( SPECIFY) 3.07 : What is the second main ethnic group in this community? 1 TANGELE 2 TERA 3 TULA 4 FULANI 5 IGBO 6 YORUBA 96 OTHERS ( SPECIFY) 3.07 : What is the third main ethnic group in this community? 1 TANGELE 2 TERA 3 TULA 4 FULANI 5 IGBO 6 YORUBA 96 OTHERS ( SPECIFY) 3.08 : What is the number of households in the community that belongs to the fir 3.08 : What is the number of households in the community that belongs to the sec 3.08 : What is the number of households in the community that belongs to the thi 4.01 : What is most common type of road surface in this community? 1 TAR/TARMAC(PAVED) 2 GRAVEL 3 DUST 96 OTHER (SPECIFY) 4.02 : How far is it to the nearest paved (tar/tarmac) road? 4.03 : Do vehicles pass on the main road in this community throughout the year? 1 YES 2 NO 4.04 : During the past 12 months, how many months was the main road passable by 4.05 : During the past 12 months, how many months was the main road passable by 4.06 : Do light trucks and public transport (buses, minibuses or taxis) stop in 1 YES 2 NO 4.07 : Do you have a body of water in this community 1 YES 2 NO 4.08 : Are boats an important means of transportation in this community? 1 YES 2 NO 4.09 : For how many months last year could motorboats travel on the main waterwa 4.10 : Which is the nearest Urban Center? 1 BAJOGA 2 BILIRI 3 GOMBE TOWN 4 KUMO 96 OTHER (SPECIFY) 4.11 : How far is the major urban center 4.12 : What is the cost of the total fare to go by public transport from here to 4.13 : Is there a primary school classrooms and staff housing in or near your co 1 YES 2 NO 4.13 : Is there a secondary school classrooms and staff housing in or near your 1 YES 2 NO 4.13 : Is there a health center or staff housing in or near your community? 1 YES 2 NO 4.13 : Is there a drug store/health shop in or near your community? 1 YES 2 NO 4.13 : Is there a pharmacy in or near your community? 1 YES 2 NO 4.13 : Is there a market in or near your community? 1 YES 2 NO 4.13 : Is there other important infrastructure in or near your community? 1 YES 2 NO 4.14 : How far from your community is the primary school classrooms and staff ho 4.14 : How far from your community is the second school classrooms and staff hou 4.14 : How far from your community is the health center or staff housing? 4.14 : How far from your community is the drug store/health shop? 4.14 : How far from your community is the pharmacy? 4.14 : How far from your community is the market? 4.14 : How far from your community is the other important infrastructure? 4.15 : How many people work at the primary school classrooms and staff housing? 4.15 : How many people work at the secondary school classrooms and staff housing 4.15 : How many people work at the health center or staff housing? 4.15 : How many people work at the drug store/health shop? 4.15 : How many people work at the pharmacy?? 4.15 : How many people work at the market? 4.15 : How many people work at the other important infrastructure? 4.16 : How many people does the primary school classrooms and staff housing serv 4.16 : How many people does the secondary school classrooms and staff housing se 4.16 : How many people does the health center or staff housing serve? 4.16 : How many people does the drug store/health shop serve? 4.16 : How many people does the pharmacy serve? 4.16 : How many people does the market serve? 4.16 : How many people does the the other important infrastructure serve? 4.17 : How large is the geographical area served by this primary school classroo 4.17 : How large is the geographical area served by this secondary school classr 4.17 : How large is the geographical area served by this health center or staff 4.17 : How large is the geographical area served by this drug store/health shop? 4.17 : How large is the geographical area served by this pharmacy? 4.17 : How large is the geographical area served by this market? 4.17 : How large is the geographical area served by this other important infrast 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.18 : Which organisations help with the construction/rehabilitation/expansion o 1 FAWEZA 2 DANIDA 3 WORLD VISION 4 CHURCH 5 GOVERNMENT 6 WORLD BANK 7 DFID 8 USAID 9 NGO 10 JICA 96 OTHER 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.19 : What type of contribution did the organisation(s) make? 1 FINANCIAL ASSISTANCE 2 TECHNICAL ASSISTANCE 3 CONSTRUCTION 4 REHABILITATION 5 EXPANSTION 4.20 : In which year did the organisation start halping with the financial/techn 4.20 : In which year did the organisation start halping with the financial/techn 4.20 : In which year did the organisation start halping with the financial/techn 4.20 : In which year did the organisation start halping with the financial/techn 4.20 : In which year did the organisation start halping with the financial/techn 4.20 : In which year did the organisation start halping with the financial/techn 4.20 : In which year did the organisation start halping with the financial/techn 4.21 : What did the community contribute towards the construction of the primary 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 4.21 : What did the community contribute towards the construction of the seconda 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 4.21 : What did the community contribute towards the construction of the health 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 4.21 : What did the community contribute towards the construction of the drug st 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 4.21 : What did the community contribute towards the construction of the pharmac 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 4.21 : What did the community contribute towards the construction of the market? 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 4.21 : What did the community contribute towards the construction of the other i 1 LABOR 2 MATERIALS 3 CASH 4 NOTHING 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 1 NEW OR FUNCTIONAL, NEEDING NO REPAIR 2 FUNCTIONAL BUT NEEDS SOME REPAIR 3 DELAPIDATED,UNUSABLE,NOT UNDER REPAIR 4 UNUSABLE UNDER CONSTRUCTION OR REPAIR 96 OTHER SPECIFY 4.23 : What is the main source of drinking water for the resident of this commun 1 PUMPED (PIPED) WATER FROM RIVER/LAKE 2 DIRECTLY FROM THE RIVER/LAKE/STREAM 3 BOREHOLE 4 UNPROTECTED WELL 5 PROTECTED WELL 6 SPRING WATER 7 RAIN 8 TAP(E.G OWN/PUBLIC/FROM THE NEAR BY BUILDING 9 BOUGHT FROM VENDOR 10 WATER DELIVERED BY TANKER TRUCK 11 MINERAL BOTTLED WATER 96 OTHER {SPECIFY) 4.23 : What is the main source of drinking water for the resident of this commun 1 PUMPED (PIPED) WATER FROM RIVER/LAKE 2 DIRECTLY FROM THE RIVER/LAKE/STREAM 3 BOREHOLE 4 UNPROTECTED WELL 5 PROTECTED WELL 6 SPRING WATER 7 RAIN 8 TAP(E.G OWN/PUBLIC/FROM THE NEAR BY BUILDING 9 BOUGHT FROM VENDOR 10 WATER DELIVERED BY TANKER TRUCK 11 MINERAL BOTTLED WATER 96 OTHER {SPECIFY) 4.24 : What is the first most common type of toilet that household in this commu 1 OWN PIT LATRIN 2 COMMUNAL PIT LATRIN 3 OWN VIP LATRIN 4 COMMUNAL VIP LATRIN 5 NEIGHBOURS/ANOTHER HOUSEHOLDS PIT LATRIN 6 AQUA PRIVY 7 OWN FLUSH TOILET INSIDE THE HOUSE 8 OWN FLUSH TOILET OUTSIDE THE HOUSE 9 COMMUNAL / SHARED FLUSH TOILET 96 OTHER (SPECIFY) 4.24 : What is the second most common type of toilet that household in this comm 1 OWN PIT LATRIN 2 COMMUNAL PIT LATRIN 3 OWN VIP LATRIN 4 COMMUNAL VIP LATRIN 5 NEIGHBOURS/ANOTHER HOUSEHOLDS PIT LATRIN 6 AQUA PRIVY 7 OWN FLUSH TOILET INSIDE THE HOUSE 8 OWN FLUSH TOILET OUTSIDE THE HOUSE 9 COMMUNAL / SHARED FLUSH TOILET 96 OTHER (SPECIFY) 4.24 : What is the third most common type of toilet that household in this commu 1 OWN PIT LATRIN 2 COMMUNAL PIT LATRIN 3 OWN VIP LATRIN 4 COMMUNAL VIP LATRIN 5 NEIGHBOURS/ANOTHER HOUSEHOLDS PIT LATRIN 6 AQUA PRIVY 7 OWN FLUSH TOILET INSIDE THE HOUSE 8 OWN FLUSH TOILET OUTSIDE THE HOUSE 9 COMMUNAL / SHARED FLUSH TOILET 96 OTHER (SPECIFY) 4.25 : How many households in this community uss the first most common type of t 4.25 : How many households in this community uss the second most common type of 4.25 : How many households in this community uss the third most common type of t 4.26 : How many household in this community have electricity? 4.27 : For how many hours each day do these households normally have electricity 4.28 : What is the first most common way that households in this community dispo 1 BURYING 2 REFUSE COLLECTED 3 PIT 4 DUMPING 5 BURNING 96 OTHER 4.28 : What is the second most common way that households in this community disp 1 BURYING 2 REFUSE COLLECTED 3 PIT 4 DUMPING 5 BURNING 96 OTHER 4.28 : What is the third most common way that households in this community dispo 1 BURYING 2 REFUSE COLLECTED 3 PIT 4 DUMPING 5 BURNING 96 OTHER 4.29 : What is the nearest body of water in this community? 1 STREAM 2 RIVER 3 POND 4 LAKE 5 SWAMP 6 MARSH 7 NONE 4.30 : How far to the community is this body of water? 4.31 : For how many months each year does this body of water contains water? 4.32 : How much has it rain during the last month of previous season as compared 1 VERY MUCH 2 MUCH 3 AVERAGE 4 LITTLE 5 VERY LITTLE 4.33 : How much did it rain during the previous season as compared to a typical 1 MUCH MORE THAN NORMAL 2 MORE THAN NORMAL 3 NORMAL 4 LESS THAN NORMAL 5 MUCH LESS THAN NORMAL 4.34 : How does the temperature this year compared to the temperature in a typic 1 MUCH HIGHER THAN USUAL 2 SOMEWHAT HIGHER THAN USUAL 3 ABOUT THE SAME 4 SOMEWHAT LOWER THAN USUAL 5 MUCH LESS THAN USUAL 1 MUCH MORE THAN USUAL 2 SOMEWHAT MORE THAN USUAL 3 ABOUT THE SAME 4 SOMEWHAT LESS THAN USUAL 5 MUCH LESS THAN USUAL 6 NOT PRONE TO FLOODING 5.01 : Are there any Neighbourhood Health Committee active in this community? 1 YES 2 NO 5.01 : Are there any women's club active in this community? 1 YES 2 NO 5.01 : Are there any credit club active in this community? 1 YES 2 NO 5.01 : Are there any peer educators club active in this community? 1 YES 2 NO 5.01 : Are there any football club active in this community? 1 YES 2 NO 5.01 : Are there any agricultural cooperative active in this community? 1 YES 2 NO 5.01 : Are there any youth club active in this community? 1 YES 2 NO 5.01 : Are there any FAWEZA active in this community? 1 YES 2 NO 5.01 : Are there any goat club active in this community? 1 YES 2 NO 5.01 : Are there any other ... active in this community? 1 YES 2 NO 5.02 : How many member does the Neighbourhood Health Committee have? (RECORD THE 5.02 : How many member does the women's club have? (RECORD THE MOST ACTIVE) 5.02 : How many member does the credit club have? (RECORD THE MOST ACTIVE) 5.02 : How many member does the peer educators club have? (RECORD THE MOST ACTIV 5.02 : How many member does the football club have? (RECORD THE MOST ACTIVE) 5.02 : How many member does the agricultural cooperative have? (RECORD THE MOST 5.02 : How many member does the youth club have? (RECORD THE MOST ACTIVE) 5.02 : How many member does the FAWEZA have? (RECORD THE MOST ACTIVE) 5.02 : How many member does the goat club e have? (RECORD THE MOST ACTIVE) 5.02 : How many member does the other... have? (RECORD THE MOST ACTIVE) 5.03 : In what year was the Neighbourhood Health Committee started? 5.03 : In what year was the credit club started? 5.03 : In what year was the peer educators club started? 5.03 : In what year was the football club started? 5.03 : In what year was the agricultural cooperative started? 5.03 : In what year was the youth club started? 5.03 : In what year was the FAWEZA started? 5.03 : In what year was the goat club started? 5.03 : In what year was the other ... started? 5.04 : In this community, can women purchase land? 1 YES 2 NO 5.04 : In this community, can women inherit land? 1 YES 2 NO 5.04 : In this community, can women sell land? 1 YES 2 NO 5.04 : In this community, can women leave land as a bequest when they die? 1 YES 2 NO 5.05 : Do individuals in this community trace their descent through their father 1 MOTHER 2 FATHER 3 BOTH 96 OTHER (SPECIFY) 5.06 : How is the village headman in this community chosen? 1 ELECTED 2 APPOINTED BY ELDERS 3 APPOINTED BY ADMIN 4 INHERITED 96 OTHER (SPECIFY) 5.07 : Who participates in deciding which community development project is to ta 1 GOVERNMENT 2 CHIEF/HEADMAN 3 COMMUNITY 4 NGO FINANCING PROJECT 96 OTHER 5.07 : Who participates in deciding which community development project is to ta 1 GOVERNMENT 2 CHIEF/HEADMAN 3 COMMUNITY 4 NGO FINANCING PROJECT 96 OTHER 5.07 : Who participates in deciding which community development project is to ta 1 GOVERNMENT 2 CHIEF/HEADMAN 3 COMMUNITY 4 NGO FINANCING PROJECT 96 OTHER 5.08 : Do community heads hold regular meetings with the households? 1 YES 2 NO 5.09 : How often do community leaders hold meetings? 1 TWICE A MONTH 2 ONCE A MONTH 3 ONCE IN TWO MONTHS 4 ONCE IN THREE MONTHS 5 TWICE A YEAR 6 ONCE A YEAR 7 IRREGULAR 8 NEVER Village A Name Village B Name Village C Name Village D Name Village E Name No Of People of Village A No Of People of Village B No Of People of Village C No Of People of Village D No Of People of Village E 6.01 : Is there a place to purchase common medicines such as panadol in this com 1 YES 2 NO 6.02 : Where can one purchase common medicines such as panadol? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.02 : Where can one purchase common medicines such as panadol? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.02 : Where can one purchase common medicines such as panadol? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.03 : What is the distance to thye nearest place where one can puchase common m 6.04 : Is there a place to get antimalerial mecidine (coartem) in this community 1 YES 2 NO 6.05 : Where can one purchase Coartem in this community? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.05 : Where can one purchase Coartem in this community? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.05 : Where can one purchase Coartem in this community? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.06 : What is the distance to thye nearest place where one can puchase common m 6.07 : Is there a place to get antimalerial mecidine (Fancider) in this communit 1 YES 2 NO 6.08 : Where can one purchase Fancider in this community? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.08 : Where can one purchase Fancider in this community? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.08 : Where can one purchase Fancider in this community? (up to three) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 6 DRUG STORE/HEALTH SHOP 7 PHARMACY 8 TRADITIONAL HEALER 9 FAITH/CHURCH HEALER 10 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.09 : What is the distance to thye nearest place where one can puchase common m 6.10 : What is the name of the nearest hospital? 6.10 : What is the name of the nearest clinic? 6.10 : What is the name of the nearest health post? 6.11 : Record facility code of nearest hospital? 6.11 : Record facility code of nearest clinic? 6.11 : Record facility code of nearest health post? 6.12 : What is distance to the nearest hospital? 6.12 : What is distance to the nearest clinic? 6.12 : What is distance to the nearest health post? 6.13 : How often is Coartem available at the hospital? 1 ALWAYS 2 SOMETIMES 3 NEVER 4 DONT KNOW 6.13 : How often is Coartem available at the clinic? 1 ALWAYS 2 SOMETIMES 3 NEVER 4 DONT KNOW 6.13 : How often is Coartem available at the health post? 1 ALWAYS 2 SOMETIMES 3 NEVER 4 DONT KNOW 6.14 : How often are rapid diagnostic test (RDTs) for malerial available at the 1 ALWAYS 2 SOMETIMES 3 NEVER 4 DONT KNOW 6.14 : How often are rapid diagnostic test (RDTs) for malerial available at the 1 ALWAYS 2 SOMETIMES 3 NEVER 4 DONT KNOW 6.14 : How often are rapid diagnostic test (RDTs) for malerial available at the 1 ALWAYS 2 SOMETIMES 3 NEVER 4 DONT KNOW 6.17 : Are there any group or programs in this community providing insecticide t 1 YES 2 NO 6.18 : What organisation provide insecticide-treated mosquito nets for free or a 1 NEIGHBORHOOD HEALTH COMMITTES 2 NON-GOVERNMENTAL ORGANIZATIONS 3 GOVERNMENT/PUBLIC ORGANISATIONS 4 PRIVATE ORGANISATIONS 96 OTHER (SPECIFY) 6.19 : What is the name of the last three programs that provides insecticides tr 6.19 : What is the name of the last three programs that provides insecticides tr 6.19 : What is the name of the last three programs that provides insecticides tr 6.20 : What is the price of these treated mosquito nets (single bed size) in the 7.01 : What are the first most important sources livelihood for individuals in t 1 WAGE EMPLOYMENT 2 RUNNING A BUSINESS/SELF-EMPLOYED 3 FARMING 4 FISHING 5 CHARCOAL/FIREWOOD 6 BEE KEEPING 7 PIECE WORK 96 OTHER (SPECIFY) 7.01 : What are the second most important sources livelihood for individuals in 1 WAGE EMPLOYMENT 2 RUNNING A BUSINESS/SELF-EMPLOYED 3 FARMING 4 FISHING 5 CHARCOAL/FIREWOOD 6 BEE KEEPING 7 PIECE WORK 96 OTHER (SPECIFY) 7.01 : What are the third most important sources livelihood for individuals in t 1 WAGE EMPLOYMENT 2 RUNNING A BUSINESS/SELF-EMPLOYED 3 FARMING 4 FISHING 5 CHARCOAL/FIREWOOD 6 BEE KEEPING 7 PIECE WORK 96 OTHER (SPECIFY) 7.02 : Do people in this community leave tenporarily during certain times of the 1 YES 2 NO 7.03 : In tha past 12 months, from how many households in this community have me 7.04 : Where do most of them go? 1 RURAL AREAS 2 URBAN AREAS 3 OUTSIDE NIGERIA 7.05 : Do people outside this community come to work temporarily in this communt 1 YES 2 NO 7.06 : in thye past 12 months, how many people came into this community to work 7.07 : Where do most of them come from? 1 RURAL AREAS 2 URBAN AREAS 3 OUTSIDE NIGERIA 7.08 : Do any household grow crops or keep livestock in this community? 1 YES 2 NO 7.09 : How many household grow crops or keep livestock in this community? 7.10 : How many households keep goats in this community? 7.11 : How many households keep sheep in this community? 7.12 : How many households keep cattle in this community? 8.01 : Has drought taken place in this community in the past 10 years? 1 YES 2 NO 8.01 : Has flood taken place in this community in the past 10 years? 1 YES 2 NO 8.01 : Has crop disease/pests taken place in this community in the past 10 years 1 YES 2 NO 8.01 : Has livestock disease taken place in this community in the past 10 years? 1 YES 2 NO 8.01 : Has human epidemic disease taken place in this community in the past 10 y 1 YES 2 NO 8.01 : Has sharp changes in prices taken place in this community in the past 10 1 YES 2 NO 8.01 : Has massive job layoffs taken place in this community in the past 10 year 1 YES 2 NO 8.01 : Has loss of key social services taken place in this community in the past 1 YES 2 NO 8.01 : Has new health facility/major improvement to old facility taken place in 1 YES 2 NO 8.01 : Has new school/major improvement to old school taken place in this commun 1 YES 2 NO 8.01 : Has new road.major improvement to old road taken place in this community 1 YES 2 NO 8.01 : Has new employment opportunity taken place in this community in the past 1 YES 2 NO 8.01 : Has other ... taken place in this community in the past 10 years? 1 YES 2 NO 8.02 : How many times in the past 10 years has drought taken place? 8.02 : How many times in the past 10 years has flood taken place? 8.02 : How many times in the past 10 years has crop disease/pests taken place? 8.02 : How many times in the past 10 years has livestock disease taken place? 8.02 : How many times in the past 10 years has human epidemic disease taken plac 8.02 : How many times in the past 10 years has sharp changes in prices taken pla 8.02 : How many times in the past 10 years has massive job layoffs taken place? 8.02 : How many times in the past 10 years has loss of key social services taken 8.02 : How many times in the past 10 years has new health facility/major improve 8.02 : How many times in the past 10 years has new school/major improvement to o 8.02 : How many times in the past 10 years has new road/major improvement to old 8.02 : How many times in the past 10 years has new employment opportunity taken 8.02 : How many times in the past 10 years has other... taken place? 8.03 : In which year did drought last occur? 8.03 : In which year did flood last occur? 8.03 : In which year did crop disease/pests last occur? 8.03 : In which year did livestock disease last occur? 8.03 : In which year did human epidemic disease last occur? 8.03 : In which year did sharp changes in prices last occur? 8.03 : In which year did massive job layoffs last occur? 8.03 : In which year did loss of key social services last occur? 8.03 : In which year did new health facility/major improvement to old facility l 8.03 : In which year did new school/major improvement to old school last occur? 8.03 : In which year did new road/major improvement to old road last occur? 8.03 : In which year did new employment opportunity last occur? 8.03 : In which year did other ... last occur? 8.04 : How many households in the community were affected by drought? 8.04 : How many households in the community were affected by flood? 8.04 : How many households in the community were affected by crop disease/pests? 8.04 : How many households in the community were affected by livestock disease? 8.04 : How many households in the community were affected by human epidemic dise 8.04 : How many households in the community were affected by sharp changes in pr 8.04 : How many households in the community were affected by massive job layoffs 8.04 : How many households in the community were affected by loss of key social 8.04 : How many households in the community were affected by new health facility 8.04 : How many households in the community were affected by new school/major im 8.04 : How many households in the community were affected by new road/major impr 8.04 : How many households in the community were affected by new employment oppo 8.04 : How many households in the community were affected by other ...? 9.01 : What is the price of 1 Mudu of Maize Grain 9.01 : What is the price of 1 loaf of bread 9.01 : What is the price of 1 mudu of garri 9.01 : What is the price of 1 chicken (kaaza) 9.01 : What is the price of 1 small basket of dry fish (kifi) 9.01 : What is the price of 1 nudu of rice 9.01 : What is the price of 1 mudu of pepper (borkono) 9.01 : What is the price of 1 mudu of sugar 9.01 : What is the price of 750 ml cooking oil (1 bottle) 9.01 : What is the price of 1 mudu of salt 9.01 : What is the price of 1 bottle of milk (kwalba nono) 9.01 : What is the price of 1 litre of petrol 9.02 : Government hospital/clinic: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : Government hospital/clinic: LAB TESTING 9.02 : Government hospital/clinic: HOSPITALIZATION (1 NIGHT) 9.02 : Government hospital/clinic: PARACETAMOL (ADULT DOSE) 9.02 : Government hospital/clinic: COARTEM (ADULT DOSE) 9.02 : Government hospital/clinic: FANSIDAR(ADULT DOSE) 9.02 : Government hospital/clinic: RAPID DIAGNOSTIC TEST (RDT) 9.02 : Health post: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : Health post: LAB TESTING 9.02 : Health post: HOSPITALIZATION (1 NIGHT) 9.02 : Health post: PARACETAMOL (ADULT DOSE) 9.02 : Health post: COARTEM (ADULT DOSE) 9.02 : Health post: FANSIDAR(ADULT DOSE) 9.02 : Health post: RAPID DIAGNOSTIC TEST (RDT) 9.02 : private hospital/clinic: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : private hospital/clinic: LAB TESTING 9.02 : private hospital/clinic: HOSPITALIZATION (1 NIGHT) 9.02 : private hospital/clinic: PARACETAMOL (ADULT DOSE) 9.02 : private hospital/clinic: COARTEM (ADULT DOSE) 9.02 : private hospital/clinic: FANSIDAR(ADULT DOSE) 9.02 : private hospital/clinic: RAPID DIAGNOSTIC TEST (RDT) 9.02 : drug shop/pharmacy: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : drug shop/pharmacy: LAB TESTING 9.02 : drug shop/pharmacy: HOSPITALIZATION (1 NIGHT) 9.02 : drug shop/pharmacy: PARACETAMOL (ADULT DOSE) 9.02 : drug shop/pharmacy: COARTEM (ADULT DOSE) 9.02 : drug shop/pharmacy: FANSIDAR(ADULT DOSE) 9.02 : drug shop/pharmacy: RAPID DIAGNOSTIC TEST (RDT) 9.02 : traditional healer: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : traditional healer: LAB TESTING 9.02 : traditional healer: HOSPITALIZATION (1 NIGHT) 9.02 : traditional healer: PARACETAMOL (ADULT DOSE) 9.02 : traditional healer: COARTEM (ADULT DOSE) 9.02 : traditional healer: FANSIDAR(ADULT DOSE) 9.02 : traditional healer: RAPID DIAGNOSTIC TEST (RDT) 9.02 : faith church healer: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : faith church healer: LAB TESTING 9.02 : faith church healer: HOSPITALIZATION (1 NIGHT) 9.02 : faith church healer: PARACETAMOL (ADULT DOSE) 9.02 : faith church healer: COARTEM (ADULT DOSE) 9.02 : faith church healer: FANSIDAR(ADULT DOSE) 9.02 : faith church healer: RAPID DIAGNOSTIC TEST (RDT) 9.02 : other: REGISTRATION FEE FOR HEALTH CONSULTATION 9.02 : other: LAB TESTING 9.02 : other: HOSPITALIZATION (1 NIGHT) 9.02 : other: PARACETAMOL (ADULT DOSE) 9.02 : other: COARTEM (ADULT DOSE) 9.02 : other: FANSIDAR(ADULT DOSE) 9.02 : other: RAPID DIAGNOSTIC TEST (RDT) Is there a doctor working at this hospital 1 YES 2 NO 3 DONT KNOW Is there a nurce working at this hospital 1 YES 2 NO 3 DONT KNOW Is there a midwife working at this hospital 1 YES 2 NO 3 DONT KNOW Is there a medical officer working at this hospital 1 YES 2 NO 3 DONT KNOW Is there a medical assistant working at this hospital 1 YES 2 NO 3 DONT KNOW Is there an envionmental/lab technician working at this hospital 1 YES 2 NO 3 DONT KNOW Is there a doctor working at this clinic 1 YES 2 NO 3 DONT KNOW Is there a nurce working at this clinic 1 YES 2 NO 3 DONT KNOW Is there a midwife working at this clinic 1 YES 2 NO 3 DONT KNOW Is there a medical officer working at this clinic 1 YES 2 NO 3 DONT KNOW Is there a medical assistant working at this clinic 1 YES 2 NO 3 DONT KNOW Is there an envionmental/lab technician working at this clinic 1 YES 2 NO 3 DONT KNOW Is there a doctor working at this health post 1 YES 2 NO 3 DONT KNOW Is there a nurce working at this health post 1 YES 2 NO 3 DONT KNOW Is there a midwife working at this health post 1 YES 2 NO 3 DONT KNOW Is there a medical officer working at this health post 1 YES 2 NO 3 DONT KNOW Is there a medical assistant working at this health post 1 YES 2 NO 3 DONT KNOW Is there an envionmental/lab technician working at this health post 1 YES 2 NO 3 DONT KNOW 6.16 : Is the hospistal a government facility, church facility, or private facil 1 GOVERNMENT 2 PRIVATE 3 CHURCH 4 OTHER (SPECIFY) 6.16 : Is the clinic a government facility, church facility, or private facility 1 GOVERNMENT 2 PRIVATE 3 CHURCH 4 OTHER (SPECIFY) 6.16 : Is the health post a government facility, church facility, or private fac 1 GOVERNMENT 2 PRIVATE 3 CHURCH 4 OTHER (SPECIFY) STATE NAME STATE CODE SENATORIAL DISTRICT LGA NAME LGA CODE WARD NAME TREATMENT PRIMARY HEALTH FACILITY NAME PRIMARY HEALTH FACILITY ID PRIMARY HEALTH FACILITY TYPE COMMUNITY NAME Health Facility Worker ID STATE CODE LGA CODE 1 AKKO 2 BALANGA 3 BILLIRI 4 DUKKU 5 FUNAKAYE 6 GOMBE 7 KALTUNGO 8 KWAMI 9 NAFADA 10 SHONGOM 11 YAMALTU/DEBA WARD CODE 101 AKKO 102 GARKO 103 KALSHINGI 104 KASHERE 105 KUMO CENTRAL 106 KUMO EAST 107 KUMO NORTH 108 KUMO WEST 109 PINDIGA 110 TUMU 111 TUKULMA 201 BAMBAM 203 DADIYA 204 GELENGU/BALANGA 205 KINDIYO 206 KULANI/DEGRI/SIKKAM 207 MWONA 208 NYUWAR/JESSU 209 SWA/REF/GASI/W.WAJA 210 TALASEE/DONG/REME 301 BANGANJE NORTH 303 BARE 304 305 306 KALMAI 307 TAL 308 TANGLANG 309 TODI 310 401 GOMBE ABBA 402 HASHIDU 403 JAMARI 404 KUNDE 406 MALALA 407 WAZIRI NORTH 408 409 WURO TALE 410 ZANGE 411 ZAUNE 501 ASHAKA/MAGABA 502 BAGE 503 BAJOGA 504 BAJOGA 505 BODOR/TILDE 506 JILLAHI 507 kupto 508 RIBADU 509 TONGO 510 WAWA/WAKKALTU 603 604 605 DAWAKI 606 HERWA GANA 608 KUMBIYA KUMBIYA 609 NASARAWA 610 PANTAMI 611 SHAMAKI 701 AWAK 702 BULE/KALTIN 703 KALTUNGO WEST 704 KALTUNGO EAST 705 KAMO 707 TULA WANGE 708 TULA YIRI 709 TUNGO 710 TURE 801 BOJUDE 802 DABA FULANI 803 DOHO 804 DUKUL 805 GADAM 806 JURARA 807 KOMFULATA 808 KWAMI 809 MALAM-SIDI 810 MALLERI 901 BARWO NASARAWA 902 BARWO WINDE 903 BIRIN BOLEWA 904 BIRIN FULANI EAST 905 BIRIN FULANI WEST 906 GUDUKKU 907 JIGAWA 908 NAFADA CENTRAL 909 NAFADA EAST 910 NAFADA WEST 1001 BANGUNJI 1002 BOH 1003 BURAK 1004 FILIYA 1006 GWANDUM 1007 KULISHIM 1008 KUSHI 1009 LALIPIDO 1010 LAPAN 1101 DEBA 1102 DIFA/LUBO/KINAFA 1103 GWANI/SHINGA/WADE 1104 HINNA 1105 JAGALI NORTH 1106 JAGALI SOUTH 1107 KANAWA/WAJARI 1108 KURI/LANO/LAMBAM 1109 KWADON/LIJI/KURBA 1110 NONO/KUNUWA/W.BIRDEKA 1111 ZAMBUK/KWALI Health Facility Code SEA Code Town Type 1 RURAL 2 PERI-URBAN 3 URBAN Name Of Village/Community Interviewer Name Date of the 1ST Interviewer Second Interviwer's Name Date of the 2ND Interviewer Language spoken by respondent during interview 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Respondent Local Language Mother Tongue 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Translated Used Supervisor Name Date of the Supervisor Data Entry Operator Data Entry Operator (Date) Data Entry Supervisor Data Entry Supervisor (Date) Consent 1 YES 2 NO 1.01 : What is your current age, in years? 1.02 : What is your marital status? 1 MARRIED 2 SINGLE 3 DIVORCED 4 WIDOWED 96 OTHER (SPECIFY) 1.03 : What is the highest grade you have completed in school? 21 JS1 22 JS2 23 JS3 24 SS1 25 SS2 26 SS3 32 VOCATIONAL 33 TECHNICAL 42 UNIVERSITY UNDERGRADUATE 43 UNIVERSITY GRADUATE 96 OTHER (SPECIFY) 1.04 : For how many years have you been resident in this community? 1.05 : For how many years have you worked as a health worker, after formal compl 1.06 : What type of primary health facility are you employed at? 1 HEALTH POST 2 PRIMARY HEALTH CLINIC 3 PRIMARY HEALTH CARE CENTER 96 OTHER (SPECIFY) 1.07 : For how many years have you worked as a health worker at this facility? 1.08 : What is your official position at this health facility? 1 DOCTOR 2 CLINICAL OFFICER 3 NURSE 4 MIDWIFE 5 PHARMACIST 6 LAB TECHNICIAN 7 SENIOR CHEW 8 JUNIOR CHEW 96 OTHER (SPECIFY) 1.09 : What type of employment contract do you have? 1 PERMARNENT WITH PENSION 2 PERMANENT WITHOUT PENSION 3 SHORT TERM 4 PART TIME 96 OTHER (SPECIFY) 1.10 : Are you, or have you been, involved with volunteer and / or community wor 1 YES, VOLUNTEER 2 YES,COMMUNITY 3 YES,VOLUNTEER AND COMMUNITY 4 NO 1.11 : What kind of community and / or volunteer work are / were you involved in 1 CAMPAIGN FOR SPECIAL EVENTS(E.G NATIONAL IMMUNIZATION DAYS,SAFE MOTHERHOOD DAY,LLIN DISTRIBUTION, WORLD MALERIA DAY, E.T.C) 2 COMMUNITY DEVELOPMENT WORK(e.g BUILDING BORE HOLES, E.T.C) 3 PROVIDING COMMUNITY/NEIGHBOURHOOD SECURITY 4 COMMUNITY HEALTH PROMOTION(e.g FAMILY PLANNING, IMMUNIZATION,HIV E.T.C) 96 OTHER (SPECIFY) 2.01 : Have you received any training for your current work (in addition to your 1 YES 2 NO 2.02 : Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 SOCIETY FOR FAMILY HEALTH(SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANISATION 96 OTHER (SPECIFY) 1 YES 2 NO 2.04 : Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 SOCIETY FOR FAMILY HEALTH(SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 2.05 : Have you received any training specifically for management of malaria wit 1 YES 2 NO 2.06 : Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 SOCIETY FOR FAMILY HEALTH(SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 2.08 : Are there other training needs you personally feel you need for your pres 1 YES 2 NO 2.11 : Do you have any job aids hanging in your health facility which describe t 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 3.04 : How many days did you work at this facility last week? 3.05 : How many hours in total did you work at this facility last week? 3.06 : Did you work yesterday? 1 YES 2 NO 3.07 : How many hours did you work yesterday? 3.08 : How many hours did you work on the last day you were at work (not includi 3.09 : How have your actual total hours worked per week changed since 1 year ago 1 INCREASED 2 DECREASED 3 SAME 3.10 : In the last month, what were the first most common reasons for you being 1 TRAVELLING TO WORKS TOO LONG 2 SICK 3 SICK RELATIVES / FAMILY 4 HAVE ANOTHER JOB (PAID) 5 HAVE ANOTHER JOB (UNPAID) 6 MUST CARE FOR CHILDREN 7 HOUSEHOOD CHORES 8 TIRED FROM PREVIOUS DAY 9 AUTHOURIZED LATE ARRIVAL (TRAINING) 10 AUTHORIZED LATE ARRIVAL (PICK UP SALARY /DRUGS / EQUIPMENT) 11 NEVER LATE 96 OTHER (SPECIFY) 3.10 : In the last month, what were the second most common reasons for you being 1 TRAVELLING TO WORKS TOO LONG 2 SICK 3 SICK RELATIVES / FAMILY 4 HAVE ANOTHER JOB (PAID) 5 HAVE ANOTHER JOB (UNPAID) 6 MUST CARE FOR CHILDREN 7 HOUSEHOOD CHORES 8 TIRED FROM PREVIOUS DAY 9 AUTHOURIZED LATE ARRIVAL (TRAINING) 10 AUTHORIZED LATE ARRIVAL (PICK UP SALARY /DRUGS / EQUIPMENT) 11 NEVER LATE 96 OTHER (SPECIFY) 3.10 : In the last month, what were the third most common reasons for you being 1 TRAVELLING TO WORKS TOO LONG 2 SICK 3 SICK RELATIVES / FAMILY 4 HAVE ANOTHER JOB (PAID) 5 HAVE ANOTHER JOB (UNPAID) 6 MUST CARE FOR CHILDREN 7 HOUSEHOOD CHORES 8 TIRED FROM PREVIOUS DAY 9 AUTHOURIZED LATE ARRIVAL (TRAINING) 10 AUTHORIZED LATE ARRIVAL (PICK UP SALARY /DRUGS / EQUIPMENT) 11 NEVER LATE 96 OTHER (SPECIFY) 3.11 : The last time you were late for work, what was the reason why? 1 TRAVELLING TO WORK TAKES TOO LONG 2 SICK 3 SICK RELATIVES/FAMILY 4 HAVE ANOTHER JOB (PAID) 5 HAVE ANOTHER JOB (UNPAID) 6 MUST CARE FOR CHILDREN 7 HOUSEHOLD CHORES 8 TIRED FROM PREVIOUS DAY 9 AUTHORIZED LATE ARRIVAL (TRAINING) 10 AUTHORIZED LATE ARRIVAL (PICK UP SALARY/DRUGS/ EQUIPMENT) 96 OTHER(SPECIFY) 3.12 : In the last month (30 days), how many days were you absent from work? 3.13 : The last time you were absent from work, what was the reason why? 1 TRAVELLING TO WORK TAKES TOO LONG 2 SICK 3 SICK RELATIVES/FAMILY 4 HAVE ANOTHER JOB (PAID) 5 HAVE ANOTHER JOB (UNPAID) 6 MUST CARE FOR CHILDREN 7 HOUSEHOLD CHORES 8 TIRED FROM PREVIOUS DAY 9 AUTHOURIZED LATE ARRIVAL (TRAINING) 10 AUTHORIZED LATE ARRIVAL (PICK SALARY/DRUGS/EQUIPMENT) 96 OTHER (SPECIFY) 3.15 : What is the distance from your house to the health facility at which you 3.16 : What mode of transport do you use most often to travel to the health faci 1 WALKING 2 MOTOR CYCLE 3 BICYCLE 4 MOTOR VEHICLE (TRUCK OR CAR) 5 BOAT 96 OTHER (SPECIFY) 3.17A How much time does it usually take for you to travel to the health facilit 3.17B How much time does it usually take for you to travel to the health facilit 4.01 : How long ago did you last receive your salary? 1 < 7 DAYS AGO 2 1-2 WEEKS AGO 3 2-4 WEEKS AGO 4 1-2 MONTHS AGO 5 >2 MONTHS AGO 4.02 : What is your current monthly net salary? 4.03 : What was your monthly net salary one year ago? 4.04 : What major factor determines the size of your salary change? 1 ROUTINE INCREMENT 2 INDIVIDUAL PERFORMANCE 3 PROMOTION 4 NO CHANGE 89 DONT KNOW 96 OTHER (SPECIFY) 4.05 : For the last 12 months, did you receive all your due salaries for all mon 1 YES 2 NO 4.06 : How many months were you not paid your due salary? 4.08 : For the last 12 months, did you ever receive less money than your net sal 1 YES 2 NO 4.09 : What percentage, or how much, of your salary was removed or 'missing'? amount 4.10 : Did you ever recover this part of your salary? 1 YES 2 NO 4.12 : Do you currently receive a housing allowance? 1 YES 2 NO 4.13 : What is the payment period? 1 DAY 2 WEEK 3 MONTH 4 YEAR 4.14 : On average, how much do you receive per period? 4.15 : Do you receive a hardship allowance for living in rural areas? 1 YES 2 NO 4.16 : What is the payment period? 1 DAY 2 WEEK 3 MONTH 4 YEAR 4.17 : On average, how much do you receive per period? 4.18 : Do you receive a travel allowance? 1 YES 2 NO 4.19 : What is the payment period? 1 DAY 2 WEEK 3 MONTH 4 YEAR 4.20 : On average, how much do you receive per period? 4.21 : Do you currently receive bonuses that are based on the volume of services 1 YES 2 NO 4.22 : What is the payment period? 1 DAY 2 WEEK 3 MONTH 4 YEAR 4.23 : On average, how much do you receive per period? 4.24 : Do you receive any other allowances? 1 YES (SPECIFY) 2 NO 4.25 : What is the payment period? 1 DAY 2 WEEK 3 MONTH 4 YEAR 4.26 : On average, how much do you receive per period? 4.27 : Other than your work at the health facility, have you done any other job 1 YES 2 NO 4.28 : Other than your health facility job, what kind of work did you mainly do? 1 PROFESSIONAL 2 TECHNICAL 3 SMALL BUSINESS OWNER 4 FARMER 5 LIVESTOCKS KEEPER 6 FISHERMAN 7 LABORER 86 OTHER (SPECIFY) 4.29 : What sector is this job connected with? 1 AGRICULTURE 2 FISHING 3 FORESTRY, HUNTING LIVESTOCK 4 MINING AND QUARRYING 5 MANUFACTURING 6 ELECTRICITY/GAS/WATER 7 CONSTRUCTION 8 TOURISM / HOTEL 9 TRADE AND COMMERCE 10 TRANSPORT AND COMMUNICATION 11 FINANCE AND INSURANCE 12 PUBLIC ADMINISTRATION 13 EDUCATION 14 HEALTH 96 OTHER (SPECIFY) 4.30 : What is the main reasons for pursuing this other job? 1 CANNNOT MAKE ENDS MEET ON PRIMARY INCOME 2 HOURLY PAY IS VERY GOOD 3 GAIN EXPERIENCE NOT AVAILABLE IN HEALTH FACILITY WORK 4 BETTER WORKING ENVIROMENT 5 SEEING PATIENTS I COULD NOT SEE DURING WORKING HOURS 96 OTHER (SPECIFY) 4.31 : Who paid your wages? 1 SELF EMPLOYED 2 EMPLOYER 3 FAMILY (PAID) 4 FAMILY (UNPAID) 96 OTHER (SPECIFY) 4.32 : How many hours per week did you normally work on this other job? 4.33 : During the past 12 months, how many months did you work at this other job 4.34 : What was your total income from this other job during the past 12 months, 4.36 : Does your household own any land? 1 YES 2 NO 4.37 : What is the size of the land?Unit Code 1 SQUARE METER 2 HECTARE 3 OTHER (SPECIFY) Amount 1 SQUARE METER 2 HECTARE 3 OTHER (SPECIFY) 4.38 : If you were to sell all of the land you own, how much do you think you wo 4.39 : unit How much land did you cultivate during the past agricultural season? 1 SQUARE METER 2 HECTARE 96 OTHER (SPECIFY) amount 5.01 : Do you have a supervisor, or anyone responsible for providing feedback on 1 YES 2 NO 5.02 : Who is responsible for supervising your work (e.g. providing feedback on 1 HEALTH FACILITY MANAGER 2 OTHER HEALTH FACILITY WORKER 3 LGA OFFICER 4 OTHER (SPECIFY) 5.03 : How many times per year do you meet with your supervisor to discuss your 1 WEEKLY 2 MONTHLY 3 EVERY TWO MONTHS 4 EVERY THREE MONTHS 96 OTHERS(SPECIFY) 5.05 : When is the last time you met with your supervisor to discuss your perfor 1 WITHIN PAST 30 DAYS 2 WITHIN PAST 30-91 DAYS 3 WITHIN PAST 3- 6 MONTHS 4 MORE THAN 6 MONTHS 5.07 : Have you discussed job difficulties with your supervisor within the last 1 YES 2 NO 5.08 : What is the main reasons you have not discussd your job difficulties with 1 SUPERVISOR NOT AVAILABLE 2 SUPERVISOR CANNOT HELP ME 3 IT IS NOT APPROPRIATE / I DON'T FEEL COMFORTABLE DISCUSSING IT WITH SUPERVISOR 4 TRIED TO DISCUSS BEFORE, AND NO CHANGE RESULTED 96 OTHER (SPECIFY) 5.09 : After these discussions, did you notice any improvements? 1 YES 2 NO 5.10 : How satisfied were you with the last supervisory meeting? 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5.11 : Do these supervisory meetings motivate you? 1 YES 2 NO 5.12 : Why are the results not useful? 1 NO FEEDBACK FROM MANAGEMENT 2 NO CHANGES ARE MADE 3 NO APRECIATION OF GOOD WORK 4 OTHER (SPECIFY) 5.14 : Do you keep regular records of your work in this health facility? 1 YES 2 NO 5.15 : Can I see your records? 1 YES 2 NO 5.18 : Do you submit your records to anyone? 1 YES 2 NO 5.20 : Do you have any documentation of the records you have submitted? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.21 : Do you receive any feedback on your records? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.01 : In the last 3 months, did you receive any other support from the general 1 YES 2 NO 7.01 : Why have you chosen to do health work? 1 DESIRE TO SERVE COMMUNITY 2 STATUS 3 MONETARY COMPENSATION 4 HAD FORCED TO ACCEPT 96 OTHER (SPECIFY) 7.07 : Do you know of any health workers that have stopped working at this facil 1 YES 2 NO 7.08 : What is the reason they no longer work at this facility? 1 MOVED OUT OF VILLAGE 2 DIED 3 FOUND ANOTHER JOB 4 DISSATISFIED DUE TO LACK OF SALARY OR PAY 5 DID NOT FEEL SUPPORTED BY COMMUNITY 6 CONFLICT WITH FACILITY MANAGEMENT 7 DID NOT FEEL SUPPORTED BY HEALTH FACILITY/SUPERVISOR 8 SECURITY 96 OTHER (SPECIFY) 7.09 : In the past 3 months, has there been any incidence that made you feel thr 1 YES 2 NO 7.10 : What was the primary reason you felt threatened or afraid to continue pro 1 DANGER FROM ARMED GROUPS / MILITANTS 2 DANGER FROM CRIMINAL ACTIVITIES LIKE ROBBERY 3 RESISTANCE TO WORK FROM COMMUNITY 4 RESISTANCE TO WORK FROM COMMUNITY LEADERS 5 RESISTANCE TO WORK FROM FACILITY MANAGEMENT 6 CONFLIT WITH OTHER HEALTH WORKERS 96 OTHER (SPECIFY) 8.01 : What is the main cause of malaria? 1 MOSQUITOES 2 DIRTY FOODS 3 DIRTY LIQUIDS 4 CLIMATE / WEATHER 5 WITCHCRAFT 96 OTHER (SPECIFY) 8.08 : In the last two weeks, have you seen any patients with fever? 1 YES 2 NO 8.09 : How many patients have you seen in the last two weeks? 8.10 : When did you see your last patient with fever? 1 IN THE LAST 24 HOURS 2 IN THE LAST 7 DAYS (WEEK) 3 IN THE LAST 7 DAYS (WEEK) 96 OTHER 8.11 : Was this patient male or female? 1 MALE 2 FEMALE 8.12 : How old was this patient? 1 12 MONTHS OR LESS 2 BETWEEN 1 AND 5 YEARS 3 OLDER THAN FIVE YEARS 4 DON'T KNOW / DON'T REMEMBER 8.14 : How did you diagnose the patient? 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST 3 MICROSCOPY 96 OTHER (SPECIFY) 8.15 : What was your initial diagnosis? 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 96 OTHER (SPECIFY) 8.16 : What action did you take? 1 TEPID SPONGE CHILD AND PROVIDE TREATMENT WITH ARTEMISININ COMBINATION THERAPY 2 PROVIDE TREATMENT WITH ACT 3 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 4 PROVIDE TREATMENT WITH OTHER MEDICINE 5 REFER TO HOSPITAL 6 NO ACTION 96 OTHER (SPECIFY) 8.17 : Did you record details about this patient? 1 YES 2 NO 8.18 : Can I see this entry? 1 YES 2 NO 8.19 : CHECK THE RESPONSES 1 YES 2 NO (SPECIFY) 8.20 : What was the outcome for the patient? 1 FULL RECOVERY 2 PARTIAL RECOVERY 3 STILL SICK 4 DEATH 5 ADVERSE REACTION TO MEDICINE 96 OTHER (SPECIFY) 8.21 : Do you use microscopy for diagnosis? 1 YES 2 NO 8.22 : Do you use RDTs for diagnosis? 1 YES 2 NO 8.23 : Are there any community outlets or mini-labs that support malaria diagnos 1 YES 2 NO 8.24 : Do you ever refer patients to such community outlets or mini-labs for dia 1 YES 2 NO 8.25 : Do you keep records on patient diagnoses? 1 YES 2 NO 8.26 : Can I see your records? 1 YES 2 NO 8.29 : How would you diagnose the patient? 1 CLINICAL DIAGNOSIS 2 WITH RAPID DIAGNOSTIC TEST 3 MICROSCOPY 96 OTHER (SPECIFY) 8.30 : What would be your initial diagnosis 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 5 OTHER (SPECIFY) 8.31 : What action would you take? 1 CONDUCT DIAGNOSIS 2 TEPID SPONGE CHILD AND PROVIDE TREATMENT WITH ARTEMISININ COMBINATION THERAPY 3 PROVIDE TREATMENT WITH ACT 4 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 5 PROVIDE TREATMENT WITH OTHER MEDICINE 6 REFER TO HOSPITAL 7 NO ACTION 96 OTHER (SPECIFY) 8.32 : How would you advise the mother / parents to act in the future if they no 1 TAKE SIMILAR ACTION 2 GO TO HEALTH FACILITY / HOSPITAL IMMEDIATELY IF DAUGHTER'S CONDITION DETERIORATES 3 PROVIDE TREATMENT WITH ACT 4 PROVIDE TREATMENT WITH OTHER ANTI-MALARIA 5 PROVIDE TREATMENT WITH OTHER MEDICINE 6 REFER TO HOSPITAL 7 NO ACTION 96 OTHER (SPECIFY) 8.33 : What action would you take first? 1 ADMINISTER IPT 2 DIAGNOSE WITH RDT 3 DIAGNOSE WITH MICROSCOPY 4 TREAT WITH ACT 5 TREAT WITH OTHER MEDICINE 6 TREAT WITH OTHER ANTI-MALARIAL 7 REFER TO HOSPITAL 96 OTHER (SPECIFY) 8.34 : What additional actions would you take to ensure the woman is effectively 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST 3 MICROSCOPY 96 OTHER (SPECIFY) 8.35 : How would you diagnose the patient? 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST 3 MICROSCOPY 96 OTHER (SPECIFY) 8.36 : What would you do? 1 GIVE ANOTHER DOSE OF ACT 2 REFER TO HOSPITAL 3 ASK HIM TO WAIT, THE MEDICINE WILL WORK 96 OTHER (SPECIFY) 8.37 : What advice would you offer to the man, in case a similar situation arise 1 GO IMMEDIATELY TO HEALTH FACILITY OR HOSPITAL IF NOT FEELING BETTER ONE DAY AFTER 2 NO ADVICE 10.01 : In the past year, have you had any other job, in addition to your health 1 YES 2 NO 10.03 : At any time in the past, have you had any other job (other than this hea 1 YES 2 NO 2.07: Was topic of childhood disease covered in these trainings? 1 YES 2 NO 2.07: Was topic of family planning covered in these trainings? 1 YES 2 NO 2.07: Was topic of antenatal and postnatal care covered in these trainings? 1 YES 2 NO 2.07: Was topic of referral to facility for delivery or danger signs covered in 1 YES 2 NO 2.07: Was topic of newborn care covered in these trainings? 1 YES 2 NO 2.07: Was topic of tuberculosis covered in these trainings? 1 YES 2 NO 2.07: Was topic of vaccinations covered in these trainings? 1 YES 2 NO 2.07: Was topic of record keeping/inventory management covered in these training 1 YES 2 NO 2.07: Was topic of malaria covered in these trainings? 1 YES 2 NO 2.07: Was topic of nutrition covered in these trainings? 1 YES 2 NO 2.07: Was topic of sanitation and home hygiene covered in these trainings? 1 YES 2 NO 2.07: Was topic of mental health covered in these trainings? 1 YES 2 NO 2.07: Was topic of disabilities covered in these trainings? 1 YES 2 NO 2.07: Was topic of management training covered in these trainings? 1 YES 2 NO 2.07: Was topic of other (specify) covered in these trainings? 1 YES 2 NO 2.09 : What additional training do you feel you need? childhood disease 1 YES 2 NO 2.09 : What additional training do you feel you need? family planning 1 YES 2 NO 2.09 : What additional training do you feel you need? antenatal and postnatal ca 1 YES 2 NO 2.09 : What additional training do you feel you need? referral to facility 1 YES 2 NO 2.09 : What additional training do you feel you need? newborn care 1 YES 2 NO 2.09 : What additional training do you feel you need? tuberculosis 1 YES 2 NO 2.09 : What additional training do you feel you need? vaccinations 1 YES 2 NO 2.09 : What additional training do you feel you need? record keeping 1 YES 2 NO 2.09 : What additional training do you feel you need? malaria 1 YES 2 NO 2.09 : What additional training do you feel you need? nutrition 1 YES 2 NO 2.09 : What additional training do you feel you need? sanitation 1 YES 2 NO 2.09 : What additional training do you feel you need? mental health 1 YES 2 NO 2.09 : What additional training do you feel you need? disabilities 1 YES 2 NO 2.09 : What additional training do you feel you need? management training 1 YES 2 NO 2.09 : What additional training do you feel you need? other (specify) 1 YES 2 NO 2.10: Have you provided service of treating sick children within the past 3 mont 1 YES 2 NO 2.10: Have you provided service of referring very sick children within the past 1 YES 2 NO 2.10: Have you provided service of supporting outreach vacination campaigns with 1 YES 2 NO 2.10: Have you provided service of consultations for adults within the past 3 mo 1 YES 2 NO 2.10: Have you provided service of birth spacing methods within the past 3 month 1 YES 2 NO 2.10: Have you provided service of giving iron tablets and nutrition advice to p 1 YES 2 NO 2.10: Have you provided service of referring pregnant women for tetanus toxoid a 1 YES 2 NO 2.10: Have you provided service of supervising and advising TBA within the past 1 YES 2 NO 2.10: Have you provided service of supervising home deliveries within the past 3 1 YES 2 NO 2.10: Have you provided service of referring pregnant women with daner signs wit 1 YES 2 NO 2.10: Have you provided service of PNC within the past 3 months? 1 YES 2 NO 2.10: Have you provided service of supervising and advising traditional birth at 1 YES 2 NO 2.10: Have you provided service of supervising home deliveries within the past 3 1 YES 2 NO 2.10: Have you provided service of referring pregnant women with danger signs wi 1 YES 2 NO 2.10: Have you provided service of PNC within the past 3 months? 1 YES 2 NO 2.10: Have you provided service of newborn care within the past 3 months? 1 YES 2 NO 2.10: Have you provided service of referring for TB diagnosis within the past 3 1 YES 2 NO 2.10: Have you provided service of supervising DOTS treatment for TB within the 1 YES 2 NO 2.10: Have you provided service of malaria treatment within the past 3 months? 1 YES 2 NO 2.10: Have you provided service of distributing mosquito nets within the past 3 1 YES 2 NO 2.10: Have you provided service of advising and referring on mental health withi 1 YES 2 NO 2.10: Have you provided service of advising and referring on disabilities within 1 YES 2 NO 2.10: Have you provided service of health education for groups of people within 1 YES 2 NO 2.10: Have you provided service of other (specify) within the past 3 months? 1 YES 2 NO 3.01 : StarTime According to your contract, what are your hours of work at this 3.01 : StarTime According to your contract, what are your hours of work at this 3.01 : StarTime According to your contract, what are your hours of work at this 3.01 : StarTime According to your contract, what are your hours of work at this 3.01 : EndTime According to your contract, what are your hours of work at this f 3.01 : EndTime According to your contract, what are your hours of work at this f 3.01 : EndTime According to your contract, what are your hours of work at this f 3.01 : EndTime According to your contract, what are your hours of work at this f 3.02 : On average, how many hours per day are you at this facility on Monday to 3.02 : On average, how many hours per day are you at this facility on Saturday 3.02 : On average, how many hours per day are you at this facility on Sunday 3.02 : On average, how many hours per day are you at this facility on public hol 3.03 : Do you feel that this is too few, too many, or just the right amount? on 1 TOO FEW 2 TOO MANY 3 JUST RIGHT 3.03 : Do you feel that this is too few, too many, or just the right amount? on 1 TOO FEW 2 TOO MANY 3 JUST RIGHT 3.03 : Do you feel that this is too few, too many, or just the right amount? on 1 TOO FEW 2 TOO MANY 3 JUST RIGHT 3.03 : Do you feel that this is too few, too many, or just the right amount? on 1 TOO FEW 2 TOO MANY 3 JUST RIGHT 3.14 : When you are away from the facility, do any of the following occur? facil 1 YES 2 NO 3.14 : When you are away from the facility, do any of the following occur? salar 1 YES 2 NO 3.14 : When you are away from the facility, do any of the following occur? manag 1 YES 2 NO 3.14 : When you are away from the facility, do any of the following occur? absen 1 YES 2 NO 3.14 : When you are away from the facility, do any of the following occur? other 4.07 : What reasons were usually given for not being paid? lack of fund 1 YES 2 NO 4.07 : What reasons were usually given for not being paid? systemic delay 1 YES 2 NO 4.07 : What reasons were usually given for not being paid? salary withheld to se 1 YES 2 NO 4.07 : What reasons were usually given for not being paid? non-payment was not e 1 YES 2 NO 4.07 : What reasons were usually given for not being paid? other (specify) 1 YES 2 NO H409_1 H409_2 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.11 : Do you currently receive any of the following benefits as part of your pr 1 YES 2 NO 4.35: How many of radio/CD/casette player does your household own? 4.35: How many of television does your household own? 4.35: How many of perssing iron does your household own? 4.35: How many of electric stove does your household own? 4.35: How many of gas stove does your household own? 4.35: How many of lamp does your household own? 4.35: How many of bed does your household own? 4.35: How many of mattress/sleeping mat does your household own? 4.35: How many of refrigerator does your household own? 4.35: How many of paraffin stove does your household own? 4.35: How many of sewing machine does your household own? 4.35: How many of table does your household own? 4.35: How many of sofa does your household own? 4.35: How many of land line telephone does your household own? 4.35: How many of mobile telephone does your household own? 4.35: How many of motorcycle does your household own? 4.35: How many of bicycle does your household own? 4.35: How many of motor vehicle does your household own? 4.35: How many of wheelbarrow does your household own? 4.35: How many of boat does your household own? 4.35: How many of tractor does your household own? 4.35: How many of crop sprayer does your household own? 4.35: How many of irrigation equipment does your household own? 4.35: How many of ploughs/harrows does your household own? 4.35: How many of hoes/awes does your household own? 4.35: How many of fishing net/fishing equipment does your household own? 4.40: How many of goats does your household own? 4.40: How many of sheep does your household own? 4.40: How many of pigs does your household own? 4.40: How many of chicken does your household own? 4.40: How many of guinea fowl does your household own? 4.40: How many of ducks/geese does your household own? 4.40: How many of turkey does your household own? 4.40: How many of donkey/horse does your household own? 4.40: How many of cow does your household own? 4.40: How many of bull does your household own? 4.40: How many of oxen does your household own? 4.40: How many of calves does your household own? 4.40: How many of rabbits does your household own? 5.06: During your last visit with your supervisor, did your supervisor bring sup 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor check sup 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor check rec 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor observe c 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor ask knowl 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor provide m 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor visit hou 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor meet with 1 YES 2 NO 5.06: During your last visit with your supervisor, did your supervisor other (sp 1 YES 2 NO 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.13 : How would you characterize the following issues associated with your work 1 MAJOR PROBLEM 2 PROBLEM 3 SOMEWHAT OF A PROBLEM 4 NOT A PROBLEM 5.16 : How often do you keep such records? daily 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.16 : How often do you keep such records? weekly 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.16 : How often do you keep such records? monthly 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.16 : How often do you keep such records? other (specify) 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? patient details 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? diagnosis 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? drugs received 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? drugs dispensed 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? patient referrals 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? accounting records 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.17 : What do these records contain? other (specify) 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.19 : Who do you submit your records to? head of facility 1 YES 2 NO 5.19 : Who do you submit your records to? LGA authorities 1 YES 2 NO 5.19 : Who do you submit your records to? state authorities 1 YES 2 NO 5.19 : Who do you submit your records to? other (specify) 1 YES 2 NO 5.22 : What kind of feedback do you receive? ways to improve record-keeping 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.22 : What kind of feedback do you receive? ways to imrprove work 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.22 : What kind of feedback do you receive? feedback on your performance 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.22 : What kind of feedback do you receive? special recognition for work well d 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.22 : What kind of feedback do you receive? criticism for work not done 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 5.22 : What kind of feedback do you receive? other (specify) 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.02 : What types of support did you receive? cash payment 1 YES 2 NO 6.02 : What types of support did you receive? other in-kind payment 1 YES 2 NO 6.02 : What types of support did you receive? donations of supplies/equipment 1 YES 2 NO 6.02 : What types of support did you receive? community mobilization to use PMV 1 YES 2 NO 6.02 : What types of support did you receive? appreciation/recognition 1 YES 2 NO 6.02 : What types of support did you receive? other (specify) 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 6.03 : In what ways have other health workers in the community supported you in 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of tra 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of sup 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? patients/ca 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of tim 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of mot 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of sup 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of sup 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? inadequate 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? lack of com 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? security 1 YES 2 NO 7.02 : What are the biggest difficulties you face in doing your job? other (spec 1 YES 2 NO 7.03 : Do you agree: your job makes you feel good about yourself? 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: you are proud to be working in this HF 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: you are glad that you are working for this facility other t 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: the HF really inspires you to do your very best on the job 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: you always complete your tasks efficiently and effectively 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: you are a hard worker 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: you are punctual about coming to work 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: these days, you feel motivated wo work as hard as you can 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: overall, you are very satisfied with your job 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.03 : Do you agree: you are satisfied with the opportunity to use your abilitie 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: working relationship with other facility staff 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: working relationship with LGA health authorities 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: working relationship with state health authoritie 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: management of HF 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: relationships with local traditional leaders 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: availability of medicine in the HF 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: availability of equipment in the HF 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: the physical condition of the HF building 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your bility to provide high quality care 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your respect in the community 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your training opportunities to upgrade your skill 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your ability to meet the needs of the community 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your salary 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: employment benefits 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: safety and security to live and practice in the c 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: living accommodations for your family 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: education for your children 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your boss' recognition of your good work 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: your opportunities for promotion 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.04 : Are you satisfied with: overall, your satisfaction with your job 1 VERY UNSATISFIED 2 UNSATISFIED 3 SATISFIED 4 VERY SATISFIED 5 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.05 : Compared to your expectation when you started work in this HF, are satisf 1 LESS SATISFIED THAN YOU EXPECTED? 2 AS SATISFIED AS YOU EXPECTED? 3 MORE SATISFIED THAN YOU EXPECTED 4 NOT APPLICABLE 89 DON'T KNOW 7.06 : What are the top three things you would change about your work to improve 1 WORKING RELATIONSHIP WITH OTHER HEALTH FACILITY WORKERS 2 RELATIONSHIP WITH COMMUNITY/COMMUNITY LEADERS 3 COMMUNITY SUPPORT (FINANCIAL/OTHER) 4 AVAILABILITY OF MEDICINES 5 QUALITY OF MEDICINES 6 YOUR LEVEL OF RESPECT IN THE COMMUNITY 7 TRAINING OPPORTUNITIES 8 YOUR ABILITY TO MEET THE NEEDS OF THE COMMUNITY 9 INCENTIVES 10 OTHER EMPLOYMENT BENEFITS 11 SAFETY AND SECURITY TO LIVE AND WORK IN YOUR COMMUNITY 12 LIVING ACCOODATIONS FOR YOUR FAMILY 13 RECOGNITION OF YOUR GOOD WORK 14 OVERALL SATISFACTION WITH CDD WORK 96 OTHER (SPECIFY) 7.06 : What are the top three things you would change about your work to improve 1 WORKING RELATIONSHIP WITH OTHER HEALTH FACILITY WORKERS 2 RELATIONSHIP WITH COMMUNITY/COMMUNITY LEADERS 3 COMMUNITY SUPPORT (FINANCIAL/OTHER) 4 AVAILABILITY OF MEDICINES 5 QUALITY OF MEDICINES 6 YOUR LEVEL OF RESPECT IN THE COMMUNITY 7 TRAINING OPPORTUNITIES 8 YOUR ABILITY TO MEET THE NEEDS OF THE COMMUNITY 9 INCENTIVES 10 OTHER EMPLOYMENT BENEFITS 11 SAFETY AND SECURITY TO LIVE AND WORK IN YOUR COMMUNITY 12 LIVING ACCOODATIONS FOR YOUR FAMILY 13 RECOGNITION OF YOUR GOOD WORK 14 OVERALL SATISFACTION WITH CDD WORK 96 OTHER (SPECIFY) 7.06 : What are the top three things you would change about your work to improve 1 WORKING RELATIONSHIP WITH OTHER HEALTH FACILITY WORKERS 2 RELATIONSHIP WITH COMMUNITY/COMMUNITY LEADERS 3 COMMUNITY SUPPORT (FINANCIAL/OTHER) 4 AVAILABILITY OF MEDICINES 5 QUALITY OF MEDICINES 6 YOUR LEVEL OF RESPECT IN THE COMMUNITY 7 TRAINING OPPORTUNITIES 8 YOUR ABILITY TO MEET THE NEEDS OF THE COMMUNITY 9 INCENTIVES 10 OTHER EMPLOYMENT BENEFITS 11 SAFETY AND SECURITY TO LIVE AND WORK IN YOUR COMMUNITY 12 LIVING ACCOODATIONS FOR YOUR FAMILY 13 RECOGNITION OF YOUR GOOD WORK 14 OVERALL SATISFACTION WITH CDD WORK 96 OTHER (SPECIFY) 8.02 : What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 7 OTHER (SPECIFY) 8.02 : What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 7 OTHER (SPECIFY) 8.02 : What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 7 OTHER (SPECIFY) 8.03 : How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 8.03 : How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 8.03 : How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 8.04 : Which of the following have members of your household done to protect the 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 12 Other? (SPECIFY) 8.04 : Which of the following have members of your household done to protect the 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 12 Other? (SPECIFY) 8.04 : Which of the following have members of your household done to protect the 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 12 Other? (SPECIFY) 8.05 : What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 8.05 : What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 8.05 : What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 8.06 : What drug does the government recommend for the treatment of malaria? (up 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 8.06 : What drug does the government recommend for the treatment of malaria? (up 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 8.06 : What drug does the government recommend for the treatment of malaria? (up 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 8.07 : What is the primary source of knowledge about malaria in your community? 1 COMMUNITY HEALTH WORKER (CHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 96 OTHER (SPECIFY) 8.07 : What is the primary source of knowledge about malaria in your community? 1 COMMUNITY HEALTH WORKER (CHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 96 OTHER (SPECIFY) 8.07 : What is the primary source of knowledge about malaria in your community? 1 COMMUNITY HEALTH WORKER (CHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 96 OTHER (SPECIFY) 8.13 : What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.13 : What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.13 : What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 8.27 : RECORD THE NUMBER OF FEVER CASES IN LAST 2 WEEKS 8.27 : RECORD NUMBER OF RDT POSITIVE CASES (IF APPLICABLE)IN LAST 2 WEEKS 8.27 : RECORD NUMBER OF MINI-LAB POSITIVE CASES (IF APPLICABLE) IN LAST 2 WEEKS 8.27 : RECORD NUMBER OF MICROSCOPY POSTITVE CASES (IF APPLICABLE) IN LAST 2 WEEK 8.27 : RECORD DOSES OF ACT DISPENSED IN LAST 2 WEEKS 8.28 : What activities have you engaged in for the prevention of malaria in the 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 IPT 4 BCC FOR IPT 5 NONE 96 OTHER (SPECIFY) 8.28 : What activities have you engaged in for the prevention of malaria in the 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 IPT 4 BCC FOR IPT 5 NONE 96 OTHER (SPECIFY) 8.28 : What activities have you engaged in for the prevention of malaria in the 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 IPT 4 BCC FOR IPT 5 NONE 96 OTHER (SPECIFY) 8.28 : What activities have you engaged in for the prevention of malaria in the 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 IPT 4 BCC FOR IPT 5 NONE 96 OTHER (SPECIFY) 8.28 : What activities have you engaged in for the prevention of malaria in the 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 IPT 4 BCC FOR IPT 5 NONE 96 OTHER (SPECIFY) 8.28 : What activities have you engaged in for the prevention of malaria in the 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 IPT 4 BCC FOR IPT 5 NONE 96 OTHER (SPECIFY) 9.01 : Do you agree: staff willingly share their expertise with other members 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: when disagreements occur, staff try to ack like peacemakers 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: staff willingly give their time to heal each other 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: staff discuss work issues with each other 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: staff take steps to prevent problems arising between them 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: staff focus on what is wrong rather than the positive side 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: staff spend a lot of time chatting 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: my job allows me freedom in how I organiza my work 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: I am given enough authority by my supervisors to do my job 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: my job is a source of pride 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: if I did not do well at work, I would feel ashamed 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: if I were known as a bad professional, it would bring shame 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: when changes occur in the facility, I adjust to the change 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: rapid changes are difficult for staff to cope with 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.01 : Do you agree: changes bring opportunities to make improvements in the fac 0 NOT APPLICABLE 1 Strongly agree? 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 9.02 : Please rate: the staff in my facility interact in an easy manner and are 9.02 : Please rate: my facility is very dynamic and innovative place 9.02 : Please rate: my facility is very formal and structured 9.02 : Please rate: in my facility, we focus on achieving daily goals and gettin 9.02 : Please rate: the head of my facility is considered to be a mentor and a r 9.02 : Please rate: the head of my facility is considered to be a risk-taker and 9.02 : Please rate: the head of my facility relies on policies and procedures 9.02 : Please rate: the head of my facility pushes staff to achieve goals 9.02 : Please rate: loyalty and tradition is very important in my facility 9.02 : Please rate: innovation and being first to try something new is important 9.02 : Please rate: following procedures and rules is very important in my famil 9.02 : Please rate: achieving results and high performance is very important in 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does opportunities for training in your HF work compare to your other 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does your level of respect in the community in your HF work compare t 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does availability of necessary equipment/commodities in your HF work 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does adequate time availabel to perform tasks in your HF work compare 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does supervision and feedback from supervisor in your HF work compare 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does teamwork/relationships with other co-workers in your HF work com 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does motivation and satisfaction with work in your HF work compare to 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.02: How does recognition of your good work in your HF work compare to your ot 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does opportunities for training in your HF work compare to your previ 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does your level of respect in the community in your HF work compare t 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does availability of necessary equipment/commodities in your HF work 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does adequate time available to perform tasks in your HF work compare 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does supervision and feedback from supervisor in your HF work compare 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does teamwork/relationships with other co-workers in your HF work com 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does motivation and satisfaction with work in your HF work compare to 0 NOT APPLICABLE 1 Worse 2 Same 3 Better 10.04: How does other (specify) with work in your HF work compare to your previo 0 NOT APPLICABLE 1 Worse 2 Same 3 Better H1004_13 0 NOT APPLICABLE 1 Worse 2 Same 3 Better STATE NAME STATE CODE SENATORIAL DISTRICT LGA NAME LGA CODE WARD NAME TREATMENT PRIMARY HEALTH FACILITY NAME PRIMARY HEALTH FACILITY ID PRIMARY HEALTH FACILITY TYPE COMMUNITY NAME HouseholdID NAME OF STATE NAME OF LGA 1 AKKO 2 BALANGA 3 BILLIRI 4 DUKKU 5 FUNAKAYE 6 GOMBE 7 KALTUNGO 8 KWAMI 9 NAFADA 10 SHONGOM 11 YAMALTU/DEBA NAME OF WARD 101 AKKO 102 GARKO 103 KALSHINGI 104 KASHERE 105 KUMO CENTRAL 106 KUMO EAST 107 KUMO NORTH 108 KUMO WEST 109 PINDIGA 110 TUMU 111 TUKULMA 201 BAMBAM 203 DADIYA 204 GELENGU/BALANGA 205 KINDIYO 206 KULANI/DEGRI/SIKKAM 207 MWONA 208 NYUWAR/JESSU 209 SWA/REF/GASI/W.WAJA 210 TALASEE/DONG/REME 301 BANGANJE NORTH 303 BARE 304 305 306 KALMAI 307 TAL 308 TANGLANG 309 TODI 310 401 GOMBE ABBA 402 HASHIDU 403 JAMARI 404 KUNDE 406 MALALA 407 WAZIRI NORTH 408 409 WURO TALE 410 ZANGE 411 ZAUNE 501 ASHAKA/MAGABA 502 BAGE 503 BAJOGA 504 BAJOGA 505 BODOR/TILDE 506 JILLAHI 507 kupto 508 RIBADU 509 TONGO 510 WAWA/WAKKALTU 603 604 605 DAWAKI 606 HERWA GANA 608 KUMBIYA KUMBIYA 609 NASARAWA 610 PANTAMI 611 SHAMAKI 701 AWAK 702 BULE/KALTIN 703 KALTUNGO WEST 704 KALTUNGO EAST 705 KAMO 707 TULA WANGE 708 TULA YIRI 709 TUNGO 710 TURE 801 BOJUDE 802 DABA FULANI 803 DOHO 804 DUKUL 805 GADAM 806 JURARA 807 KOMFULATA 808 KWAMI 809 MALAM-SIDI 810 MALLERI 901 BARWO NASARAWA 902 BARWO WINDE 903 BIRIN BOLEWA 904 BIRIN FULANI EAST 905 BIRIN FULANI WEST 906 GUDUKKU 907 JIGAWA 908 NAFADA CENTRAL 909 NAFADA EAST 910 NAFADA WEST 1001 BANGUNJI 1002 BOH 1003 BURAK 1004 FILIYA 1006 GWANDUM 1007 KULISHIM 1008 KUSHI 1009 LALIPIDO 1010 LAPAN 1101 DEBA 1102 DIFA/LUBO/KINAFA 1103 GWANI/SHINGA/WADE 1104 HINNA 1105 JAGALI NORTH 1106 JAGALI SOUTH 1107 KANAWA/WAJARI 1108 KURI/LANO/LAMBAM 1109 KWADON/LIJI/KURBA 1110 NONO/KUNUWA/W.BIRDEKA 1111 ZAMBUK/KWALI NAME OF PRIMARY HEATHCARE FACILITY Household Individual ID SEA NUMBER Phone Number RelationshipID 1 HEAD OF OUSEHOLD 2 SPOUSE(WIFE/HUSBAND) 3 OWN SON/DAUGHTER 4 STEP SON/DAUGHTER 5 SON/DAUGHTER IN-LAW 6 GRANDCHILD 7 BROTHER/SISTER 8 PARENT 9 PARENT-IN-LAW 10 NIECE/NEPHEW 11 OTHER RELATIVE 12 DOMESTIC HELP 13 OTHER NON_RELATIVE 14 CO-WIFE 96 OTHER (SPECIFY) RelationshipID 1 HEAD OF OUSEHOLD 2 SPOUSE(WIFE/HUSBAND) 3 OWN SON/DAUGHTER 4 STEP SON/DAUGHTER 5 SON/DAUGHTER IN-LAW 6 GRANDCHILD 7 BROTHER/SISTER 8 PARENT 9 PARENT-IN-LAW 10 NIECE/NEPHEW 11 OTHER RELATIVE 12 DOMESTIC HELP 13 OTHER NON_RELATIVE 14 CO-WIFE 96 OTHER (SPECIFY) LGA Gender of household members 1 MALE 2 FEMALE TOWN TYPE 1 RURAL 2 PERI-URBAN 3 URBAN NAME OF VILLAGE INTERVIEWER NAME Date of the 1ST Interviewer INTERVIEWER NAME Date of the 2ND Interviewer Result Of Interview 1 COMPLETED 2 PARTIALLY COMPLETED 3 REFUSAL 4 CDD NOT PRESENT 96 OTHER (SPECIFY) Language spoken by respondent during interview 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Respondent Local Language Mother Tongue 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Translated Used 1 NEVER 2 SOMETIMES 3 ALWAYS Supervisor Name Date of the Supervisor Data Entry Operator Data Entry Operator (Date) Data Entry Supervisor Data Entry Supervisor (Date) 0.01 Do you agree to participate in the interview? 1 YES 2 NO GENDER OF RESPONDENT 1 MALE 2 FEMALE 1.07 : What is ....'s relationship to the head of the household? 1 HEAD OF OUSEHOLD 2 SPOUSE(WIFE/HUSBAND) 3 OWN SON/DAUGHTER 4 STEP SON/DAUGHTER 5 SON/DAUGHTER IN-LAW 6 GRANDCHILD 7 BROTHER/SISTER 8 PARENT 9 PARENT-IN-LAW 10 NIECE/NEPHEW 11 OTHER RELATIVE 12 DOMESTIC HELP 13 OTHER NON_RELATIVE 14 CO-WIFE 96 OTHER (SPECIFY) 1.08 : What is ....'s date of birth? 1.09 : How old is ......? YEARS 1.09B: MONTHS 1.10 : What is ....'s present marital status? 1 NEVER MARRIED 2 MONOGAMOUSLY MARRIED 3 POLYGAMOUSLY MARRIED 4 COHABIT 5 DIVORCED / SEPARATED 6 WIDOWED 96 OTHER (SPECIFY) 1.11 : SPOUSE'S ID CODE (ID1) 1.11 : SPOUSE'S ID CODE (ID2) 1.11 : SPOUSE'S ID CODE (ID3) 1.11 : SPOUSE'S ID CODE (ID4) 1.12 : FATHER'S ID CODE 1.13 : MOTHER'S ID CODE 1.14 : What is ....'s religion? 1 NONE 2 CHRISTIANITY 3 MUSLIM / ISLAM 4 TRADITIONAL 96 OTHER (SPECIFY) 1.15 : Has ...... been away from the household for more than 6 months in the las 1 YES 2 NO 3 NOT APPLICABLE 1.16 : For how many months during the past 12 months has ….. been away? 2.01 : What is [NAME]'s mother tongue? 1 ENGLISH 2 HAUSA 3 IGBO 4 YORUBA 96 OTHER (SPECIFY) 1 YES 2 NO 2.03 : Is [NAME] currently in school? 1 YES 2 NO 0 None 1 N1 2 N2 11 P1 12 P2 13 P3 14 P4 15 P5 16 P6 21 JS1 22 JS2 23 JS3 24 SS 1 25 SS 2 26 SS 3 27 Lower 6 28 Upper 6 31 Teacher training 32 Vocational 33 Technical 34 Modern schooling 35 NCE 41 Poly / prof 42 1st degree 43 Higher degree 2.05 : Has ...... ever attended school? 1 YES 2 NO 0 None 1 N1 2 N2 11 P1 12 P2 13 P3 14 P4 15 P5 16 P6 21 JS1 22 JS2 23 JS3 24 SS 1 25 SS 2 26 SS 3 27 Lower 6 28 Upper 6 31 Teacher training 32 Vocational 33 Technical 34 Modern schooling 35 NCE 41 Poly / prof 42 1st degree 43 Higher degree 2.01: What is [NAME]'s mother tongue (other specify)? 3.01 : What is ......'s main economic activity? 1 WAGE EMPLOYMENT 2 OWN BUSINESS / SELF-EMPLOYED 3 AGRICULTURE 4 PIECEWORK 5 UNPAID FAMILY WORKER 6 NOT WORKING BUT LOOKING FOR WORK/MEANS TO DO BUSINESS 7 NOT WORKING AND NOT LOOKING FOR WORK/MEANS TO DO BUSINESS BUT AVAILABLE FOR WORK 8 FULL TIME STUDENT 9 HOMEMAKER 10 RETIRED 11 TOO OLD/YOUNG TO WORK 12 TOO SICK TO WORK 96 OTHER (SPECIFY) 3.02 : In the last 12 months, did ...... do anything to earn income or help the 1 YES 2 NO 3.03 : Which main INDUSTRY of economic activity is ...... engaged in? 1 FARMING/HERDING 2 FORESTRY/CHARCOAL 3 FISHING 4 MINING 5 MANUFACTURING 6 ELECTRICITY/WATER 7 CONSTRUCTION 8 WHOLESALE/RETAIL TRADE 9 HOSPITALITY 10 TRANSPORT 11 FINANCIAL SERVICES 12 REAL ESTATE 14 GOVERNMENT 15 EDUCATION 16 HEALTH/SOCIAL WORK 17 COMMUNITY ORGANIZATION 96 OTHER (SPECIFY) 3.04 : Who does ...... work for at his/her primary work? (SECTOR OF EMPLOYER) 1 SELF-EMPLOYED 2 FAMILY ENTERPRISE 3 PRIVATE SECTOR 4 PUBLIC SECTOR 5 NGO 6 STATE GOVERNMENT/FEDERAL GOVERNMENT 7 CASUAL LABOURER 96 OTHER (SPECIFY) 1 DAY 2 WEEK 3 EVERY TWO WEEKS 4 MONTH 5 YEAR 3.06 : During the last 12 months, how many months did ...... engage in this prim 3.07 : In addition to this primary work, did ...... engage in any other (i.e. se 1 YES 2 NO 1 DAY 2 WEEK 3 EVERY TWO WEEKS 4 MONTH 5 YEAR 3.09 : During the last 12 months, how many months did ...... engage in this seco 3.10 : How many hours did you work last week? 6.01 : How is your health today? 1 EXCELLENT 2 GOOD 3 FAIR 4 POOR 6.02 : 12 months ago, how was your health on a normal day? 1 BETTER 2 WORSE 3 SAME 6.03 : In the last 4 weeks, have you been sick at any time? 1 YES 2 NO 6.04 : What were you mainly suffering from? (1st) 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 6.04 : What were you mainly suffering from? (2nd) 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 6.04 : What were you mainly suffering from? (3rd) 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 6.05 : How long ago did the last episode of illness start? (number) 6.05 : How long ago did the last episode of illness start? (unit) 1 DAYS 2 WEEKS 3 MONTHS 6.06 : How long ago did the illness stop?(number) 6.06 : How long ago did the illness stop?(unit) 1 DAYS 2 WEEKS 3 MONTHS 6.07 : Did you consult any health institution/personnel for this illness? 1 YES 2 NO 6.08 : Why didn't you consult a health institution or personnel for care? 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 WASN'T SICK ENOUTH 5 FACILITY HAS POOR INFRASTRUCTURE 6 FACILITY POORLY STOCKED 7 POOR STAFF ATTITUDE 8 POOR STAFF KNOWLEDGE 9 DON'T TRUST THE STAFF 10 SELF-TREATED 96 OTHER (SPECIFY) 6.09 : Who decided you should go there for your illness? 1 SELF 2 SPOUSE 3 PARENT 4 PARENT-IN-LAW 5 OTHER RELATIVE 6 FRIENDS/NEIGHBORS 7 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 6.10 : How long after the illness started did you seek care? 1 WITHIN 24 HOURS 2 AFTER 24 HOURS, NEXT DAY 3 SAME WEEK 4 WITHIN 2 WEEKS 5 WITHIN 3 WEEKS 96 OTHER (SPECIFY) 6.11 : Where did you seek care? 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE/HEALTH SHOP 15 MISSION FACILITIES 96 OTHER (SPECIFY) 6.12 : What is the distance from your household to this point of service? 6.13 : For the last visit, how much time did it take you to travel to and from y 6.13 : For the last visit, how much time did it take you to travel to and from y 6.14 : For the last visit, how much time did you wait to be seen in the institut 6.14 : For the last visit, how much time did you wait to be seen in the institut 6.15 : For the last visit, who did you consult with? 1 DOCTOR/CLINIC STAFF 2 NURSE/MIDWIFE 3 COMMUNITY HEALTH WORKER 4 LAD TECHNICIAN 5 PHARMACIST 6 TRADITIONAL HEALER 7 SPIRITUAL HEALER 8 DRUG STORE/HEALTH SHOP ATTENDANT 9 TEMPORARY WORKER 10 ENVIONMENTAL HEALTH TECHNICIAN 96 OTHER (SPECIFY) 6.16 : How was your illness diagnosed? 1 SYMPTOMATIC DIAGNOSIS 2 CLINICAL DIAGNOSIS 3 MICROSCOPY/BLOOD SLIDE 4 RAPID DIAGNOSTIC TEST 5 X-RAY 96 OTHER (SPECIFY) 6.16b : Why was a blood test not taken (Microscopy/blood slide or RDT)? 1 DID NOT NEED IT 2 DID NOT TRUST IT 3 AFRAID OF SIDE EFFECT 4 TEST TAKES TOO LONG 5 TOO EXPENSIVE 6 WAS NOT SUGGESTED 7 WAS NOT AVAILBALE AT ORIGINAL FACILITY 8 WAS NOT AVAILABLE AT REFERRAL FACILITY 96 OTHER (SPECIFY) 6.17a : When you were diagnosed, what was the result of the lab / RDT test? 1 POSITIVE 2 NEGATIVE 3 NOT VALID 97 DON'T KNOW 6.17b : Was this diagnosis done in the original facility you went to for care, o 1 ORIGINAL FACILITY 2 DIFFERENT FACILITY 6.17c : Did you get a referral slip with clear instructions on where to go for y 1 YES 2 NO 6.17d : Who performed the diagnostic test? 1 PUBLIC FACILITY STAFF 2 PRIVATE FACILITY STAFF 3 DRUG STORE/HEALTH SHOP ATTENDANT 4 VILLAGE HEALTH WORKER 5 PHARMACIST 96 OTHER (SPECIFY) 6.18 : Did you feel safe and well-taken-care-of during the diagnostic process? 1 YES 2 NO 6.19 : How satisfied were you with the information provided to you throughout th 1 VERY SATISFIED 2 SATISFIED 3 UNSATISFIED 4 VERY UNSATISFIED 6.20 : In the last 4 weeks, how much did you spend for treatment at this institu 6.20 : In the last 4 weeks, how much did you spend for treatment at this institu 6.20 : In the last 4 weeks, how much did you spend for treatment at this institu 6.20 : In the last 4 weeks, how much did you spend for treatment at this institu 6.21 : IF THE PAYMENT WAS FORGONE / POSTPONED BECAUSE THE RESPONDENT COULD NOT A 6.22 : In the last 4 weeks, were you hospitalized to treat this illness? 1 YES 2 NO 6.23 : For how long were you hospitalized?(Number) 6.23 : For how long were you hospitalized?(unit) 1 HOURS 2 DAYS 3 WEEKS 4 STILL HOSPITALIZED 6.24 : In the last 4 weeks, how much did you spend on hospitalization to treat t 6.25 : In the last 4 weeks, did you take any medication to treat this illness? 1 YES 2 NO 6.26 : How long after the illness started did you start taking medication? 1 WITHIN 24 HOURS 2 AFTER 24 HOURS, NEXT DAY 3 SAME WEEK 4 WITHIN 2 WEEKS 5 WITHIN 3 WEEKS 6.27A : SP/Fansidar 1 YES 2 NO 97 DON'T KNOW 6.27B : Chloroquine 1 YES 2 NO 97 DON'T KNOW 6.27C : Amodiaquine 1 YES 2 NO 97 DON'T KNOW 6.27D : Quinine Tablets 1 YES 2 NO 97 DON'T KNOW 6.27E : Quinine Injectables 1 YES 2 NO 97 DON'T KNOW 6.27F : Artemeter 1 YES 2 NO 97 DON'T KNOW 6.27G : Coartem 1 YES 2 NO 97 DON'T KNOW 6.27H : Aspirin 1 YES 2 NO 97 DON'T KNOW 6.27I : Acetaminophen / Paracetamol 1 YES 2 NO 97 DON'T KNOW 6.27J : Ibuprofen (Brufen) 1 YES 2 NO 97 DON'T KNOW 6.27K : OTHER, SPECIFY 1 YES 2 NO 97 DON'T KNOW 6.27L : OTHER, SPECIFY 1 YES 2 NO 97 DON'T KNOW 6.28A : SP/Fansidar 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28B : Chloroquine 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28C : Amodiaquine 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28D : Quinine Tablets 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28E : Quinine Injectables 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28F : Artemeter 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28G : Coartem 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28H : Aspirin 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28I : Acetaminophen / Paracetamol 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28J : Ibuprofen (Brufen) 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28K : OTHER, SPECIFY 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.28L : OTHER, SPECIFY 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 6.29A : SP/Fansidar 6.29B : Chloroquine 6.29C : Amodiaquine 6.29D : Quinine Tablets 6.29E : Quinine Injectables 6.29F : Artemeter 6.29G : Coartem 6.29H : Aspirin 6.29I : Acetaminophen / Paracetamol 6.29J : Ibuprofen (Brufen) 6.29K : OTHER, SPECIFY 6.29L : OTHER, SPECIFY 6.30 : ADD & CONFIRM: IN THE LAST 4 WEEKS, HOW MUCH DID …... SPEND ON DRUGS IN T 6.31 : Why didn't you take medication for the illness? 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 OUT OF STOCK 5 WASN'T SICK ENOUGH 6 DOESN'T HELP 7 AFRAID OF SIDE EFFECTS 96 OTHER (SPECIFY) 6.32 : What information was this decision based on? 1 PREVIOUS EXPERIENCE 2 HEARD FROM FRIEND 3 HEARD IN COMMUNITY 96 OTHER (SPECIFY) 6.33 : In the last 4 weeks, how many days of work or other main activities did y 6.34 : In the last 4 weeks, how many days have you been confined to bed due to p 6.35 : What was the outcome of your illness? 1 FULL RECOVERY 2 PARTIAL RECOVERY 3 NOT YET RECOVERED 6.36 : How many episodes of fever/malaria have you had in the last 3 months? 6.37 : How many days of regular activity did you miss during these episodes of f 6.38 : Have you been continuously ill for at least 3 months in the last 12 month 1 YES 2 NO 6.39A : What have you been mainly suffering from? (1st) 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 6.39B : What have you been mainly suffering from? (2nd) 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 6.40 : Are you pregnant now? 1 YES 2 NO 3 NOT SURE 6.41 : How many months pregnant are you? 6.42 : Have you delivered a baby in the past 12 months? 1 YES 2 NO 6.43 : Did you consult any health institution / personnel for antenatal care for 1 YES 2 NO 6.44 : Who did you see for antenatal care for this pregnancy? (IF MORE THAN ONE, 1 MEDICAL DOCTOR/CLINICAL OFFICIER 2 NURSE/MIDWIFE 3 COMMUNITY HEALTH WORKER 4 LAD TACHNICIAN 5 PHARMACIST 6 TRADITIONAL HEALER 7 SPIRITURAL HEALER 8 TRADITIONAL BIRTH ATTENDANT 9 FAMILY MEMBER 10 FRIEND/NEIGHBOR 11 ENVIRONMENTAL HEALTH TECHNICIAN 96 OTHER (SPECIFY) 6.45 : Where did you seek antenatal care for this pregnancy? (IF MORE THAN ONE, 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 12 HOME 15 MISSION FACILITIES 96 OTHER (SPECIFY) 6.46 : How many months pregnant were you when you went for your first antenatal 6.47 : How many times did you receive antenatal care for this pregnancy? 6.48 : How many months pregnant were you when you went for your last antenatal c 6.49A : Why didn't you consult any formal health institution/personnel for anten 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 SELF-TREATED 5 WASN'T SICK ENOUGH 6 FACILITY HAS POOR STRUCTURE 7 FACILITY POORLY STOCKED 8 POOR STAFF ATTITUDE 9 POOR STAFF KNOWLEDGE 10 DON'T TRUST THE STAFF 11 SERVE NOT AVAILABLE 96 OTHER (SPECIFY) 6.49B : Why didn't you consult any formal health institution/personnel for anten 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 SELF-TREATED 5 WASN'T SICK ENOUGH 6 FACILITY HAS POOR STRUCTURE 7 FACILITY POORLY STOCKED 8 POOR STAFF ATTITUDE 9 POOR STAFF KNOWLEDGE 10 DON'T TRUST THE STAFF 11 SERVE NOT AVAILABLE 96 OTHER (SPECIFY) 6.49C : Why didn't you consult any formal health institution/personnel for anten 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 SELF-TREATED 5 WASN'T SICK ENOUGH 6 FACILITY HAS POOR STRUCTURE 7 FACILITY POORLY STOCKED 8 POOR STAFF ATTITUDE 9 POOR STAFF KNOWLEDGE 10 DON'T TRUST THE STAFF 11 SERVE NOT AVAILABLE 96 OTHER (SPECIFY) 6.50 : During this pregnancy, did you take any drugs to prevent you from getting 1 YES 2 NO 6.51A : What drugs did you take?(SP/Fansidar) 1 YES 2 NO 6.51B : What drugs did you take?(Chloroquine) 1 YES 2 NO 6.51C : What drugs did you take?(OTHER, SPECIFY) 1 YES 2 NO 6.52A : Where did you get these drugs?(SP/Fansidar) 1 ANTENATAL VISIT 2 COMMUNITY HEALTH WORKER 3 TRADITIONAL HEALER 4 FAMILY MEMBER 5 FRIEND/NEIGHBOR 96 OTHER (SPECIFY) 6.52B : Where did you get these drugs?(Chloroquine) 1 ANTENATAL VISIT 2 COMMUNITY HEALTH WORKER 3 TRADITIONAL HEALER 4 FAMILY MEMBER 5 FRIEND/NEIGHBOR 96 OTHER (SPECIFY) 6.52C : Where did you get these drugs?(OTHER, SPECIFY) 1 ANTENATAL VISIT 2 COMMUNITY HEALTH WORKER 3 TRADITIONAL HEALER 4 FAMILY MEMBER 5 FRIEND/NEIGHBOR 96 OTHER (SPECIFY) 6.53A : How many courses of each drug did you take?(SP/Fansidar) 6.53B : How many courses of each drug did you take?(Chloroquine) 6.53C : How many courses of each drug did you take?(OTHER, SPECIFY) 6.55:How much did you pay for healthcare associated with this episode of illness 6.56: How did you pay for healthcare associated with this episode of illness? 1 OUT OF POCKET 2 HEALTH INSURANCE 3 SOME ELSE PAID THAT YOU DON'T HAVE TO PAY BACK 4 BORROWED 5 SOLD ASSETS 6 SAVINGS 7 OTHER (SPECIFY) 6.57: Did you borrow money to pay for the treatment that you had/have to pay bac 1 YES 2 NO 6.58 : Did you sell assets for the treatment? 1 YES 2 NO 6.59: Did you have to use your savings to pay for the treatment? 1 YES 2 NO 6.60: What is the type of your health insurance Policy? 1 GOVERNMENT HEALTH INSURANCE 2 COMMERCIAL PUBLIC HEALTH INSURANCE 3 COMMUNITY-BASED HEALTH INSURANCE 4 PRIVATE HEALTH INSURANCE 5 OTHER (SPECIFY) 6.61:How many people in your household are covered by your insurance policy? 1 YES 2 NO 7.01 : RECORD ID CODE OF MOTHER OR PRIMARY CAREGIVER 1 EXCELLENT 2 GOOD 3 FAIR 4 POOR 7.03 : How is …..'s health today? 1 BETTER 2 WORSE 3 SAME 7.04 : Given …..'s health, how is ….. currently able to do daily activities, suc 1 EASILY 2 WITH SOME DIFFICULTY 3 WITH MUCH DIFFICULTY 4 UNABLE TO DO 7.05 : In the last 4 weeks, has ….. been sick at any time? 1 YES 2 NO 7.06A : What was … mainly suffering from?1st 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 7.06B : What was … mainly suffering from?2nd 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 7.06C : What was … mainly suffering from?3rd 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 7.07 : Did you (the respopndent) consult any health institution/personnel for th 1 YES 2 NO 7.08 : Why didn't you (the respondent) consult a health institution or personnel 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 WASN'T SICK ENOUTH 5 FACILITY HAS POOR INFRASTRUCTURE 6 FACILITY POORLY STOCKED 7 POOR STAFF ATTITUDE 8 POOR STAFF KNOWLEDGE 9 DON'T TRUST THE STAFF 10 SELF-TREATED 96 OTHER (SPECIFY) 7.09 : Who decided ….. should go there for the illness? 1 SELF 2 SPOUSE 3 PARENT 4 PARENT-IN-LAW 5 OTHER RELATIVE 6 FRIENDS/NEIGHBORS 7 COMMUNITY HEALTH WORKER 96 OTHER (SPECIFY) 7.10 : How long after the illness started did you (the respondent) seek care for 1 WITHIN 24 HOURS 2 AFTER 24 HOURS, NEXT DAY 3 SAME WEEK 4 WITHIN 2 WEEKS 5 WITHIN 3 WEEKS 96 OTHER (SPECIFY) 7.11 : Where did you (the respondent) seek care for …'s illness? 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE/HEALTH SHOP 15 MISSION FACILITIES 96 OTHER (SPECIFY) 7.12 : How far is your homestead to this point of service? 7.13A : For the last visit with …'s illness, how much time did it take to travel 7.13B : For the last visit with …'s illness, how much time did it take to travel 7.14 : For the last visit, how much time did ….. wait to be seen in the institut 7.14A : For the last visit, how much time did ….. wait to be seen in the institu 7.14B : For the last visit, how much time did ….. wait to be seen in the institu 7.15 : For the last visit, who did you consult with? 1 DOCTOR/CLINIC STAFF 2 NURSE/MIDWIFE 3 COMMUNITY HEALTH WORKER 4 LAD TECHNICIAN 5 PHARMACIST 6 TRADITIONAL HEALER 7 SPIRITUAL HEALER 8 DRUG STORE/HEALTH SHOP ATTENDANT 9 TEMPORARY WORKER 10 ENVIONMENTAL HEALTH TECHNICIAN 96 OTHER (SPECIFY) 7.16 : How was …'s illness diagnosed? 1 SYMPTOMATIC DIAGNOSIS 2 CLINICAL DIAGNOSIS 3 MICROSCOPY/BLOOD SLIDE 4 RAPID DIAGNOSTIC TEST 5 X-RAY 96 OTHER (SPECIFY) 7.17 : DOES RESPONDENT REPORT FEVER/MALARIA (01), HEADACHE (17) OR JOINT ACHE (2 7.18 : Why was a blood test not taken (Microscopy/blood slide or RDT)? 1 DID NOT NEED IT 2 DID NOT TRUST IT 3 AFRAID OF SIDE EFFECT 4 TEST TAKES TOO LONG 5 TOO EXPENSIVE 6 WAS NOT SUGGESTED 7 WAS NOT AVAILBALE AT ORIGINAL FACILITY 8 WAS NOT AVAILABLE AT REFERRAL FACILITY 96 OTHER (SPECIFY) 7.19 : When …… was diagnosed, what was the result of the lab / RDT test? 1 POSITIVE 2 NEGATIVE 3 NOT VALID 97 DON'T KNOW 7.20 : Was this diagnosis done in the original facility …... went to for care, o 1 ORIGINAL FACILITY 2 DIFFERENT FACILITY 7.21 : Who performed the diagnostic test? 1 PUBLIC FACILITY STAFF 2 PRIVATE FACILITY STAFF 3 DRUG STORE/HEALTH SHOP ATTENDANT 4 VILLAGE HEALTH WORKER 5 PHARMACIST 96 OTHER (SPECIFY) 7.22 : How satisfied were you with the information provided to you throughout …. 1 VERY SATISFIED 2 SATISFIED 3 UNSATISFIED 4 VERY UNSATISFIED 7.23A : In the last 4 weeks, how much did you spend for treatment of … at this i 7.23B : In the last 4 weeks, how much did you spend for treatment of … at this i 7.23C : In the last 4 weeks, how much did you spend for treatment of … at this i 7.23D : In the last 4 weeks, how much did you spend for treatment of … at this i 7.24 : IF THE PAYMENT WAS FORGONE / POSTPONED BECAUSE THE RESPONDENT COULD NOT A 7.25 : In the last 4 weeks, was …... hospitalized to treat this illness? 1 YES 2 NO 7.26A : For how long was …... hospitalized? (Number) 7.26B : For how long was …... hospitalized? (Unit) 1 HOURS 2 DAYS 3 WEEKS 4 STILL HOSPITALIZED 7.27 : In the last 4 weeks, how much did you spend on …'s hospitalization to tre 7.28 : In the last 4 weeks, did ….. take any medication to treat this illness? 1 YES 2 NO 7.29 : How long after the illness started did ….. start taking medication? 1 WITHIN 24 HOURS 2 AFTER 24 HOURS, NEXT DAY 3 SAME WEEK 4 WITHIN 2 WEEKS 5 WITHIN 3 WEEKS 7.30 : In the last 4 weeks, did ….. take any of the following medication in orde 1 YES 2 NO 97 DON'T KNOW 7.30A : SP/Fansidar 1 YES 2 NO 97 DON'T KNOW 7.30B : Chloroquine 1 YES 2 NO 97 DON'T KNOW 7.30C : Amodiaquine 1 YES 2 NO 97 DON'T KNOW 7.30D : Quinine Injectables 1 YES 2 NO 97 DON'T KNOW 7.30E : Artemeter 1 YES 2 NO 97 DON'T KNOW 7.30F : Coartem 1 YES 2 NO 97 DON'T KNOW 7.30G : Aspirin 1 YES 2 NO 97 DON'T KNOW 7.30H : Acetaminophen / Paracetamol 1 YES 2 NO 97 DON'T KNOW 7.30I : Ibuprofen 1 YES 2 NO 97 DON'T KNOW 7.30J : Oral Rehydration Therapy 1 YES 2 NO 97 DON'T KNOW 7.30K : OTHER, SPECIFY 1 YES 2 NO 97 DON'T KNOW 7.30L : OTHER, SPECIFY 1 YES 2 NO 97 DON'T KNOW 7.31 : Where did you obtain the medication? 1 GOVERNMENT HOSPITAL 2 GOVERNMENT CLINIC 3 GOVERNMENT HEALTH POST 4 PRIVATE HOSPITAL 5 PRIVATE CLINIC 7 PHARMACY 9 TRADITIONAL HEALER 10 FAITH/CHURCH HEALER 11 COMMUNITY HEALTH WORKER 13 DRUG STORE 14 FRIEND/NEIGHBORS 15 MISSION FACILITIES 16 FAMILY MEMBER 17 PERSONAL SUPPLY 96 OTHER (SPECIFY) 7.31A : SP/Fansidar 7.31B : Chloroquine 7.31C : Amodiaquine 7.31D : Quinine Injectables 7.31E : Artemeter 7.31F : Coartem 7.31G : Aspirin 7.31H : Acetaminophen / Paracetamol 7.31I : Ibuprofen 7.31J : Oral Rehydration Therapy 7.31K : OTHER, SPECIFY 7.31L : OTHER, SPECIFY 7.32 : In the last 4 weeks, how much did you spend on each of the following medi 7.32A : SP/Fansidar 7.32B : Chloroquine 7.32C : Amodiaquine 7.32D : Quinine Injectables 7.32E : Artemeter 7.32F : Coartem 7.32G : Aspirin 7.32H : Acetaminophen / Paracetamol 7.32I : Ibuprofen 7.32J : Oral Rehydration Therapy 7.32K : OTHER, SPECIFY 7.32L : OTHER, SPECIFY 7.33 : ADD & CONFIRM: IN THE LAST 4 WEEKS, HOW MUCH DID YOU(RESPONDENT) SPEND ON 7.34 : Why didn't ….. take medication for the illness? 1 TOO EXPENSIVE 2 TOO FAR 3 TOO BUSY 4 OUT OF STOCK 5 WASN'T SICK ENOUGH 6 DOESN'T HELP 7 AFRAID OF SIDE EFFECTS 96 OTHER (SPECIFY) 7.35 : What information was this decision based on? 1 PREVIOUS EXPERIENCE 2 HEARD FROM FRIEND 3 HEARD IN COMMUNITY 96 OTHER (SPECIFY) 7.36 : In the last 4 weeks, how many days of school, work, play or other main ac 7.37 : In the last 4 weeks, how many days has ….. been confined to bed due to po 7.38 : What was the outcome of …..'s illness? 1 FULL RECOVERY 2 PARTIAL RECOVERY 3 NOT YET RECOVERED 7.39 : When ….. was sick, did you stop working to take care of him/her? 1 YES 2 NO 3 DOES NO WORK 7.4 : In the last 4 weeks, how many days of work did you miss to take care of …. 7.41 : How many episodes of fever/malaria has ….. had in the last 1 month? 7.42 : How many days of regular activity did ….. miss during these episodes of f 7.43 : Has … been continuously ill for at least 3 months in the last 12 months? 1 YES 2 NO 7.44 : What has … been mainly suffering from? 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 7.44A : 1st 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 7.44B : 2nd 1 FEVER/MALARIA 2 COUGH/CHEST INFECTION 3 TUBERCULOSIS 4 ASTHMA 5 BRONCHITIS 6 PNEUMONIA/KALASO 7 DIARRHEA WITHOUT BLOOD 8 DIARRHEA WITH BLOOD 9 DIARRHEA AND VOMITTING 10 VOMITTING 11 ABDOMINAL PAIN 12 ANEMIA 13 SKIN RASH/INFECTION 14 EYE/EAR INFECTION 15 MEASLES 16 JAUNDICE/YELLOW FEVER 17 HEADACHE 18 TOOTHACHE 19 STROKE 20 HYPERTENSION/BP 21 DIABETES/SUGAR 22 HIV/AIDS 23 PARALYSIS 24 JOINT ACH 96 OTHER, SPECIFY 4.01 : At any time in the past 12 months has anyone sprayed the interior walls o 1 YES 2 NO 4.02 : How many months ago did they spray? 4.03 : Who sprayed the house? 1 GOVERNMENT PROGRAM / WORKER 2 PRIVATE COMPANY 3 HOUSEHOLD MEMBER 96 OTHER (SPECIFY) 4.04 : How many mosquito nets does your household own? 4.05 : ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. IF MORE THAN SIX 1 OBSERVED 2 NOT OBSERVED 4.05 : ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. IF MORE THAN SIX 1 OBSERVED 2 NOT OBSERVED 4.05 : ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. IF MORE THAN SIX 1 OBSERVED 2 NOT OBSERVED 4.05 : ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. IF MORE THAN SIX 1 OBSERVED 2 NOT OBSERVED 4.05 : ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. IF MORE THAN SIX 1 OBSERVED 2 NOT OBSERVED 4.05 : ASK RESPONDENT TO SHOW YOU THE NET(S) IN THE HOUSEHOLD. IF MORE THAN SIX 1 OBSERVED 2 NOT OBSERVED 4.06 : How long ago did your household obtain the mosquito nets? (Number) 4.06 : How long ago did your household obtain the mosquito nets? (Number) 4.06 : How long ago did your household obtain the mosquito nets? (Number) 4.06 : How long ago did your household obtain the mosquito nets? (Number) 4.06 : How long ago did your household obtain the mosquito nets? (Number) 4.06 : How long ago did your household obtain the mosquito nets? (Number) 4.06 : How long ago did your household obtain the mosquito nets?(Units) 1 DAYS 2 WEEKS 3 MONTHS 4 YEARS 4.06 : How long ago did your household obtain the mosquito nets?(Units) 1 DAYS 2 WEEKS 3 MONTHS 4 YEARS 4.06 : How long ago did your household obtain the mosquito nets?(Units) 1 DAYS 2 WEEKS 3 MONTHS 4 YEARS 4.06 : How long ago did your household obtain the mosquito nets?(Units) 1 DAYS 2 WEEKS 3 MONTHS 4 YEARS 4.06 : How long ago did your household obtain the mosquito nets?(Units) 1 DAYS 2 WEEKS 3 MONTHS 4 YEARS 4.06 : How long ago did your household obtain the mosquito nets?(Units) 1 DAYS 2 WEEKS 3 MONTHS 4 YEARS 4.07 : OBSERVE OR ASK THE BRAND OF THE MOSQUITO NET 1 OLYSET 2 PERMANET 3 ICONET 4 FENNET 5 KO NET 6 SAFINET 7 NO BRAND 8 OTHER PRETREATED 96 OTHER, SPECIFY 97 DON'T KNOW 4.07 : OBSERVE OR ASK THE BRAND OF THE MOSQUITO NET 1 OLYSET 2 PERMANET 3 ICONET 4 FENNET 5 KO NET 6 SAFINET 7 NO BRAND 8 OTHER PRETREATED 96 OTHER, SPECIFY 97 DON'T KNOW 4.07 : OBSERVE OR ASK THE BRAND OF THE MOSQUITO NET 1 OLYSET 2 PERMANET 3 ICONET 4 FENNET 5 KO NET 6 SAFINET 7 NO BRAND 8 OTHER PRETREATED 96 OTHER, SPECIFY 97 DON'T KNOW 4.07 : OBSERVE OR ASK THE BRAND OF THE MOSQUITO NET 1 OLYSET 2 PERMANET 3 ICONET 4 FENNET 5 KO NET 6 SAFINET 7 NO BRAND 8 OTHER PRETREATED 96 OTHER, SPECIFY 97 DON'T KNOW 4.07 : OBSERVE OR ASK THE BRAND OF THE MOSQUITO NET 1 OLYSET 2 PERMANET 3 ICONET 4 FENNET 5 KO NET 6 SAFINET 7 NO BRAND 8 OTHER PRETREATED 96 OTHER, SPECIFY 97 DON'T KNOW 4.07 : OBSERVE OR ASK THE BRAND OF THE MOSQUITO NET 1 OLYSET 2 PERMANET 3 ICONET 4 FENNET 5 KO NET 6 SAFINET 7 NO BRAND 8 OTHER PRETREATED 96 OTHER, SPECIFY 97 DON'T KNOW 4.08 : Where did you obtain the net? 1 GOVERNMENT 2 CLINIC / HOSPITAL 3 NEIGHBORHOOD HEALTH COMMITTEE 4 COMMUNITY HEALTH WORKER 5 NGO 6 RETAIL SHOP 7 PHARMACY 8 EMPLOYER 96 OTHER, SPECIFY 4.08 : Where did you obtain the net? 1 GOVERNMENT 2 CLINIC / HOSPITAL 3 NEIGHBORHOOD HEALTH COMMITTEE 4 COMMUNITY HEALTH WORKER 5 NGO 6 RETAIL SHOP 7 PHARMACY 8 EMPLOYER 96 OTHER, SPECIFY 4.08 : Where did you obtain the net? 1 GOVERNMENT 2 CLINIC / HOSPITAL 3 NEIGHBORHOOD HEALTH COMMITTEE 4 COMMUNITY HEALTH WORKER 5 NGO 6 RETAIL SHOP 7 PHARMACY 8 EMPLOYER 96 OTHER, SPECIFY 4.08 : Where did you obtain the net? 1 GOVERNMENT 2 CLINIC / HOSPITAL 3 NEIGHBORHOOD HEALTH COMMITTEE 4 COMMUNITY HEALTH WORKER 5 NGO 6 RETAIL SHOP 7 PHARMACY 8 EMPLOYER 96 OTHER, SPECIFY 4.08 : Where did you obtain the net? 1 GOVERNMENT 2 CLINIC / HOSPITAL 3 NEIGHBORHOOD HEALTH COMMITTEE 4 COMMUNITY HEALTH WORKER 5 NGO 6 RETAIL SHOP 7 PHARMACY 8 EMPLOYER 96 OTHER, SPECIFY 4.08 : Where did you obtain the net? 1 GOVERNMENT 2 CLINIC / HOSPITAL 3 NEIGHBORHOOD HEALTH COMMITTEE 4 COMMUNITY HEALTH WORKER 5 NGO 6 RETAIL SHOP 7 PHARMACY 8 EMPLOYER 96 OTHER, SPECIFY 4.09 : When you obtained the net, was it already treated with insecticide? 1 YES 2 NO 97 DON'T KNOW 4.09 : When you obtained the net, was it already treated with insecticide? 1 YES 2 NO 97 DON'T KNOW 4.09 : When you obtained the net, was it already treated with insecticide? 1 YES 2 NO 97 DON'T KNOW 4.09 : When you obtained the net, was it already treated with insecticide? 1 YES 2 NO 97 DON'T KNOW 4.09 : When you obtained the net, was it already treated with insecticide? 1 YES 2 NO 97 DON'T KNOW 4.09 : When you obtained the net, was it already treated with insecticide? 1 YES 2 NO 97 DON'T KNOW 4.10 : Did you purchase the net? 1 YES 2 NO 4.10 : Did you purchase the net? 1 YES 2 NO 4.10 : Did you purchase the net? 1 YES 2 NO 4.10 : Did you purchase the net? 1 YES 2 NO 4.10 : Did you purchase the net? 1 YES 2 NO 4.10 : Did you purchase the net? 1 YES 2 NO 4.11 : How much did you pay when you purchased the net? IMPUTED VALUE IF IT WAS 4.11 : How much did you pay when you purchased the net? IMPUTED VALUE IF IT WAS 4.11 : How much did you pay when you purchased the net? IMPUTED VALUE IF IT WAS 4.11 : How much did you pay when you purchased the net? IMPUTED VALUE IF IT WAS 4.11 : How much did you pay when you purchased the net? IMPUTED VALUE IF IT WAS 4.11 : How much did you pay when you purchased the net? IMPUTED VALUE IF IT WAS 4.12 : Who slept under this mosquito net last night? FOR EACH NET, RECORD VALUE 1 YES 2 NO 3 NOBODY 4.13 : FOR EACH NET, UNDER COLUMN (4.13) IN THE TABLE, VERIFY THE TYPE OF PERSON 1 CHILD UNDER 5 YEARS OLD 2 CHILD FROM 5-12 YEARS 3 PREGNANT WOMAN 4 WOMAN OF REPRODUCTIVE AGE (15-49) 5 HOUSEHOLD HEAD 6 OTHER ADULT OVER 12 YEARS OLD 4.12 : Who slept under this mosquito net last night? FOR EACH NET, RECORD VALUE 1 YES 2 NO 3 NOBODY 4.13 : FOR EACH NET, UNDER COLUMN (4.13) IN THE TABLE, VERIFY THE TYPE OF PERSON 1 CHILD UNDER 5 YEARS OLD 2 CHILD FROM 5-12 YEARS 3 PREGNANT WOMAN 4 WOMAN OF REPRODUCTIVE AGE (15-49) 5 HOUSEHOLD HEAD 6 OTHER ADULT OVER 12 YEARS OLD 4.12 : Who slept under this mosquito net last night? FOR EACH NET, RECORD VALUE 1 YES 2 NO 3 NOBODY 4.13 : FOR EACH NET, UNDER COLUMN (4.13) IN THE TABLE, VERIFY THE TYPE OF PERSON 1 CHILD UNDER 5 YEARS OLD 2 CHILD FROM 5-12 YEARS 3 PREGNANT WOMAN 4 WOMAN OF REPRODUCTIVE AGE (15-49) 5 HOUSEHOLD HEAD 6 OTHER ADULT OVER 12 YEARS OLD 4.12 : Who slept under this mosquito net last night? FOR EACH NET, RECORD VALUE 1 YES 2 NO 3 NOBODY 4.13 : FOR EACH NET, UNDER COLUMN (4.13) IN THE TABLE, VERIFY THE TYPE OF PERSON 1 CHILD UNDER 5 YEARS OLD 2 CHILD FROM 5-12 YEARS 3 PREGNANT WOMAN 4 WOMAN OF REPRODUCTIVE AGE (15-49) 5 HOUSEHOLD HEAD 6 OTHER ADULT OVER 12 YEARS OLD 4.12 : Who slept under this mosquito net last night? FOR EACH NET, RECORD VALUE 1 YES 2 NO 3 NOBODY 4.13 : FOR EACH NET, UNDER COLUMN (4.13) IN THE TABLE, VERIFY THE TYPE OF PERSON 1 CHILD UNDER 5 YEARS OLD 2 CHILD FROM 5-12 YEARS 3 PREGNANT WOMAN 4 WOMAN OF REPRODUCTIVE AGE (15-49) 5 HOUSEHOLD HEAD 6 OTHER ADULT OVER 12 YEARS OLD 4.12 : Who slept under this mosquito net last night? FOR EACH NET, RECORD VALUE 1 YES 2 NO 3 NOBODY 4.13 : FOR EACH NET, UNDER COLUMN (4.13) IN THE TABLE, VERIFY THE TYPE OF PERSON 1 CHILD UNDER 5 YEARS OLD 2 CHILD FROM 5-12 YEARS 3 PREGNANT WOMAN 4 WOMAN OF REPRODUCTIVE AGE (15-49) 5 HOUSEHOLD HEAD 6 OTHER ADULT OVER 12 YEARS OLD 5.01 : What is the main cause of malaria? 1 MOSQUITOES 2 DIRTY FOODS 3 DIRTY LIQUIDS 4 CLIMATE / WEATHER 5 OILY FOOD 6 SUN 7 WITCHCRAFT 96 OTHER (SPECIFY) 5.02 : What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACH 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 5.02 : What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACH 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 5.02 : What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACH 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 5.02a : Which group is the most vulnerable to malaria? 1 CHILDREN UNDER 5 2 CHILDREN AGED 5-12 3 PREGNANT WOMEN 4 ADULTS 5 ELDERLY PEOPLE 96 OTHER (SPECIFY) 5.03 : How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 5.03 : How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 5.03 : How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 5.04 : Which of the following have members of your household done to protect the 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 5.04 : Which of the following have members of your household done to protect the 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 5.04 : Which of the following have members of your household done to protect the 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 5.05 : What is the best medicine to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 5.05 : What is the best medicine to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 5.05 : What is the best medicine to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 8 DON'T KNOW 96 OTHER (SPECIFY) 5.05a : Why do you think this is the best medicine for treating malaria? 1 USED IT BEFORE 2 HEARD FROM FRIEND 3 HEARD IN COMMUNITY 4 HEARD ABOUT IN ON TV/RADIO 5 READ ABOUT IT IN NEWSPAPER/MAGAZINE 6 AFFORDABLE 7 ACCESSIBLE 8 COMMUNITY MEETING/STRET PLA 9 IRRELEVANT 96 OTHER (SPECIFY) 5.05b : For how many days should treatment with ACTs be taken? 5.05c : How many times per day should you take ACTs on each of these days? 5.06 : Where do you typically get information about malaria? (up to three) 1 VILLAGE HEALTH WORKER (VHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 5.06 : Where do you typically get information about malaria? (up to three) 1 VILLAGE HEALTH WORKER (VHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 5.06 : Where do you typically get information about malaria? (up to three) 1 VILLAGE HEALTH WORKER (VHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 5.07a : Have you heard of Coartem? 1 YES 2 NO 5.07b : Where did you first hear of Coartem? 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 4 NEIGHBORHOOD HEALTH COMMITTEE 5 RADIO/TELEVISION PROGRAM 6 MAGAZINE 13 DRUG STORE/HEALTH SHOP 15 COMMUNITY MEETING/STREET PLA 96 OTHER (SPECIFY) 5.08 : Have you heard about Rapid Diagnostic Tests (RDTs) for malaria? 1 YES 2 NO 5.09 : Where did you first hear about RDT test? 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 4 NEIGHBORHOOD HEALTH COMMITTEE 5 RADIO/TELEVISION PROGRAM 6 MAGAZINE 13 DRUG STORE/HEALTH SHOP 15 COMMUNITY MEETING/STREET PLA 96 OTHER (SPECIFY) 5.10 : True or false: RDTs are devices, which can be used to test if a person ha 1 TRUE 2 FALSE 5.11 : If you had a sick child, would you allow your child to be tested with an 1 YES 2 NO 5.12 : Why would you not allow your sick child to be tested with an RDT for mala 1 WOULD NOT NEED IT 2 WOULD NOT TRUST IT 3 AFRAID OF SIDE EFFECTS 4 TEST TAKES TOO LONG 5 TOO EXPENSIVE 96 OTHER (SPECIFY) 5.13 : Where can you go for a malaria RDT test? (up to six) 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 5 MISSION FACILITY 7 PHARMACY 13 DRUG STORE 96 OTHER (SPECIFY) 5.13 : Where can you go for a malaria RDT test? (up to six) 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 5 MISSION FACILITY 7 PHARMACY 13 DRUG STORE 96 OTHER (SPECIFY) 5.13 : Where can you go for a malaria RDT test? (up to six) 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 5 MISSION FACILITY 7 PHARMACY 13 DRUG STORE 96 OTHER (SPECIFY) 5.13 : Where can you go for a malaria RDT test? (up to six) 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 5 MISSION FACILITY 7 PHARMACY 13 DRUG STORE 96 OTHER (SPECIFY) 5.13 : Where can you go for a malaria RDT test? (up to six) 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 5 MISSION FACILITY 7 PHARMACY 13 DRUG STORE 96 OTHER (SPECIFY) 5.13 : Where can you go for a malaria RDT test? (up to six) 1 PUBLIC HEALTH FACILITY 2 PRIVATE HEALTH FACILITY 3 COMMUNITY HEALTH WORKER 5 MISSION FACILITY 7 PHARMACY 13 DRUG STORE 96 OTHER (SPECIFY) 5.14 : Suppose never sleep under the bed net, how likely that you will be infect 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.14 : Suppose never sleep under the bed net, how likely that your youngest chil 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.14 : Suppose sleep under the bed net 3 days a week, how likely that you will b 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.14 : Suppose sleep under the bed net 3 days a week, how likely that your young 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.14 : Suppose sleep under the bed net everyday, how likely that you will be inf 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.14 : Suppose sleep under the bed net everyday, how likely that your youngest c 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.17: Suppose you are infected with malaria, what is the minimum number of days 5.18 : Suppose you are infected with malaria, what is the maximum number of days 5.19 : Interviewer: compute the average of minumim and maximum. [(A+B)/2= C] 5.20 : How likely is that you will miss more than [C] number of days of work? 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.21 : How likely is that you will miss less than [C] number of days of work? 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.22 : Suppose your youngest child is infected with malaria, what is the minimum 5.23 : Suppose your youngest child is infected with malaria, what is the maximum 5.24 : Interviewer: compute the average of minumim and maximum. [(A+B)/2= C] 5.25 : How likely is that your youngest child will miss more than [C] number of 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.26 : How likely is that your youngest child will miss less than [C] number of 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.27 : Suppose your youngest child is infected with malaria, what is the minimum 5.28 : Suppose your youngest child is infected with malaria, what is the maximum 5.29 : Interviewer: compute the average of minumim and maximum. [(A+B)/2= C] 5.30 : How likely is that you will miss more than [C] number of days of work to 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.31 : How likely is that you will miss less than [C] number of days of work to 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.32 : Suppose you have fever, how likely that this is malaria? 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.33 : Suppose you have malaria, how likely that you will need treatment for mal 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.34 : Suppose you have malaria, how likely that you will be cured within 4 if y 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.35 : Suppose you have malaria, how likely that you will be cured within 7 days 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.36 : Suppose you have malaria, how likely that you will be cured within 4 if y 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.37 : Suppose you have malaria, how likely that you will be cured within 7 days 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.38 : Suppose you have malaria, how likely that you will be cured within 4 if y 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.39 : Suppose you have malaria, how likely that you will be cured within 7 days 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.40 : Suppose you have malaria, how likely that you will be cured within 4 if y 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 5.41 : Suppose you have malaria, how likely that you will be cured within 7 days 1 UNLIKELY 2 LIKELY 3 VERY LIKELY 8.01 : INTERVIEWER: OBSERVE THE TYPE OF DWELLING THE HOUSEHOLD LIVES IN 1 TRAIDITIONAL HOUSE 2 DUPLEX/IMPROVED TRADITIONAL HOUSE 3 DETACHED HOUSE/BUNGALAW 4 HOUSE ATTACHED TO/ON TOP OF SHOP/STORIES BUILDING 5 SEMI-DETACHED/DUPLEX HOUSE 6 SERVANT QUARTERS 7 GEST HOUSE/WING 8 FLAT/APARTMENT/MULTI-UNIT 9 HOSTEL 10 NON-RESIDENTIAL BUILDING 11 UNCONVENTIONAL 96 OTHER (SPECIFY) 8.02 : OBSERVE MAIN MATERIAL USED FOR WALLS 1 BRICKS ORBLOCKS 2 ASBESTOS 3 CROORUGATED IRON/METAL 4 PLASTIC 5 POLES/REED 6 TILES/SLAETS 7 THATCH/GRASS 8 WOOD/BAMBOO 9 EARTH/MUD 10 CONCRETE ONLY 11 COVERED CHCRETE 12 CARDBOARD 96 OTHER (SPECIFY) 8.02 : OBSERVE MAIN MATERIAL USED FOR ROOFTOP 1 BRICKS ORBLOCKS 2 ASBESTOS 3 CROORUGATED IRON/METAL 4 PLASTIC 5 POLES/REED 6 TILES/SLAETS 7 THATCH/GRASS 8 WOOD/BAMBOO 9 EARTH/MUD 10 CONCRETE ONLY 11 COVERED CHCRETE 12 CARDBOARD 96 OTHER (SPECIFY) 8.02 : OBSERVE MAIN MATERIAL USED FOR FLOOR 1 BRICKS ORBLOCKS 2 ASBESTOS 3 CROORUGATED IRON/METAL 4 PLASTIC 5 POLES/REED 6 TILES/SLAETS 7 THATCH/GRASS 8 WOOD/BAMBOO 9 EARTH/MUD 10 CONCRETE ONLY 11 COVERED CHCRETE 12 CARDBOARD 96 OTHER (SPECIFY) 8.03 : What is the ownership status of your house? 1 OWNER OCCUPIED DWELLING 2 RENTED FROM LOCAL GOVT 3 RENTED FROM CENTRAL GOVT 4 RENTED FROM PRIVATE CO 5 RENTED FROM PARASTATAL 6 RENTED FROM INDICIDUAL 7 BORROWED DWELLING 8 HOUSE OWNED AND PROVIDED FREE BY EMPLOYER (GOVT) 9 HOUSE OWNED AND PROVIDED FREE BY EMPLOYER (PRIVATE) 10 OTHER FREE HOUSING 96 OTHER (SPECIFY) 8.04 : How much rent are you charged? AMOUNT 1 MONTHLY 2 EVERY 3 MONTHS 3 EVERY 6 MONTHS 4 ANNUALLY 96 OTHER (SPECIFY) 8.04 : How much rent are you charged? PERIOD 1 MONTHLY 2 EVERY 3 MONTHS 3 EVERY 6 MONTHS 4 ANNUALLY 96 OTHER (SPECIFY) 8.05 : If you were to sell this dwelling today, how much would you receive for i 8.06 : If you rented this dwelling, how much rent would you receive per month? 8.07 : How many rooms does your household have (including rooms outside the main 8.08 : How many rooms does your household use for sleeping (including rooms outs 8.09 : What is your household's main source of drinking water IN DRY SEASON? 1 DIRECTLY FROM UNPROTECTED WELL 3 PUMPED FROM THE RIVER/LAKE/DAM 4 PROTECTED WELL 5 BOREHOLE 6 PUBLIC TAP 7 OWN TAP 8 OTHER TAP 9 BOUGHT FROM WATER VENDOR 10 MINERAL BOTTLED WATER 11 RAIN WATER 96 OTHER (SPECIFY) 8.09 : What is your household's main source of drinking water IN RAINY SEASON? 1 DIRECTLY FROM UNPROTECTED WELL 3 PUMPED FROM THE RIVER/LAKE/DAM 4 PROTECTED WELL 5 BOREHOLE 6 PUBLIC TAP 7 OWN TAP 8 OTHER TAP 9 BOUGHT FROM WATER VENDOR 10 MINERAL BOTTLED WATER 11 RAIN WATER 96 OTHER (SPECIFY) 8.10 : How far is this source from the house? Unit Code 1 POLES 2 KILOMETERS 8.10 : How far is this source from the house? Number 1 NO TREATMENT 2 BOIL 3 ADD CHLORINE 4 IODINE 96 OTHER (SPECIFY) 1 NO TREATMENT 2 BOIL 3 ADD CHLORINE 4 IODINE 96 OTHER (SPECIFY) 8.12 : What is the main type of toilet facility for this household? 1 OWN FLUSH TOILET INSIDE HOUSE 2 OWN FLUSH TOILET OUTSIDE HOUSE 3 COMMUNAL/SHARED FLUSH TOILET 4 OWN PIT LATRINE 5 COMMUNAL/SHARED PIT LATRINE 6 NEIGHBOURS/ANOTHER HOUSEHOLD'S PIT LATRINE 7 VIP LATRINE 8 COMMUNAL/SHARED VIP LATRINE 9 NONE 96 OTHER (SPECIFY) 8.13 : How many other households does your household share the toilet with? 8.14 : How does your household dispose the rubish? 1 REFUSE COLLECTED 2 PIT 3 BURY 4 BURN 5 DUMPING 96 OTHER (SPECIFY) 8.15 : What is your household's main source of energy for lighting? 1 KEROSINE/PARAFFIN/GAS/OIL LAMP 2 ELECTRICITY 3 CANDLES 4 DIESEL/GENERATOR 5 OPEN FIRE 6 TORCH 7 SOLAR PANEL 96 OTHER (SPECIFY) 8.16 : What is your household's main source of energy for cooking? 1 KEROSINE/PARAFFIN/GAS STOVE 2 ELECTRICITY 3 DIESEL/GENERATOR 4 FIRE WOOD 5 CHARCOAL 6 SOLAR PANEL 96 OTHER (SPECIFY) 8.17 : Does your household have electricity? 1 YES 2 NO 8.18 : For how many hours per day does your household normally have electricity? 8.19 : What is the nearest body of water to your household? 1 STREAM 2 RIVER 3 POND 4 LAKE 5 SWAMP 6 MARSH 7 DAM 96 OTHER (SPECIFY) 8.20 : How far from your household is this body of water? UNIT CODE 1 POLES 2 KILOMETERS 8.20 : How far from your household is this body of water? NUMBER 9.01: How many of radio/CD/casette player does your household own? 9.01: How many of television does your household own? 9.01: How many of perssing iron does your household own? 9.01: How many of electric stove does your household own? 9.01: How many of gas stove does your household own? 9.01: How many of lamp does your household own? 9.01: How many of improvised lamp does your hosuehold own? 9.01: How many of bed does your household own? 9.01: How many of mattress/sleeping mat does your household own? 9.01: How many of refrigerator does your household own? 9.01: How many of paraffin stove does your household own? 9.01: How many of sewing machine does your household own? 9.01: How many of table does your household own? 9.01: How many of sofa does your household own? 9.01: How many of land line telephone does your household own? 9.01: How many of mobile telephone does your household own? 9.01: How many of motorcycle does your household own? 9.01: How many of bicycle does your household own? 9.01: How many of motor vehicle does your household own? 9.01: How many of wheelbarrow does your household own? 9.01: How many of boat does your household own? 9.01: How many of tractor does your household own? 9.01: How many of crop sprayer does your household own? 9.01: How many of irrigation equipment does your household own? 9.01: How many of ploughs/harrows does your household own? 9.01: How many of hoes/awes does your household own? 9.01: How many of fishing net/fishing equipment does your household own? 9.02 : Does your household own the land for this residence? 1 YES 2 NO 9.03 : What is the size of this land for the residence? UNIT 1 LIMA 2 ACRE 3 HEACTARE 4 SQUARE METER 5 PLOT 9.03 : What is the size of this land for the residence? QUANTITY 9.04 : Does your household own any other land? 1 YES 2 NO 9.05 : What is the size of your other land? UNIT 1 LIMA 2 ACRE 3 HECTARE 4 SQUARE METER 5 PLOT 9.05 : What is the size of your other land? QUANTITY 9.06 : IF ANSWER TO 9.02 or 9.04 IS 'YES' THEN 3.20: How many of goats does your household own? 3.20: How many of sheep does your household own? 3.20: How many of pigs does your household own? 3.20: How many of chicken does your household own? 3.20: How many of guinea fowl does your household own? 3.20: How many of ducks/geese does your household own? 3.20: How many of turkey does your household own? 3.20: How many of donkey/horse does your household own? 3.20: How many of cow does your household own? 3.20: How many of bull does your household own? 3.20: How many of calves does your household own? 3.20: How many of rabbits does your household own? 3.20: How many of OTHER (SPECIFY) does your household own? 9.08 : Does your household operate a non-farm microenterprise? 1 YES 2 NO 9.09 : LIST UP TO 3 BUSINESSES THAT THIS HH OPERATED DURING THE PAST 12 MONTHS ( 1 PETTY VENDING AT HOME 2 PETTY VENDING OR HAWKING OUTSIDE THE HOMW 3 SELLING KNITTED ITEMS 4 SELLING OWN SEWED CLOTHES 5 BAKING FRITTERS/SCONES/CAKES FOR SALE 6 BREWING LOCAL NON-ALCOHOLIC DRINKS 7 BREWING BEER OR OTHER ALCOHOLIC DRINKS 8 CARPENTRY 9 MAKING HANDCRAFTS 10 MAKING REEDMATS OR BASKETS FOR SALE 11 HAIRDRESSING 12 PIECEWORK 13 REPAIRING AND PAINTING HOUSES 96 OTHER (SPECIFY) 9.09 : LIST UP TO 3 BUSINESSES THAT THIS HH OPERATED DURING THE PAST 12 MONTHS ( 1 PETTY VENDING AT HOME 2 PETTY VENDING OR HAWKING OUTSIDE THE HOMW 3 SELLING KNITTED ITEMS 4 SELLING OWN SEWED CLOTHES 5 BAKING FRITTERS/SCONES/CAKES FOR SALE 6 BREWING LOCAL NON-ALCOHOLIC DRINKS 7 BREWING BEER OR OTHER ALCOHOLIC DRINKS 8 CARPENTRY 9 MAKING HANDCRAFTS 10 MAKING REEDMATS OR BASKETS FOR SALE 11 HAIRDRESSING 12 PIECEWORK 13 REPAIRING AND PAINTING HOUSES 96 OTHER (SPECIFY) 9.09 : LIST UP TO 3 BUSINESSES THAT THIS HH OPERATED DURING THE PAST 12 MONTHS ( 1 PETTY VENDING AT HOME 2 PETTY VENDING OR HAWKING OUTSIDE THE HOMW 3 SELLING KNITTED ITEMS 4 SELLING OWN SEWED CLOTHES 5 BAKING FRITTERS/SCONES/CAKES FOR SALE 6 BREWING LOCAL NON-ALCOHOLIC DRINKS 7 BREWING BEER OR OTHER ALCOHOLIC DRINKS 8 CARPENTRY 9 MAKING HANDCRAFTS 10 MAKING REEDMATS OR BASKETS FOR SALE 11 HAIRDRESSING 12 PIECEWORK 13 REPAIRING AND PAINTING HOUSES 96 OTHER (SPECIFY) 9.10 : What was the total expenditure on this business during the most recent mo 9.10 : What was the total expenditure on this business during the most recent mo 9.10 : What was the total expenditure on this business during the most recent mo 9.11A : What was the profit of this business in the last operating month? 9.11A : What was the profit of this business in the last operating month? 9.11A : What was the profit of this business in the last operating month? 9.11B : For how many months in the past 12 months did this enterprise operate? 9.11B : For how many months in the past 12 months did this enterprise operate? 9.11B : For how many months in the past 12 months did this enterprise operate? 9.12 : ASK THIS SECTION TO THE FARM ENTERPRISE OWNER (OR THE HH HEAD) 9.13 : Does your household own or rent land for farming? 1 YES 2 NO 9.14 : What is the total size of land available for farming owned by your househ 9.14 : What is the total size of land available for farming owned by your househ 1 LIMA 2 ACRE 3 HEACTARE 4 SQUARE METERS 9.15 : Did any member of your household grow any crops in the last agricultural 1 YES 2 NO 9.16 : What is the size of land cultivated by all household members in the last 1 LIMA 2 ACRE 3 HEACTARE 4 SQUARE METERS 9.16 : What is the size of land cultivated by all household members in the last 1 LIMA 2 ACRE 3 HEACTARE 4 SQUARE METERS 9.17A : What are the three most valuable crops that the household harvested? 1 LOCAL MAIZE 2 HYBRID MAIZE 3 CASSAVA 4 SORGHUM 5 MILLET 6 RICE 7 MIXED BEANS 8 SOYA BEANS 9 YAM 10 COCO YAM 11 SWEET POTATOES 12 IRISH POTATOES 13 GROUNDNUTS 14 COTTON 15 TOBACCO 16 SUNFLOWER 17 PAPRIKA 96 OTHER (SPECIFY) 9.17A : What are the three most valuable crops that the household harvested? 1 LOCAL MAIZE 2 HYBRID MAIZE 3 CASSAVA 4 SORGHUM 5 MILLET 6 RICE 7 MIXED BEANS 8 SOYA BEANS 9 YAM 10 COCO YAM 11 SWEET POTATOES 12 IRISH POTATOES 13 GROUNDNUTS 14 COTTON 15 TOBACCO 16 SUNFLOWER 17 PAPRIKA 96 OTHER (SPECIFY) 9.17A : What are the three most valuable crops that the household harvested? 1 LOCAL MAIZE 2 HYBRID MAIZE 3 CASSAVA 4 SORGHUM 5 MILLET 6 RICE 7 MIXED BEANS 8 SOYA BEANS 9 YAM 10 COCO YAM 11 SWEET POTATOES 12 IRISH POTATOES 13 GROUNDNUTS 14 COTTON 15 TOBACCO 16 SUNFLOWER 17 PAPRIKA 96 OTHER (SPECIFY) 9.17B : What is the size of the land cultivated for each of these crops?(Quantit 9.17B : What is the size of the land cultivated for each of these crops?(Quantit 9.17B : What is the size of the land cultivated for each of these crops?(Quantit 9.17B : What is the size of the land cultivated for each of these crops?(unit) 1 LIMA 2 ACRE 3 HECTARE 4 SQUARE METERS 9.17B : What is the size of the land cultivated for each of these crops?(unit) 1 LIMA 2 ACRE 3 HECTARE 4 SQUARE METERS 9.17B : What is the size of the land cultivated for each of these crops?(unit) 1 LIMA 2 ACRE 3 HECTARE 4 SQUARE METERS 9.17C : Is this a mono-cropped field? 1 YES 2 NO 9.17C : Is this a mono-cropped field? 1 YES 2 NO 9.17C : Is this a mono-cropped field? 1 YES 2 NO 9.18 : What is the quantity of ……. harvested during the last agricultural season 9.18 : What is the quantity of ……. harvested during the last agricultural season 9.18 : What is the quantity of ……. harvested during the last agricultural season 9.18 : What is the quantity of ……. harvested during the last agricultural season 1 KG 2 20 LTR TIN 3 25 KG BAG 4 50 KG BAG 5 90 KG BAG 6 KG-UNSHELLED 7 20 LTR TIN-UNSHELLED 8 25 KG BAG-UNSHELLED 9 50 KG BAG-UNSHELLED 10 90 KG BAG-UNSHELLED 9.18 : What is the quantity of ……. harvested during the last agricultural season 1 KG 2 20 LTR TIN 3 25 KG BAG 4 50 KG BAG 5 90 KG BAG 6 KG-UNSHELLED 7 20 LTR TIN-UNSHELLED 8 25 KG BAG-UNSHELLED 9 50 KG BAG-UNSHELLED 10 90 KG BAG-UNSHELLED 9.18 : What is the quantity of ……. harvested during the last agricultural season 1 KG 2 20 LTR TIN 3 25 KG BAG 4 50 KG BAG 5 90 KG BAG 6 KG-UNSHELLED 7 20 LTR TIN-UNSHELLED 8 25 KG BAG-UNSHELLED 9 50 KG BAG-UNSHELLED 10 90 KG BAG-UNSHELLED 9.19 : From the quantity harvested last agricultural season (October 1, 2011 - S 9.19 : From the quantity harvested last agricultural season (October 1, 2011 - S 9.19 : From the quantity harvested last agricultural season (October 1, 2011 - S 9.19 : From the quantity harvested last agricultural season (October 1, 2011 - S 1 KG 2 20 LTR TIN 3 25 KG BAG 4 50 KG BAG 5 90 KG BAG 6 KG-UNSHELLED 7 20 LTR-UNSHELLED 8 25 KG BAG-UNSHELLED 9 50 KG BAG-UNSHELLED 10 90 KG BAG-UNSHELLED 9.19 : From the quantity harvested last agricultural season (October 1, 2011 - S 1 KG 2 20 LTR TIN 3 25 KG BAG 4 50 KG BAG 5 90 KG BAG 6 KG-UNSHELLED 7 20 LTR-UNSHELLED 8 25 KG BAG-UNSHELLED 9 50 KG BAG-UNSHELLED 10 90 KG BAG-UNSHELLED 9.19 : From the quantity harvested last agricultural season (October 1, 2011 - S 1 KG 2 20 LTR TIN 3 25 KG BAG 4 50 KG BAG 5 90 KG BAG 6 KG-UNSHELLED 7 20 LTR-UNSHELLED 8 25 KG BAG-UNSHELLED 9 50 KG BAG-UNSHELLED 10 90 KG BAG-UNSHELLED 9.20 : What was the unit price of …… sold? 9.20 : What was the unit price of …… sold? 9.20 : What was the unit price of …… sold? 9.21 : What is the total value of [CROP(S)] sold from the last agricultural seas 9.21 : What is the total value of [CROP(S)] sold from the last agricultural seas 9.21 : What is the total value of [CROP(S)] sold from the last agricultural seas 9.21A : RECORD THE TOTAL FOR ALL IF MORE THAN 1 CROP 9.22A : Did any member of your household raise or own any livestock or poultry d 1 YES 2 NO 9.22B : How many …… were sold during the last 12 months (May 2011 - May 2012)? N 9.22B : How many …… were sold during the last 12 months (May 2011 - May 2012)? N 9.22B : How many …… were sold during the last 12 months (May 2011 - May 2012)? N 9.22B : How many …… were sold during the last 12 months (May 2011 - May 2012)? N 1 GOATS 2 SHEEP 3 PIGS 4 CHICKEN 5 GUINDEA FOWL 6 DUCKS/GEESE 7 TURKEY 8 DONKEY/HORSE 9 COW 10 HEIFER 11 BULL 12 UNTRAINED OXEN 13 TRAINED OXEN 14 CALVES 15 RABBITS 96 OTHER (SPECIFY) 9.22B : How many …… were sold during the last 12 months (May 2011 - May 2012)? N 1 GOATS 2 SHEEP 3 PIGS 4 CHICKEN 5 GUINDEA FOWL 6 DUCKS/GEESE 7 TURKEY 8 DONKEY/HORSE 9 COW 10 HEIFER 11 BULL 12 UNTRAINED OXEN 13 TRAINED OXEN 14 CALVES 15 RABBITS 96 OTHER (SPECIFY) 9.22B : How many …… were sold during the last 12 months (May 2011 - May 2012)? N 1 GOATS 2 SHEEP 3 PIGS 4 CHICKEN 5 GUINDEA FOWL 6 DUCKS/GEESE 7 TURKEY 8 DONKEY/HORSE 9 COW 10 HEIFER 11 BULL 12 UNTRAINED OXEN 13 TRAINED OXEN 14 CALVES 15 RABBITS 96 OTHER (SPECIFY) 9.23 : What is the price of ……. per unit sold? 9.23 : What is the price of ……. per unit sold? 9.23 : What is the price of ……. per unit sold? 9.24 : What is the total value of [LIVESTOCK] sold during the past 12 months (Ma 9.24 : What is the total value of [LIVESTOCK] sold during the past 12 months (Ma 9.24 : What is the total value of [LIVESTOCK] sold during the past 12 months (Ma 9.25 : RECORD THE TOTAL FOR ALL IF MORE THAN 1 KIND 10.01: How much did your household receive from interest or investment income in 10.01: How much did your household receive from renting building/land to others 10.01: How much did your household receive from renting equipment/vehicles/machi 10.01: How much did your household receive from renting animals in the past 12 m 10.01: How much did your household receive from workman's compensation in the pa 10.01: How much did your household receive from other government transfer in the 10.01: How much did your household receive from scholarship for study or trainin 10.01: How much did your household receive from assistance from community groups 10.01: How much did your household receive from remittances/gifts within Nigeria 10.01: How much did your household receive from remittances/gifts outside Nigeri 10.01: How much did your household receive from inheritance in the past 12 month 10.01: How much did your household receive from other (specify) in the past 12 m 11.01 : Did your household consume Gari In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Beans In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Cassava In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Rice In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Fish In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Meat In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Chicken In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Cooking oil In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Milk In the last 2 weeks? 1 YES 2 NO 11.01 : Did your household consume Yam In the last 2 weeks? 1 YES 2 NO 11.02 What is the total value of the purchased Gari in the last 2 weeks? 11.02 What is the total value of the purchased Beans in the last 2 weeks? 11.02 What is the total value of the purchased Cassava in the last 2 weeks? 11.02 What is the total value of the purchased Rice in the last 2 weeks? 11.02 What is the total value of the purchased Fish in the last 2 weeks? 11.02 What is the total value of the purchased Meat in the last 2 weeks? 11.02 What is the total value of the purchased Chicken in the last 2 weeks? 11.02 What is the total value of the purchased Cooking oil in the last 2 weeks? 11.02 What is the total value of the purchased Milk in the last 2 weeks? 11.02 What is the total value of the purchased Yam in the last 2 weeks? 11.03 What is the total value of home produced or gifted Gari in the last 2 week 11.03 What is the total value of home produced or gifted Beans in the last 2 wee 11.03 What is the total value of home produced or gifted Cassava in the last 2 w 11.03 What is the total value of home produced or gifted Rice in the last 2 week 11.03 What is the total value of home produced or gifted Fish in the last 2 week 11.03 What is the total value of home produced or gifted Meat in the last 2 week 11.03 What is the total value of home produced or gifted Chicken in the last 2 w 11.03 What is the total value of home produced or gifted Cooking oil in the last 11.03 What is the total value of home produced or gifted Milk in the last 2 week 11.03 What is the total value of home produced or gifted Yam in the last 2 week 11.04 Has your household paid for or received public transport to work for free 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received public transport to school for fre 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received public transport to HF for free du 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received other public transport for free du 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received health consultation for free durin 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received lab fees for free during the past 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received medicines for free during the past 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received hospitalization for free during th 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.04 Has your household paid for or received other health-related expenditure f 1 PURCHASED/PAID FOR 2 GIFT 3 FORGONE PAYMENT 4 NO 11.05 : How much did your household spend on public transport to work in the pas 11.05 : How much did your household spend on public transport to school in the p 11.05 : How much did your household spend on public transport to HF in the past 11.05 : How much did your household spend on other public transport in the past 11.05 : How much did your household spend on health consultation in the past 30 11.05 : How much did your household spend on lab fees in the past 30 days? 11.05 : How much did your household spend on medicines in the past 30 days? 11.05 : How much did your household spend on hospitalization in the past 30 days 11.05 : How much did your household spend on other health-related expenditure in STATE NAME STATE CODE SENATORIAL DISTRICT LGA NAME LGA CODE WARD NAME TREATMENT PRIMARY HEALTH FACILITY NAME PRIMARY HEALTH FACILITY ID PRIMARY HEALTH FACILITY TYPE COMMUNITY NAME LGA Household ID Household member ID 12.01 : INTERVIEWER 12.02 : GENDER 1 MALE 2 FEMALE 12.03 : COPY AGE FROM (1.04) 12.04 : Circle ID of All Female Household Members 15-49 years old 12.05 : Circle ID of All Women with Children 0-5 years old 12.06 : Circle ID of All Children under 5 years old 12.07 : READ CONSENT FORM TO ALL ELIGIBLE WOMEN AND MOTHERS/ADULTS RESPONSIBLE F 12.08 : RECORD THE RESPONSE TO THE BIOMEDICAL CONSENT FORM FOR ALL ELIGIBLE RESP 1 MEASURED 2 NOT PRESENT, SCHOOL 3 NOT PRESENT, WORK 4 NOT PRESENT, HEALTH POST 5 TOO ILL OR DISABLED 6 REFISED 96 OTHER (SPECIFY) 12.09 : RECORD HEIGHT IN CENTIMETERS 12.10 : RECORD METHOD FOR MEASURING HEIGHT 12.11 : RECORD WEIGHT IN KILOGRAMS 12.12 : RECORD PID OF MEMBER, FOR CHILDREN <5 YEARS, RECORD PID OF MOTHER OR PRI 12.13 : Why did you not agree to have the tests done? 1 RESULTS UNRELIABLE 2 CONCERN FOR BODILY HARM 3 RELIGIOUS BELIEFS 4 TRADITIONAL BELIEFS 5 TOO ILL OR DISABLED 96 OTHER (SPECIFY) 12.14 : RECORD HEMOGLOBIN LEVEL (g/dl) 12.15 : Is the level recorded below the cut-off point for age and altitude? 1 YES 2 NO 12.16 : Do you agree that the information about the level of hemoglobin in the b 1 YES 2 NO 12.17 : RDT TEST RESULT 1 GE+ 2 GE- 12.18 : INTERVIEWER: DOES [NAME] HAVE A FEVER? 1 YES 2 NO 12.19 : Do you agree that the information about the presence of malaria parasite PRIMARY HEALTH FACILITY NAME OF STATE NAME OF LGA 1 AKKO 2 BALANGA 3 BILLIRI 4 DUKKU 5 FUNAKAYE 6 GOMBE 7 KALTUNGO 8 KWAMI 9 NAFADA 10 SHONGOM 11 YAMALTU/DEBA NAME OF WARD 101 AKKO 102 GARKO 103 KALSHINGI 104 KASHERE 105 KUMO CENTRAL 106 KUMO EAST 107 KUMO NORTH 108 KUMO WEST 109 PINDIGA 110 TUMU 111 TUKULMA 201 BAMBAM 203 DADIYA 204 GELENGU/BALANGA 205 KINDIYO 206 KULANI/DEGRI/SIKKAM 207 MWONA 208 NYUWAR/JESSU 209 SWA/REF/GASI/W.WAJA 210 TALASEE/DONG/REME 301 BANGANJE NORTH 303 BARE 304 305 306 KALMAI 307 TAL 308 TANGLANG 309 TODI 310 401 GOMBE ABBA 402 HASHIDU 403 JAMARI 404 KUNDE 406 MALALA 407 WAZIRI NORTH 408 409 WURO TALE 410 ZANGE 411 ZAUNE 501 ASHAKA/MAGABA 502 BAGE 503 BAJOGA 504 BAJOGA 505 BODOR/TILDE 506 JILLAHI 507 kupto 508 RIBADU 509 TONGO 510 WAWA/WAKKALTU 603 604 605 DAWAKI 606 HERWA GANA 608 KUMBIYA KUMBIYA 609 NASARAWA 610 PANTAMI 611 SHAMAKI 701 AWAK 702 BULE/KALTIN 703 KALTUNGO WEST 704 KALTUNGO EAST 705 KAMO 707 TULA WANGE 708 TULA YIRI 709 TUNGO 710 TURE 801 BOJUDE 802 DABA FULANI 803 DOHO 804 DUKUL 805 GADAM 806 JURARA 807 KOMFULATA 808 KWAMI 809 MALAM-SIDI 810 MALLERI 901 BARWO NASARAWA 902 BARWO WINDE 903 BIRIN BOLEWA 904 BIRIN FULANI EAST 905 BIRIN FULANI WEST 906 GUDUKKU 907 JIGAWA 908 NAFADA CENTRAL 909 NAFADA EAST 910 NAFADA WEST 1001 BANGUNJI 1002 BOH 1003 BURAK 1004 FILIYA 1006 GWANDUM 1007 KULISHIM 1008 KUSHI 1009 LALIPIDO 1010 LAPAN 1101 DEBA 1102 DIFA/LUBO/KINAFA 1103 GWANI/SHINGA/WADE 1104 HINNA 1105 JAGALI NORTH 1106 JAGALI SOUTH 1107 KANAWA/WAJARI 1108 KURI/LANO/LAMBAM 1109 KWADON/LIJI/KURBA 1110 NONO/KUNUWA/W.BIRDEKA 1111 ZAMBUK/KWALI NAME OF PRIMARY HEATHCARE FACILITY SEA NUMBER TOWN TYPE 1 RURAL 2 PERI-URBAN 3 URBAN NAME OF VILLAGE INTERVIEWER NAME Date of the 1ST Interviewer Day Month Year INTERVIEWER NAME Date of the 2ND Interviewer Day Month Year 0.01 Are you in charge of this facility today 1 YES 2 NO 0.02 Are you authourized to represent the facility? 1 YES 2 NO 0.03 Do you agree to participate in the interview? 1 YES 2 NO 0.04 What is your role / position in this health facility 1 DIRECTOR OR VICE DIRECTOR 2 HEAD OF HEALTH FACILITY 3 MEDICAL DIRECTOR 4 OTHER DOCTOR 5 ADMINISRATION 6 NURSE 96 OTHER (SPECIFY) 0.05 GENDER OF RESPONDENT 1 MALE 2 FEMALE Language spoken by respondent during interview 1 ENGLISH 2 BOLEWA 3 FULFULDU 4 HAUSA 5 IGBO 6 KANURI 7 TANGALE 8 TERA 96 OTHER (SPECIFY) 98 DEFAULT 99 MISSING Respondent Local Language Mother Tongue 1 ENGLISH 2 YOURUBA 3 IGBO 4 HAUSA Translated Used Supervisor Name Date of the Supervisor Day Month Year Data Entry Operator Data Entry Operator (Date) Day Month Year Data Entry Supervisor Data Entry Supervisor (Date) Day Month Year LGA 1.01 : TYPE OF HEALTH FACILITY 1 HEALTH POST 2 HEALTH CLINIC 3 PRIMARY HEALTH CARE CENTER 96 OTHER (SPECIFY) 1.02 : What authority manages the facility? 1 STATE GOVERNMENT 2 LOCAL GOVERNMENT 96 OTHER (SPECIFY) 1.03 : Is this funded through the MDG-DRG? 1 YES 2 NO 1.05 : When (month and year) was the last major renovation of the physical struc Month Year 1.07 : Is 24 hour emergency service available at this facility? 1 YES 2 NO 1.10 : What was the total income for 2011? 1.12 : What was the total expenditure of this health facility in 2011? 1.13 : NOTE THE SOURCE OF THE EXPENDITURE DATA 1 OFFICIAL ACCOUNTS 2 FACILITY RECORDS 3 ORAL REPORT 96 OTHER (SPECIFY) 1.14 : Is there a reception / registration room? 1 YES 2 NO 1.15 : Is there an indoor waiting area for patients? 1 YES 2 NO 1.16 : Is there a serapate waiting room for women in the facility? 1 YES 2 NO 1.17 : Is their air conditioning in patient areas? 1 YES 2 NO 1.18 : Are there any observation beds? 1 YES 2 NO 1.19 : How many beds are available? 1.20 : Are accommodations for persons on-call present? 1 YES 2 NO 1.21 : For how many hours per day does the facility normally have electricity? 1.22 : What is the main source of energy for lighting (i.e. which do you use the 1 ELECTRICITY FROM GRID (NEPA / PHCN) 2 ELECTRICITY FROM GENERATOR 3 KEROSINE / PARAFFIN / GAS / OIL LAMP 4 CANDLES 5 OPEN FIRE 6 TOUCH 7 SOLAR PANEL 96 OTHER (SPECIFY) 1.25 : Last week, was this water source available for all working hours? 1 YES 2 NO 1.26 : Last week, how many hours was the water source available? 1.27 : What is the primary source for a telephone? 1 IN-FACILITY LANDLINE 2 IN-FACILITY MOBILE 3 ONE OR TWO-WAY RADIO 4 OUTSIDE FACILITY 1.28 : How long, in hours and minutes, does it take to reach the primary telepho Hours Minutes 1.29 : Last week, how many hours was the water source available? 1.30 : Does this facility refer patients to other facilities? 1 YES 2 NO 1.301 : How far, in kilometers, is the referral facility / hospital from this fa 1.32 : How long, in hours and minutes, does it take to travel from this health f Hours Minites 1.33 : Does the facility have access to transportation (to pick up patients or t 1 YES 2 NO 1.35 : Last week, how many hours was the transportation available? 1.36 : Does the facility have access to a functioning computer? 1 YES 2 NO 2.01 : How many health facility staff meetings were held in the past 12 months? 2.02 : Has a facility workplan been developed for this year? 1 YES, SEEN 2 YES, NOT SEEN 3 NO 2.04 : Are priority activities identified for 2010? 1 YES 2 NO 2.06 : Is there a written emergency preparedness plan? 1 YES 2 NO 2.07 : How long ago was the emergency preparedness plan last updated? 1 WITHIN LAST 6 MONTHS 2 WITHIN LAST YEAR 3 MORE THAN A YEAR AGO 2.08 : Is there a community group, such as a ward or village development council 1 YES 2 NO 2.10 : Were recommendations written in a supervision book from last supervision? 1 YES, SEEN 2 YES, NOT SEEN 3 NO 2.11 : Is there a community group, such as a ward or village development council 1 YES 2 NO 2.13 : Were recommendations written in a supervision book from last supervision? 1 YES, SEEN 2 YES, NOT SEEN 3 NO 2.15 : Were recommendations written in a supervision book from last supervision? 1 YES, SEEN 2 YES, NOT SEEN 3 NO 2.16 : In the past 6 months, how many supervision visits were made by an LGA rep 2.17 : Were recommendations written in a supervision book from last supervision? 1 YES, SEEN 2 YES, NOT SEEN 3 NO 2.18 : In the past 6 months, how many times did employees of this health facilit 2.19 : In the last 6 months, how many times was staff performance at this facili 2.20 : In the last 6 months, how many times was staff performance at this facili 2.21 : Is patient opinion obtained through client surveys or other methods? 1 YES 2 NO 2.22 : Is patient opinion reviewed / reported to staff? 1 YES 2 NO 2.23 : In the last 12 months, have any changes occurred as a result of patient o 1 YES 2 NO 2.24 : Is there an annual budget for the health facility in the form of a writte 1 YES, SEEN 2 YES, NOT SEEN 3 NO 3.01 : Do all facility workers have written job descriptions? 1 ALL HAVE DESCRIPTIONS 2 SOME HAVE DESCRIPTIONS 3 NONE HAVE DESCRIPTIONS 3.06 : for clinical officers, how many positions are possible? 3.06 : for doctors, how many positions are possible? 3.06 : for midwives, how many positions are possible? 3.06 : for nurses, how many positions are possible? 3.06 : for environmental health officers, how many positions are possible? 3.06 : for pharmacist and pharmacy technicans, how many positions are possible? 3.06 : for lab tecnicians, how many positions are possible? 3.06 : for junior CHEWS, how many positions are possible? 3.06 : for senior CHEWS, how many positions are possible? 3.06 : for administrative staff, how many positions are possible? 3.06 : for data manager, how many positions are possible? 3.06 : for other staff, how many positions are possible? 3.07 : for clinical officers, how many positions are filled? 3.07 : for doctors, how many positions are filled? 3.07 : for midwives, how many positions are filled? 3.07 : for nurses, how many positions are filled? 3.07 : for environmental health officers, how many positions are filled? 3.07 : for pharmacist and pharmacy technicans, how many positions are filled? 3.07 : for lab tecnicians, how many positions are filled? 3.07 : for junior CHEWS, how many positions are filled? 3.07 : for senior CHEWS, how many positions are filled? 3.07 : for administrative staff, how many positions are filled? 3.07 : for data manager, how many positions are filled? 3.07 : for other staff, how many positions are filled? 3.08 : for clinical officers, how many positions are vacant? 3.08 : for doctors, how many positions are vacant? 3.08 : for midwives, how many positions are vacant? 3.08 : for nurses, how many positions are vacant? 3.08 : for environmental health officers, how many positions are vacant? 3.08 : for pharmacist and pharmacy technicans, how many positions are vacant? 3.08 : for lab tecnicians, how many positions are vacant? 3.08 : for junior CHEWS, how many positions are vacant? 3.08 : for senior CHEWS, how many positions are vacant? 3.08 : for administrative staff, how many positions are vacant? 3.08 : for data manager, how many positions are vacant? 3.08 : for other staff, how many positions are vacant? 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.09 : In the past 12 months, how many facility- based staff have received train 3.10 : In the past 12 months, how many CHWs and CDDs have received training in p 3.10 : In the past 12 months, how many CHWs and CDDs have received training in i 3.10 : In the past 12 months, how many CHWs and CDDs have received training in p 3.10 : In the past 12 months, how many CHWs and CDDs have received training in i 3.10 : In the past 12 months, how many CHWs and CDDs have received training in n 3.10 : In the past 12 months, how many CHWs and CDDs have received training in I 3.10 : In the past 12 months, how many CHWs and CDDs have received training in m 3.10 : In the past 12 months, how many CHWs and CDDs have received training in T 3.10 : In the past 12 months, how many CHWs and CDDs have received training in H 3.10 : In the past 12 months, how many CHWs and CDDs have received training in d 3.10 : In the past 12 months, how many CHWs and CDDs have received training in q 3.10 : In the past 12 months, how many CHWs and CDDs have received training in o 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.11 : NAME OF HEALTH WORKER. 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.12 : Is [NAME] male or female? 1 MALE 2 FEMALE 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.13 : How old is [NAME]? 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.14 : What is [NAME]'s position in this facility? 1 CLINICAL OFFICER 2 DOCTOR 3 MIDWIFE 4 NURSE 5 ENVIRONMENTAL HEALTH OFFICER 6 PHARMACIST / PHARMACY TECH. 7 LAB TECHNICIAN 8 JUNIOR CHEW 9 SENIOR CHEW 10 ADMINISTRATIVE STAFF 11 DATA MANAGER 12 OTHER STAFF 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.15 : What year did [NAME] receive his / her medical degree? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.16 : How many years has [NAME] worked at this facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.17 : How many days per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.18 : How many hours per week does [NAME] usually work at this health facility? 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.19 : How many hours per week does [NAME] usually spend providing medical care 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.20 : Does [NAME] provide prenatal care directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.21 : Does [NAME] provide curative care for children directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 3.22 : Does [NAME] provide curative care for adults directly? 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.24 : Is [NAME] here today? 1 YES 2 NO 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.25 : What service is [NAME] providing today? 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 3.26 : Why is [NAME] not here today? 1 OFF DUTY / OFF HOURS 2 ON LEAVE 3 SICK 4 FAMILY MEMBER SICK 5 OTHER AUTHORIZED ABSENCE 6 UNAUTHORIZED ABSENCE 7 LATE 8 OTHER (SPECIFY) 4.01 : Is there a laboratory in this health facility? 1 YES 2 NO 5.01 : Is there a malaria register to record details of patients with malaria or 1 YES, SEEN 2 YES, NOT SEEN 3 NO 5.03 : What is the population of the catchment area of this health facility? 6.01 : How many community health workers (CHWs) are supported by this facility? 6.01 : How many community-directed distributors (CDDs) are supported by this fac 6.02 : How many community health workers (CHWs) are currently active in this are 6.02 : How many community-directed distributors (CDDs) are currently active in t 6.03 : On average, how often do CHWs visit this facility for instruction, meetin 1 DAILY 2 WEEKLY 3 EVERY 2 WEEKS 4 MONTHLY 5 LESS THAN ONCE A MONTH 6.03 : On average, how often do CDDs visit this facility for instruction, meetin 1 DAILY 2 WEEKLY 3 EVERY 2 WEEKS 4 MONTHLY 5 LESS THAN ONCE A MONTH 7.01 : BCG (In-facility) 1 YES 2 NO 7.01 : DPT (In-facility) 1 YES 2 NO 7.01 : Polio (In-facility) 1 YES 2 NO 7.01 : Measles (In-facility) 1 YES 2 NO 7.01 : Tetanus Toxid (In-facility) 1 YES 2 NO 7.01 : Curative care for children (In-facility) 1 YES 2 NO 7.01 : Curative are for adults (In-facility) 1 YES 2 NO 7.01 : Child growth monitoring (In-facility) 1 YES 2 NO 7.01 : Nutritional advice for children (In-facility) 1 YES 2 NO 7.01 : Prenatal care (In-facility) 1 YES 2 NO 7.01 : Normal (In-facility) 1 YES 2 NO 7.01 : Ceasanian (In-facility) 1 YES 2 NO 7.01 : Assisted (In-facility) 1 YES 2 NO 7.01 : Home delivery with skilled staff (In-facility) 1 YES 2 NO 7.01 : Blood transfusion (In-facility) 1 YES 2 NO 7.01 : Pill (In-facility) 7.01 : Injection (In-facility) 7.01 : Impatient insertion (In-facility) 7.01 : Male condomes (In-facility) 7.01 : IUD insertion (In-facility) 7.01 : Female sterilization (In-facility) 7.01 : Male sterilization (In-facility) 7.01 : Tuberculosis diagnosis (In-facility) 7.01 : Tuberculosis treatment (In-facility) 7.01 : Malaria microscopy (In-facility) 7.01 : Malaria RDT (In-facility) 7.01 : Malaria ACT (In-facility) 7.01 : Other anti-malarial (In-facility) 7.01 : Malaria IPT (In-facility) 7.01 : Treatment for complicated malaria (In-facility) 7.01 : STI services (In-facility) 7.01 : HIV/AIDS VCT (In-facility) 7.01 : HIV/AIDS PMTCT (In-facility) 7.01 : HIV/AIDS ART (In-facility) 7.01 : 24 emergency care (In-facility) 7.01 : Inpatient stay (In-facility) 7.01 : Referral to another facility (In-facility) 7.01 : BCG (Outreach) 1 YES 2 NO 7.01 : DPT (Outreach) 1 YES 2 NO 7.01 : Polio (Outreach) 1 YES 2 NO 7.01 : Measles (Outreach) 1 YES 2 NO 7.01 : Tetanus Toxid (Outreach) 1 YES 2 NO 7.01 : Curative care for children (Outreach) 1 YES 2 NO 7.01 : Curative are for adults (Outreach) 1 YES 2 NO 7.01 : Child growth monitoring (Outreach) 1 YES 2 NO 7.01 : Nutritional advice for children (Outreach) 1 YES 2 NO 7.01 : Prenatal care (Outreach) 1 YES 2 NO 7.01 : Normal (Outreach) 1 YES 2 NO 7.01 : Ceasanian (Outreach) 1 YES 2 NO 7.01 : Assisted (Outreach) 1 YES 2 NO 7.01 : Home delivery with skilled staff (Outreach) 1 YES 2 NO 7.01 : Blood transfusion (Outreach) 1 YES 2 NO 7.01 : Pill (Outreach) 7.01 : Injection (Outreach) 7.01 : Impatient insertion (Outreach) 7.01 : Male condomes (Outreach) 7.01 : IUD insertion (Outreach) 7.01 : Female sterilization (Outreach) 7.01 : Male sterilization (Outreach) 7.01 : Tuberculosis diagnosis (Outreach) 7.01 : Tuberculosis treatment (Outreach) 7.01 : Malaria microscopy (Outreach) 7.01 : Malaria RDT (Outreach) 7.01 : Malaria ACT (Outreach) 7.01 : Other anti-malarial (Outreach) 7.01 : Malaria IPT (Outreach) 7.01 : Treatment for complicated malaria (Outreach) 7.01 : STI services (Outreach) 7.01 : HIV/AIDS VCT (Outreach) 7.01 : HIV/AIDS PMTCT (Outreach) 7.01 : HIV/AIDS ART (Outreach) 7.01 : 24 emergency care (Outreach) 7.01 : Inpatient stay (Outreach) 7.01 : Referral to another facility (Outreach) 7.02 : BCG (DAYS/WEEK) 7.02 : DPT (DAYS/WEEK) 7.02 : Polio (DAYS/WEEK) 7.02 : Measles (DAYS/WEEK) 7.02 : Tetanus Toxid (DAYS/WEEK) 7.02 : Curative care for children (DAYS/WEEK) 7.02 : Curative are for adults (DAYS/WEEK) 7.02 : Child growth monitoring (DAYS/WEEK) 7.02 : Nutritional advice for children (DAYS/WEEK) 7.02 : Prenatal care (DAYS/WEEK) 7.02 : Normal (DAYS/WEEK) 7.02 : Ceasanian (DAYS/WEEK) 7.02 : Assisted (DAYS/WEEK) 7.02 : Home delivery with skilled staff (DAYS/WEEK) 7.02 : Blood transfusion (DAYS/WEEK) 7.02 : Pill (DAYS/WEEK) 7.02 : Injection (DAYS/WEEK) 7.02 : Impatient insertion (DAYS/WEEK) 7.02 : Male condomes (DAYS/WEEK) 7.02 : IUD insertion (DAYS/WEEK) 7.02 : Female sterilization (DAYS/WEEK) 7.02 : Male sterilization (DAYS/WEEK) 7.02 : Tuberculosis diagnosis (DAYS/WEEK) 7.02 : Tuberculosis treatment (DAYS/WEEK) 7.02 : Malaria microscopy (DAYS/WEEK) 7.02 : Malaria RDT (DAYS/WEEK) 7.02 : Malaria ACT (DAYS/WEEK) 7.02 : Other anti-malarial (DAYS/WEEK) 7.02 : Malaria IPT (DAYS/WEEK) 7.02 : Treatment for complicated malaria (DAYS/WEEK) 7.02 : STI services (DAYS/WEEK) 7.02 : HIV/AIDS VCT (DAYS/WEEK) 7.02 : HIV/AIDS PMTCT (DAYS/WEEK) 7.02 : HIV/AIDS ART (DAYS/WEEK) 7.02 : 24 emergency care (DAYS/WEEK) 7.02 : Inpatient stay (DAYS/WEEK) 7.02 : Referral to another facility (DAYS/WEEK) 7.03 : BCG (PRICE IN NAIRA) 7.03 : DPT (PRICE IN NAIRA) 7.03 : Polio (PRICE IN NAIRA) 7.03 : Measles (PRICE IN NAIRA) 7.03 : Tetanus Toxid (PRICE IN NAIRA) 7.03 : Curative care for children (PRICE IN NAIRA) 7.03 : Curative are for adults (PRICE IN NAIRA) 7.03 : Child growth monitoring (PRICE IN NAIRA) 7.03 : Nutritional advice for children (PRICE IN NAIRA) 7.03 : Prenatal care (PRICE IN NAIRA) 7.03 : Normal (PRICE IN NAIRA) 7.03 : Ceasanian (PRICE IN NAIRA) 7.03 : Assisted (PRICE IN NAIRA) 7.03 : Home delivery with skilled staff (PRICE IN NAIRA) 7.03 : Blood transfusion (PRICE IN NAIRA) 7.03 : Pill (PRICE IN NAIRA) 7.03 : Injection (PRICE IN NAIRA) 7.03 : Impatient insertion (PRICE IN NAIRA) 7.03 : Male condomes (PRICE IN NAIRA) 7.03 : IUD insertion (PRICE IN NAIRA) 7.03 : Female sterilization (PRICE IN NAIRA) 7.03 : Male sterilization (PRICE IN NAIRA) 7.03 : Tuberculosis diagnosis (PRICE IN NAIRA) 7.03 : Tuberculosis treatment (PRICE IN NAIRA) 7.03 : Malaria microscopy (PRICE IN NAIRA) 7.03 : Malaria RDT (PRICE IN NAIRA) 7.03 : Malaria ACT (PRICE IN NAIRA) 7.03 : Other anti-malarial (PRICE IN NAIRA) 7.03 : Malaria IPT (PRICE IN NAIRA) 7.03 : Treatment for complicated malaria (PRICE IN NAIRA) 7.03 : STI services (PRICE IN NAIRA) 7.03 : HIV/AIDS VCT (PRICE IN NAIRA) 7.03 : HIV/AIDS PMTCT (PRICE IN NAIRA) 7.03 : HIV/AIDS ART (PRICE IN NAIRA) 7.03 : 24 emergency care (PRICE IN NAIRA) 7.03 : Inpatient stay (PRICE IN NAIRA) 7.03 : Referral to another facility (PRICE IN NAIRA) 7.04 : Month 1 - In PHFM1IN_02 PHFM1IN_03 PHFM1IN_04 PHFM1IN_05 PHFM1IN_06 PHFM1IN_07 PHFM1IN_08 PHFM1IN_09 PHFM1IN_10 PHFM1IN_11 PHFM1IN_12 PHFM1IN_13 PHFM1IN_14 PHFM1IN_15 PHFM1IN_16 PHFM1IN_17 PHFM1IN_18 PHFM1IN_19 PHFM1IN_20 PHFM1IN_21 PHFM1IN_22 PHFM1IN_23 PHFM1IN_24 PHFM1IN_25 PHFM1IN_26 PHFM1IN_27 PHFM1IN_28 PHFM1IN_29 PHFM1IN_30 PHFM1IN_31 PHFM1IN_32 PHFM1IN_33 PHFM1IN_34 PHFM1IN_35 PHFM1IN_36 PHFM1IN_37 7.04 : Month 1 - Out PHFM1OUT_02 PHFM1OUT_03 PHFM1OUT_04 PHFM1OUT_05 PHFM1OUT_06 PHFM1OUT_07 PHFM1OUT_08 PHFM1OUT_09 PHFM1OUT_10 PHFM1OUT_11 PHFM1OUT_12 PHFM1OUT_13 PHFM1OUT_14 PHFM1OUT_15 PHFM1OUT_16 PHFM1OUT_17 PHFM1OUT_18 PHFM1OUT_19 PHFM1OUT_20 PHFM1OUT_21 PHFM1OUT_22 PHFM1OUT_23 PHFM1OUT_24 PHFM1OUT_25 PHFM1OUT_26 PHFM1OUT_27 PHFM1OUT_28 PHFM1OUT_29 PHFM1OUT_30 PHFM1OUT_31 PHFM1OUT_32 PHFM1OUT_33 PHFM1OUT_34 PHFM1OUT_35 PHFM1OUT_36 PHFM1OUT_37 7.04 : Month 2 - In PHFM1IO_02 PHFM1IO_03 PHFM1IO_04 PHFM1IO_05 PHFM1IO_06 PHFM1IO_07 PHFM1IO_08 PHFM1IO_09 PHFM1IO_10 PHFM1IO_11 PHFM1IO_12 PHFM1IO_13 PHFM1IO_14 PHFM1IO_15 PHFM1IO_16 PHFM1IO_17 PHFM1IO_18 PHFM1IO_19 PHFM1IO_20 PHFM1IO_21 PHFM1IO_22 PHFM1IO_23 PHFM1IO_24 PHFM1IO_25 PHFM1IO_26 PHFM1IO_27 PHFM1IO_28 PHFM1IO_29 PHFM1IO_30 PHFM1IO_31 PHFM1IO_32 PHFM1IO_33 PHFM1IO_34 PHFM1IO_35 PHFM1IO_36 PHFM1IO_37 7.04 : Month 2 - Out PHFM1OUU_02 PHFM1OUU_03 PHFM1OUU_04 PHFM1OUU_05 PHFM1OUU_06 PHFM1OUU_07 PHFM1OUU_08 PHFM1OUU_09 PHFM1OUU_10 PHFM1OUU_11 PHFM1OUU_12 PHFM1OUU_13 PHFM1OUU_14 PHFM1OUU_15 PHFM1OUU_16 PHFM1OUU_17 PHFM1OUU_18 PHFM1OUU_19 PHFM1OUU_20 PHFM1OUU_21 PHFM1OUU_22 PHFM1OUU_23 PHFM1OUU_24 PHFM1OUU_25 PHFM1OUU_26 PHFM1OUU_27 PHFM1OUU_28 PHFM1OUU_29 PHFM1OUU_30 PHFM1OUU_31 PHFM1OUU_32 PHFM1OUU_33 PHFM1OUU_34 PHFM1OUU_35 PHFM1OUU_36 PHFM1OUU_37 7.04 : Month 3 - In PHFM1IP_02 PHFM1IP_03 PHFM1IP_04 PHFM1IP_05 PHFM1IP_06 PHFM1IP_07 PHFM1IP_08 PHFM1IP_09 PHFM1IP_10 PHFM1IP_11 PHFM1IP_12 PHFM1IP_13 PHFM1IP_14 PHFM1IP_15 PHFM1IP_16 PHFM1IP_17 PHFM1IP_18 PHFM1IP_19 PHFM1IP_20 PHFM1IP_21 PHFM1IP_22 PHFM1IP_23 PHFM1IP_24 PHFM1IP_25 PHFM1IP_26 PHFM1IP_27 PHFM1IP_28 PHFM1IP_29 PHFM1IP_30 PHFM1IP_31 PHFM1IP_32 PHFM1IP_33 PHFM1IP_34 PHFM1IP_35 PHFM1IP_36 PHFM1IP_37 7.04 : Month 3 - Out PHFM1OUV_02 PHFM1OUV_03 PHFM1OUV_04 PHFM1OUV_05 PHFM1OUV_06 PHFM1OUV_07 PHFM1OUV_08 PHFM1OUV_09 PHFM1OUV_10 PHFM1OUV_11 PHFM1OUV_12 PHFM1OUV_13 PHFM1OUV_14 PHFM1OUV_15 PHFM1OUV_16 PHFM1OUV_17 PHFM1OUV_18 PHFM1OUV_19 PHFM1OUV_20 PHFM1OUV_21 PHFM1OUV_22 PHFM1OUV_23 PHFM1OUV_24 PHFM1OUV_25 PHFM1OUV_26 PHFM1OUV_27 PHFM1OUV_28 PHFM1OUV_29 PHFM1OUV_30 PHFM1OUV_31 PHFM1OUV_32 PHFM1OUV_33 PHFM1OUV_34 PHFM1OUV_35 PHFM1OUV_36 PHFM1OUV_37 7.04 : Month 4 - In PHFM1IQ_02 PHFM1IQ_03 PHFM1IQ_04 PHFM1IQ_05 PHFM1IQ_06 PHFM1IQ_07 PHFM1IQ_08 PHFM1IQ_09 PHFM1IQ_10 PHFM1IQ_11 PHFM1IQ_12 PHFM1IQ_13 PHFM1IQ_14 PHFM1IQ_15 PHFM1IQ_16 PHFM1IQ_17 PHFM1IQ_18 PHFM1IQ_19 PHFM1IQ_20 PHFM1IQ_21 PHFM1IQ_22 PHFM1IQ_23 PHFM1IQ_24 PHFM1IQ_25 PHFM1IQ_26 PHFM1IQ_27 PHFM1IQ_28 PHFM1IQ_29 PHFM1IQ_30 PHFM1IQ_31 PHFM1IQ_32 PHFM1IQ_33 PHFM1IQ_34 PHFM1IQ_35 PHFM1IQ_36 PHFM1IQ_37 7.04 : Month 4 - Out PHFM1OUW_02 PHFM1OUW_03 PHFM1OUW_04 PHFM1OUW_05 PHFM1OUW_06 PHFM1OUW_07 PHFM1OUW_08 PHFM1OUW_09 PHFM1OUW_10 PHFM1OUW_11 PHFM1OUW_12 PHFM1OUW_13 PHFM1OUW_14 PHFM1OUW_15 PHFM1OUW_16 PHFM1OUW_17 PHFM1OUW_18 PHFM1OUW_19 PHFM1OUW_20 PHFM1OUW_21 PHFM1OUW_22 PHFM1OUW_23 PHFM1OUW_24 PHFM1OUW_25 PHFM1OUW_26 PHFM1OUW_27 PHFM1OUW_28 PHFM1OUW_29 PHFM1OUW_30 PHFM1OUW_31 PHFM1OUW_32 PHFM1OUW_33 PHFM1OUW_34 PHFM1OUW_35 PHFM1OUW_36 PHFM1OUW_37 7.04 : Month 5 - In PHFM1IR_02 PHFM1IR_03 PHFM1IR_04 PHFM1IR_05 PHFM1IR_06 PHFM1IR_07 PHFM1IR_08 PHFM1IR_09 PHFM1IR_10 PHFM1IR_11 PHFM1IR_12 PHFM1IR_13 PHFM1IR_14 PHFM1IR_15 PHFM1IR_16 PHFM1IR_17 PHFM1IR_18 PHFM1IR_19 PHFM1IR_20 PHFM1IR_21 PHFM1IR_22 PHFM1IR_23 PHFM1IR_24 PHFM1IR_25 PHFM1IR_26 8.01 : Are user fees being collected for outpatient visits? 1 YES 2 NO 8.02 : Are written guidelines on user fees present for outpatient visits? 1 YES, PUBLICLY POSTED 2 YES, NOT POSTED 3 NO 8.03 : Do patients pay for registration / consultation / doctor's fees? 1 YES 2 NO 8.04 : Are written guidelines on registration fees present for outpatient visits 1 YES, PUBLICLY POSTED 2 YES, NOT POSTED 3 NO 8.05 : Do patients pay fees for medicine 1 YES 2 NO 8.06 : Are written guidelines on drug fees present for outpatient visits? 1 YES, PUBLICLY POSTED 2 YES, NOT POSTED 3 NO 8.08 : Do patients pay fees for lab tests (e.g. lab diagnosis, x-ray)? 1 YES 2 NO 8.09 : Are written guidelines on lab fees present for outpatient visits? 1 YES, PUBLICLY POSTED 2 YES, NOT POSTED 3 NO 8.10 : Do patients pay fees for supplies (e.g. dressing)? 1 YES 2 NO 8.11 : Are written guidelines on supplies fees present for outpatient visits? 1 YES, PUBLICLY POSTED 2 YES, NOT POSTED 3 NO 8.13 : In the last 12 months, has the user fee pattern been revised, updated, or 1 YES 2 NO 8.16 : Are there different rates for children and adults? 1 YES 2 NO 8.19 : Do exempt patients receive a special exemption card that allows them to r 1 YES 2 NO 8.21 : Does this facility accept health insurance payments? 1 YES 2 NO 8.22 : What proportion or percentage of payments are covered by health insurance 8.23 : Is the insurance provided by the facility (i.e. does the facility collect 1 YES 2 NO 8.24 : Who sponsors the health insurance schemes accepted by this facility? 1 NATIONAL HEALTH INSURANCE SCHEME 2 INTERNATIONAL NGO 3 LOCAL NGO 4 PRIVATE COMPANY 5 COMMUNITY-BASED HEALTH INSURANCE 96 OTHER (SPECIFY) 8.25 : Do clients with health insurance pay some out of pocket fee? 1 YES 2 NO 8.26 : Are these fees a percentage of total charges, or a co-payment? 1 PERCENTAGE OF CHARGES 2 FIXED CO-PAYMENT 3 EITHER, DEPENDING ON INSURANCE PLAN 9.01 : Is there a safety box or closed container present for disposal of used sh 1 YES 2 NO 9.02 : Is there evidence that the safety boxes or closed containers are being us 1 YES 2 NO 9.03 : Is there evidence that syringes are being disposed of WITHOUT being recap 1 YES 2 NO 9.04 : Does this site have a vaccination refrigerator? 1 YES 2 NO 9.05 : Is a temperature log kept? 1 YES 2 NO 9.06 : In the last 30 days, how many times per day was the tempreature logged? 9.07 : In the last 30 days, how many times was the refrigerator temperature over 9.08 : Is there a functional incinerator for disposing of medical waste? 1 YES 2 NO 9.09 : Is there evidence that the incinerator is being used regularly? 1 YES 2 NO 9.10 : Is there a closed container present for disposal of other bedical waste ( 1 YES 2 NO 9.11 : Is there evidence that this container is being used properly for disposal 1 YES 2 NO 11.01 : Where is the outpatient equipment located? 1 GENERAL CONSULTATION 2 SEPARATE OUTPATIENT ROOM 96 OTHER (SPECIFY) 11.03 : Where is the sterilization equipment located? 1 GENERAL CONSULTATION 2 SEPARATE STERILIZATOIN 96 OTHER (SPECIFY) 11.05 : Where is the lab equipment located 1 GENERAL CONSULTATION 2 SEPARATE STERILIZATOIN 96 OTHER (SPECIFY) 11.07 : Where is the vaccination equipment located 1 GENERAL CONSULTATION 2 SEPARATE STERILIZATOIN 96 OTHER (SPECIFY) 11.09 : Where is the antenatal equipment located 1 GENERAL CONSULTATION 2 SEPARATE STERILIZATOIN 96 OTHER (SPECIFY) 11.11 : Where is the delivery and neonatal equipment located? 1 GENERAL CONSULTATION 2 SEPARATE STERILIZATOIN 96 OTHER (SPECIFY) 12.01 : Is there a separate pharmacy or drug storage area in the health facility 1 YES 2 NO 12.02 : Can the doors and windows be locked to keep the drug storage area secure 1 YES 2 NO 12.03 : is the drug storage area clean? 1 YES 2 NO 12.04 : Are drugs protected from water and sunlight? 1 YES 2 NO 12.05 : Does the outpatient pharmacy maintain stock cards or stock register? 1 YES 2 NO 12.06 : Has [Tetracycline ophthalmic ointment] been continuously available for t 1 YES 2 NO 12.06 : Has [Paracetamol tabs] been continuously available for the past 12 month 1 YES 2 NO 12.06 : Has [Amoxicilin] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [ORS packets] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Iron tabs] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Condomes] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Oral contraceptive tablets] been continuously available for the pas 1 YES 2 NO 12.06 : Has [DMPA] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [IUD] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [ACT] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [SP/fansidar] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Chloroquine] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Rifampin] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Streptomycin] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [INH] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Pyrazinamide] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Ethambutal] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Magnesium suffate] been continuously available for the past 12 mont 1 YES 2 NO 12.06 : Has [Diazepam injection] been continuously available for the past 12 mon 1 YES 2 NO 12.06 : Has [Misoprostol] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [Oxytocin] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [BCG] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [OPV] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [TT vaccine] been continuously available for the past 12 months? 1 YES 2 NO 12.06 : Has [DPT/HVB tetravalent] been continuously available for the past 12 mo 1 YES 2 NO 12.06 : Has [Measles] been continuously available for the past 12 months? 1 YES 2 NO 12.07 : For how many days has [Tetracycline ophthalmic ointment] been out of sto 12.07 : For how many days has [Paracetamol tabs] been out of stock? 12.07 : For how many days has [Amoxicilin] been out of stock? 12.07 : For how many days has [ORS packets] been out of stock? 12.07 : For how many days has [Iron tabs] been out of stock? 12.07 : For how many days has [Condomes] been out of stock? 12.07 : For how many days has [Oral contraceptive tablets] been out of stock? 12.07 : For how many days has [DMPA] been out of stock? 12.07 : For how many days has [IUD] been out of stock? 12.07 : For how many days has [ACT] been out of stock? 12.07 : For how many days has [SP/fansidar] been out of stock? 12.07 : For how many days has [Chloroquine] been out of stock? 12.07 : For how many days has [Rifampin] been out of stock? 12.07 : For how many days has [Streptomycin] been out of stock? 12.07 : For how many days has [INH] been out of stock? 12.07 : For how many days has [Pyrazinamide] been out of stock? 12.07 : For how many days has [Ethambutal] been out of stock? 12.07 : For how many days has [Magnesium suffate] been out of stock? 12.07 : For how many days has [Diazepam injection] been out of stock? 12.07 : For how many days has [Misoprostol] been out of stock? 12.07 : For how many days has [Oxytocin] been out of stock? 12.07 : For how many days has [BCG] been out of stock? 12.07 : For how many days has [OPV] been out of stock? 12.07 : For how many days has [TT vaccine] been out of stock? 12.07 : For how many days has [DPT/HVB tetravalent] been out of stock? 12.07 : For how many days has [Measles] been out of stock? 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.08 : BRAND NAME, INCLUDING DRUG SPECIFICATIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.09 : UNIT FORM 1 COUNTING 2 PACKET / SACHET 3 SYRUP 4 MIXTURE 5 SUSPENSION 6 POWDER 7 DROPS 8 INJECTIONS 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.10 : DOSE 1 ADULT 2 CHILD 3 COUNTING (ANYBODY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.11 : From where do you usually procure this drug? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.12 : What is the cost per unit at which you usually procure this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.13 : What is the cost per unit at which you usually sell this drug? 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.14 : NAFDAC No. 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.15 : EXPIRATION DATE 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.16 : How popular is this drug? 1 CUSTOMERS REQUEST VERY OFTEN 2 REQUESTED SOMETIMES 3 RARELY REQUESTED 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.17 : How often do you recommend this drug? 1 VERY OFTEN 2 OFTEN 3 OFTEN 4 RARELY 5 NEVER 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 12.18 : How many doses of this drug do you normally dispense in a day? 13.03 : IS RESPONDENT FACILITY MANAGER / DIRECTOR OR DEPUTY MANAGER / DIRECTOR? 1 YES 2 NO 1 Stress their responsibilities and standards 2 Take no particular action 3 Give positive feedback and make staff feel involved in the achievements 4 Emphasize the importance of deadlines and tasks 13.05 : Members of your staff have been unable to solve a problem over the past 1 Call a meeting and together try to solve the problem 2 Let your staff address this problem on their own 3 Give them direction and instructions on how to solve the problem 4 Encourage the group to solve the problem on their own, and you are available when needed to discuss 13.06 : You are considering a major change in how things are done in the facilit 1 Collaborate with your staff to develop the needed changes 2 Announce your vision for the changes and implement a clear plan 3 Ask your staff to develop and implement their own plan for change 4 Consult with your staff, but direct the changes yourself 1 Ask your staff to rethink their direction and goals and come up with a plan together 2 Ask for suggestions from your staff on what to do, and formulate a specific plan to meet objectives 3 Redefine goals clearly and supervise whether these are being met closely 4 Allow your staff freedom to set their own goals and do not push them. 13.01 : Do you agree: staff willingly share their expertise with other members 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: when disaggrements occur among staff, they tray to act lik 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: staff willingly give their to heal each other 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: staff fiscuess work issues with each other 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: staff take steps to prevent problems arising 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: staff focus on what is wrong rather than the positive side 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: staff spend a lot of time chatting 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: my job allows me freedom in how I organize my work 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: I am given enouth authority by my supervisors 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: my job is a source of pride 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: if I did not do well atwork, I would feel ashamed 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: if I were known as a bad professional, it would bring sham 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: when changes occur, I adjust to the change rather than res 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: rapid changes are diffcult for staff 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.01 : Do you agree: changes bring opportunities to make improvements in the fa 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.02 : Rate: the staff interact in an easy manner 13.02 : Rate: my facility is a very dynamic and innovative place 13.02 : Rate: my facility is very formal and structured 13.02 : Rate: we focus on achieving daily goals and getting our work done 13.02 : Rate: the head of facility is considered to be mentor 13.02 : Rate: the head of facility is considered to be a risk-taker and innovato 13.02 : Rate: the head of facility relies on policies and procedures 13.02 : Rate: the head of faclity pushes staff to achieve goals 13.02 : Rate: loyalty and tradition is very important in facility 13.02 : Rate: innovation and being first to try something new is important in fa 13.02 : Rate: following precedures and rules is very important in facility 13.02 : Rate: achieving results and high performance is very important in facili 1.08 : What are the three major sources of funding or income for this facility? 1 USER FEES 2 LGA GOVERNMENT 3 STATE GOVERNMENT 4 RELIGIOUS ORGANIZATION 5 NGO 6 PRIVATE COMPANY 7 HEALTH INSURANCE PAYMENTS 96 OTHER (SPECIFY) 1.08 : What are the three major sources of funding or income for this facility? 1 USER FEES 2 LGA GOVERNMENT 3 STATE GOVERNMENT 4 RELIGIOUS ORGANIZATION 5 NGO 6 PRIVATE COMPANY 7 HEALTH INSURANCE PAYMENTS 96 OTHER (SPECIFY) 1.08 : What are the three major sources of funding or income for this facility? 1 USER FEES 2 LGA GOVERNMENT 3 STATE GOVERNMENT 4 RELIGIOUS ORGANIZATION 5 NGO 6 PRIVATE COMPANY 7 HEALTH INSURANCE PAYMENTS 96 OTHER (SPECIFY) 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.09 : Can you please tell me the amount received from each of the following inc 1.11: How much from this facility's budget was spend on each item in 2011? drug 1.11: How much from this facility's budget was spend on each item in 2011? salar 1.11: How much from this facility's budget was spend on each item in 2011? salar 1.11: How much from this facility's budget was spend on each item in 2011? per d 1.11: How much from this facility's budget was spend on each item in 2011? water 1.11: How much from this facility's budget was spend on each item in 2011? commu 1.11: How much from this facility's budget was spend on each item in 2011? petro 1.11: How much from this facility's budget was spend on each item in 2011? other 1.11: How much from this facility's budget was spend on each item in 2011? outre 1.11: How much from this facility's budget was spend on each item in 2011? build 1.11: How much from this facility's budget was spend on each item in 2011? equip 1.11: How much from this facility's budget was spend on each item in 2011? equip 1.11: How much from this facility's budget was spend on each item in 2011? other 1 DIRECTLY FROM RIVER / LAKE / STREAM / DAM 2 PUMPED / PIPED FROM RIVER / LAKE / STREAM / DAM 3 UNPROTECTED WELL 4 PROTECTED WELL 5 BOREHOLE 6 PUBLIC TAP 7 OWN TAP 8 OTHER TAP (E.G. IN NEARBY BUILDING) 9 BOUGHT FROM WATER VENDOR 10 BOTTLED / BAGGED WATER 11 RAIN WATER 96 OTHER (SPECIFY) 1 DIRECTLY FROM RIVER / LAKE / STREAM / DAM 2 PUMPED / PIPED FROM RIVER / LAKE / STREAM / DAM 3 UNPROTECTED WELL 4 PROTECTED WELL 5 BOREHOLE 6 PUBLIC TAP 7 OWN TAP 8 OTHER TAP (E.G. IN NEARBY BUILDING) 9 BOUGHT FROM WATER VENDOR 10 BOTTLED / BAGGED WATER 11 RAIN WATER 96 OTHER (SPECIFY) 1.24 : How long, in hours and minutes, does it take to fetch water from the main 1.24 : How long, in hours and minutes, does it take to fetch water from the main 1.34 : What type of transportation does the facility have access to? ambulance o 1 YES 2 NO 1.34 : What type of transportation does the facility have access to? ambulance o 1 YES 2 NO 1.34 : What type of transportation does the facility have access to? private veh 1 YES 2 NO 1.34 : What type of transportation does the facility have access to? private veh 1 YES 2 NO 1.34 : What type of transportation does the facility have access to? other vehic 1 YES 2 NO 1.34 : What type of transportation does the facility have access to? pricate cwh 1 YES 2 NO 1.34 : What type of transportation does the facility have access to? other (spec 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: tracking or 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: managing lab 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: billing pati 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: tracking num 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: tracking exp 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: tracking dru 1 YES 2 NO 1.37 : Does the facility use the computer for any of the following: other (speci 1 YES 2 NO 2.03 : Who was involved in setting this workplan? health facility staff 1 YES 2 NO 2.03 : Who was involved in setting this workplan? NGO staff 1 YES 2 NO 2.03 : Who was involved in setting this workplan? local government 1 YES 2 NO 2.03 : Who was involved in setting this workplan? community health workers 1 YES 2 NO 2.03 : Who was involved in setting this workplan? community members 1 YES 2 NO 2.03 : Who was involved in setting this workplan? village/ward development commi 1 YES 2 NO 2.03 : Who was involved in setting this workplan? other (specify) 1 YES 2 NO 2.05 : What are the priority activities for 2012? prenatal care 1 YES 2 NO 2.05 : What are the priority activities for 2012? institutional delivery 1 YES 2 NO 2.05 : What are the priority activities for 2012? post natal care 1 YES 2 NO 2.05 : What are the priority activities for 2012? immunization 1 YES 2 NO 2.05 : What are the priority activities for 2012? nutrition 1 YES 2 NO 2.05 : What are the priority activities for 2012? IMCI 1 YES 2 NO 2.05 : What are the priority activities for 2012? malaria 1 YES 2 NO 2.05 : What are the priority activities for 2012? TB 1 YES 2 NO 2.05 : What are the priority activities for 2012? HIV/AIDS 1 YES 2 NO 2.05 : What are the priority activities for 2012? other (specify) 1 YES 2 NO 2.25 : Who was involved with developing the budget? myself 1 YES 2 NO 2.25 : Who was involved with developing the budget? other health facility staff 1 YES 2 NO 2.25 : Who was involved with developing the budget? NGO staff 1 YES 2 NO 2.25 : Who was involved with developing the budget? local government 1 YES 2 NO 2.25 : Who was involved with developing the budget? community health workers 1 YES 2 NO 2.25 : Who was involved with developing the budget? community members 1 YES 2 NO 2.25 : Who was involved with developing the budget? village/ward development com 1 YES 2 NO 2.25 : Who was involved with developing the budget? other (specify) 1 YES 2 NO 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.26 : Who was most important, second most important, and third most important i 1 FIRST MOST IMPORTANT 2 SECOND MOST IMPORTANT 3 THIRD MOST IMPORTANT 2.27 : Do you agree that I have sufficient physical resources to heal care for p 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have sufficient human resources to heal care for pati 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have sufficient medical ersonnel to treat the patient 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have sufficient other professional staff to assist at 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that medical equipment and supplies are readily availabel 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that there is sufficient time to care for each patient 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have pharmaceuticals I want to prescribe available 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have funds available to make improvements 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that open positions for health staff are filled within 2 mon 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that examming room equipment is in working order 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have influence on the way my work unit is managed 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have the ability to initiate changes in the way work 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I can set the pace of own work 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am satisfied in the manner in which I receive directi 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am satisfied in the way in which I must report my act 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have the freedom to care for patients even when they 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am satisfied with the appreciation received from my s 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have my professional judgement questionned by non-phy 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am satisfied with the harmony of relationships among 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I have input into major organizational decisions 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am appreciated by staff in the organizations 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that the physicians who work here are competent 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that the nurses who work here are competent 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that staff are appropriately ly compensated for their work 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am able to provide bonuses to staff at my discretion 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 2.27 : Do you agree that I am appropriately compensated for my work 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE 5 NOT APPLICABLE 6 DON'T KNOW 3.02 : In the past 12 months, how many new clinical staff were hired? 1 Record of clinical staff 2 Record number of non-clinical staff 3.02 : In the past 12 months, how many new non-clinical staff were hired? 1 Record of clinical staff 2 Record number of non-clinical staff 3.03 : In the past 12 months, how many new clinical staff were transferred to an 1 Record of clinical staff 2 Record number of non-clinical staff 3.03 : In the past 12 months, how many new non-clinical staff were transferred t 1 Record of clinical staff 2 Record number of non-clinical staff 3.04 : In the past 12 months, how many new clinical staff were transferred? 1 Record of clinical staff 2 Record number of non-clinical staff 3.04 : In the past 12 months, how many new non-clinical staff were transferred? 1 Record of clinical staff 2 Record number of non-clinical staff 3.05 : In the past 12 months, how many clinical staff resigned? 3.05 : In the past 12 months, how many non-clinical staff resigned? 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 4.02 : Are/Were you able to do this today/in the past 6 months (but not today)? 1 ABLE TO DO TODAY 2 ABLE TO DO IN PAST 6 MONTHS 3 UNABLE TO DO 5.02 : What details are recorded in this register? patient name 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? patient age 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? patient address 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? method of diagnosis 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? result of diagnosis 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? treatment 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? result of treatment 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? liver function testing 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? syphilis testing 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? urine dipstick tests 1 RECORDED 2 NOT RECORDED 5.02 : What details are recorded in this register? pregnance testing 1 RECORDED 2 NOT RECORDED 5.04 : During the 1 month, how many of total outpatient cases attended? 5.04 : During the 1 month, how many of total malaria outpatients cases attended? 5.04 : During the 1 month, how many of? total inpatients admitted 5.04 : During the 1 month, how many of? total inpatients admitted for malaria 5.04 : During the 1 month, how many of? total number of bed-days of occupancy 5.04 : During the 1 month, how many of? total number of bed-days of occupancy du 5.04 : During the 1 month, how many of? total number of inpatient deaths recorde 5.04 : During the 1 month, how many of? total number of inpatient deaths recorde 5.04 : During the 1 month, how many of? total number of matenal deaths recorded 5.04 : During the 1 month, how many of? total number of matenal deaths recorded 5.04 : During the 1 month, how many of? total infant deaths recorded 5.04 : During the 1 month, how many of? total infant deaths recorded due to mala 5.05 : Does this facility have a [REGISTER / REPORT]? daily patient report 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? monthly patient report 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? annual patient report 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? facility status report 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? monthly inventory report 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? vacinnation coverage repor 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? family planning register 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 5.05 : Does this facility have a [REGISTER / REPORT]? other relevent reports 1 YES, SEEN AND COMPLETE 2 YES, SEEN AND NOT COMPLETE 3 YES, NOT SEEN 4 NO 6.05 : Does this facility have a designated supervisor for CHWs? 1 YES 2 NO 6.05 : Does this facility have a designated supervisor for CDDs? 1 YES 2 NO 6.06 : How many CHWs is this person responsible for? 6.06 : How many CDDs is this person responsible for? 6.07 : In the last 6 months, did the CHWs participate in CHW meetings 1 YES 2 NO 6.07 : In the last 6 months, were the CHWs under supervision 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs replace supplies 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs support training 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs provide training 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs collect and compile monthly activity r 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs promote specific health programs 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs bednet distribution assistance 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs provide malaria treatment services 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs provide malaria prevention services 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs general clinic assistance 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs have no specific role 1 YES 2 NO 6.07 : In the last 6 months, did the CHWs ... other(specify) 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs participate in CDD meetings 1 YES 2 NO 6.07 : In the last 6 months, were the CDDs under supervision 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs replace supplies 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs support training 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs provide training 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs collect and compile monthly activity r 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs promote specific health programs 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs bednet distribution assistance 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs provide malaria treatment services 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs provide malaria prevention services 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs general clinic assistance 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs have no specific role 1 YES 2 NO 6.07 : In the last 6 months, did the CDDs ... other(specify) 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.08 : In what ways does the village/ward development committee support this fac 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? helped 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? repairs 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? mobiliz 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? provide 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? gave in 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? gave fi 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? improve 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? improve 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? improve 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? support 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? support 1 YES 2 NO 6.09 : In what ways does the community in general support this facility? other ( 1 YES 2 NO 8.07 : What percent of the drug cost is charged to patients, and is this of the 8.07 : What percent of the drug cost is charged to patients, and is this of the 8.12 : Who was involved in setting the fees? HF staff 1 YES 2 NO 8.12 : Who was involved in setting the fees? NGO staff 1 YES 2 NO 8.12 : Who was involved in setting the fees? local government 1 YES 2 NO 8.12 : Who was involved in setting the fees? state government 1 YES 2 NO 8.12 : Who was involved in setting the fees? CHWs 1 YES 2 NO 8.12 : Who was involved in setting the fees? village/ward development committee 1 YES 2 NO 8.12 : Who was involved in setting the fees? community 1 YES 2 NO 8.12 : Who was involved in setting the fees? other (specify) 1 YES 2 NO 8.14 : Who was involved in revising the fees? HF staff 1 YES 2 NO 8.14 : Who was involved in revising the fees? NGO staff 1 YES 2 NO 8.14 : Who was involved in revising the fees? local government 1 YES 2 NO 8.14 : Who was involved in revising the fees? state government 1 YES 2 NO 8.14 : Who was involved in revising the fees? CHWs 1 YES 2 NO 8.14 : Who was involved in revising the fees? village/ward development committee 1 YES 2 NO 8.14 : Who was involved in revising the fees? community 1 YES 2 NO 8.14 : Who was involved in revising the fees? other (specify) 1 YES 2 NO 8.15 : What does the facility do with the user fees? facility infrastructure 1 YES 2 NO 8.15 : What does the facility do with the user fees? facility programs 1 YES 2 NO 8.15 : What does the facility do with the user fees? use in community 1 YES 2 NO 8.15 : What does the facility do with the user fees? send back to managing agenc 1 YES 2 NO 8.15 : What does the facility do with the user fees? staff salaries 1 YES 2 NO 8.15 : What does the facility do with the user fees? send back to state governme 1 YES 2 NO 8.15 : What does the facility do with the user fees? other (specify) 1 YES 2 NO 8.15 : What does the facility do with the user fees? 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? widows 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? children un 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? orphans 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? TB patients 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? HIV/AIDS pa 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? extremely p 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? physical di 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? military pe 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? pregnant wo 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? refugees 1 YES 2 NO 8.17 : Are any of the following individuals exempt from paying fees? other (spec 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? HF staff 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? NGO staff 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? local government 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? state government 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? CHWs 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? village/ward devel 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? community 1 YES 2 NO 8.18 : Who decides with patients are exempt from paying fees? other (spedify) 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? prenatal care 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? institutional del 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? postnatal care 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? immunization 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? nutrition 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? IMCI 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? malaria 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? TB 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? HIV/AIDS 1 YES 2 NO 8.20 : Are there some services that are free for ALL patients? other (specify) 1 YES 2 NO 10.01 : patient education mateirials IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : IMCI chart book IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : acute respiratory infection IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : diagonosis/treatment of diarrhea IS PRESENT (SEEN) OR NOT PRESENT (NOT S 1 SEEN 2 NOT SEEN 10.01 : graphs for growth monitoring IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : tuberculosis diagnosis/treatment IS PRESENT (SEEN) OR NOT PRESENT (NOT S 1 SEEN 2 NOT SEEN 10.01 : HMIS guidelines IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : HMIS data IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : malaria diagnosis and treatment IS PRESENT (SEEN) OR NOT PRESENT (NOT SE 1 SEEN 2 NOT SEEN 10.01 : immunization schedule IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : family planning IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : antenatal care national standards IS PRESENT (SEEN) OR NOT PRESENT (NOT 1 SEEN 2 NOT SEEN 10.01 : newborn care national standards IS PRESENT (SEEN) OR NOT PRESENT (NOT SE 1 SEEN 2 NOT SEEN 10.01 : post-partum care national standards IS PRESENT (SEEN) OR NOT PRESENT (NO 1 SEEN 2 NOT SEEN 10.01 : procedures manual for infection prevention and control IS PRESENT (SEEN) 1 SEEN 2 NOT SEEN 10.01 : management of STI guidelines IS PRESENT (SEEN) OR NOT PRESENT (NOT SEEN) 1 SEEN 2 NOT SEEN 10.01 : national HIV testing and counceling guidelines IS PRESENT (SEEN) OR NOT 1 SEEN 2 NOT SEEN 11.02 : sterilizer IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : timer/clock with second hand IS PRESENT AND WORKING, PRESENT BUT NOT WOR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : children's scale IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : height measure IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT P 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : adult scale IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRES 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : blood pressure instrument IS PRESENT AND WORKING, PRESENT BUT NOT WORKIN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : thermometer IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRES 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : stethoscopy IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRES 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : otoscopy IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : suction/aspirating device IS PRESENT AND WORKING, PRESENT BUT NOT WORKIN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : vision chart IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : oxygen tank IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRES 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : ambubag IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : incubaor IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : drip stand IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : flashlight IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : stretcher IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESEN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : minor surgical instruments IS PRESENT AND WORKING, PRESENT BUT NOT WORKI 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.02 : ORT coner with equipment IS PRESENT AND WORKING, PRESENT BUT NOT WORKING 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : electric autoclave IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR N 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : non-electric autoclave IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : electric dry heat sterilizer IS PRESENT AND WORKING, PRESENT BUT NOT WOR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : electric boiler or steamer IS PRESENT AND WORKING, PRESENT BUT NOT WORKI 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : non-electric pot with cover IS PRESENT AND WORKING, PRESENT BUT NOT WORK 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : heat source for non-electric equipment IS PRESENT AND WORKING, PRESENT B 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : automatic timer IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.04 : TST indicator strips IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 OTHER (SPECIFY) 11.06 : microscope IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.06 : centrifuge IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.06 : hemoglobinometer IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.06 : refrigerator for storing regents IS PRESENT AND WORKING, PRESENT BUT NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.08 : main vaccine thermometer IS PRESENT AND WORKING, PRESENT BUT NOT WORKING 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.08 : cold box IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.08 : ice packs IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESEN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.08 : refrigerator IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.10 : general consultation IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.10 : separaten lab IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.10 : other (specify) IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.10 : IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : delivery table IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT P 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : fetoscope IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESEN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : partograph IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : delivery light IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT P 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : aspirator/suction bulb IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : resusciation bag, newborn IS PRESENT AND WORKING, PRESENT BUT NOT WORKIN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : eye drops or ointment for newborn IS PRESENT AND WORKING, PRESENT BUT NO 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : IV sets IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : IV fluids IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESEN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : scissors IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : one umbilical cord clamp IS PRESENT AND WORKING, PRESENT BUT NOT WORKING 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : suturing material IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NO 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : clean towels IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : clean razor blade IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NO 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : examination gloves IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR N 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : sterile cotton or gauze IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : hand soap detergent IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : hand scrubbing brush IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : sterile tray IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : plastic container with a plastic liner to dispose the placenta IS PRESEN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : plastic container with a plastic liner for medical waste IS PRESENT AND 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : stethoscope, adult IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR N 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : stethoscope, pinard fetal IS PRESENT AND WORKING, PRESENT BUT NOT WORKIN 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : sphygmomanometer IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : kidney basin IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : steel bowl IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : protective apron and plastic draw sheet IS PRESENT AND WORKING, PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : tourniquet IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : two sterile towels IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR N 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : baby scale IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESE 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : forceps, artery IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : forceps, dressing IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NO 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : forceps, urine IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT P 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : needle holder IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PR 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : syringes and disposable needles IS PRESENT AND WORKING, PRESENT BUT NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : 16- or 18-gauge needles IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : speculum, vaginal IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NO 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : clamps IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : suction pump, hand or foor operated IS PRESENT AND WORKING, PRESENT BUT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : vacuum extractor IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : uterine dilator IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : curette, uterine IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : vaginal retractor IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NO 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : ambu bag IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT PRESENT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 11.12 : guerdal airways IS PRESENT AND WORKING, PRESENT BUT NOT WORKING, OR NOT 1 PRESENT AND WORKING 2 PRESENT AND NOT WORKING 3 NOT PRESENT 1.06 : Opening Time from Monday to Friday 1.06 : Opening Time on Saturday 1.06 : Opening Time on Sunday 1.06 : Opening Time on public holidays 1.06 : Closing Time from Monday to Friday 1.06 : Closing Time on Saturday 1.06 : Closing Time on Sunday 1.06 : Closing Time on public holidays 6.04 : What activities do CHWs perform: vaccinations 1 YES 2 NO 6.04 : What activities do CHWs perform: at-home deliveries 1 YES 2 NO 6.04 : What activities do CHWs perform: vital registration 1 YES 2 NO 6.04 : What activities do CHWs perform: distribution/sale of ACT 1 YES 2 NO 6.04 : What activities do CHWs perform: distribution/sale of other anti-malaria 1 YES 2 NO 6.04 : What activities do CHWs perform: diagnosis of malaria with RDT 1 YES 2 NO 6.04 : What activities do CHWs perform: diagnosis of malaria 1 YES 2 NO 6.04 : What activities do CHWs perform: illness referral 1 YES 2 NO 6.04 : What activities do CHWs perform: DOTS 1 YES 2 NO 6.04 : What activities do CHWs perform: behavior change communication for malari 1 YES 2 NO 6.04 : What activities do CHWs perform: anti-natal care 1 YES 2 NO 6.04 : What activities do CHWs perform: post-natal care 1 YES 2 NO 6.04 : What activities do CHWs perform: other (specify) 1 YES 2 NO 6.04 : What activities do CDDs perform: vaccinations 1 YES 2 NO 6.04 : What activities do CDDs perform: at-home deliveries 1 YES 2 NO 6.04 : What activities do CDDs perform: vital registration 1 YES 2 NO 6.04 : What activities do CDDs perform: distribution/sale of ACT 1 YES 2 NO 6.04 : What activities do CDDs perform: distribution/sale of other anti-malaria 1 YES 2 NO 6.04 : What activities do CDDs perform: diagnosis of malaria with RDT 1 YES 2 NO 6.04 : What activities do CDDs perform: diagnosis of malaria 1 YES 2 NO 6.04 : What activities do CDDs perform: illness referral 1 YES 2 NO 6.04 : What activities do CDDs perform: DOTS 1 YES 2 NO 6.04 : What activities do CDDs perform: behavior change communication for malari 1 YES 2 NO 6.04 : What activities do CDDs perform: anti-natal care 1 YES 2 NO 6.04 : What activities do CDDs perform: post-natal care 1 YES 2 NO 6.04 : What activities do CDDs perform: other (specify) 1 YES 2 NO 8.27 : Is preventive care covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is immunizations covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is antenatal care covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is labor/delivery covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is postnatal care covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is child curative care covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is adult curative care covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is medicine covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is survery covered by the health insurance scheme? 1 YES 2 NO 8.27 : Is other(specify) covered by the health insurance scheme? 1 YES 2 NO 13.09 : Do you agree: I am able to allocate my facility budget accoring to how i 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: I am able to assign tasks and activities to staff as neede 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: The LGA-level health authorities support my decisions and 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: I have choice over who I hire for what tasks 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: I have choice over what services are provided in this faci 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: I have enouth authority to obtain the resources I need 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: The policies and procedures for doing things are clear to 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: The policies and procedures for doing things are useful to 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree 13.09 : Do you agree: LGA-level health authorities provide adequate feedback to 0 NOT APPLICABLE 1 Strongly Disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree STATE NAME STATE CODE SENATORIAL DISTRICT LGA NAME LGA CODE WARD NAME TREATMENT PRIMARY HEALTH FACILITY NAME PRIMARY HEALTH FACILITY ID PRIMARY HEALTH FACILITY TYPE COMMUNITY NAME PMV identification Name Of State Name Of LGA 1 AKKO 2 BALANGA 3 BILLIRI 4 DUKKU 5 FUNAKAYE 6 GOMBE 7 KALTUNGO 8 KWAMI 9 NAFADA 10 SHONGOM 11 YAMALTU/DEBA Name Of Ward 101 AKKO 102 GARKO 103 KALSHINGI 104 KASHERE 105 KUMO CENTRAL 106 KUMO EAST 107 KUMO NORTH 108 KUMO WEST 109 PINDIGA 110 TUMU 111 TUKULMA 201 BAMBAM 203 DADIYA 204 GELENGU/BALANGA 205 KINDIYO 206 KULANI/DEGRI/SIKKAM 207 MWONA 208 NYUWAR/JESSU 209 SWA/REF/GASI/W.WAJA 210 TALASEE/DONG/REME 301 BANGANJE NORTH 303 BARE 304 305 306 KALMAI 307 TAL 308 TANGLANG 309 TODI 310 401 GOMBE ABBA 402 HASHIDU 403 JAMARI 404 KUNDE 406 MALALA 407 WAZIRI NORTH 408 409 WURO TALE 410 ZANGE 411 ZAUNE 501 ASHAKA/MAGABA 502 BAGE 503 BAJOGA 504 BAJOGA 505 BODOR/TILDE 506 JILLAHI 507 kupto 508 RIBADU 509 TONGO 510 WAWA/WAKKALTU 603 604 605 DAWAKI 606 HERWA GANA 608 KUMBIYA KUMBIYA 609 NASARAWA 610 PANTAMI 611 SHAMAKI 701 AWAK 702 BULE/KALTIN 703 KALTUNGO WEST 704 KALTUNGO EAST 705 KAMO 707 TULA WANGE 708 TULA YIRI 709 TUNGO 710 TURE 801 BOJUDE 802 DABA FULANI 803 DOHO 804 DUKUL 805 GADAM 806 JURARA 807 KOMFULATA 808 KWAMI 809 MALAM-SIDI 810 MALLERI 901 BARWO NASARAWA 902 BARWO WINDE 903 BIRIN BOLEWA 904 BIRIN FULANI EAST 905 BIRIN FULANI WEST 906 GUDUKKU 907 JIGAWA 908 NAFADA CENTRAL 909 NAFADA EAST 910 NAFADA WEST 1001 BANGUNJI 1002 BOH 1003 BURAK 1004 FILIYA 1006 GWANDUM 1007 KULISHIM 1008 KUSHI 1009 LALIPIDO 1010 LAPAN 1101 DEBA 1102 DIFA/LUBO/KINAFA 1103 GWANI/SHINGA/WADE 1104 HINNA 1105 JAGALI NORTH 1106 JAGALI SOUTH 1107 KANAWA/WAJARI 1108 KURI/LANO/LAMBAM 1109 KWADON/LIJI/KURBA 1110 NONO/KUNUWA/W.BIRDEKA 1111 ZAMBUK/KWALI Name Of Nearest Primary HealthCare Facility PMV_SEA Town Type 1 RURAL 2 PERRI UBAN 3 URBAN Name Of village Interviwer Name Interview Date Interview Date2 Result Of Interview 1 COMPLETED 2 PARTIALLY COMPLETED 3 REFUSAL 4 CDD NOT PRESENT 96 OTHER (SPECIFY) Language Of The Interviewer 1 ENGLISH 2 YORUBA 3 IGBO 4 HAUSA 96 OTHER (SPECIFY) Respondent Local Language 1 ENGLISH 2 YORUBA 3 IGBO 4 HAUSA 96 OTHER (SPECIFY) Translator Used 1 NEVER 2 SOMETIMES 3 ALWAYS Supervisor Name Supervision Date Data Entry Operator Data Enty Date Data Entry Supervisor Data Entry Supervision Date Do you agree to participate in this interview? 1 YES 2 NO Gender Respondent 1 MALE 2 FEMALE PMV COMMENTS 1.01 What is your current age in years? 1.02 What is your marital status? 1 MARRIED 2 SINGLE 3 DIVORCED 4 WIDOWED 96 OTHER (SPECIFY) 1.03 What is the hightest grade you have completed in school? 21 JS1 22 JS2 23 JS3 24 SS1 25 SS2 26 SS3 32 VOCATIONAL 33 TECHNICAL 42 UNIVERSITY UNDERGRADUATE 43 UNIVERSITY GRADUATE 96 OTHER (SPECIFY) 1.04 What is your religion? 1 NONE 2 CHRISTIANITY 3 MUSLIM / ISLAM 4 TRADITIONAL 96 OTHER (SPECIFY 1.05 What is your ethnic group? 1 TANGALE 2 TERA 3 TULA 4 FULANI 5 IGBO 6 YORUBA 96 OTHER (SPECIFY) 1.06 For how many years have you been resident in this community? 1.07 For how many years have you worked as a PMV? 1.08 Are you, or have you been, involved with volunteer and / or community work? 1 YES, VOLUNTEER 2 YES, COMMUNITY 3 YES, VOLUNTEER AND COMMUNITY 4 NO 1.09 What kind of community and / or volunteer work are / were you involved in? 1 CAMPAIGNS FOR SPECIAL EVENTS (e.g. NATIONAL IMMUNIZATION DAYS, SAFE MOTHERHOOD DAY, LLIN DISTRIBUTION, WORLD MALARIA DAY, ETC.) 2 COMMUNITY DEVELOPMENT WORK (e.g. BUILDING BOREHOLES, ETC.) 3 PROVIDING COMMUNITY / NEIGHBORHOOD SECURITY 4 COMMUNITY HEALTH PROMOTION (e.g. FAMILY PLANNING, IMMUNIZATION, HIV, ETC.) 96 OTHER (SPECIFY) 1.10 OBSERVE THE TYPE OF STRUCTURE THE SHOP / OUTLET IS IN 1 TRADITIONAL HOUSE 2 DETACHED HOUSE 3 SEMI-DETACHED HOUSE 4 FLAT / APARTMENT / MULTI-UNIT BUILDING 5 ROADISDE STALL 6 MOBILE UNIT 1.12 Do you have a source of clean drinking water in this shop / outlet? 1 YES 2 NO 1.14 How do you dispose of rubbish? 1 RUBBISH COLLECTED 2 PIT 3 BURY 4 BURN 5 DUMP 96 OTHER (SPECIFY) 1.15 Does the shop have electricity? 1 YES 2 NO 1.16 For how many hours per day does the shop normally have electricity? 1.17 What is the main source of energy for lighting (i.e. which do you use the m 1 ELECTRICITY FROM GRID (NEPA / PHCN) 2 KEROSINE / PARAFFIN / GAS / OIL LAMP 3 KEROSINE / PARAFFIN / GAS / OIL LAMP 4 CANDLES 5 OPEN FIRE 6 TORCH 7 SOLAR PANEL 96 OTHER (SPECIFY) 1.18 Are you the owner of this business? 1 YES 2 NO 1.19 For how many years has this shop / outlet operated? 1.20 Before you, did someone else own this shop / outlet? 1 YES 2 NO 1.21 Before you, who was the owner of this shop / outlet? 1 PARENT (FATHER / MOTHER) 2 BROTHER / SISTER 4 OTHER RELATIVE 5 FRIEND / NEIGHBOR 96 OTHER (SPECIFY) 1.22 you sold this shop / outlet today, how much money would you receive for it? PMV_123_A 1.23 If you rented the right to operate this business, how much rent would you r 1.24 Do you pay rent for the right to operate this business? 1 YES 2 NO 1.25 How much rent do you pay? 1.26 Are there any apprentices or assistants working in this shop / outlet? 1 YES 2 NO 1.27 How many apprentices are working in this shop / outlet? 1.28 In a normal week, how many days is the shop / outlet closed? 1.30 On a normal business day, for how many hours is this shop / outlet typicall 1.31 On a normal business day, for how many hours are you typically in this shop 1.32 Do you own any other shops / outlets? 1 YES 2 NO 1.33 How many shops / outlets do you own? 2.01 Have you received any training for your PMV work? 1 YES 2 NO 2.02 Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 SOCIETY FOR FAMILY HEALTH (SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 96 OTHER (SPECIFY) 1 YES 2 NO 2.04 Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 SOCIETY FOR FAMILY HEALTH (SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 2.05 Have you received any training specifically for management of malaria with 1 YES 2 NO 2.06 Who provided this training? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 SOCIETY FOR FAMILY HEALTH (SFH) 6 OTHER NGO 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 2.08 Do you have any job aids hanging in your shop which describe the signs and 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 2.09 Have you provided any health services in the past 3 months, in addition to 1 YES 2 NO 3.01 What is the main cause of malaria? 1 MOSQUITOES 2 DIRTY FOODS 3 DIRTY LIQUIDS 4 CLIMATE / WEATHER 5 ONLY FOOD 6 SUN 7 WITCHCRAFT 3.08 In the last two weeks, have you seen any patients with fever? 1 YES 2 NO 3.09 How many patients have you seen in the last two weeks? 3.10 When did you see your last patient with fever? 1 IN THE LAST 24 HOURS 2 IN THE LAST 7 DAYS (WEEK) 3 IN THE LAST 7 DAYS (WEEK) 96 OTHER 3.11 Was this patient male or female? 1 MALE 2 FEMALE 3.12 How old was this patient? 1 12 MONTHS OR LESS 2 BETWEEN 1 AND 5 YEARS 3 OLDER THAN FIVE YEARS 4 DON'T KNOW / DON'T REMEMBER 3.14 How did you diagnose the patient? 1 CLINICAL DIAGNOSIS (BY OBSERVATION) 2 WITH RAPID DIAGNOSTIC TEST 3 SEND TO LAB / HEALTH FACILITY FOR MICROSCOPY 96 OTHER (SPECIFY) 3.15 What was your initial diagnosis? 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 96 OTHER (SPECIFY) 3.16 What action did you take? 1 TEPID SPONGE CHILD AND PROVIDE TREATMENT WITH ARTEMISININ COMBINATION THERAPY 2 PROVIDE TREATMENT WITH ACT 3 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 4 PROVIDE TREATMENT WITH OTHER MEDICINE 5 REFER TO HEALTH FACILITY 6 REFER TO HOSPITAL 7 NO ACTION 96 OTHER (SPECIFY) 3.17 Did you record details about this patient? 1 YES 2 NO 3.18 Can I see this entry? 1 YES 2 NO 3.19 DO THESE MATCH THE ENTRY IN THE PATIENT REGISTER? 1 Did you record details about this patient? 2 Can I see this entry? 3.20 What was the outcome for the patient? 1 FULL RECOVERY 2 PARTIAL RECOVERY 3 STILL SICK 4 DEATH 5 ADVERSE REACTION TO MEDICINE 6 DON'T KNOW 96 OTHER (SPECIFY) 3.21 Do you use RDTs for diagnosis? 1 YES 2 NO 3.22 Are there any community outlets or mini-labs that support malaria diagnosis 1 YES 2 NO 3.23 Do you ever refer patients to such community outlets or mini-labs for diagn 1 YES 2 NO 3.24 Do you ever refer patients to health facilities for diagnosis of malaria? 1 YES 2 NO 3.25 Do you keep records on patient diagnoses? 1 YES 2 NO 3.26 Can I see your records? 1 YES 2 NO 3.30 What would be your initial diagnosis? 1 UNCOMPLICATED MALARIA 2 COMPLICATED MALARIA 3 FEVER (NOT MALARIA-RELATED) 4 DEHYDRATION 96 OTHER (SPECIFY) 3.31 What action would you take? 1 CONDUCT DIAGNOSIS 2 TEPID SPONGE CHILD AND PROVIDE TREATMENT WITH ARTEMISININ COMBINATION THERAPY 3 PROVIDE TREATMENT WITH ACT 4 PROVIDE TREATMENT WITH OTHER ANTI-MALARIAL 5 PROVIDE TREATMENT WITH OTHER MEDICINE 6 REFER TO HEALTH FACILITY 7 REFER TO HOSPITAL 8 NO ACTION 96 OTHER (SPECIFY) 3.32 How would you advise the mother / parents to act in the future if they noti 1 TAKE SIMILAR ACTION 2 COME TO SHOP IMMEDIATELY UPON NOTICING SYMPTOMS 3 GO TO HEALTH FACILITY / HOSPITAL IMMEDIATELY IF DAUGHTER'S CONDITION DETERIORATES 4 NO ADVICE TO GIVE 96 OTHER (SPECIFY) 3.33 What would you do? 1 GIVE HIM CHLOROQUINE 2 GIVE HIM ACT 3 GIVE HIM OTHER ANTI-MALARIAL 4 GIVE HIM ASPIRIN / FEVER-RELIEF MEDICINE 5 REFER TO HEALTH FACILITY / HOSPITAL 96 OTHER (SPECIFY) 3.34 You would like to give ACT to the man, but find out that you don't have any 1 GIVE HIM OTHER ANTI-MALARIAL 2 GIVE ASPIRIN / FEVER-RELIEF MEDICINE 3 REFER TO OTHER PMV 4 REFER TO CDD 5 REFER TO HEALTH FACILITY / HOSPITAL 6 NOTHING 96 OTHER (SPECIFY) 3.35 Immediately after taking the action just mentinoed, you remember that you h 1 GIVE PARTIAL DOSE OF ACT 2 GIVE HIM OTHER ANTI-MALARIAL 3 GIVE ASPIRIN / FEVER-RELIEF MEDICINE 4 REFER TO OTHER PMV 5 REFER TO CDD 6 REFER TO HEALTH FACILITY / HOSPITAL 7 NOTHING 96 OTHER (SPECIFY) 3.36 What would you do? 1 GIVE ACT 2 GIVE OTHER ANTI-MALARIAL 3 ASK ABOUT THE SYMPTOMS THE DAUGHTER IS EXHIBITING 4 TELL THE WOMAN TO COME BACK WITH HER DAUGHTER 5 REFER TO HEALTH FACILITY / HOSPITAL 6 REFER TO CDD 7 SEND HER AWAY 8 DO NOTHING 96 OTHER (SPECIFY) 1 GIVE OTHER ANTI-MALARIAL 2 COLLECT ACT FROM OTHER PMV 3 COLLECT ACT FROM CDD 4 REFER TO OTHER PMV 5 REFER TO CDD 6 REFER TO HEALTH FACILITY / HOSPITAL 7 DO NOTHING 96 OTHER (SPECIFY) 4.01Do you receive any incentives for your PMV work, other than payment for medi 1 YES 2 NO 4.02 What is (was) the primary source of these incentives? 1 LOCAL GOVERNMENT 2 STATE GOVERNMENT 3 FEDERAL GOVERNMENT 4 PMV ASSOCIATION 5 NGO 6 COMMUNITY/VILLAGE 7 PRIVATE ORGANIZATION 8 RELIGIOUS ORGANIZATION 96 OTHER (SPECIFY) 4.04 In a typical week, how much do you earn from your PMV jop? 4.05 Do you charge your patients other fees beyond what is required to pay for m 1 YES 2 NO 4.06 On average, how much? 4.07 Do you receive payment other than money from patients? 1 YES 2 NO 4.09 During the last 12 months, what has been your primary job (other than PMV w 1 PROFESSIONAL 2 TECHNICAL 3 SMALL BUSINESS OWNER 4 FARMER 5 LIVESTOCK KEEPER 6 FISHERMAN 7 LABORER 8 NO OTHER WORK / NOT APPLICABLE 96 OTHER (SPECIFY) 4.10 What sector is this job connected with? 1 AGRICULTURE 2 FISHING 3 FORESTRY, HUNTING, LIVESTOCK 4 MINING AND QUARRYING 5 MANUFACTURING 6 ELECTRICITY / GAS / WATER 7 CONSTRUCTION 8 TOURISM / HOTEL 9 TRADE AND COMMERCE 10 TRANSPORT AND COMMUNICATION 11 FINANCE AND INSURANCE 12 PUBLIC ADMINISTRATION 13 EDUCATION 14 HEALTH 96 OTHER (SPECIFY) 4.11 Who paid your wages? 1 SELF-EMPLOYED 2 EMPLOYER 3 FAMILY (PAID) 4 FAMILY (UNPAID) 96 OTHER (SPECIFY) 4.12 : During the past 12 months, how many months did you work at your primary j 4.13 : On average, how many hours per week did you work at your primary job? 4.14 What was your total income from your primary job during the past 12 months, 4.15 : What was your total value of in-kind payments you received for your prima 4.17 Does your household own any land? 1 YES 2 NO 4.18 What is the size of this land? 4.18A Unit Code 1 SQUARE METER 2 HECTARE 3 PLOT 96 OTHER (SPECIFY) 4.18B Number 4.19 If you were to sell all of the land you own, how much do you think you woul 4.20 How much land did you cultivate during the past agricultural season? 4.20A Unit Code 1 SQUARE METER 2 HECTARE 3 PLOT 96 OTHER (SPECIFY) 4.20B Amount 5.01 In your work as a PMV, about how many people do you provide drugs to in a d .02 How much time in hours do you spend each week on PMV work? 6.01 Does anybody monitor or supervise your work as a PMV? 1 YES 2 NO 1 WEEKLY 2 MONTHLY 3 EVERY TWO MONTHS 4 EVERY THREE MONTHS 96 OTHER (SPECIFY) 6.05 Do you keep regular records of your PMV work? 1 YES 2 NO 6.06 Can I see your records? 1 YES 2 NO 6.09 Do you submit your records to anyone? 1 YES 2 NO 6.11 Do you have any documentation of the records you have submitted? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.12 Do you receive any feedback on your records? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 7.01 Are you registered as a PMV? 1 YES 2 NO 7.02 Why are you not registered as a PMV 1 NO BENEFITS 2 NOT INTERESTED 3 TOO MUCH SUPERVISION 4 NOT QUALIFIED 96 OTHER (SPECIFY) 7.03 If you were given the opportunity to register, would you do so? 1 YES 2 NO 1 YES 2 NO 7.05A UNIT CODE 1 KILOMETERS 2 OTHER, SPECIFY 7.05B NUMBER OF UNITS: 7.06A HOURS 7.06B MINUTES 7.07 Are you a member of this association? 1 YES 2 NO 7.08 In general, how often do you attend PMV association meetings? 1 WEEKLY 2 MONTHLY 3 EVERY TWO MONTHS 4 EVERY THREE MONTHS 96 OTHER (SPECIFY) 7.09 What is your role in the PMV association 1 CHAIRMAN 2 VICE-CHAIRMAN 3 TREASURER 4 SECRETARY 5 MEMBER 96 OTHER (SPECIFY) 7.10 In the past 3 months, did you receive any support from this association? 1 YES 2 NO 7.12 Have you ever been sanctioned by the PMV association? 1 YES 2 NO 7.13 What was the reson for these sanctions? 1 SELLING UNCERTIFIED / SUBSTANDARD DRUGS 2 DID NOT PAY DUES 96 OTHER (SPECIFY) 7.14 Did you feel that the sanctions imposed on you were fair or unfair? 1 FAIR 2 UNFAIR 7.15 Why are you not a member of the PMV association? 1 NO BENEFITS 2 NOT INTERESTED 3 TOO MUCH SUPERVISION 4 NOT QUALIFIED 96 OTHER (SPECIFY) 7.16 If you were given the opportunity to join this association, would you do so 1 YES 2 NO 1 YES 2 NO 7.18 In the past 3 months, did you receive any support from this committee? 1 YES 2 NO 7,22 How are you addressed in your community? 1 PMV 2 HEALTH WORKER 3 DOCTOR 96 OTHER (SPECIFY) 8.02 How frequently do you procure/order drugs and supplies? 1 WEEKLY 2 BI-WEEKLY 3 MONTHLY 96 OTHERS 8.03A Unit Code 1 WEEKLY 2 BI-WEEKLY 3 MONTHLY 96 OTHER 8.03B Number 8.04 How do you store your drugs and supplies, which are not displayed in your s 1 DRY & COOL PLACE AT HOME 2 DRY & COOL PLACE OUTSIDE HOME 3 IN DEDICATED DRAWER / CLOSET 4 IN BAG 5 AT HOME (IN OPEN SPACE) 6 ANYWHERE / NO PLACE IN PARTICULAR 7 NO STORAGE 96 OTHER (SPECIFY) 8.05 Is the storage space secured? 1 YES, WITH A LOCK 2 NO 96 YES, WITH OTHER (SPECIFY) 8.06 Do you keep a stock register? 1 YES 2 NO 8.07 Can I see this register? 1 YES 2 NO 8.08 Do you currently have ACTs available? 1 YES 2 NO 8.09 How many doses of ACT do you have available right now? 8.10 How many ACT stockouts have you experienced in the last 3 months? 8.11 What was the number one reason for these stockouts? 1 LACK OF AVAILABILITY IN HEALTH FACILITY 2 UNEXPECTED HIGH DEMAND 3 LACK OF PLANNING 4 NOT APPLICABLE 96 OTHER (SPECIFY) 8.12 Do you currently have SP available? 1 YES 2 NO 8.13 How many doses of SP do you have available right now? 8.14 How many SP stockouts have you experienced in the last 6 months? 8.15 What was the number one reason for these stockouts? 1 LACK OF AVAILABILITY IN HEALTH FACILITY 2 UNEXPECTED HIGH DEMAND 3 LACK OF PLANNING 4 NOT APPLICABLE 96 OTHER (SPECIFY) 8.16 Do you currently have RDT kits available? 1 YES 2 NO 8.17 How many RDT kits do you have available right now? 8.18 How many RDT kit stockouts have you experienced in the last 6 months? 8.19 What was the number one reason for these stockouts? 1 LACK OF AVAILABILITY IN HEALTH FACILITY 2 UNEXPECTED HIGH DEMAND 3 LACK OF PLANNING 4 NOT APPLICABLE 96 OTHER (SPECIFY) 1.11 Observe the main materials used for walls 1 BRICKS OR BLOCKS 2 ASBESTOS 3 CORRUGATED IRON / METAL 4 PLASTIC 5 POLES / REED 6 TILES / SLATES 7 THATCH / GRASS 8 WOOD / BAMBOO 9 EARTH / MUD 10 CONCRETE ONLY 11 COVERED CONCRETE 12 CARDBOARD 96 OTHER (SPECIFY) 1.11 Observe the main materials used for rooftop 1 BRICKS OR BLOCKS 2 ASBESTOS 3 CORRUGATED IRON / METAL 4 PLASTIC 5 POLES / REED 6 TILES / SLATES 7 THATCH / GRASS 8 WOOD / BAMBOO 9 EARTH / MUD 10 CONCRETE ONLY 11 COVERED CONCRETE 12 CARDBOARD 96 OTHER (SPECIFY) 1.11 Observe the main materials used for floor 1 BRICKS OR BLOCKS 2 ASBESTOS 3 CORRUGATED IRON / METAL 4 PLASTIC 5 POLES / REED 6 TILES / SLATES 7 THATCH / GRASS 8 WOOD / BAMBOO 9 EARTH / MUD 10 CONCRETE ONLY 11 COVERED CONCRETE 12 CARDBOARD 96 OTHER (SPECIFY) 1.13 What is the main source of clean drinking water in this shop / outlet in th 1 DIRECTLY FROM RIVER / LAKE / STREAM / DAM 2 PUMPED / PIPED FROM RIVER / LAKE / STREAM / DAM 3 UNPROTECTED WELL 4 PROTECTED WELL 5 BOREHOLE 6 PUBLIC TAP 7 OWN TAP 8 OTHER TAP (E.G. IN NEARBY BUILDING) 9 BOUGHT FROM WATER VENDOR 10 BOTTLED / BAGGED WATER 11 RAIN WATER 96 OTHER (SPECIFY) 1.13 What is the main source of clean drinking water in this shop / outlet in th 1 DIRECTLY FROM RIVER / LAKE / STREAM / DAM 2 PUMPED / PIPED FROM RIVER / LAKE / STREAM / DAM 3 UNPROTECTED WELL 4 PROTECTED WELL 5 BOREHOLE 6 PUBLIC TAP 7 OWN TAP 8 OTHER TAP (E.G. IN NEARBY BUILDING) 9 BOUGHT FROM WATER VENDOR 10 BOTTLED / BAGGED WATER 11 RAIN WATER 96 OTHER (SPECIFY) 1.29 On what days of the week do you typically close the shop, MONDAY? 1 YES 2 NO 1.29 On what days of the week do you typically close the shop, TUESDAY? 1 YES 2 NO 1.29 On what days of the week do you typically close the shop, WEDNESDAY? 1 YES 2 NO 1.29 On what days of the week do you typically close the shop, THURSDAY? 1 YES 2 NO 1.29 On what days of the week do you typically close the shop, FRIDAY? 1 YES 2 NO 1.29 On what days of the week do you typically close the shop, SATURDAY? 1 YES 2 NO 1.29 On what days of the week do you typically close the shop, SUNDAY? 1 YES 2 NO 2.07 What topics were covered in these trainings? Childhood diseases (ARI, diarr 1 YES 2 NO 2.07 What topics were covered in these trainings? family planning 1 YES 2 NO 2.07 What topics were covered in these trainings? antenatal care and postnatal c 1 YES 2 NO 2.07 What topics were covered in these trainings? referral to facility for deliv 1 YES 2 NO 2.07 What topics were covered in these trainings? newborn care 1 YES 2 NO 2.07 What topics were covered in these trainings? tuberculosis 1 YES 2 NO 2.07 What topics were covered in these trainings? vaccination 1 YES 2 NO 2.07 What topics were covered in these trainings? record keeping/inventory manag 1 YES 2 NO 2.07 What topics were covered in these trainings? malaria 1 YES 2 NO 2.07 What topics were covered in these trainings? nutrition 1 YES 2 NO 2.07 What topics were covered in these trainings? sanitation and home hygiene 1 YES 2 NO 2.07 What topics were covered in these trainings? mental health 1 YES 2 NO 2.07 What topics were covered in these trainings? disabilities 1 YES 2 NO 2.07 What topics were covered in these trainings? other (specify) 1 YES 2 NO 2.10 Did you provide service of treating sick children within the past 3 months? 1 YES 2 NO 2.10 Did you provide service of referring very sick children within the past 3 m 1 YES 2 NO 2.10 Did you provide service of supporting outreach vaccination campaigns within 1 YES 2 NO 2.10 Did you provide service of consultation for adults within the past 3 months 1 YES 2 NO 2.10 Did you provide service of prociding birth spacing methods within the past 1 YES 2 NO 2.10 Did you provide service of giving iron tablets and nutrition advice to preg 1 YES 2 NO 2.10 Did you provide service of referring pregnant women for tetanus toxoid and 1 YES 2 NO 2.10 Did you provide service of supervising and advising TBA within the past 3 m 1 YES 2 NO 2.10 Did you provide service of supervising home deliveries within the past 3 mo 1 YES 2 NO 2.10 Did you provide service of referring pregnant women with danger signs withi 1 YES 2 NO 2.10 Did you provide service of postnatal care within the past 3 months? 1 YES 2 NO 2.10 Did you provide service of newborn care within the past 3 months? 1 YES 2 NO 2.10 Did you provide service of referring for TB diagnosis within the past 3 mon 1 YES 2 NO 2.10 Did you provide service of supervising DOTS treatment for TB within the pas 1 YES 2 NO 2.10 Did you provide service of malaria treatment within the past 3 months? 1 YES 2 NO 2.10 Did you provide service of distributing mosquito nets children within the p 1 YES 2 NO 2.10 Did you provide service of advising and referring on mental health within t 1 YES 2 NO 2.10 Did you provide service of advising amd referring pm disabilities within th 1 YES 2 NO 2.10 Did you provide service of health education for groups of people within the 1 YES 2 NO 2.10 Did you provide service of other (specify) within the past 3 months? 1 YES 2 NO 3.02 What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 3.02 What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 3.02 What are the danger signs or symptoms of malaria? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 3.03 How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 3.03 How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 3.03 How can someone protect themselves against malaria? (up to three) 1 MOSQUITO NET 2 INSECT REPELLENT 3 INSECT SCREENS 4 PREVENTIVE MEDICATION 5 INSECTICIDE (IRS) 6 MOSQUITO COILS 7 AVOID DIRTY FOODS 8 AVOID DIRTY LIQUIDS 9 FILL IN PUDDLES 10 KEEP HOUSE CLEAN 11 BURN GRASS 96 OTHER (SPECIFY) 3.04 Which of the following have members of your household done to protect thems 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 3.04 Which of the following have members of your household done to protect thems 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 3.04 Which of the following have members of your household done to protect thems 1 Used mosquito net? 2 Used insect repellent? 3 Use insect screens? 4 Used Preventive medication? 5 Used insecticide (IRS)? 6 Use mosquito coils? 7 Avoided dirty foods? 8 Avoided dirty liquids? 9 Filled in puddles / Avoided stagnant water? 10 Kept house clean? 11 Burned grass? 96 Other? (SPECIFY) 3.05 What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 3.05 What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 3.05 What is the best way to treat malaria? (up to three) 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 3.06 What drug does the government recommend for the treatment of malaria? (up t 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 3.06 What drug does the government recommend for the treatment of malaria? (up t 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 3.06 What drug does the government recommend for the treatment of malaria? (up t 1 SP / FANSIDAR 2 CHLOROQUINE 3 AMODIQUINE 4 QUININE 5 ACT (COARTEM) 6 ARTHEMETAN 7 TRADITIONAL MEDICINE 96 OTHER (SPECIFY) 3.07 What is the primary source of knowledge about malaria in your community? (u 1 COMMUNITY HEALTH WORKER (CHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 3.07 What is the primary source of knowledge about malaria in your community? (u 1 COMMUNITY HEALTH WORKER (CHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 3.07 What is the primary source of knowledge about malaria in your community? (u 1 COMMUNITY HEALTH WORKER (CHW) 2 COMMUNITY-DIRECTED DISTRIBUTOR (CDD) 3 VILLAGE / WARD DEVELOPMENT COMMITTEE 4 PATENT MEDICINE VENDOR 5 DOCTOR AND / OR NURSE 6 HEALTH FACILITY / HOSPITAL 7 RADIO / TV 8 NEWSPAPER / MAGAZINE 9 FAMILY 10 FRIENDS AND / OR NEIGHBORS IN THE CITY 11 PMV ASSOCIATION 12 FRIENDS AND / OR NEIGHBORS IN THE VILLAGE 13 CHURCH 14 MOSQUE 96 OTHER (SPECIFY) 3.13 What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 3.13 What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 3.13 What symtpoms did the patient have? (up to three) 1 FEVER 2 HEADACHE 3 NAUSEA 4 VOMITING 5 BODY WEAKNESS 6 SEIZURE / CONVULSION 96 OTHER (SPECIFY) 3.27 RECORD THE NUMBER OF FEVER CASES 3.27 RECORD THE NUMBER OF RDT POSTIVE CASES 3.27 RECORD THE NUMBER OF MINI-LAB POSITIVE CASES 3.27 RECORD THE NUMBER OF HEALTH FACILITY POSITIVE CASES 3.27 RECORD THE NUMBER OF DOSES OF ACT DISPENSED 3.28 What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.28 What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.28 What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.28 What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.28 What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.28 What types of activities have you engaged in for the prevention of malaria 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.29 : How many times have you engaged in each of these activities in the last t 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.29 : How many times have you engaged in each of these activities in the last t 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.29 : How many times have you engaged in each of these activities in the last t 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.29 : How many times have you engaged in each of these activities in the last t 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.29 : How many times have you engaged in each of these activities in the last t 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 3.29 : How many times have you engaged in each of these activities in the last t 1 ITN/LLIN NET HANGING ASSISTANCE 2 BCC FOR ITN/LLIN USE 3 REFERRALS FOR IPT 4 BCC FOR IPT 5 BCC FOR PROMPT TREATMENT WITH ACT 6 NONE 96 OTHER (SPECIFY) 4.03 What type of incentives do you receive? regular salary or stipend 1 YES 2 NO 4.03 What type of incentives do you receive? ad-hoc/irregular salary or stipend 1 YES 2 NO 4.03 What type of incentives do you receive? loan 1 YES 2 NO 4.03 What type of incentives do you receive? bicycle 1 YES 2 NO 4.03 What type of incentives do you receive? literacy training 1 YES 2 NO 4.03 What type of incentives do you receive? computer training 1 YES 2 NO 4.03 What type of incentives do you receive? cloth 1 YES 2 NO 4.03 What type of incentives do you receive? food for work 1 YES 2 NO 4.03 What type of incentives do you receive? festival bonus 1 YES 2 NO 4.03 What type of incentives do you receive? shoes 1 YES 2 NO 4.03 What type of incentives do you receive? food 1 YES 2 NO 4.03 What type of incentives do you receive? transport money 1 YES 2 NO 4.03 What type of incentives do you receive? food for training 1 YES 2 NO 4.03 What type of incentives do you receive? money for referral 1 YES 2 NO 4.03 What type of incentives do you receive? other 1 YES 2 NO 4.08 What type of payment do you / did you receive? food 1 YES 2 NO 4.08 What type of payment do you / did you receive? livestock 1 YES 2 NO 4.08 What type of payment do you / did you receive? other 1 YES 2 NO 4.16: How many of radio/CD/casette player does your household own? 4.16: How many of television does your household own? 4.16: How many of perssing iron does your household own? 4.16: How many of electric stove does your household own? 4.16: How many of gas stove does your household own? 4.16: How many of lamp does your household own? 4.16: How many of bed does your household own? 4.16: How many of mattress/sleeping mat does your household own? 4.16: How many of refrigerator does your household own? 4.16: How many of paraffin stove does your household own? 4.16: How many of sewing machine does your household own? 4.16: How many of table does your household own? 4.16: How many of sofa does your household own? 4.16: How many of land line telephone does your household own? 4.16: How many of mobile telephone does your household own? 4.16: How many of motorcycle does your household own? 4.16: How many of bicycle does your household own? 4.16: How many of motor vehicle does your household own? 4.16: How many of wheelbarrow does your household own? 4.16: How many of boat does your household own? 4.16: How many of tractor does your household own? 4.16: How many of crop sprayer does your household own? 4.16: How many of irrigation equipment does your household own? 4.16: How many of ploughs/harrows does your household own? 4.16: How many of hoes/awes does your household own? 4.16: How many of fishing net/fishing equipment does your household own? 4.21: How many of goats does your household own? 4.21: How many of sheep does your household own? 4.21: How many of pigs does your household own? 4.21: How many of chicken does your household own? 4.21: How many of guinea fowl does your household own? 4.21: How many of ducks/geese does your household own? 4.21: How many of turkey does your household own? 4.21: How many of donkey/horse does your household own? 4.21: How many of cow does your household own? 4.21: How many of bull does your household own? 4.21: How many of oxen does your household own? 4.21: How many of calves does your household own? 4.21: How many of rabbits does your household own? 6.02 Who monitors or supervises your PMV work? local government 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? state government 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? federal government 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? PMV association 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? NGO 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? community/village 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? private organization 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? religious organization 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? pharmaceutical council of Nigeria 1 YES 2 NO 6.02 Who monitors or supervises your PMV work? other 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor check sup 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor check rec 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor observe c 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor ask knowl 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor provide m 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor visit hou 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor meet with 1 YES 2 NO 6.04: During your last visit with your supervisor, did your supervisor other (sp 1 YES 2 NO 6.07: Do you keep record daily? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.07: Do you keep record weekly 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.07: Do you keep record monthly 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.07: Do you keep record other (specify) 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain patient details? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain diagnose? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain drug received? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain drug dispensed? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain patient referrals? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain BCC/IEX material distributed? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain number of persons councelled? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain other (specify)? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.08: Do these records contain patient details? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.10 Who do you submit your records to? PMV association 1 YES 2 NO 6.10 Who do you submit your records to? other 1 YES 2 NO 6.13: Do you receive feedback of ways to improve record-keeping? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.13: Do you receive feedback of ways to improve work? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.13: Do you receive feedback of your performance? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.13: Do you receive feedback of special recogniction for work well done? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.13: Do you receive feedback of criticism for work not done well? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 6.13: Do you receive feedback of other (specify)? 1 YES (SEEN) 2 YES (NOT SEEN) 3 NO 7.11 What types of support did you receive? cash payments 1 YES 2 NO 7.11 What types of support did you receive? other payments 1 YES 2 NO 7.11 What types of support did you receive? donations of supplies/equipment 1 YES 2 NO 7.11 What types of support did you receive? community mobilization to use PMV se 1 YES 2 NO 7.11 What types of support did you receive? appreciation/recognition 1 YES 2 NO 7.11 What types of support did you receive? other 1 YES 2 NO 7.19 What types of support did you receive? cash payments 1 YES 2 NO 7.19 What types of support did you receive? other payments 1 YES 2 NO 7.19 What types of support did you receive? donations of supplies/equipment 1 YES 2 NO 7.19 What types of support did you receive? community mobilization to use PMV se 1 YES 2 NO 7.19 What types of support did you receive? appreciation/recognition 1 YES 2 NO 7.19 What types of support did you receive? other 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? share durg 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? referred p 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? shared kno 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? community 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? help with 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? appreciati 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? no support 1 YES 2 NO 7.20 In what ways have other PMVs supported you in the past 3 months? other 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? mo 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? ot 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? sh 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? re 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? tr 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? he 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? ap 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? no 1 YES 2 NO 7.21 In what ways has the health facility supported you in the past 3 months? ot 1 YES 2 NO 8.01 From where do you procure your drugs and supplies? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 8.01 From where do you procure your drugs and supplies? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 8.01 From where do you procure your drugs and supplies? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 8.01 From where do you procure your drugs and supplies? 1 HEALTH FACILITY 2 MARKET 3 PMV ASSOCIATION 96 OTHER (SPECIFY) 1 Worse 2 Some 3 Better 1 Worse 2 Some 3 Better 1 Worse 2 Some 3 Better 1 Worse 2 Some 3 Better 9.02: How does opportunities for training in your PMV work compare to your other 1 Worse 2 Some 3 Better 9.02: How does your level of respect in the community in your PMV work compare t 1 Worse 2 Some 3 Better 9.02: How does availability of necessary equipment/commodities in your PMV work 1 Worse 2 Some 3 Better 9.02: How does adequate time availabel to perform tasks in your PMV work compare 1 Worse 2 Some 3 Better 9.02: How does supervision and feedback from supervisor in your PMV work compare 1 Worse 2 Some 3 Better 9.02: How does teamwork/relationships with other PMVs/co-workers in your PMV wor 1 Worse 2 Some 3 Better 9.02: How does motivation and satisfaction with work in your PMV work compare to 1 Worse 2 Some 3 Better 9.02: How does recognition of your good work in your PMV work compare to your ot 1 Worse 2 Some 3 Better 1 WORSE 2 SAME 3 BETTER 1 WORSE 2 SAME 3 BETTER 1 WORSE 2 SAME 3 BETTER 1 WORSE 2 SAME 3 BETTER 9.04: How does opportunities for training in your PMV work compare to your previ 1 WORSE 2 SAME 3 BETTER 9.04: How does your level of respect in the community in your PMV work compare t 1 WORSE 2 SAME 3 BETTER 9.04: How does availability of necessary equipment/commodities in your PMV work 1 WORSE 2 SAME 3 BETTER 9.04: How does adequate time available to perform tasks in your PMV work compare 1 WORSE 2 SAME 3 BETTER 9.04: How does supervision and feedback from supervisor in your PMV work compare 1 WORSE 2 SAME 3 BETTER 9.04: How does teamwork/relationships with other PMVs/co-workers in your PMV wor 1 WORSE 2 SAME 3 BETTER 9.04: How does motivation and satisfaction with work in your PMV work compare to 1 WORSE 2 SAME 3 BETTER 9.04: How does recognition and satisfaction with work in your PMV work compare t 1 WORSE 2 SAME 3 BETTER 9.01 In the past year, have you had any other job, in addition to your PMV work? 1 YES 2 NO 9.03 At any time in the past, have you had any other job (other than this PMV wo 1 YES 2 NO STATE NAME STATE CODE SENATORIAL DISTRICT LGA NAME LGA CODE WARD NAME TREATMENT PRIMARY HEALTH FACILITY NAME PRIMARY HEALTH FACILITY ID PRIMARY HEALTH FACILITY TYPE COMMUNITY NAME