Questionnaire Text

Burkina Faso 2020 Congo (Democratic Republic) 2021 Kenya 2020 Nigeria 2020b
Burkina Faso 2021 Congo (Democratic Republic) 2021 Kenya 2021 Nigeria 2021a
Burkina Faso 2022 Cote d'Ivoire 2020 Niger 2020 Nigeria 2021b
Congo (Democratic Republic) 2019a Cote d'Ivoire 2021 Niger 2022 Uganda 2020
Congo (Democratic Republic) 2019b India 2020 Nigeria 2019a Uganda 2021
Congo (Democratic Republic) 2020 India 2021 Nigeria 2019b
Congo (Democratic Republic) 2020 Kenya 2019 Nigeria 2020a
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Burkina Faso 2020
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303a. If you needed family planning, where would you go?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Regional Hospital Center
[] Medical Center with Surgery Unit (public)
[] Medical Center (public)
[] Fieldworker and community health volunteers (public)
[] Private hospital or clinic
[] Pharmacy
[] Private practice
[] Mobile clinic (private)
[] Maternity
[] Health Agent
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Other
[] Don't know
[] No Response

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Burkina Faso 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Regional Hospital Center
[] Medical Center with Surgery Unit (public)
[] Medical Center (public)
[] Fieldworker and community health volunteers (public)
[] Private hospital or clinic
[] Pharmacy
[] Private practice
[] Mobile clinic (private)
[] Maternity
[] Health Agent
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Other
[] Don't know
[] No Response

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Burkina Faso 2022
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] National Hospital Center
[] Health and Social Services Center (public)
[] Family planning clinic
[] Mobile clinic (public)
[] Regional Hospital Center
[] Medical Center with Surgery Unit (public)
[] Medical Center (public)
[] Fieldworker and community health volunteers (public)
[] Private hospital or clinic
[] Pharmacy
[] Private practice
[] Mobile clinic (private)
[] Maternity
[] Health Agent
[] Store/market/supermarket/mobile vendors
[] Religious organizations
[] Community event
[] Other
[] Don't know
[] No Response

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Congo (Democratic Republic) 2019a
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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Congo (Democratic Republic) 2019b
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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Congo (Democratic Republic) 2020
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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Congo (Democratic Republic) 2020
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious instituteion
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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Congo (Democratic Republic) 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious institution
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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Congo (Democratic Republic) 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] National hospital
[] Family planning clinic
[] Health center/Poste de sante
[] Maternity
[] Community health volunteer
[] Regional hospital
[] Private hospital/clinic
[] pharmacy
[] NGO
[] Private health center
[] Private practice
[] Private doctor
[] Mobile nurse
[] Community health worker (ASC)
[] Community-based medical student
[] Boutique
[] Religious institution
[] Friend / Relative
[] Bar / Night club
[] Ligablo / Kiosk
[] Chayeur
[] Other
[] Don't know
[] No Response

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Cote d'Ivoire 2020
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] Government hospital
[] Government health center
[] Family planning clinic
[] Mobile clinic (public)
[] Other public
[] Private hospital / clinic
[] Pharmacy
[] Private doctor
[] Mobile clinic (private)
[] Health agent
[] Other private
[] Store
[] Religious organizations
[] Community event
[] Friend / parent
[] Community health agent
[] Street vendor
[] Other
[] Do not know
[] No response

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Cote d'Ivoire 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Government hospital
[] Government health center
[] Family planning clinic
[] Mobile clinic (public)
[] Other public
[] Private hospital / clinic
[] Pharmacy
[] Private doctor
[] Mobile clinic (private)
[] Health agent
[] Other private
[] Store
[] Religious organizations
[] Community event
[] Friend / parent
[] Community health agent
[] Street vendor
[] Other
[] Do not know
[] No response

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India 2020
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] Govt./Municipal Hospital
[] Govt. Dispensary
[] UFWC/UHC/UHP
[] CHC/Rural Hospital/PHC
[] Sub-Centre/ANM
[] Govt. Mobile clinic
[] Camp
[] Anganwadi/ICDS Centre
[] ASHA
[] Other Community-Based Worker
[] NGO or Trust Hospital/Clinic
[] Pvt hospital
[] Pvt. Doctor/Clinic
[] Pvt. Mobile Clinic
[] Vaidya/Hakim/Homeopath (Ayush)
[] Traditional Healer
[] Pharmacy/Drugstore
[] Dai (TBA)
[] Shop
[] Friend / parent / relative
[] Community event
[] Other
[] Do not know
[] No response

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India 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Govt./Municipal Hospital
[] Govt. Dispensary
[] UFWC/UHC/UHP
[] CHC/Rural Hospital/PHC
[] Sub-Centre/ANM
[] Govt. Mobile clinic
[] Camp
[] Anganwadi/ICDS Centre
[] ASHA
[] Other Community-Based Worker
[] NGO or Trust Hospital/Clinic
[] Pvt hospital
[] Pvt. Doctor/Clinic
[] Pvt. Mobile Clinic
[] Vaidya/Hakim/Homeopath (Ayush)
[] Traditional Healer
[] Pharmacy/Drugstore
[] Dai (TBA)
[] Shop
[] Friend / parent / relative
[] Community event
[] Other
[] Do not know
[] No response

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Kenya 2019
Questionnaire form view entire document:  text 
303a. If you needed family planning, where would you go?

[] Govt. Hospital / polyclinic
[] Govt. Health Center
[] Govt. Dispensary
[] Other Public
[] Private Hospital/Clinic
[] Pharmacy/Chemist
[] Nursing/Maternity Home
[] Faith-based, church, mission hospital/clinic
[] Family options/FHOK clinic
[] Other private medical sector
[] Shop
[] Mobile clinic
[] Community-based distributor
[] Community health volunteer/CHV
[] Friend/relative
[] Other
[] Don't know
[] No Response

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Kenya 2020
Questionnaire form view entire document:  text 
303a. If you needed family planning, where would you go?

[] Govt. Hospital / polyclinic
[] Govt. Health Center
[] Govt. Dispensary
[] Other Public
[] Private Hospital/Clinic
[] Pharmacy/Chemist
[] Nursing/Maternity Home
[] Faith-based, church, mission hospital/clinic
[] Family options/FHOK clinic
[] Other private medical sector
[] Shop
[] Mobile clinic
[] Community-based distributor
[] Community health volunteer/CHV
[] Friend/relative
[] Other
[] Don't know
[] No Response

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Kenya 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Govt. Hospital / polyclinic
[] Govt. Health Center
[] Govt. Dispensary
[] Other Public
[] Private Hospital/Clinic
[] Pharmacy/Chemist
[] Nursing/Maternity Home
[] Faith-based, church, mission hospital/clinic
[] Family options/FHOK clinic
[] Other private medical sector
[] Shop
[] Mobile clinic
[] Community-based distributor
[] Community health volunteer/CHV
[] Community event
[] Friend/relative
[] Other
[] Don't know
[] No Response

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Niger 2020
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] Pharmacy - public
[] Maternity Central
[] Center of Madonna and Child
[] Maternity CHR
[] Maternity HD
[] Health Center
[] Community-based distribution site
[] Case de sante
[] Mobile clinic
[] Private hospital or clinic
[] Pharmacy - private
[] Mobile clinic (private)
[] Center ANBEF
[] Kiosk Routier
[] Polyclinic or Private clinic
[] Boutique
[] Religious organizations
[] Community event
[] Friend / parent
[] Walking pharmacy
[] Other
[] Do not know
[] No Response

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Niger 2022
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Pharmacy - public
[] Maternity Central
[] Center of Madonna and Child
[] Maternity CHR
[] Maternity HD
[] Health Center
[] Community-based distribution site
[] Case de santé
[] Mobile clinic
[] Private hospital or clinic
[] Pharmacy - private
[] Mobile clinic (private)
[] Center ANBEF
[] Kiosk Routier
[] Polyclinic or Private clinic
[] Boutique
[] Religious organizations
[] Community event
[] Friend / parent
[] Walking pharmacy
[] Other
[] Do not know
[] No Response

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Nigeria 2019a
Questionnaire form view entire document:  text 
303a. If you needed family planning, where would you go?

[] Government Hospital
[] Government Health Center
[] Family planning clinic
[] Mobile clinic (public)
[] TBA/Fieldworker (public)
[] Private hospital/clinic
[] Pharmacy
[] Chemist/PMS Store
[] Private doctor or nurse
[] Mobile clinic (private)
[] TBA/Fieldworker (private)
[] Shop
[] FBO/Church
[] Friend / relative
[] NGO
[] Market / hawking
[] Community event
[] Other
[] Do not know
[] No response

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Nigeria 2019b
Questionnaire form view entire document:  text 
303a. If you needed family planning, where would you go?

[] Government Hospital
[] Government Health Center
[] Family planning clinic
[] Mobile clinic (public)
[] TBA/Fieldworker (public)
[] Private hospital/clinic
[] Pharmacy
[] Chemist/PMS Store
[] Private doctor or nurse
[] Mobile clinic (private)
[] TBA/Fieldworker (private)
[] Shop
[] FBO/Church
[] Friend / relative
[] NGO
[] Market / hawking
[] Community event
[] Other
[] Do not know
[] No response

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Nigeria 2020a
Questionnaire form view entire document:  text 
303a. If you needed family planning, where would you go?

[] Government Hospital
[] Government Health Center
[] Family planning clinic
[] Mobile clinic (public)
[] TBA/Fieldworker (public)
[] Private hospital/clinic
[] Pharmacy
[] Chemist/PMS Store
[] Private doctor or nurse
[] Mobile clinic (private)
[] TBA/Fieldworker (private)
[] Shop
[] FBO/Church
[] Friend / relative
[] NGO
[] Market / hawking
[] Community event
[] Other
[] Do not know
[] No response

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Nigeria 2020b
Questionnaire form view entire document:  text 
303a. If you needed family planning, where would you go?

[] Government Hospital
[] Government Health Center
[] Family planning clinic
[] Mobile clinic (public)
[] TBA/Fieldworker (public)
[] Private hospital/clinic
[] Pharmacy
[] Chemist/PMS Store
[] Private doctor or nurse
[] Mobile clinic (private)
[] TBA/Fieldworker (private)
[] Shop
[] FBO/Church
[] Friend / relative
[] NGO
[] Market / hawking
[] Community event
[] Other
[] Do not know
[] No response

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Nigeria 2021a
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Government Hospital
[] Government Health Center
[] Family planning clinic
[] Mobile clinic (public)
[] TBA/Fieldworker (public)
[] Private hospital/clinic
[] Pharmacy
[] Chemist/PMS Store
[] Private doctor or nurse
[] Mobile clinic (private)
[] TBA/Fieldworker (private)
[] Shop
[] FBO/Church
[] Friend / relative
[] NGO
[] Market / hawking
[] Community event
[] Other
[] Do not know
[] No response

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Nigeria 2021b
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Government Hospital
[] Government Health Center
[] Family planning clinic
[] Mobile clinic (public)
[] TBA/Fieldworker (public)
[] Private hospital/clinic
[] Pharmacy
[] Chemist/PMS Store
[] Private doctor or nurse
[] Mobile clinic (private)
[] TBA/Fieldworker (private)
[] Shop
[] FBO/Church
[] Friend / relative
[] NGO
[] Market / hawking
[] Community event
[] Other
[] Do not know
[] No response

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Uganda 2020
Questionnaire form view entire document:  text 
305. If you needed family planning, where would you go?

[] Govt. Hospital
[] Govt. Health Center
[] Public Family Planning Clinic
[] Public Outreach
[] Public Fieldwork/VHT
[] Other Public
[] Private Hospital/Clinic
[] Pharmacy
[] Private Doctor
[] Private Outreach
[] Private Fieldwork/VHT
[] Other Private
[] Shop
[] Church
[] Friend/relative
[] Other
[] Do not know
[] No Response

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Uganda 2021
Questionnaire form view entire document:  text 
306. If you needed family planning, where would you go?

[] Govt. Hospital
[] Govt. Health Center
[] Public Family Planning Clinic
[] Public Outreach
[] Public Fieldwork/VHT
[] Other Public
[] Private Hospital/Clinic
[] Pharmacy
[] Private Doctor
[] Private Outreach
[] Private Fieldwork/VHT
[] Other Private
[] Shop
[] Church
[] Friend/relative
[] Other
[] Do not know
[] No Response