Questionnaire Text

Burkina Faso 2021 Cote d'Ivoire 2021 Niger 2020 Uganda 2020
Congo (Democratic Republic) 2020 India 2020 Niger 2022 Uganda 2021
Congo (Democratic Republic) 2020 India 2021 Nigeria 2020a
Cote d'Ivoire 2020 Kenya 2020 Nigeria 2020b
top
Burkina Faso 2021
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Congo (Democratic Republic) 2020
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Congo (Democratic Republic) 2020
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Cote d'Ivoire 2020
Questionnaire form view entire document:  text 
COV_15. During the Coronavirus (COVID-19) restrictions, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] Abortion / post-abortion services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] HIV
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Cote d'Ivoire 2021
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
India 2020
Questionnaire form view entire document:  text 
COV_15. During the Coronavirus(COVID-19) lockdowns, did you want to visit a health facility for any of the following services?

Read all options
Select all that apply

You selected no response with another option.

[] Family planning services
[] Abortion / post-abortion services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] HIV
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
India 2021
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Kenya 2020
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Niger 2020
Questionnaire form view entire document:  text 
COV_15. During the Coronavirus (COVID-19) restrictions, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

[] Family planning services
[] Abortion / post-abortion services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] HIV
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Niger 2022
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Nigeria 2020a
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Nigeria 2020b
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response

top
Uganda 2020
Questionnaire form view entire document:  text 
COV_15. During the Coronavirus (COVID-19) restrictions, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] HIV
[] Emergency services
[] General health services
[] Did not want to access a health facility
[] Other
[] No response

top
Uganda 2021
Questionnaire form view entire document:  text 
COV_15. During the past 4 weeks, did you want to visit a health facility for any of the following services?

Read each option aloud and select if yes.

You selected no response with another option.

[] Family planning services
[] ANC
[] Delivery
[] PNC
[] Child's health
[] Immunization
[] Pick up of regular medications
[] Emergency services
[] General health services
[] Other
[] Did not want to access a health facility
[] No response