Questionnaire Text

Burkina Faso 2021
Congo (Democratic Republic) 2020
Congo (Democratic Republic) 2020
Cote d'Ivoire 2020
India 2020
Kenya 2020
Niger 2020
Nigeria 2020a
Nigeria 2020b
Uganda 2020
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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

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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

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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

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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

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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

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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

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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

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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