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Social Impact Assessment of Microfinance Programmes - weman

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Section 5a – All Respondents<br />

File: ‘HEALTH COMPLAINTS’<br />

What health complaints did your family has in the last 30 days<br />

[Multiple Answers Possible]<br />

What health complaints<br />

did your family has in<br />

the last 30 days<br />

Number <strong>of</strong><br />

Family<br />

Members<br />

Reported<br />

How many<br />

times did your<br />

family<br />

member visit<br />

a health care<br />

facility<br />

What kind <strong>of</strong><br />

health care<br />

facility or health<br />

care provider did<br />

your family<br />

member visit<br />

How much<br />

did your<br />

family spend<br />

on health<br />

care facility<br />

[HCODE] [NUMBER] [FREQ] [SOURCE] [EXPEND]<br />

1 Stomach disorder<br />

2 Cough<br />

3 Cold<br />

4 Back pin<br />

5 Asthma<br />

6 Stomach ache<br />

7 Headaches<br />

8 Toothaches<br />

9 Ear pain<br />

10 Diarrhea<br />

11 Skin problem<br />

12 Fever<br />

13 Accidents<br />

14 Malaria<br />

15 Joint/muscle pain<br />

16<br />

17 Others<br />

Source Codes:<br />

1. Public Hospital<br />

2. Public Health Clinic<br />

3. Basic Health Unit<br />

4. Rural Health Centre<br />

5. Private Hospital<br />

6. Private Clinic<br />

7. Medical Store<br />

8. Private Doctor<br />

9. Hakim / Homeopathic Doctor<br />

10. Lady Health Visitor<br />

11. Other __________________<br />

Questionnaire – <strong>Social</strong> <strong>Impact</strong> <strong>Assessment</strong> <strong>of</strong> Micr<strong>of</strong>inance<br />

9

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