Questionnaire - Measurement, Learning & Evaluation Project

PUBLIC SECTORGOVERNMENTHOSPITAL……..……................11WOMEN AND CHILDREN’S HOSPITAL……….12CHILD WELFARE CLINIC………………….……13GOVT. HEALTH CENTER………………….……14GOVERNMENT POST/DISPENSARY………….15MATERNITY HOME……………………….…..….16MOBILE CLINIC……………………………..……17OTHER PUBLIC________________________18(SPECIFY)Q412What type of facility is this?Wanne irin asibiti ne?PRIVATE SECTORPRIVATEHOSPITAL/CLINIC……………………….………21PRIVATE DOCTOR’S OFFICE…………………22NURSING/MATERNITY HOME………………...23PHARMACY…………………………………….…24PMS/CHEMIST…………………..…………….…25MOBILE CLINIC………………………………….26CHW/TBA…………………………………….……27TRADITIONAL HEALER………………………....28OTHER PRIVATE_______________________29(SPECIFY)FAITH-BASED SECTORMISSION HOSPITAL…………….……................31FAITH-BASED, CHURCH CLINIC……………...32OTHER SOURCEOTHER NGOHOSPITAL/CLINIC…………………..…………..41WORKSITE CLINIC…………….…………….….42YOUTH CENTER………………………………...43OTHER ______________________________96(SPECIFY)DON'T KNOW . . . . . . . . . . . . . . …………………... . .98Q413Q414Did you receive any information or counseling onfamily planning/child birth spacing/child spacingduring this visit?Kin samu wani bayani ko shawara akan tsariniyali/tazara tsakanin haihuwa /tazara tsakanin yara awannan lokacin ziyarar?Did you receive a method or a referral for familyplanning/child birth spacing/child spacing method atthat time?Kin samu dabara ko an tura ki wajen tsariniyali/tazara tsakanin haihuwa/tazara tsakanin yara awancan lokacin?YES . . . . . . . . . . . . . . . . . . . . . …………………..1NO . . . . . . . . . . . . . . . . . . . . . ………………….. .2YES, RECEIVED A METHOD. . . . . . . . . . …………….1YES, RECEIVED A PRESCRIPTION……………...…..2YES, RECEIVED A REFERRAL . . . . . . . ……………. 3NO, DID NOT RECEIVE ANY OF THESE…………..…4Q415In the last year, have you gone to a health facility formaternal health services, such as prenatal andpostpartum care?Cikin shekararda ta shige, kin je asibiti domin awoncikiko kuma kula bayan haihuwa/lokacin jego?YES . . . . . . . . . . . . . . . . . . . . . . ………….1NO . . . . . . . . . . . . . . . . . . . . . . . ………….2Q41923