11.07.2015 Views

Afghanistan Mortality Survey 2010 - Measure DHS

Afghanistan Mortality Survey 2010 - Measure DHS

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Introduction and ConsentHello. My name is _____________________________________ and I am working with the Ministry of Public Health.We are conducting a survey about health all over <strong>Afghanistan</strong>. Your household was selected for the survey.The questions usually take about 30-45 minutes.We are collecting information on women's health in the community. This information will help the government toplan health services. We would very much appreciate your participation in this survey. As part of the survey wewould first like to ask some questions about your health and your family. Whatever information you provide will bekept strictly confidential. No information identifying you or your family will ever be released to anyone outside of thissurvey.Participation in this survey is voluntary, and if we should come to any question you don't want to answer, just let meknow and I will go on to the next question; or you can stop the interview at any time. However, we hope you willparticipate in the survey since your answers will help the government improve health services for Afghans.At this time, do you want to ask me anything about the survey?May I begin the interview now?Signature of interviewer:Date:RESPONDENT AGREES TO BE . . 1 RESPONDENT DOES NOT AGREE TO BE . . 2 ENDINTERVIEWED INTERVIEWED .216 | Appendix F

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