Measurement, Learning & Evaluation (MLE) Project Health Facility audit Kenya 2014

Transcription

1 Measurement, Learning & Evaluation (MLE) Project Health Facility audit Kenya 2014 CITY NAME & CODE (Nairobi=1, Mombasa=2, Kisumu =3, Machakos=4, Kakamega=5) COUNTY NAME &CODE SUBCOUNTY NAME & CODE (OFFICE ONLY) MLE FACILITY NAME AND CODE MFL FACILITY CODE (OFFICE ONLY) FACILITY PHYSICAL ADDRESS [ ] [ ] [ ] [ (City + Fac. type + Facility ID) [ ] TYPE OF HEALTH FACILITY PUBLIC SECTOR GOVT. NATIONAL REFERRAL (PROVINCIAL) HOSPITAL 11 GOVT. DISTRICT/COUNTY REFERRAL HOSPITAL 12 GOVT.SUB-DISTRICT/SUB-COUNTY)HOSPITAL...13 GOVT. HEALTH CENTRE. 14 GOVT. DISPENSARY OTHER PUBLIC 18 PRIVATE SECTOR PRIVATE HOSPITAL.. 21 PRIVATE CLINIC. 22 NURSING/MATERNITY HOME OTHER PRIVATE 24 FBO MISSION HOSPITAL..31 FAITH-BASED HOME/HEALTH CENTRE 32 NGO OTHER NGO HOSPITAL..41 OTHER NGO CLINIC.42 OTHER 96 1

2 INTERVIEWER VISITS VISIT No FINAL VISIT DATE DAY/MONTH/YEAR DAY/MONTH/YEAR DAY/MONTH/YEAR DAY [ ] [ / /_14_] [ / / 14_] [ / / 14_] MONTH [ ] YEAR [_2_ _0_ _1_ _4_] INTERVIEWER S NAME INTERVIEWER CODE RESULT* NEXT VISIT: DATE [ / /14_] [ / /14_] [ / /14_] TIME TOTAL NO. OF VISITS *RESULT CODES: 1. COMPLETED 2. FACILITY MOVED OR IS DESTROYED 3. RESPONDENT NOT AVAILABLE (NOT AT WORK, ON STRIKE, ETC) H H M M H H M M H H M M 4. RESPONDENT REFUSED 5. PARTLY COMPLETED 6. POSTPONED 7. OTHER RESPONSIBILITY OF MAIN PERSON INTERVIEWED - CIRCLE ONE CLINIC MANAGER/FACILITY ADMINISTRATOR FACILITY IN CHARGE..02 DEPUTY FACILITY INCHARGE...03 DEPUTY IN CHARGE...04 DEPARTMENTAL IN CHARGE 05 FACILITY OWNER.06 OTHER.96 NAME MOBILE PHONE NUMBER [_0 7_][ ][ ][ ][ ] SEX OF MAIN PERSON INTERVIEWED MALE..1 FEMALE. 2 SUPERVISOR FIELD EDITOR OFFICE EDITOR KEYED BY NAME.. NAME.. CODE: NAME. NAME CODE: CODE: CODE: DATE [ / / 14_] DD MM YY DATE [ / / 14_] DD MM YY DATE [ / / 14_] DD MM YY DATE [ / / 14_] DD MM YY Introduction Hello! My name is, I am part of a research team working for Research and Care Training Program-KEMRI under the Kenya Urban Reproductive Health Initiative (KURHI). We are carrying out research on family planning in urban areas of Kenya. Your site was selected as a participating facility in a private and public health facility sector survey in this city. Your participation in this study will help to improve family planning services. We will be asking questions to selected health facilities about the reproductive health services including family planning services they provide. Your answers will not be shared with anyone outside this project. Your name will not appear on the survey. We will not share answers with your clients, colleagues, or anyone else. At the end of the study, we will put all the answers together and make a report. May I continue? 2

3 GENERAL FACILITY INFORMATION Sourc Questions Coding Skip/Notes e Q1. RECORD THE TIME (IN 24 HOUR FORMAT) Hour.. Minutes. Q2. In what year did this facility open? YEAR OPENED PROBE, IF RESPONDENT SAYS KNOW: THIS IS VERY IMPORTANT. Can KNOW you tell me how old this facility is? For example, would you say it is about 3 years OR old? 7 years old? (etc.) YEARS OLD FILL IN EITHER YEAR OPENED OR YEARS OLD. Q3. On average, how many days per week is the facility open? Days per week Q4. What time does the facility typically open? WRITE ANSWER ON 24-HOUR CLOCK (IE. IF OPENS AT 7:00 AM, MARK 07:00 Q5. What time does the facility typically close? WRITE ANSWER ON 24-HOUR CLOCK (IE. IF CLOSES AT 7:00 PM, MARK 19:00 Q6. How many permanent regular staff offer DIRECT clinical services in this facility? List the staff by type (cadre). 1. Obstetrician/Gynecologists (OB/GYN) 2. Surgeons 3. Pediatricians 4. Physicians 5. Pharmacists 6. Medical Officers 7. Clinical Officers 8. Registered Nurses 9. Enrolled Community Nurses 10. BSC Nurses 11. Community health extension workers (CHEWs) 12. Public health officers (PHO) 13. Lab technologists/technicians 14. Health Information Officers 15. Nutritionists 16. VCT/HTC providers/counselors 17. Others FOR LARGE MEDICAL HOSPITALS AND COLLEGES, PLEASE PROBE TO ESTIMATE TO YOUR BEST ABILITY. INCLUDE DIRECT HIRES AND STAFF HIRED BY PARTNERS *NOTE: PLEASE EXCLUDE DOCTORS IN RESIDENCY TRAINING, INTERNS, VOLUNTEERS : Open 24 hours a day 99:91 : OB/GYNS SURGEONS PEDIATRICIANS PHYSICIANS PHARMACISTS MEDICAL OFFICERS CLINICAL OFFICERS REGISTERED NURSES ENROLLED COMM.NURSES BSC NURSES CHEW PUBLIC HEALTH OFFICER LAB TECHS Q6 You can read out the options: HEALTH INFO OFFICER NUTRITIONISTS VCT/HTC S OTHER SPECIFY 3

4 Now I would like to ask you some questions about the permanent and contract staff who work in this facility. We would like to ask their names, positions and departments, so that we can randomly sample a few to interview using a separate questionnaire. These few will then represent the group. Remember that this is for research purposes only and we will keep all details strictly confidential. STAFF LIST NAMES OF ALL PERMANENT REGULAR STAFF INVOLVED IN PROVIDING REPRODUCTIVE HEALTH AND CHILD CLINICAL HEALTH SERVICES, INCLUDING FAMILY PLANNING, MATERNAL AND CHILD HEALTH AND STI/VCT/HTC/HIV SERVICES. MATERNAL HEALTH SERVCIES INCLUDE ANTENATAL CARE, PMTCT, DELIVERY CARE, POST NATAL CARE AND POST ABORTION CARE SERVCES. CODE YES IN Q7c FOR THOSE S ON DUTY TODAY, AND NO FOR THOSE NOT ON DUTY AT ANY TIME TODAY. FOR EACH PERMANENT SERVICE WHO IS NOT ON DUTY TODAY, WRITE 999 (NOT ELIGIBLE) IN Q7d. FOR ALL PERMANENT SERVICE S WHO ARE ON DUTY TODAY, ASSIGN A NUMBER TO EACH OF THEM (SERIALIZE) IN Q7d STARTING WITH 01 TO THE LAST NUMBER. DO NOT INCLUDE SERVICE S WHO DO NOT DIRECTLY PROVIDE RH AND CHILD HEALTH SERVICES, E.G. PHARMACIST. ALSO, DO NOT CONSIDER THE 999 AS PART OF THE NUMBERING BELOW. FOR FACILITIES WITH FOUR OR FEWER S ON DUTY TODAY, INTERVIEW ALL OF THEM. FOR FACILITIES WITH FIVE OR MORE S ON DUTY TODAY, WRITE ALL NUMBERS FROM Q7d (EXCEPT FOR 999 ) ON SMALL PIECES OF PAPER AND RANDOMLY SELECT FOUR S. ONCE YOU HAVE BALLOTED/SELECTED FOUR S FROM Q7d, CAREFULLY AND NEATLY CIRCLE THE NUMBERS IN Q7d FOR THOSE SELECTED. Does NAME provide service(s)? Q7a. No. of staff (01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) Q7b. NAME CODE: 1. Obstetrician/Gynecologists 2. Surgeons 3. Pediatricians Q7c. Is NAME scheduled to be on duty any time today? 4. Physicians 5. Pharmacists 6. Medical Officers 7. Clinical Officers Q7d. Serial number of sampled on-duty staff Q7e. POSITION CODE Q7f. Does NAME work full-time? 8. Registered Nurses 9. Enrolled Community Nurses 10. BSC Nurses 11. CHEWs Q7g. SEX Q7h. FAMILY PLANNING YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 YES.. 1 NO...2 Q7i. MATERNAL HEALTH/ OB- GYN 12. Public health officers (PHO) 13. Lab technologists/technicians 14. Health Information Officers 15. Nutritionists Q7j. CHILD HEALTH Q7k. HIV /STI SERVICES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO VCT/HTC providers/counselors 96 Other

5 STAFF Does NAME provide service(s)? Q7a. No. of staff (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28) Q7b. NAME CODE: 1. Obstetrician/Gynecologists 2. Surgeons 3. Pediatricians Q7c. Is NAME scheduled to be on duty any time today? 4. Physicians 5. Pharmacists 6. Medical Officers 7. Clinical Officers Q7d. Serial number of sampled on-duty staff Q7e. POSITION CODE 5 Q7f. Does NAME work full-time? 8. Registered Nurses 9. Enrolled Community Nurses 10. BSC Nurses 11. CHEWs Q7g. SEX Q7h. FAMILY PLANNING 12. Public health officers (PHO) 13. Lab technologists/technicians 14. Health Information Officers 15. Nutritionists Q7i. MATERNAL HEALTH/ OB- GYN Q7j. CHILD HEALTH Q7k. HIV /STI SERVICES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO VCT/HTC providers/counselors 96 Other

6 STAFF Does NAME provide service(s)? Q7a. No. of staff (29) (30) (31) (32) (33) (34) (35) (36) (37) (38) (39) (40) (41) (42) (43) (44) (45) Q7b. NAME CODE: 1. Obstetrician/Gynecologists 2. Surgeons 3. Pediatricians Q7c. Is NAME scheduled to be on duty any time today? 4. Physicians 5. Pharmacists 6. Medical Officers 7. Clinical Officers Q7d. Serial number of sampled on-duty staff Q7e. POSITION CODE 6 Q7f. Does NAME work full-time? 8. Registered Nurses 9. Enrolled Community Nurses 10. BSC Nurses 11. CHEWs Q7g. SEX Q7h. FAMILY PLANNING 12. Public health officers (PHO) 13. Lab technologists/technicians 14. Health Information Officers 15. Nutritionists Q7i. MATERNAL HEALTH/ OB- GYN Q7j. CHILD HEALTH Q7k. HIV /STI SERVICES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO VCT/HTC providers/counselors 96 Other

7 STAFF Does NAME provide service(s)? Q7a. No. of staff (46) (47) (48) (49) (50) (51) (52) (53) (54) (55) (56) (57) (58) (59) (60) (61) (62) Q7b. NAME CODE: 1. Obstetrician/Gynecologists 2. Surgeons 3. Pediatricians Q7c. Is NAME scheduled to be on duty any time today? 4. Physicians 5. Pharmacists 6. Medical Officers 7. Clinical Officers Q7d. Serial number of sampled on-duty staff Q7e. POSITION CODE 7 Q7f. Does NAME work full-time? 8. Registered Nurses 9. Enrolled Community Nurses 10. BSC Nurses 11. CHEWs Q7g. SEX Q7h. FAMILY PLANNING 12. Public health officers (PHO) 13. Lab technologists/technicians 14. Health Information Officers 15. Nutritionists Q7i. MATERNAL HEALTH/ OB- GYN Q7j. CHILD HEALTH Q7k. HIV /STI SERVICES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO VCT/HTC providers/counselors 96 Other

8 STAFF Does NAME provide service(s)? Q7a. No. of staff (63) (64) (65) (66) (67) (68) (69) (70) (71) (72) (73) (74) (75) Q7b. NAME CODE: 1. Obstetrician/Gynecologists 2. Surgeons 3. Pediatricians Q7c. Is NAME scheduled to be on duty any time today? 4. Physicians 5. Pharmacists 6. Medical Officers 7. Clinical Officers Q7d. Serial number of sampled on-duty staff Q7e. POSITION CODE Q7f. Does NAME work full-time? 8. Registered Nurses 9. Enrolled Community Nurses 10. BSC Nurses 11. CHEWs Q7g. SEX Q7h. FAMILY PLANNING 12. Public health officers (PHO) 13. Lab technologists/technicians 14. Health Information Officers 15. Nutritionists Q7i. MATERNAL HEALTH/ OB- GYN Q7j. CHILD HEALTH Q7k. HIV /STI SERVICES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO VCT/HTC providers/counselors 96 Other CHECK THE BOX IF ANOTHER FORM IS USED: TOTAL NUMBER OF FORMS: FORM NUMBER: 8

9 Now I would like to ask you about some of the services that this facility provides to their clients. SERVICE Q8a. Does this Q8c. How many clients received this service here facility provide the Q8b. How in the past 3 months? many days Q8d.WHAT WAS THE following Maternal ASK TO SEE MEDICAL per week is SOURCE OF THIS RECORD SYSTEM, IF and Child Health SERVICE INFORMATION? POSSIBLE. OTHERWISE, available? SERVICES? ASK RESPONDENT TO RECALL. GENERAL Maternal and Child Health Services 1. HIV testing and counseling (INCLUDE ANC, MCH, PNC) Yes Comprehensive care clinic Yes TB Screening 4. Antenatal Profile 5. IPPT for Malaria Intermittent preventive treatment for malaria 6. ITN for Malaria prevention during and after pregnancy 7. Nutrition Counseling during pregnancy 8. Iron Supplementation during pregnancy 9. Vitamin A supplementation after pregnancy 10. Tetanus Toxoidaccording to schedule 11. Family Planning counseling and services 12. Early Disease detection and treatment of sexually transmitted diseases 13. PMTCT Child Health Services No (2) Days... No (3) Days... Yes No (4) Days... Yes No (5) Days... Yes No Yes No Yes No Yes No Yes No Yes No Yes No (12) Days... Yes No (13) Days... Yes Child Immunization Yes No (14) Days... No (15) Days... 9 NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2

10 SERVICE Q8a. Does this facility provide the following Maternal and Child Health SERVICES? 15. Child Growth monitoring Yes Oral rehydration therapy services Yes Integrated Yes management of Childhood No illnesses(imci) Delivery and Post-Partum Services 18. Labor and delivery services Yes Blood transfusion during labor/ delivery 20. C-section 21. Care of the new born 22. Post-Partum Care Q8b. How many days per week is SERVICE available? No (16) Days... No (17) Days... No (19) Days... Yes No (20) Days... Yes No (21) Days... Yes No Yes Counseling on Yes initiating breastfeeding (after No delivery) 24. Post Abortion Care Services Yes Other RH Services 25. Cancer Yes screening, eg No Breast, Cervix 26. Youth Friendly Services Yes No (23) Days... No (25) Days... No... 2 (Q9) Days... Q8c. How many clients received this service here in the past 3 months? ASK TO SEE MEDICAL RECORD SYSTEM, IF POSSIBLE. OTHERWISE, ASK RESPONDENT TO RECALL. NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE NOT AVAILABLE Q8d.WHAT WAS THE SOURCE OF THIS INFORMATION? RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE.. 2 RECORD.1 ESTIMATE

11 Q9 Q10 Has this facility ever participated in a whole site FP training? Which organization coordinated the whole site FP training? CHECK TO DETERMINE WHETHER ORGANIZATION IS PART OF APHIAplus BEFORE ENTERING AS OTHER CIRCLE ALL MENTIONED Q11. Does this facility refer clients to other health care facilities for any of MNCH, FP, or HIV services? Q12. For which services are these referrals? [MULTIPLE RESPONSE POSSIBLE] Q13. CHECK Q8A: IF YES TO ANY CHILD HEALTH SERVICES (14, 15,16, 17) Q14 Now I would like to ask you some questions about other health services. Do providers routinely initiate a conversation about FP with clients who have come for a child health service? Q15. What routinely/generally happens when a woman who has come for a child health service is also interested in receiving FP counseling? YES..1 NO.2 KNOW.8 TUPANGE.A PSI- TUNZA......B FHOK. C MARIE STOPES..D INTRAHEALTH.E APHIAplus.....F MOH...G GIZ..H AMUA TUPANGE....I AMUA ONLY.J UNIVERSITY OF MARYLAND..K OTHER X YES NO FAMILY PLANNING..A IMMUNIZATION. B ANTENATAL CARE..C DELIVERY CARE..D EMERGENCY DELIVERY CARE (C-SECTION)..E POSTNATAL CARE....F DISEASE PREVENTION....G TREATMENT OF ADULT....H TREATMENT FOR CHILD.... I GROWTH MONITORING OF CHILD/CHILD WELFARE.....J HEALTH CHECK-UP K VCT/HTC....L HIV/AIDS MANAGEMENT...M PMTCT....N OTHER X IF Q8A IS NO TO ALL CHILD HEALTH SERVICES (14, 15,16, 17) YES...1 NO..2 KNOW..8 Always receive on same day different day Referral to another department...06 Facility does not offer family planning services..08 Q11 Q11 Q13 Q21 Q21 11

12 Q16. What routinely/generally happens when a woman who has come for child health service is also interested in receiving an FP pill? Q17. What routinely/generally happens when a woman who has come for child health service is also interested in receiving an injectable? Q18. What routinely/generally happens when a woman who has come for child health service is also interested in receiving an IUD? Q19. What routinely/generally happens when a woman who has come for child health service is also interested in receiving an implant? Q20. What routinely/generally happens when a woman who has come for child health service is also interested in receiving sterilization? Q21 CHECK Q8A: IF YES TO ANY DELIVERY SERVICES (18, 19, 20) Always receive on same day different day...04 Referral to another department...06 Always receive on same day different day...04 Referral to another department...06 Always receive on same day different day...04 Referral to another department...06 Always receive on same day...01 different day...04 Referral to another department..06 Always receive on same day..01 different day...04 Referral to another department..06 IF NO TO ALL DELIVERY SERVICES (18, 19, 20) Q29 Q22 Do providers routinely initiate a conversation about FP with clients who have come for delivery services? YES...1 NO..2 KNOW..8 12

13 Q23 Q24 Q25 Q26 Q27 Q28 What routinely/generally happens when a woman who has come for delivery care is also interested in receiving FP counseling? What routinely/generally happens when a woman who has come for delivery care is also interested in receiving an FP pill? What routinely/generally happens when a woman who has come for delivery care is also interested in receiving an injectable? What routinely/generally happens when a woman who has come for delivery care is also interested in receiving an IUD? What routinely/generally happens when a woman who has come for delivery care is also interested in receiving an implant? What routinely/generally happens when a woman who has come for delivery care is also interested in receiving sterilization? Always receive on same day Sometimes receive on same day different day...04 Referral to another department Do not offer family planning services.08 Other 96 Always receive on same day Sometimes receive on same day different day...04 Referral to another department Other 96 Always receive on same day Sometimes receive on same day...02 different day...04 Referral to another department..06 Other 96 Always receive on same day Sometimes receive on same day different day Referral to another department Other 96 Always receive on same day Sometimes receive on same day different day Referral to another department Other 96 Always receive on same day Sometimes receive on same day different day Referral to another department Other 96 Q29 13

14 Q29. CHECK Q8A: IF YES TO ANY OF POST PARTUM CARE SERVICES (9, 21, 22, 23) IF NO TO ALL POST-PARTUM CARE (9, 21, 22, 23) Q37 Q30 Do providers routinely initiate a conversation about FP with clients who have come for post-partum care? Q31. What routinely/generally happens when a woman who has come for post-partum care is also interested in receiving FP counseling? Q32. What routinely/generally happens when a woman who has come for post-partum care is also interested in receiving an FP pill? Q33. What routinely/generally happens when a woman who has come for post-partum care is also interested in receiving an injectable? Q34. What routinely/generally happens when a woman who has come for post-partum care is also interested in receiving an IUD? Q35. What routinely/generally happens when a woman who has come for post-partum care is also interested in receiving an implant? YES....1 NO..2 KNOW..8 Always receive on same day different day...04 Referral to another department...06 Do not offer family planning services.08 Always receive on same day...01 different day...04 Referral to another department Always receive on same day different day...04 Referral to another department...06 Always receive on same day different day Referral to another department...06 Always receive on same day different day Referral to another department...06 Q37 14

15 Q36. What routinely/generally happens when a woman who has come for post-partum care is also interested in receiving sterilization? Q37. CHECK Q8A: IF YES TO POST-ABORTION CARE (24) Always receive on same day...01 different day Referral to another department...06 IF NO TO POST-ABORTION CARE Q8A (24) Q41 Q38 Do providers routinely initiate a conversation about FP with clients who have come for post-abortion care? Q39. In terms of FP counseling, what routinely/generally happens when a woman comes in for post-abortion care? Q40. What routinely/generally happens when a woman who has come for post-abortion care is also interested in receiving FP method? Q41. CHECK Q8A: IF YES TO ANY HIV/AIDS TESTING AND COUNSELLING (1); TB SCREENING (3); EARLY DISEASE DETECTION AND TREATMENT FOR STI (12); PMTCT (13) (1, 3, 12, 13) Q42 Do providers routinely initiate a conversation about FP with clients who have come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT services? Q43. What routinely/generally happens when a client who has come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT services is also interested in receiving FP counseling? YES....1 NO..2 KNOW..8 Always receive on same day different day...04 Given referral to another department...06 Does not provide FP services.08 Always receive on same day.. 01 different day...04 Given referral to another department...06 IF NO TO ALL (1, 3, 12, 13) YES....1 NO..2 KNOW..8 Always receive on same day different day...04 Given referral to another facility.. 05 Referral to another department.. 06 Do not offer family planning services.08 Q49 Q49 15

16 Q44. What routinely/generally happens when a woman who has come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT is also interested in receiving an FP pill? Would you say READ OUT ANSWERS Q45. What routinely/generally happens when a woman who has come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT services is also interested in receiving an injectable? Q46. What routinely/generally happens when a woman who has come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT services is also interested in receiving an IUD? Would you say READ OUT ANSWERS Q47. What routinely/generally happens when a woman who has come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT services is also interested in receiving an implant? Q48. What routinely/generally happens when a woman who has come for HIV/AIDS Testing and Counseling, or TB Screening, or screening and treatment of STIs, or PMTCT services is also interested in receiving sterilization? Q49. CHECK Q8A: IF YES TO COMPREHENSIVE CARE CLINIC (2) Always receive on same day...01 different day...04 Referral to another department...06 Always receive on same day...01 different day...04 Referral to another department..06 Always receive on same day...01 different day...04 Referral to another department..06 Always receive on same day...01 different day Referral to another department..06 Always receive on same day...01 different day...04 Referral to another department...06 IF NO TO COMPREHENSIVE CARE CLINIC(2) Q57 Q50 Do providers routinely initiate a conversation about FP with clients who have come for the comprehensive care clinic? YES....1 NO..2 KNOW..8 16

17 Q51 What routinely/generally happens when a client who has come for the comprehensive care clinic is also interested in receiving FP counseling? Q52. What routinely/generally happens when a woman who has come for the comprehensive care clinic is also interested in receiving an FP pill? Would you say READ OUT ANSWERS Q53. What routinely/generally happens when a woman who has come for the comprehensive care clinic is also interested in receiving an injectable? Q54 Q55 Q56 What routinely/generally happens when a woman who has come for the comprehensive care clinic is also interested in receiving an IUD? Would you say READ OUT ANSWERS What routinely/generally happens when a woman who has come for the comprehensive care clinic is also interested in receiving an implant? What routinely/generally happens when a woman who has come for the comprehensive care clinic is also interested in receiving sterilization? Always receive on same day different day...04 Given referral to another facility.. 05 Referral to another department.. 06 Do not offer family planning services.08 Always receive on same day...01 different day...04 Referral to another department...06 Always receive on same day...01 different day...04 Referral to another department..06 Always receive on same day...01 different day...04 Referral to another department..06 Always receive on same day...01 different day Referral to another department..06 Always receive on same day...01 different day...04 Referral to another department Q57

18 Q57. CHECK Q8A (11): FAMILY PLANNING COUNSELING AND SERVICES ARE OFFERED YES CHECK Q8A (11): FAMILY PLANNING COUNSELING AND SERVICES ARE NOT OFFERED NO Q57a: Would FP counseling and services be appropriate to include into the existing services offered? Yes No Don t know ALL SKIP TO Q87 18

19 ASK IF THE FOLLOWING CONTRACEPTIVES ARE PROVIDED IN THIS FACILITY. FOR EACH ITEM, CIRCLE THE APPROPRIATE CODE. (01) Combined oral pill (02) Progestin only pill (03) Emergency contraceptiv e (04) Male condom (05) Female condom Q58a. Does this facility provide the following FP methods/ services? YES..1 NO....2 (02) YES..1 NO....2 (03) YES..1 NO....2 (04) YES..1 NO....2 (05) YES..1 NO....2 (06) (06) Injectables YES..1 NO....2 (07) Implant insertion (07) YES..1 NO....2 (08) Q58b. How many days per week is the method provided? Q58c. What year was first offered at this facility? Don t know = 9998 Q58d. Does this facility have any requirements for another person s consent before is provided? NO NO NO NO NO NO OTHER NO Q58e. How many staff are currently able to provide this FP method? (08) Implant removal YES..1 NO....2 (09) OTHER NO (09) IUD insertion YES..1 NO....2 (10) OTHER NO (10) Post-Partum IUD (inserted within 48 hours after delivery) YES..1 NO....2 (11) OTHER NO (11) IUD removal YES..1 NO....2 (12) OTHER NO

20 ASK IF THE FOLLOWING CONTRACEPTIVES ARE PROVIDED IN THIS FACILITY. FOR EACH ITEM, CIRCLE THE APPROPRIATE CODE. (12) Male sterilization/ Vasectomy Q58a. Does this facility provide the following FP methods/ services? YES..1 NO....2 (14) Q58b. How many days per week is the method provided? OTHER Q58c. What year was first offered at this facility? Don t know = 9998 Q58d. Does this facility have any requirements for another person s consent before is provided? NO Q58e. How many staff are currently able to provide this FP method? (13) Standard Days Method / Cycle beads YES..1 NO....2 (15) NO (14) Lactational amenorrhea method (LAM) YES..1 NO....2 Q59a NO

21 Now I would like to ask you about your specific stocks of different family planning methods/products. ONLY ASK ABOUT THOSE S THAT ARE PROVIDED (FROM Q58A). CONTRACEPTIVE (01) Combination oral contraceptives (estrogen and progestin) Q59a. Where does your stock of CONTRACEPTIVE come from? CIRCLE ALL MENTIONED KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z Q59b. When was the last time that you received a routine supply of CONTRACEPTIVE either that you ordered, or that is part of your routine supply system? READ LIST. < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Q59c. Does this facility determine the quantity of each CONTRACEPTIVE that it needs and order that, or is the quantity that you receive determined elsewhere or both? READ LIST. Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Q59d. Do you receive a standard fixed quantity of CONTRACEPTIVE or does the quantity you receive vary according to recent need or activity level? READ LIST. Quantity based on activity level..1 Standard fixed supply..2 Both 3 Don t know...8 Q59e. CHECK Q59C. IFQ59C IS 2, SKIP TO Q59G When you order CONTRACEPTIVE, how much do you order? READ LIST. Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Q59f. When do you decide to order CONTRACEPTIVE? READ LIST. Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out..3 Other.6 Specify Don t know. 8 Q59g. On average, how long does it take to receive your CONTRACEPTIVE after you have placed an order? READ LIST. One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 Q59h. Is usually delivered or must you go get them? READ LIST KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 (02) Progestin-only oral contraceptives KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Quantity based on activity level..1 Standard fixed supply..2 Both. 3 Don t know...8 Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Stock fall below predeter mined level.1 Fixed time Every [ ] days. 2 Order when stocked out..3 Other.6 Specify Don t know. 8 One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 21

22 CONTRACEPTIVE (03) Emergency contraceptive s Q59a. Where does your stock of CONTRACEPTIVE come from? CIRCLE ALL MENTIONED KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z Q59b. When was the last time that you received a routine supply of CONTRACEPTIVE either that you ordered, or that is part of your routine supply system? READ LIST. < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Q59c. Does this facility determine the quantity of each CONTRACEPTIVE that it needs and order that, or is the quantity that you receive determined elsewhere or both? READ LIST. Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Q59d. Do you receive a standard fixed quantity of CONTRACEPTIVE or does the quantity you receive vary according to recent need or activity level? READ LIST. Quantity based on activity level..1 Standard fixed supply..2 Both 3 Don t know...8 Q59e. CHECK Q59C. IFQ59C IS 2, SKIP TO Q59G When you order CONTRACEPTIVE, how much do you order? READ LIST. Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Q59f. When do you decide to order CONTRACEPTIVE? READ LIST. Stock fall below predeter-mined level.1 Fixed time Every [ ] days. 2 Order when stocked out..3 Other.6 Specify Don t know. 8 Q59g. On average, how long does it take to receive your CONTRACEPTIVE after you have placed an order? READ LIST. One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 Q59h. Is usually delivered or must you go get them? READ LIST KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 (04) Male condoms (05) Female condoms KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F NASCOP G Other X Don t know.. Z KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Quantity based on activity level..1 Standard fixed supply..2 Both. 3 Don t know...8 Quantity based on activity level..1 Standard fixed supply..2 Both. 3 Don t know...8 Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out..3 Other.6 Specify Don t know. 8 Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out..3 Other.6 Specify Don t know. 8 One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 22

23 CONTRACEPTIVE Q59a. Where does your stock of CONTRACEPTIVE come from? CIRCLE ALL MENTIONED (06) Injectables KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z Q59b. When was the last time that you received a routine supply of CONTRACEPTIVE either that you ordered, or that is part of your routine supply system? READ LIST. < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Q59c. Does this facility determine the quantity of each CONTRACEPTIVE that it needs and order that, or is the quantity that you receive determined elsewhere or both? READ LIST. Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Q59d. Do you receive a standard fixed quantity of CONTRACEPTIVE or does the quantity you receive vary according to recent need or activity level? READ LIST. Quantity based on activity level..1 Standard fixed supply...2 Both...3 Don t know...8 Q59e. CHECK Q59C. IFQ59C IS 2, SKIP TO Q59G When you order CONTRACEPTIVE, how much do you order? READ LIST. Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Q59f. When do you decide to order CONTRACEPTIVE? READ LIST. Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out...3 Other...6 Specify Don t know. 8 Q59g. On average, how long does it take to receive your CONTRACEPTIVE after you have placed an order? READ LIST. One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 Q59h. Is usually delivered or must you go get them? READ LIST KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 (07) Implant (for insertion) KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Quantity based on activity level..1 Standard fixed supply..2 Both.3 Don t know...8 Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out...3 Other...6 Specify Don t know. 8 One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 (08) IUD/Post- Partum IUD (for insertion) KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Determines own need.1 (Q59e) Determined Elsewhere..2 Both Don t know..8 (Q59g) Quantity based on activity level..1 Standard fixed supply...2 Both.. 3 Don t know...8 Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out..3 Other.6 Specify Don t know. 8 One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 23

24 CONTRACEPTIVE (09) SDM/Cycle beads Q59a. Where does your stock of CONTRACEPTIVE come from? CIRCLE ALL MENTIONED KEMSA.A District Store B Other Facility...C Intl NGO.D Local NGO..E Pharmacy wholesaler/ dealer/ distributor F Other X Don t know.. Z Q59b. When was the last time that you received a routine supply of CONTRACEPTIVE either that you ordered, or that is part of your routine supply system? READ LIST. < 4 wks ago...1 Between 4-12 wks wks ago 3 > 18 weeks..4 No routine supply system..5 Don t know 8 Q59c. Does this facility determine the quantity of each CONTRACEPTIVE that it needs and order that, or is the quantity that you receive determined elsewhere or both? READ LIST. Determines own need.1 (Q59e) Determined Elsewhere....2 Both Don t know..8 (Q59g) Q59d. Do you receive a standard fixed quantity of CONTRACEPTIVE or does the quantity you receive vary according to recent need or activity level? READ LIST. Quantity based on activity level..1 Standard fixed supply...2 Both.. 3 Don t know...8 Q59e. CHECK Q59C. IFQ59C IS 2, SKIP TO Q59G When you order CONTRACEPTIVE, how much do you order? READ LIST. Order to maintain stock..1 Order same amount.2 Order based on consumption..3 Other.6 Don t know Q59f. When do you decide to order CONTRACEPTIVE? READ LIST. Stock fall below predetermined level.1 Fixed time Every [ ] days. 2 Order when stocked out...3 Other..6 Specify Don t know. 8 Q59g. On average, how long does it take to receive your CONTRACEPTIVE after you have placed an order? READ LIST. One week or less...1 Between 2-4 weeks.2 Between 5-8 weeks.3 More than 8 weeks..4 Other 6 Don t know..8 Q59h. Is usually delivered or must you go get them? READ LIST KEMSA..1 district stores/sdp.2 other supplier/facilities/ NGOs.. 3 This facility picks them up 4 24

25 Now I would like to ask you some more questions specifically about stock-outs of family planning methods. ONLY ASK ABOUT THOSE S THAT ARE PROVIDED FROM Q58a. Q60a. Is currently available? (01) Combined oral pill NO 2 Q60b. Has this facility had a stockout of that lasted at least 24 hours in the last one year? NO.2 (Q60j) Q60c. How many times has this facility had a stockout of in the past one year? (CHECK if Yes to Q60b) KNOW.98 Q60d. How many total days of stockout of did this facility experience in the past one year? (CHECK if Yes to Q60b) CONSTANT PROBLEM.995 DK.998 Q60e. SOURCE OF INFORMATIO N FOR STOCKOUTS IN PAST ONE YEAR: RECORD.1 ESTIMATE..2 Q60f. Has this facility had a stock-out of that lasted at least 24 hours in the last 30 days (one month)? NO.2 (Q60j) Q60g. How many times has this facility had a stock-out of in the past 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60h. How many total days of stock-out of did this facility experience in the last 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60i. SOURCE OF INFORMATION ON STOCKOUTS IN PAST 30 DAYS: RECORD.1 ESTIMATE. 2 Q60j. How many times have you received an emergency distribution of in the last 3 months? KNOW..98 Q60k. Have you ever participated in redistribution of (given to another facility or received from another facility)? YES, GIVEN ONLY...1 YES, RECEIVED ONLY...2 YES, BOTH..3 NO, NEITHER..4 KNOW..8 NEXT (02) Progestin only pill NO 2 NO.2 (Q60j) KNOW.98 CONSTANT PROBLEM..995 DK RECORD.1 ESTIMATE..2 NO.2 (Q60j) KNOW..98 KNOW..98 RECORD.1 ESTIMATE.. 2 KNOW..98 YES, GIVEN ONLY 1 YES, RECEIVED ONLY....2 YES, BOTH.3 NO, NEITHER..4 KNOW...8 NEXT 25

26 (03) Emergency contraceptive Q60a. Is currently available? NO 2 Q60b. Has this facility had a stockout of that lasted at least 24 hours in the last one year? NO.2 (Q60j) Q60c. If Yes, how many times has this facility had a stockout of in the past one year? (CHECK if Yes to Q60b) KNOW.98 Q60d. If Yes, how many total days of stockout of did this facility experience in the past one year? (CHECK if Yes to Q60b) CONSTANT PROBLEM..995 DK Q60e. SOURCE OF INFORMATIO N FOR STOCKOUTS IN PAST ONE YEAR: RECORD..1 ESTIMATE...2 Q60f. Has this facility had a stockout of that lasted at least 24 hours in the last 30 days (one month)? NO.2 (Q60j) Q60g. If Yes, how many times has this facility had a stockout of in the past 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60h. If Yes, how many total days of stockout of did this facility experience in the last 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60i. SOURCE OF INFORMATION ON STOCKOUTS IN PAST 30 DAYS: RECORD.1 ESTIMATE.. 2 Q60j. How many times have you received an emergency distribution of in the last 3 months? KNOW..98 Q60k. Have you ever participated in redistribution of (given to another facility or received from another facility)? YES, GIVEN ONLY.1 YES, RECEIVED ONLY...2 YES, BOTH..3 NO, NEITHER..4 KNOW...8 NEXT (04) Male condom NO 2 NO.2 (Q60j) KNOW.98 CONSTANT PROBLEM..995 DK RECORD.1 ESTIMATE..2 NO.2 (Q60j) KNOW..98 KNOW..98 RECORD.1 ESTIMATE.. 2 KNOW..98 YES, GIVEN ONLY...1 YES, RECEIVED ONLY...2 YES, BOTH.3 NO, NEITHER.4 KNOW..8 NEXT 26

27 (05) Female condom Q60a. Is currently available? NO 2 Q60b. Has this facility had a stockout of that lasted at least 24 hours in the last one year? NO.2 (Q60j) Q60c. If Yes, how many times has this facility had a stockout of in the past one year? (CHECK if Yes to Q60b) KNOW.98 Q60d. If Yes, how many total days of stockout of did this facility experience in the past one year? (CHECK if Yes to Q60b) CONSTANT PROBLEM..995 DK Q60e. SOURCE OF INFORMATIO N FOR STOCKOUTS IN PAST ONE YEAR: RECORD.1 ESTIMATE..2 Q60f. Has this facility had a stockout of that lasted at least 24 hours in the last 30 days (one month)? NO.2 (Q60j) Q60g. If Yes, how many times has this facility had a stockout of in the past 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60h. If Yes, how many total days of stockout of did this facility experience in the last 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60i. SOURCE OF INFORMATION ON STOCKOUTS IN PAST 30 DAYS: RECORD.1 ESTIMATE.. 2 Q60j. How many times have you received an emergency distribution of in the last 3 months? KNOW..98 Q60k. Have you ever participated in redistribution of (given to another facility or received from another facility)? YES, GIVEN ONLY..1 YES, RECEIVED ONLY...2 YES, BOTH.3 NO, NEITHER..4 KNOW...8 NEXT (06) Injectable NO 2 NO.2 (Q60j) KNOW.98 CONSTANT PROBLEM..995 DK RECORD.1 ESTIMATE 2 NO.2 (Q60j) KNOW..98 KNOW..98 RECORD.1 ESTIMATE.. 2 KNOW..98 YES, GIVEN ONLY..1 YES, RECEIVED ONLY...2 YES, BOTH.3 NO, NEITHER.4 KNOW..8 NEXT 27

28 (07) Implant (for insertion) Q60a. Is currently available? NO 2 Q60b. Has this facility had a stockout of that lasted at least 24 hours in the last one year? NO.2 (Q60j) Q60c. If Yes, how many times has this facility had a stockout of in the past one year? (CHECK if Yes to Q60b) KNOW.98 Q60d. If Yes, how many total days of stockout of did this facility experience in the past one year? (CHECK if Yes to Q60b) CONSTANT PROBLEM..995 DK Q60e. SOURCE OF INFORMATIO N FOR STOCKOUTS IN PAST ONE YEAR: RECORD.1 ESTIMATE..2 Q60f. Has this facility had a stockout of that lasted at least 24 hours in the last 30 days (one month)? NO.2 (Q60j) Q60g. If Yes, how many times has this facility had a stockout of in the past 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60h. If Yes, how many total days of stockout of did this facility experience in the last 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60i. SOURCE OF INFORMATION ON STOCKOUTS IN PAST 30 DAYS: RECORD.1 ESTIMATE.. 2 Q60j. How many times have you received an emergency distribution of in the last 3 months? KNOW..98 Q60k. Have you ever participated in redistribution of (given to another facility or received from another facility)? YES, GIVEN ONLY..1 YES, RECEIVED ONLY...2 YES, BOTH.3 NO, NEITHER..4 KNOW..8 NEXT (08) IUD/Postpartum IUD (for insertion) NO 2 NO.2 (Q60j) KNOW.98 CONSTANT PROBLEM..995 DK RECORD.1 ESTIMATE...2 NO.2 (Q60j) KNOW..98 KNOW..98 RECORD.1 ESTIMATE.. 2 KNOW..98 YES, GIVEN ONLY..1 YES, RECEIVED ONLY...2 YES, BOTH.3 NO, NEITHER..4 KNOW..8 NEXT 28

29 (09) SDM / Cycle beads Q60a. Is currently available? NO 2 Q60b. Has this facility had a stockout of that lasted at least 24 hours in the last one year? NO.2 (Q60j) Q60c. If Yes, how many times has this facility had a stockout of in the past one year? (CHECK if Yes to Q60b) KNOW.98 Q60d. If Yes, how many total days of stockout of did this facility experience in the past one year? (CHECK if Yes to Q60b) CONSTANT PROBLEM..995 DK Q60e. SOURCE OF INFORMATIO N FOR STOCKOUTS IN PAST ONE YEAR: RECORD.1 ESTIMATE..2 Q60f. Has this facility had a stockout of that lasted at least 24 hours in the last 30 days (one month)? NO.2 (Q60j) Q60g. If Yes, how many times has this facility had a stockout of in the past 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60h. If Yes, how many total days of stockout of did this facility experience in the last 30 days? (CHECK if Yes to Q60f) KNOW..98 Q60i. SOURCE OF INFORMATION ON STOCKOUTS IN PAST 30 DAYS: RECORD.1 ESTIMATE.. 2 Q60j. How many times have you received an emergency distribution of in the last 3 months? KNOW..98 Q60k. Have you ever participated in redistribution of (given to another facility or received from another facility)? YES, GIVEN ONLY..1 YES, RECEIVED ONLY...2 YES, BOTH.3 NO, NEITHER..4 KNOW..8 Q61a 29

30 ONLY ASK ABOUT THOSE S THAT ARE OFFERED AT THE FACILITY FROM Q58A. Q61a. How many [NAMED ] do you usually provide to a new acceptor on her first visit? Q61b. How many [NAMED ] do you usually provide to a woman coming for resupply/continuing to use the same method? (01) Combined oral contraceptives (number of cycles) (02) Progestin-only oral contraceptives (number of cycles) (03) Male condoms (number of pieces) (04) Female condoms (number of pieces) 30

31 Now I m going to ask you some questions related to how much a new client pays for contraceptive services and methods. ONLY ASK ABOUT THOSE S/PROCEDURES THAT ARE OFFERED BY THE FACILITY FROM Q58a. Q62a. How much is the consultation/registration fee (in KES) for /PROCEDURE? ( Applies to how much a new client pays for contraceptive services and methods) Q62b. Do fees for vary depending on the product/brand available? (01) Combined oral pill (02) Progestin only pill (03) Emergency contraceptive CONSULTATION/REGISTRATION 1[ ] FREE KNOW OR PACKAGE DEAL..2 [ ] Q62d (consultation + method+procedure+any other related cost) CONSULTATION/REGISTRATION 1[ ] FREE KNOW OR PACKAGE DEAL..2 [ ] Q62d (consultation + method+procedure+any other related cost) CONSULTATION/REGISTRATION 1[ ] FREE KNOW OR PACKAGE DEAL..2 [ ] Q62d (consultation + method+procedure+any other related cost) (04) Male condom CONSULTATION/REGISTRATION 1[ ] FREE KNOW OR PACKAGE DEAL..2 [ ] Q62d (consultation + method+procedure+any other related cost) Yes... 1 No/only one brand or product available... 2 Don t know.8 Yes... 1 No/only one brand or product available... 2 Don t know.8 Yes... 1 No/only one brand or product available... 2 Don t know.8 Yes... 1 No/only one brand or product available... 2 Don t know.8 Q62c. How much is the actual cost of /PROCEDURE? RECORD THE RANGE (in KES) IF PRICE DIFFERS BY BRAND FROM LOWEST TO HIGHEST PRICE. RECORD THE PRICE IN THE FIRST FIELD IF THERE IS ONLY ONE PRODUCT/BRAND OR IF THE PRICE DOES NOT DIFFER BY PRODUCT/BRAND [ ] TO [ ]per cycle PRESCRIPTION/REFERRAL ONLY FREE., KNOW [ ] TO [ ]per cycle PRESCRIPTION/REFERRAL ONLY FREE., KNOW [ ] TO [ ]per package/cycle PRESCRIPTION/REFERRAL ONLY FREE., KNOW [ ] TO [ ]per piece PRESCRIPTION/REFERRAL ONLY FREE., KNOW CHECK IF OPTION Q62A AND Q62C is FREE, GO Q62e Q62d. What percent of clients pay the charge for / PROCEDURE? Q62e. Are clients ever asked to provide consumables to receive this /PROCE DURE? YES.1 NO 2 KNOW 8 YES....1 NO...2 KNOW 8 YES....1 NO...2 KNOW 8 YES...1 NO...2 KNOW 8 31