UGANDA QUESTIONNAIRE COMPLETE ONE QUESTIONNAIRE PER. Ministry of Health and World Bank Version: December 19, 2003 HEALTH SUB DISTRICT

Transcription

1 UGANDA HEALTH SUB DISTRICT QUESTIONNAIRE Ministry of Health and World Bank Version: December 19, COMPLETE ONE QUESTIONNAIRE PER HEALTH SUB DISTRICT Date District code Time at interview start Time at end of interview First Enumerator s name Second Enumerator s name day-month-year xx e.g e.g 1700 name name

2 Section 1. Identification of the Health Sub District Question Unit Value 1. Name of the District Name 2. District code Code 3. Region 1=Central 2=East 3=West 4=South 5=North 4. Name of Health Sub District? Name 5. The following sample facilities is located in this Health Sub District: (please, write the name and the codes of the HCIII found in this HSD) i. Sample code ii. Sample code iii. Sample code iv. Sample code v. Sample code vi. Sample code vii. Sample code viii. Sample code ix. Sample code x. Sample code We would like to find out information on disbursements of PHC funds, drugs and vaccines from the HSD to the sampled facilities in this Health Sub District. 2

3 Section 2. Financing (continued) 1. We are interested in finding out how much PHC funds was distributed from the HSD to each of the surveyed health facilities in this Health Sub District during the following months in the year (January December ). (Unit: Ug. Shs) Facility name: i. ii. iii. iv. v. Sample code a. January b. February c. March d. April e. May f. June g. July h. August i. September j. October k. November l. December 3

4 Section 2. Financing (continued) 1. We are interested in finding out how much PHC funds was distributed from the HSD to each of the surveyed health facilities within this Health Sub District during the following months in the year (January December ). (Unit: Ug. Shs) Facility name: vi. vii. viii. ix. x. Sample code a. January b. February c. March d. April e. May f. June g. July h. August i. September j. October k. November l. December 4

5 Section 3. Information on Drugs Question Unit Value 1. Does this Health Sub District distribute drug supplies to the facilities in the HSD? 1=yes 2=no Section 4, Q If yes, how much of the following drugs were sent from the HSD to each of the surveyed health facilities located in this HSD, during the following months? (collect this data from the NMS Invoices, Issue Vouchers or similar documents) (Unit: number of tablets) Facility (i-x) a. January b. February c. March d. April e. May f. June i. ii. 5

6 Section 3. Information on Drugs (continued) Facility (i-x) i. g. July h. August i. September j. October k. November l. December ii. 6

7 Section 3. Information on Drugs (continued) Facility (i-x) iii. a. January b. February c. March d. April e. May f. June iv. 7

8 Section 3. Information on Drugs (continued) Facility (i-x) iii. g. July h. August i. September j. October k. November l. December iv. 8

9 Section 3. Information on Drugs (continued) Facility (i-x) v. a. January b. February c. March d. April e. May f. June vi. 9

10 Section 3. Information on Drugs (continued) Facility (i-x) v. g. July h. August i. September j. October k. November l. December vi. 10

11 Section 3. Information on Drugs (continued) Facility (i-x) vii. a. January b. February c. March d. April e. May f. June viii. 11

12 Section 3. Information on Drugs (continued) Facility (i-x) vii. g. July h. August i. September j. October k. November l. December viii. 12

13 Section 3: Information on Drugs (continued) Facility (i-x) ix. a. January b. February c. March d. April e. May f. June x. 13

14 Section 3. Information on Drugs (continued) Facility (i-x) ix. g. July h. August i. September j. October k. November l. December x. 14

15 Section 4. Information on Vaccines Question Unit Value 1. Does this Health Sub District distribute vaccines to the health facilities in the HSD? 1=yes 2=no Section 5, Q If yes, how much of the following vaccines were sent from the HSD to each of the surveyed health facilities located in this HSD, during the following months? (Unit: doses) Facility (i.-x.) i. a. August b. September c. October d. November e. December Measles ii. Measles 15

16 Section 4. Information on Vaccines (continued) Facility (i.-x.) iii. a. August b. September c. October d. November e. December Measles iv. Measles v. Measles 16

17 Section 4. Information on Vaccines (continued) Facility (i.-x.) vi. a. August b. September c. October d. November e. December Measles vii. Measles viii. Measles 17

18 Section 4. Information on Vaccines (continued) Facility (i.-x.) ix. a. August b. September c. October d. November e. December Measles x. Measles xi. Measles 18

19 Section 5. Information on Enumerator NOTE: Not to be read out to the respondent Question Unit Value 1.Enumerators names name 1 name 2 2. Did you get the impression that the data collected at this Health Sub District were reported accurately on: a. PHC funds b. Drugs c. Vaccines 3. For the data reported on disbursements of PHC funds to the sample health facilities, did you see receipts, signed by the in-charge of the health facility? 4. How many times did you visit the HSD in order to collect all necessary information? 1=yes 2=reported numbers overstated, 3=reported numbers understated 1=yes 2=no number 19

20 5. Comments Questionnaire has been checked and approved for data entry SIGNATURE SIGNATURE FIRST ENUMERATOR S NAME SECOND ENUMERATOR S NAME DATE DATE 20

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