Household Information Panel: HH
HH3. Interviewer name and number:
Number _ _
HH4. Supervisor name and number:
Number _ _
HH5. Day/Month/Year of interview:
[] 2 Buenos Aires?s Province
[] 3 Cuyo
[] 4 Noa
[] 5 Nea
[] 6 Pampean
[] 7 Patagonian
Check that the respondent is a knowledgeable member of the household and at least 18 years old before proceeding. You may only interview a child age 15-17 if there is no adult member of the household or all adult members are incapacitated. You may not interview a child under age 15.
_ _ Minutes
HH12. Hello, my name is (your name). We are from UNICEF in conjunction with the Consejo Nacional de Coordinacion de Politicas Publicas (National Council for Public Policy Coordination). This interview usually takes about 20 minutes. Following this, I may ask to conduct additional interviews with you or other individual members of your household. All the information we obtain will remain strictly confidential and anonymous. If you do not wish to answer a question or stop the interview, please let me know. May I start now?
[] No/not asked (Go to HH46)
HH12A. Check if it is a "hogar creado".
[] No
HH12B. Do all household members share food expenses?
[] No
HH12C. How many homes are there in this household? Register the number of households and inform the supervisor to document the new households and go to the List of Household Members
HH46. Result of household questionnaire interview:
Discuss any result not completed with supervisor.
[] 02 No household member or no competent respondent at home at time of visit
[] 03 Entire household absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant or address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
HH47. Name and line number of the respondent to household questionnaire interview:
Line number _ _
To be filled after the Household Questionnaire is completed
Total number
HH48. Household members: __ __
HH49. Women age 15-49: __ __
HH51. Children under age 5: __ __
HH52. Children age 5-17: __ __
To be filled after all the questionnaires are completed
Completed number
HH53. Women age 15-49: __ __
HH55. Children under age 5: __ __
[] 1 One
First complete HL2-HL4 vertically for all household members, starting with the head of the household. Once HL2-HL4 are complete for all members, make sure to probe for additional members: Those that are not currently at home, any infants or small children and any others who may not be family (such as servants, friends) but who usually live in the household.
Then, ask questions HL5-HL20 for each member one at a time. If additional questionnaires are used, indicate by ticking this box: ____
HL2. First, please tell me the name of each person who usually lives here, starting with the head of the household.
Probe for additional household members.
HL3. What is the relationship of (name) to (name of the head of household)?
HL4. Is (name) male or female?
[] 2 Female
HL5. What is (name)'s date of birth?
[] 98 DK
Year: _ _ _ _
[] 9988 DK
HL6. How old is (name)?
Record in completed years.If age is 95 or above, record "95".
HL8. Record line number if woman and age 15-49: _ _
HL10. Record line number if age 0-4: _ _
[] 2 No (Go to next line)
HL12. Is (name)"s natural mother alive?
[] 2 No (Go to HL16)
[] 8 DK (Go to HL16)
HL13. Does (name)'s natural mother live in this household?
[] 2 No (Go to HL15)
HL14. Record the line number of mother and go to HL16: _ _
HL15. Where does (name)'s natural mother live?
[] 2 In another household in the same region
[] 3 In another household in another region
[] 4 Penitentiary institution
[] 5 Health institution
[] 6 Other national institution
[] 8 DK
HL16. Is (name)'s natural father alive?
[] 2 No (Go to HL20)
[] 8 DK (Go to HL20)
HL17. Does (name)'s natural father live in this household?
[] 2 No (go to HL19)
HL18. Record the line number of father and go to HL20: _ _
HL19. Where does (name)'s natural father live?
[] 2 In another household in the same region
[] 3 In another household in another region
[] 4 Penitentiary institution
[] 5 Health institution
[] 6 Other national institution
[] 8 DK
[] 8 DK
HL20. Copy the line number of mother from HL14. If blank, ask: Who is the primary caretaker of (name)?
If "No one" for a child age 15-17, record "90".
Code for HL3. Relationship to head of household
[] 02 Spouse/partner
[] 03 Son/daughter
[] 04 Son-in-law/daughter-in-law
[] 05 Grandchild
[] 06 Parent
[] 07 Parent-in-law
[] 08 Brother/sister
[] 09 Brother-in-law/sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew
[] 12 Other Relative
[] 13 Adopted/foster/stepchild
[] 14 Servant (live-in)
[] 96 Other (not related)
[] 98 Don't Know
ED2. Name and age
Copy names and ages of all members of the household from HL2 and HL6 to below and to next page of the module.
Age: _ _
[] 2 No (Go to next member)
ED4. Is (name) currently attending or have they attended any educational institution or preschool?
[] 2 No (Go to next member)
ED5. What is the highest level and grade or year of school (name) has ever attended?
[] 1 Primary
[] 2 EGB
[] 3 Polimodal
[] 4 Seconday
[] 5 Adult secondary (Go to ED5D)
[] 6 Tertiary
[] 7 University
[] 8 Graduate studies (Go to ED5D)
[] 9 Special education (Go to ED5D)
[] 98 DK
ED5C. Check ED4: Is (name) currently attending or have they attended any educational institution or preschool?
[] 2 Not currently, but has attended (Go to ED5F)
ED5D. Check ED4: Is (name) currently attending or have they attended any educational institution or preschool?
[] 2 Not currently, but has attended (Go to next question)
ED5E. Did (name) finish that level?
[] 2 No (Go to next household member)
[] 8 DK (Go to next household member)
ED5F. Did (name) finish that level?
[] 2 No (Go to next question)
[] 8 DK (Go to next question)
ED6. Did (name) ever complete that (grade/year)?
[] 2 No (Go to next question)
[] 8 DK (Go to next question)
[] 2 No (Go to next household member)
[] 2 No (Go to next household member)
[] 2 No (Go to next household member)
ED9. During the present schoolyear has -name- currently attending or have they attended any educational institution or preschool?
[] 2 No (Go to ED15)
[] 3 DK (Go to ED15)
ED11. Is (he/she) attending a public school?
[] 2 Private (Go to next question)
ED15. During the previous school year has -name- attended school or any educational program for the first infancy?
[] 2 No (Go to ED15)
ED16. During that previous school year, which level and grade or year did (name) attend?
[] 1 Primary
[] 2 EGB (make sure)
[] 3 Polimodal (make sure)
[] 4 Seconday
[] 5 Adult secondary (Go to next household member)
[] 6 Tertiary
[] 7 University
[] 8 Graduate studies (Go to next household member)
[] 9 Special education (Go to next household member)
[] 98 DK
D13. What kind of document does (name) have?
3 Temporary residence / Skip to next question 4 Never had one / Skip to next question 6 Other (specify) / Skip to next question 8 DK / Skip to next question
[] 2 Foreign identity document (Go to next question)
[] 3 Temporary residence (Go to next question)
[] 4 Never had one (Go to next question)
[] 6 Other (specify) ____ (Go to next question)
[] 8 DK (Go to next question)
S0. Does (name) have any health coverage?
[] 2 No (Go to S2)
S1. Which kind of coverage does (name) have?
[] C PAMI [Instituto Nacional de Servicios Sociales para Jubilados y Pensionados or PAMI, is the National Institute of Social Services for pensioners and retired individuals, it is another private entity that depends upon syndicates, it specializes in health services for the elderly.]
[] D PREPAGA individually financed [Another private entity that responds to syndicates, in which a voluntary quote can be paid for a period of time to a private institution in order to get health services. It can be provided by a company/corporation/etc. or paid by the individual itself, similar to health insurance]
[] E PREPAGA financed through OBRA SOCIAL
[] F PROGRAMA INCLUIR SALUD (FKA PROFE) [lit. Health Inclusion Program, by the National Agency for Disability, is a government program created to provide health services to its affiliates by means of the public loan networks and guarantee that people on a non-contributory pension, that don't have medical coverage by the National Healthcare Program or the Provincial Obra Social, can receive health services regardless of their place of residence.
[] X Other (specify) ____
[] Z DK
S2. In the past 3 months, did (name) go to the doctor?
[] 2 No (Go to S6)
[] 8 DK (Go to next family member)
S3. In that visit, did the doctor prescribe any medication for (name)?
[] 2 No (Go to next family member)
[] 8 DK (Go to next family member)
S4. Regarding the medications that were prescribed: Did you buy all of them, some of them, or none at all?
[] 2 Bought some of them
[] 3 Bought none
[] 8 DK (Go to next household member)
S5. Why didn't you buy all the medications (name) was prescribed?
[] 2 Did not get them yet (Go to next household member)
[] 3 (name) did not want to take them (Go to next household member)
[] 4 Got them for free (Go to next household member)
[] 5 Already had the medication (Go to next household member)
[] 6 Other reasons (Go to next household member)
[] 8 DK (Go to next household member)
S6. In the past 3 months did (name) get sick or have any health issue?
[] 2 No (Go to next household member)
[] 8 DK (Go to next household member)
S7. Why didn't (name) visit the doctor?
[] 2 No money
[] 3 No transportation/was too far away
[] 4 Didn?t think it was important
[] 5 Applied for a turn but hasn?t been called yet
[] 6 Other reason
[] 8 DK
[] 2 No (Go to next household member)
[] 2 No (Go to next household member)
HT2. During the past week did (name) work for at least one hour?
[] 2 No (Go to next question)
[] 3 DK (Go to next question)
HT3. During that week, did (name) have any odd job, made something to sell, helped a family member at their work or business?
[] 2 No (Go to next question)
[] 8 DK (Go to next question)
HT4. During last week, did (name) ____ ?
[] 2 Could not work because they were busy with domestic chores (Go to next question)
[] 3 Could not work because they were studying or incapacitated (Go to next question)
[] 4 Didn?t have a job or couldn?t get one (Go to next question)
[] 5 Didn?t have orders or customers (Go to next question)
[] 6 Had a job or business but didn?t go (Go to HT7)
HT5. In the past 30 days, did (name) look for a job?
If "yes", find out if it was an exhaustive search, that is, if they replied to job offers, consulted with friends or relatives or turned in any CV.
[] 2 No (Go to next question)
[] 8 DK (Go to HT11)
HT6. For what reason didn't (name) look for a job?
[] 2 Is waiting for the new job to begin (Go to HT11)
[] 3 Is waiting for the new job to begin (Go to HT11)
[] 4 There are no job offers (Go to HT11)
[] 5 Doesn't think they can find a job (Go to HT11)
[] 6 Age reasons (minor or elder) (Go to HT11)
[] 7 Works at home chores or helping people at home (Go to HT11)
[] 8 Is retired or on a pension (Go to HT11)
[] 9 Is a landlord (Go to HT11)
[] 10 Has a crippling disease or disability (Go to HT11)
[] 11 Is still studying or getting prepared(Go to HT11)
[] 98 DK (Go to HT11)
HT7. In that week, how many jobs did (name) have?
HT8. Let's talk about the job to which (name) dedicates the most time, in that job, (name) is...?
[] 2 Works on their own (Go to next question)
[] 3 Is a public worker (Go to next question)
[] 4 Is a private worker (Go to next question)
[] 5 Domestic worker (Go to next question)
[] 6 Non-paid worker (Go to next question)
[] 7 Works at an employment program (Go to next question)
[] 8 DK (Go to next question)
HT9. In that job, do they save money for (name's) retirement, or does (name) do it by themselves?
[] 2 Contributes (to their retirement fund pension) as a business owner
[] 3 Freelancer
[] 4 Is a social business owner
[] 5 Saves at a private retirement fund
[] 6 Neither deduct nor work contribution
[] 8 DK
HT10. How much money did (name) make last month from all his work? Include commissions, bonuses, overtime, tips, sales/production.
If no income, enter "0"?
DK 999998
[] 2 No (Go to next household member)
HT12. During last month, did (name) have any income from a retirement fund, contributory pension, elderly pension, or PUAM?
[] 2 No (Go to HT14)
[] 8 DK (Go to HT14)
HT13. Last month, how much money did (name) get from said income sources?
DK 999998
HT14. Last month, how much money did (name) get from non-work related sources, such as rent money, compound interest, steady contributions from people who don't live in the household, or alimony?
If no income, enter "0"? If any social program ask to subtract it from the total
DK 999998
HT15. Check in HT9 if they are small business owners or freelancers.
[] 2 No (HT9=1, 5 or 6) (Go to next question)
HT16. Does (name) contribute as a "monotributista" (small business owner and taxpayer) or as "autonomus" (a freelancer)?
[] 2 As a freelancer
[] 3 As none
[] 8 DK
TS1. I would like to ask about a series of benefits and programs the government provides to households. This excludes the support of NGOs such as religious or community organizations, as well as family, relatives, friends or neighbors
TS2. Is any member of the household a recipient of the AUH (Universal Child Allowance), Disability Allowance, or Pregnancy Allowance?
[] 2 No (Go to TS5B)
[] 8 DK (Go to TS5B)
TS3. Who or whom are the AUH recipients?
Register the line number of the household member. If the recipient or recipients don't live in the household, register code 99
TS4. Who or whom collect the allowance?
Register the line number of the household member. If the collector doesn?t live in the household, register code 99
TS5A. Aside from the AUH, does your household or someone in your household have access to: Proceed to read the program names
TS5B. Does your household or someone in your household receives or has access to... Proceed to read the program names
A. Educational Scholarships / PROGRESAR?
[] 2 No (Go to [B])
[] 8 DK (Go to [B])
TS5A1. Who?
Register the line number or member number
B. 7 child mother non contributory pension?
[] 2 No (Go to [C])
[] 8 DK (Go to [C])
TS5B1. Who?
Register the line number or member number
[] 2 No (Go to [D])
[] 8 DK (Go to [D])
TS5C1. Who?
Register the line number or member number
[] 2 No (Go to [E])
[] 8 DK (Go to [E])
TS5D1. Who?
Register the line number or member number
E. Hacemos Futuro [Social institution for support of young people] / Complimentary Social Income?
[] 2 No (Go to [F])
[] 8 DK (Go to [F])
TS5E1. Who?
Register the line number or member number
[] 2 No (Go to [G])
[] 8 DK (Go to [G])
TS5F1. Who?
Register the line number or member number
G. Other provincial or municipal program (specify)?
[] 2 No (Go to TS6)
[] 8 DK (Go to TS6)
TS5G1. Who?
Register the line number or member number
TS6. Does your household currently receive any food stamps, certificates or free passes to get food?
[] 2 No
TS7. Do you or anyone else from your household eat or take food to go from a shelter or soup kitchen, for free?
[] 2 No
TS8. Does the household or any household member get a discount, social discount, or a subsidy for:
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
Living environment and neighborhood infrastructure and housing: EV
EV1. The household is located at...
(personal observation)
[] 2 Social housing or monoblock [in argentina monoblock is a kind of social housing building composed of communal households]
[] 3 Country or closed neighborhood (ghetto)
[] 4 None of the above (residential neighborhood and others)
EV2. Household type
(personal observation)
[] 2 Ranch
[] 3 Casilla [a small makeshift home or shelter]
[] 4 Apartment
[] 5 Rental condo
[] 6 Rental hotel room or pension
[] 7 A space not meant for living
EV3. In the block where the household is located, is/are there...?
[] 2 No
[] 2 No
[] 2 No
D. Garbage recollection service at least twice a week?
[] 2 No
EV4. Regardless of your household having access to the service, does your block have...?
[] 2 No
[] 2 No
[] 2 No
EV5. Is your household is located at or near...?
A. An area with properties or streets that have flooded in the past 12 months?
[] 2 No
B. A permanent dump/disposal site that is three blocks away or less?
[] 2 No
HC1B. What is the mother tongue/native language of (name of the head of the household from HL2)?
[] 2 Indigenous Language
[] 3 English
[] 4 Portuguese
[] 5 French
[] 6 Other Language (specify) ____
HC2A. Is the head of household an indigenous person or a descendant of indigenous groups?
[] 2 Non-indigenous
HC3. How many rooms do members of this household usually use for sleeping?
HC4. Main material of the dwelling floor.
Record observation. If observation is not possible, ask the respondent to determine the material of the dwelling floor.
[] 32 Vinyl or asphalt strips
[] 33 Ceramic Tiles
[] 34 Cement
[] 35 Carpet
HC5. Main material of the roof.
Record observation.
Natural roofing
[] 14 Mudded boards/cane
[] 24 Cardboard
[] 25 Fibrocement or plastic sheet
[] 32 Wood
[] 34 Ceramic tiles
[] 35 Cement
[] 36 Roofing Shingles
[] 37 Exposed slab (uncovered)
[] 38 Asphalt membrane/cover
HC6. Main material of the exterior walls.
Record observation.
[] 24 Plywood
[] 25 Cardboard
[] 26 Reused Wood
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement Bricks
[] 35 Covered Adobe
[] 36 Wood Planks/shingles
HC7. Does your household have:
[] 2 No
B. A bed for each household member?
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC8A. Is your household connected to the public electricity network?
If not, probe: Does it have electricity from a generator or does it have no access?
[] 2 No, but connected to a generator or isolated system
[] 3 No electricity (Go to HC10)
HC9. Does your household have:
[] 2 No
B. A refrigerator, with no freezer?
[] 2 No
C. A refrigerator, with a freezer
(See customization guidelines)
[] 2 No
[] 2 No
[] 2 No
F. An electric stove or an oven-less kitchen?
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC10. Does any member of your household own:
[] 2 No
[] 2 No
E. Car or van from year 2009 and above?
[] 2 No
HC11. Does any member of your household have a computer or a tablet?
[] 2 No
HC11A. Including computers and tablets, how many computers do you have?
HC11B. Did you receive that/those computers through the
school for free?
[] 2 No
HC12. Does any member of your household have a mobile telephone?
[] 2 No
HC12A. Do any of the cellphones have internet access?
[] 2 No
HC13. Does your household have access to internet at home?
[] 2 No
HC14. Do you or someone living in this household own this dwelling?
If "No", then ask: Do you rent this dwelling from someone not living in this household? If "Rented from someone else", record "2". For other responses, record "6" and specify.
[] 2 Rent
[] 6 Other (specify) _____
HC19. Does any member of this household have a bank account?
[] 2 No
[] 2 Current account
[] 3 By social progam
EU1. In your household, what type of kitchen is mainly used for cooking?
[] 02 Solar cooker (Go to EU5)
[] 03 Bottle/tube/bulk (Go to EU5)
[] 04 Gas network stove (Go to EU5)
[] 05 Biogas stove (Go to EU5)
[] 06 liquid fuel stove (Go to EU4)
[] 07 manufactured solid fuel stove
[] 08 traditional solid fuel stove
[] 09 three stone stove/open fire (Go to EU4)
[] 96 Other (specify)____ (Go to EU4)
[] 97 No food cooked in household (Go to EU6)
EU2. Does it have a ventilation towards the exterior]?
[] 2 No
[] 8 DK
EU3. Does it have an extractor?
[] 2 No
[] 8 DK
EU4. What type of fuel or energy source is used in this cookstove?
If more than one, record the main energy source for this cookstove.
[] 02 Gasoline/diesel
[] 03 Kerosene/paraffin
[] 04 Coal/lignite
[] 05 Charcoal
[] 06 Wood
[] 07 Crop residue/grass/straw/shrubs
[] 08 Animal dung/waste
[] 09 Processed biomass (pellets) or woodchips
[] 10 Garbage/plastic
[] 11 Sawdust
[] 96 Other (specify) ____
EU5. Is the cooking usually done in the house, in a separate building, or outdoors?
If in main house, probe to determine if cooking is done in a separate room. If outdoors, probe to determine if cooking is done on veranda, covered porch, or open air.
[] 02 In a separate room
[] 03 In a separate building
[] 05 On veranda or covered porch
EU6. What does your household mainly use for space heating when needed?
[] 02 manufactured space heater
[] 03 traditional space heater
[] 04 manufactured kitchen
[] 05 traditional kitchen
[] 06 three stone stove/open fire (Go to EU8)
[] 96 Other (specify) (Go to EU8)
[] 97 No space heating in household (Go to EU9)
EU7. Does it have a ventilation towards the exterior?
[] 2 No
[] 8 DK
EU8. What type of fuel and energy source is used in this heater?
If more than one, record the main energy source for this heater.
[] 02 Electricity
[] 03 Gas network stove
[] 04 Bottle/tube/bulk
[] 05 Biogas
[] 06 Alcohol/ethanol
[] 07 Gasoline/diesel
[] 08 Kerosene/paraffin
[] 09 Coal/lignite
[] 10 Charcoal
[] 11 Wood
[] 12 Crop residue/grass/straw/shrubs
[] 13 Animal dung/waste
[] 14 Processed biomass (pellets) or woodchips
[] 15 Garbage/plastic
[] 16 Sawdust
[] 96 Other (specify) ____
EU9. At night, what does your household mainly use to light the household?
[] 2 Solar lantern
[] 3 Rechargeable flashlight, torch or lantern
[] 5 Biogas lamp
[] 6 Gasoline lamp
[] 7 Kerosene or paraffin lamp
[] 8 Charcoal
[] 9 Wood
[] 10 Crop residue/grass/straw/shrubs
[] 11 Animal dung/waste
[] 12 Oil lamp
[] 13 Candle
[] 96 Other (specify) ____
[] 97 No lighting in household
WS1. What is the main source of drinking water used by members of your household?
If unclear, probe to identify the place from which members of this household most often collect drinking water (collection point).
[] 12 Piped into yard/plot (Go to WS7)
[] 13 Piped into neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
[] 92 Sachet water
WS2. What is the main source of water used by members of your household for other purposes such as cooking and handwashing?
If unclear, probe to identify the place from which members of this household most often collect water for other purposes.
[] 12 Piped into yard/plot (Go to WS7)
[] 13 Piped into neighbour
[] 14 Public tap/standpipe
[] 21 Tube well/borehole
[] 32 Unprotected well
[] 61 Tanker-truck (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel)
WS3. Where is that water source located?
[] 2 In own yard/plot (Go to WS7)
[] 3 Elsewhere
WS4. How long does it take for members of your household to go there, get water, and come back?
_ _ _Number of minutes
[] 998 DK
WS5. Who usually goes to this source to collect the water for your household?
Record the name of the person and copy the line number of this person from the list of household members module.
Line number: _ _
WS6. Since last (day of the week), how many times has this person collected water?
[] 98 DK
WS7. In the last month, has there been any time when your household did not have sufficient quantities of drinking water?
[] 2 No, always sufficient (Go to WS9)
[] 8 DK (Go to WS9)
WS8. What was the main reason that you were unable to access water in sufficient quantities when needed?
[] 2 Water too expensive
[] 3 Source not accessible
[] 6 Other (specify) ____
[] 8 DK
WS9. Do you or any other member of this household do anything to the water to make it safer to drink?
[] 2 No (Go to WS11)
[] 8 DK (Go to WS11)
WS10. What do you usually do to make the water safer to drink?
Probe: Anything else?
Record all methods mentioned.
[] B Add bleach/chlorine
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, ect)
[] E Solar disinfection
[] F Let it stand and settle
[] X Other (specify) ____
[] Z DK
WS11. What kind of toilet facility do members of your household usually use?
If "Flush" or "Pour flush", probe: Where does it flush to?
If not possible to determine, ask permission to observe the facility.
[] 12 Flush to septic tank
[] 13 Flush to pit latrine
[] 14 Flush to open drain (go to WS14)
[] 18 Flush to DK where (go to WS14)
[] 23 Pit latrine without slab/open pit
[] 31 Composting toilet
[] 96 Other (specify) ____ (Go to WS14)
WS12. Has your (answer from WS11) ever been emptied?
[] 2 Yes, emptied, more than 5 years ago
[] 3 Yes, emptied, don't know when
[] 4 No, never emptied (Go to WS14)
[] 8 DK (Go to WS14)
WS13. The last time it was emptied, where were the contents emptied to?
Probe: Was it removed by a service provider?
[] 2 Buried in a covered pit
[] 3 To don't know where
[] 5 To uncovered pit, open ground, water body or elsewhere
[] 6 Other (specify) ____
[] 8 DK
WS14. Where is this toilet facility located?
[] 2 In own yard/plot
[] 3 Elsewhere
WS15. Do you share this facility with others who are not members of your household?
[] 2 No (Go to next module)
WS16. Do you share this facility only with members of other households that you know, or is the facility open to the use of the general public?
[] 2 Shared with general public (Go to next module)
WS17. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
HH15. Language of the Interview.
[] 6 Other language (specify) ____
HH16. Native language of the Respondent.
[] 6 Other language (specify) ____
HH17. Was a translator used for any parts of this questionnaire?
[] 2 Yes, part of questionnaire
[] 3 No, not used
HH18. Check HL6 in the "List of household members" and indicate the total number of children age 5-17 years:
[] 1 1 child (Go to HH27)
2 or more children (number): _
[page 21]
HH19. List each of the children age 5-17 years below in the order they appear in the list of household members. Do not include other household members outside of the age range 5-17 years. Record the line number, name, sex, and age for each child.
HH21. Line number from HL1: _ _
[] 2 Female
HH25. Check the last digit of the household number (HH2) from the household information panel. This is the number of the row you should go to in the table below.
Check the total number of children age 5-17 years in HH18 above. This is the number of the column you should go to in the table below.
Find the box where the row and the column meet and record the number that appears in the box. This is the rank number (HH20) of the selected child.
Total number of eligible children in the household (from HH18): _
HH26. Record the rank number (HH20), line number (HH21), name (HH22) and age (HH24) of the selected child.
Line number: _ _
Name: ____
Age: _ _
HH27. (When HH18=1 or when there is a single child age 5-17 in the household): Record the rank number as "1"and record the line number (HL1), the name (HL2) and age (HL6) of this child from the list of household members.
Line Number: _ _
Name: ____
Age: _ _
HH28. Issue a questionnaire for children age 5-17 to be administered to the mother/caretaker of this child.
HH29. Check HL8 in the list of household members: Are there any women age 15-49?
[] 2 No (Go to HH33A)
HH30. Issue a separate questionnaire for individual women for each woman age 15-49 years.
HH31. Check HL6 and HL8 in the list of household members: Are there any girls age 15-17?
[] 2 No (Go to HH33A)
HH32. Check HL20 in the list of household members: Is consent required for interviewing at least one girl age 15-17?
[] 2 No, HL20 does not equal 90 for all girls age 15-17 (Go to HH33A)
HH33. As part of the survey we are also interviewing women age 15-49. We ask each person we interview for permission. A female interviewer conducts these interviews.
For girls age 15-17 we must also get permission from an adult to interview them. As mentioned before, all the information we obtain will remain strictly confidential and anonymous.
May we interview (name(s) of female member(s) age 15-17) later?
[] "No" for at least one girl age 15-17 and "Yes" to at least one girl age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH33A.
[] "No" for all girls age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH33A.
HH33A. For survey quality screening purposes, please provide your cellphone or house number. Remember that all information in this survey is completely confidential.
HH40. Check HL10 in the "List of household members": Are there any children age 0-4?
[] 2 No (Go to HH45)
HH41. Issue a separate questionnaire for children under five for each child age 0-4 years.
HH45. Now return to the household information panel and,
Record "01" in question HH46 (Result of the Household Questionnaire interview). Record the name and the line number (from the list of household members) of the respondent to the household questionnaire interview in HH47. Fill the questions HH48 ? HH52. Thank the respondent for his/her cooperation and then proceed with the administration of the remaining individual questionnaire(s) in this household.
If there is no individual questionnaire and no water quality testing questionnaire to be completed in this household thank the respondent for his/her cooperation and move to the next household you have been assigned by your supervisor.
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