Rural Household Multiple Indicator Survey (RHoMIS)

1. Household identification General information Date (dd/mm/yyyy) Country Region Ward Village Name Interviewer Household ID Latitude decimal degrees Longitude degrees Household GPS code Name of the respondent Gender Age Position in household Household type

Position in household: Household type 1= Head or Head Couple 1= Man and Woman Couple (married or non-married) 2=Child of couple 2=Single Woman 3=Parent of couple 3=Single Man 4=Other family member 4=Woman at home, man works away 5=Not a family member 5=Man at home, woman works away 6=Other

The respondent must be the person most capable of answering these questions. It may be the household head, the spouse or another adult household member.

Quality Assurance Aspects DATE OF QUESTIONNAIRE INSPECTION BY SUPERVISOR / / (dd/mm/yyyy): Reviewing of questionnaire: Enumerator: Enter your comments here AFTER you have administered the questionnaire

Supervisor: Enter your comments here AFTER you have inspected the WHOLE questionnaire

2. Household Roster How old is the head man of the household? ______

How old is the head woman of the household? ______

What is the highest level of education the head man or woman has completed? ______

1 = illiterate; 2 = literate; 3 = primary; 4 = secondary; 5 = postsecondary

Which ethnic group are you from? ______

Members of the Household include only members who live there at least 3 months per year.

How many people in your household ______

ID Age Number of Number of male female 1 Aged 3 or under 2 4 – 10 3 Aged 11 to 50 4 Over 50

2 3. Farm land sizes

How much land does How much land does About how much land does your In total, how much land do you Who owns your Land size your your household rent for household rent out for other people use for growing crops? household's land? household use? to use? own? Area Unit Unit: 1= Acre, 2= Hectare Ownership: 1=Husband or other male; 2=Wife or other female 3=Male Youth or Child; 4=Female Youth or Child

Do you have a home garden? Yes / No ______

Do you use any grazing land for your animals? Yes / No ______

Do you own the grazing land? Yes / No ______

Do you use common land for either cropping or grazing? Yes / No ______

Who works on your land – household members or other people too? ______1 =Household members 2 = Reciprocal arrangements with family, friends or neighbours 3 = Hired labour

Do you grow any crops? Yes / No ______

Who decides what crops to plant? ______1=Husband or other male 2=Wife or other female 3=Male Youth or Child 4=Female Youth or Child

Did you harvest the any of your crops early in the last year? Yes / No ______

Which crops did you harvest early? ______

Why did you harvest the crops early? ______

3 1 = Fear of Theft 2 = Hunger 3 = Needed Income 4 = Erratic rainfall or poor weather 5 = Other

4 4. Crop productivity

List the 5 most important crops in the table below

What are the other crops grown or harvested by your household during the past year? ______

How many types of vegetables do you grow? ______How many types of fruits do you grow? ______How many types of fodder crops do you grow? ______

Values for last 12 months Do you grow this crop as a monoculture or Was the harvest good or Which proportion of mixed with other About how much did you bad in the last year? farm land do you use for Weight unit crops? harvest in the last year? growing this crop' 0 = mono 1= intercrop ID Crop 1 2 3 4 5 Proportions Weight unit Harvest 1= All or nearly all (87-100%); 1= Kg, 1 = Good harvest 2= More than half of it (63-87%) 2= Tonne, 2 = Normal harvest 3= About half of it (38-62%) 3= Bunch 3 = Bad harvest 4= Less than half of it (13-37%) 5= A small amount (1-12%)

5 6 Copy the 5 previous crops in the table below, and continue with these crops asking for the following information:

Which What do you do proporti with the crop Unit of value on of residues? Who usually Who usually Which proportion of the 1=total value the Value of sold crop sells or trades decides when to harvest did you consume? 2=value per unit harvest the harvest eat the crop weight did you ID Crop sell? 1 2 3 4 5 Crop residues Who: 1= Leave it in 1 = Husband or other male; the fields or 2= Wife or other female; return to soil 3= Male Youth or Child; 2= Burn it in 4 = Female Youth or Child the fields 3= Use it as a fuel 4= Feed it to animals 5= Make compost 6= Use as construction materials 7= Sell it

7 Do you make any of your crops into products you can store or sell? Yes/No ______

If yes

How much money Who makes Who usually sells Who decides Does your Do you Do you sell this Product did you make from these the products? when to eat the household make eat this product? selling the products products? products? this product? product in the last year? 1=yes at 0 = no home? Flour or 1 Meal Foods for sale (breads, snacks, 2 meals) Food ingredient s (e.g. spices, coffee, 3 tea) Dried fruits, nuts 4 or similar Sweet preserves (jams, 5 syrups etc) 6 Pickled foods (preserved

8 in vinegar) Drinks (alcoholic or non- 7 alcoholic) 8 Medicines Baskets, carvings, 9 etc Fuel wood, charcoal, 10 etc

Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child

9 5. Agricultural inputs

On which crops did you use fertilisers during the last year? ______

How much fertiliser in total was used on your farm in the last year? ______

Fertiliser amount units: ______

What types of fertiliser do you normally use? ______

On which crops did you use manures or compost during the last year? ______

On which crops did you use herbicides or pesticides during the last year? ______

For which crops did you use improved seed varieties during the last year? ______

For which crops did you use post-harvest chemicals during the last year? ______

10 How do you store your crops after harvest? ______1 = Traditional granary 2 = Sacks

3 = Metal silos 4 = Clay pots

5 = Other

Do you add anything to help preserve the crops in the storage? Yes / No ______

Do you grow any crops under irrigation? Yes / No ______

Which crops did you irrigate during the last year?

______

Which months of the year do you irrigate?

______

Where do you get the water from for irrigation? ? ______1 = Communal pond or reservoir; 2 = Household pond 3 = Household pond with fish 4 = River 5 = Well 6 = Rainwater harvesting 7 = Other

What type of irrigation method do you use? ? ______1 = Basin dug around plant 2 = Gravity-fed (river diversion) 3 = Sprinkler 4 = Drip 5 = Other Do you use an electric or diesel powered water pump? Yes / No ______

11 6. Integrated farming

Do you manage any trees on your land? Yes / No ______

What do you use the trees for? ______

1 = Food or fruits 2 = Fuel wood 3 = Timber

4 = Animal food 5 = Good for land (soil, water, shelter etc) 6 Clear trees to make space

7 = Other

Do you till or plough your land? Yes / No ______

If yes, how do you do the tillage? ______1 = By hand 2 = Use animal power 3 = Use a machine

Do you use any particular tillage techniques? ______

1 = No, just normal tillage 2 = Conservation agriculture 3 = Conservation tillage with residue retention 4 = Conservation tillage without residue retention 5 = Soil bunds 6 = Stone bunds

Do you grow legumes (peas, beans) in combination with other crops? Yes / No ______

Do you grow legumes (peas, beans) in rotation with other crops? Yes / No ______

Do you grow trees and crops mixed together? Yes / No ______

12 8. Key livestock species

Breed: Amount of Total amount How many 1)Local, Nr. bought the Nr. sold in the Who owns the Who sold the time spent in earned from owned? 2)foreign or last year last year animals? animals? stable or pen? selling 3)both Cattle Goats Sheep Pigs Chicken Other birds Horses, donkeys, or similar Fish Beehives Other 1 Other 2 Other 3 Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Amount of time in pen: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

13 9. Animals products:

Animals products: Meat

14 Which Who usually Which proportion How much money proportion of Who usually sells decides when to Nr slaughtered of the milk do you do you make from the meat do the meat? eat the meat? sell? selling the meat? Cattle you consume Cattle Goats Sheep Pigs Chicken Other birds Fish Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

Animal products - milk

15 How much Unit of milk Which How much Sales unit Who usually Which milk production Dry season proportion money do (1=total; Who usually decides proportion produced in (e.g. liter, milk of the milk you make 2=per litre sells the when to eat of the milk the wet bottle, produced? do you from selling product) milk? the milk? do you sell? Cattle season bucket,etc.) consume? the milk? Cattleows Goats Sheep Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

16 Animal products - eggs How many Unit sales Who How many Which Which How much eggs (1 = total Who usually eggs proportion proportion money do Who usually (nr/day), 2 =per unit usually decides (nr/day), of the eggs of the eggs you make sells the during the product) collects when to during the do you do you from selling eggs? good the eggs? eat the bad season? consume? sell? the eggs? season? eggs? Chicken Other birds Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

Animal products - honey How much Unit sales Who usually How much Which Which money do you (1 = total decides when honey do you proportion of proportion of Who usually make from 2 =per unit to eat the collect in the the honey do the honey do sells the honey? selling the product) honey? year? you consume? you sell? honey? Honey Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

17 Processed animal products and other products– How much Unit sales Who usually How much do Which Who usually Units of proportion do Which money do you (1 = total decides when you usually proportion do sells the production you consume? make from 2 =per unit to eat the produce? you sell? produce? selling? product) produce? Cheese Butter Wool 0 NA Other1 Other2 Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

18 10. Livestock input use

Do you buy or use any medicines for your livestock? Yes / No ______If yes:

Use: Yes / No ? Which animals do you give the medicines to?

Vaccinations De-Worming Antibiotics Traditional Medicines Other Which animals: 1=Cattle; 2=Goats; 3=Sheep; 4=Pigs; 5=Chicken; 6=Other birds; 7=Horses, donkeys, or similar; 8=Fish; 9=Bees; 10-=other

11. Animals – Manure

What do you do with the manure from the animal pens? Proportion put Proportion Proportion Proportion put Proportion used Proportion Proportion sold on crops stored in a pile stored inside in a digester as fuel disposed All animals Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

Think of the money your household earned through selling crops and livestock during the last year. What was that money spent on? ______1 = food Buying food 2 = possessions Buying possessions – e.g. clothes, household items 3 = invest_farm Improving the farm – e.g. machinery, fertilisers 4 = invest_people Spend on people – e.g. education, health care, travel to city

19 12. Wild foods

Do you or your family gather any wild foods? Yes / No ______

If yes, which months of the year do you collect wild foods? ______

Which wild food do you collect? (multiple options possible) ______1 =meat; 2 = fish; 3= insects; 4= plants; 5= fruits; 6 = nuts; 7 = honey; 8 = mushrooms

How important is it for you to collect wild foods? ______1 = very important food source 2 = very important for selling 3 = common part of the diet 4 = not important

Approximately, which proportion of your household's food comes from wild foods? ______Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

20 13. Food security

Food Security Is there a time of year when there is a less food available compared to other times? If so, which months?

During the worst month How often did somebody have to go a whole day and night without eating anything? How often did somebody have to go to sleep hungry at night? How often was there no food to eat of any kind in your household?

If the answer to all three above questions was “never”, proceed and ask the following 6 questions. Otherwise, move on to the next section.

How often did somebody have to eat fewer meals than they wanted? How often did somebody have to eat smaller meals than they wanted? How often did somebody have to eat some foods that you really did not want to eat? How often did someone have to eat a less variety of foods? How often was someone in the house not able to eat the kinds of food they wanted to? How often do you ever worry that there will not be enough food for your household?

Options: 1= Daily, or more than three times per week 2= once or twice a week 3= once or twice a month 4= never, or less than once a month

21 14. Nutritional diversity

Where does Nutritional Diversity How often? this food come from?

Think of: grains, rice, flour, or starchy white vegetables. How often were these eaten in your house? (e.g. rice, maize, bread, noodles, yucca, plantain, yam, cassava, taro, potato, kohlrabi, white or pale wweet potato) Worst month? Good month? Think of: beans, peas, lentils. How often were these eaten in your house? (e.g. black bean, soy bean, green bean, red bean, cow pea, lentil, chickpea) Worst month? Good month? Think of: nuts or seeds. How often were these eaten in your house? ( e.g. peanut, groundnut, cashew, pumpkin seeds, sunflower seeds) Worst month? Good month? Think of: leafy green vegetables. How often were these eaten in your house? ( e.g. amaranth, green mustard, pak choi, spinach, kale, sweet potato leafs, cassava leafs, broccoli) Worst month? Good month? Think of: orange coloured vegetables or fruits. How often were these eaten in your house? ( e.g. pumpkin, squash, carrot, orange sweet potato, red pepper, red palm oil, palm nuts, mango, ripe papaya, peach, mandarin, orange, avocado, persimmon, also avocado) Worst month? Good month?

How often: 1= everyday (or almost everyday) 2= a few times a week 3= once a week 4= once a month 5= Rarely 6= never Where does the food come from: 1= self produced; 2 = purchased; 3=both; 4= gathered, gifted or traded Nutritional Diversity continued

22 Where does Nutritional Diversity How often? this food come from?

Think of: other vegetables. How often were these eaten in your house? (e.g. tomato, cabbage, onions, gourd, cauliflower, lettuce, chayoute fruit, cucumber, egg plant) Worst month? Good month? Think of: other fruits. How often were these eaten in your house? (e.g. durian, green papaya, guava, lemon, white sappote, banana, watermelon, longan, pomelo, apple, pineapple, hanoi plum, strawberry, mulberry.) Worst month? Good month? Think of: meat, poultry or fish. How often were these eaten in your house? ( e.g. chicken, beef, pork, goat, duck, buffalo, meat, liver, heart, frog, river fish, sea fish, crab etc.) Worst month? Good month? Think of: eggs. How often were these eaten in your house? ( e.g. chicken eggs, duck eggs) Worst month? Good month? Think of milk: or dairy foods. How often were these eaten in your house? ( e.g. cow milk, goat milk, cheese, butter, yoghurt) Worst month? Good month?

How often: 1= everyday (or almost everyday) 2= a few times a week 3= once a week 4= once a month 5= Rarely 6= never Where does the food come from: 1= self produced; 2 = purchased; 3=both; 4= gathered, gifted or traded

23 15. AID

Have you received aid from the government, NGOs or other organisations in the last year? Yes / No ______

If yes, which type (multiple options possible) 1 = Food; 2 = Agri_Inputs; 3 = Animals; 4 = Cash; 5 = other

During the last year, about how much of the food eaten by your household was from aid sources? ______1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

Have you received any significant gifts from family, friends, neighbours in the past year? Yes / No? ______

If yes, which type (multiple options possible) ______1 = Food; 2 = Agri_Inputs; 3 = Animals; 4 = Cash; 5 = other

During the last year, about how much of the food eaten by your household was from gift sources? ______1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

24 16. Off farm income

In total, what proportion of the household's total income is from off farm sources? (code below)? ______

Does your household earn Which months does About how much money money from this source? your household earn Who decides how to spend Type of income does your household make 1=yes money from this the money of this source? from this source? 0 = no source? Work on other farms Work in local business Work in own business Remittances Work for government or public institution Rent out land to others Rent out equipment or animals to others other Who: 1 = Husband or other male; 2= Wife or other female; 3= Male Youth or Child; 4 = Female Youth or Child Proportions: 1= All or nearly all (87-100%); 2= More than half of it (63-87%) 3= About half of it (38-62%) 4= Less than half of it (13-37%) 5= A small amount (1-12%)

Think of all the money your household earned through off farm incomes during the last year. What was that money spent on? ______(multiple options possible) 1 =food; 2 = possessions; 3 = invest_farm; 4 = invest_people (education, etceteras)

17. Debt

Do you have any debts, or have you had debts in the last 12 months? Yes / No ______

In the last year, did you find it difficult to repay the debt? Yes / No ______

25 18. Progress out of Poverty indicator

Response Yes / No Were all the children aged between 6 and 17 enrolled in school this year? Yes / No Can the female head or head's wife read and write? Which languages? Yes / No What is the main construction material of the residence’s floors? Earth / Cement, tiles, timber / Other:______What is the main building material of the roof of the main dwelling? Mud / grass, leaves, thatch, bamboo / metal, other How many bicycles, mopeds, motorcycles, tractors and motorvehicles do you own? None / one / two or more Does your household have any radios or radio cassettes? Yes / No Does your household have any lanterns? Yes / No Do you have an iron (charcoal or electric)? Yes / No How many tables does your household own? None / One / Two / Three or more Time interview ended : HH: MM:

To be answered privately by the enumerator immediately following the interview

How many people contributed to answering the survey? ______

In your opinion, how easily did you establish rapport with the respondent? ______

1 = easy 2 = medium 3 = difficult 4 = very_difficult

How reliable do you think these answers are?

26 Consider the accuracy and willingness to answer. ______

5 = very reliable 4 = reliable 3 = ok 2 = occasional doubts 1 = regular or serious doubts

Do you have any notes or comments from the interview? ______

I certify that I have checked the questionnaire two times to be sure that all the questions have been answered, and that the answers are legible.

Signed: ______Date ____/____/____

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