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PAHAL) Program Annual Beneficiary Collection of Data (ABCD)

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PAHAL) Program Annual Beneficiary Collection of Data (ABCD) Promoting Agriculture, Health and Alternative Livelihoods (PAHAL) Program Annual Beneficiary Collection of Data (ABCD) A. QUESTIONNAIRE DATA (ENUMERATOR ID, LOCATION, ID NUMBER, INFORMED CONSENT) A1. Name of enumerator A2. Time stamp A3. Date stamp A4. GPS stamp A5. Location Old Government Structure New Government Structure A5a. District A5e. District A5f. Rural Municipality/ A5b. VDC/Municipality Municipality A5c. Ward No A5g. Ward No A5d. Tole 1 = Yes Q A7 A6. Is the PAHAL member home to respond to this interview? 2 = No Terminate Interview B. INFORMED CONSENT INTRODUCTION Hello, my name is ________________ and I am a ……. working with for PAHAL Program which is being implemented in your district. We have come to your community to ask our beneficiaries about health and nutrition, governance, and civil society. Our objective is to learn about your current practices to reflect on our interventions and improve our program for the betterment of the work we do with your communities. Choosing to talk with us is your choice alone. You can decide at any time to stop talking with us or taking. If at any time we ask you a question(s) that you don’t want to answer just tell us you don’t want to answer and we can skip that question(s). If at any time while we are talking you have questions for us about a question we ask, the study, who we are, or about what we are doing you are invited to stop us and ask us. We expect to be returning to this location multiple times over the coming months, so you can continue the conversation with us or ask us additional questions at any time. PROCEDURES TO BE FOLLOWED If you are interested to talk with us, we would ask for about an hour of your time to talk with you. RISKS & CONFIDENTIALITY We do not foresee any risk to you in participating in this study. We will maintain confidentiality for anything you tell us in the study and we will not attribute what is said to you as an individual. PARTICIPANT CONSENT B1. Are you willing to participate in the study? 1 = Yes (If no, thank you very much for your time). TERMINATE SURVEY 2 = No B2. If yes, do you understand everything I have explained to you about the fact that you are 1 = Yes free to participate or not in this study, you can ask question at any time, and that at any time 2 = No you can refuse to answer any question or stop the interview? B3. If yes, do you feel you have been fully informed of the study with its risks and benefits, 1 = Yes and do you agree to participate in this interview and the study? 2 = No PAHAL ABCD FY18 Questionnaire 2018-06-01 EN_Updated 1 of 10 C. RESPONDENT DATA C1. Respondent name a. family name b. first given name c. second given name C2a. Respondent age 01 = male C2b. Sex (in years) 02 = female C3a. PAHAL ID C3b. Phone number C4. PAHAL household ID: 01 = Yes 02 = No C5. Are you the Household head? (Yes/No) C6. Do you have a child under 2 years of age at your household? 01 = Yes C7. Are you the primary caregiver of a child under 2 years of age? 02 = No 01 = Mother 03 = Grandparent C8. What is your relationship to the child? 02 = Father 04 = Other D. NUTRITION DATA Now I would like to ask you some questions about health and nutrition D1. Please name five foods that contain Vitamin A. Circle the foods mentioned. For foods mentioned not on the list, select “Other” and write in the food names. Probe for specific food names when general categories are mentioned. For example the category “leafy greens” requires probing to elicit responses 1 – 11 on the list. 1 Amaranth, tender 10 Rape leaves 19 Mango 2 Bethe Leaves 11 Spinach 20 Papaya, ripe 3 Colocasia Leaves 12 Stinging Nettle 21 Lentil 4 Coriander leaves 13 Cabbage 22 Soya bean 5 Fenugreek leaves 14 Carrot 23 Egg, hen 6 Mustard Leaves 15 Onion stalk 24 Liver chicken 7 Mustard leaf “Gundrukh” 16 Pumpkin 25 Liver goat 8 Pumpkin leaves 17 Sweet potato 00 None on list mentioned 9 Radish Leaves 18 Yams 90 Other, Specify D2. How many days a week do you eat/consume following food category in your household? This is a follow of question of D1 to know the consumption of vitamin A foods in households. See lists of foods for the category? Frequency shouldn’t be greater than 7 (we are recalling 7 days before the day of interview). Category Frequency D2a Dairy D2b Organ meat D2c Eggs D2 Green vegetables D2e Other vegetables D2f fruits D3. Please name all the foods you know that contain iron. Circle the foods mentioned. For foods mentioned not on the list, select “Other” and write in the food names. Probe for specific food names when general categories are mentioned. PAHAL ABCD FY18 Questionnaire 2018-06-01 EN_Updated 2 of 10 1 Colocasia leaves 11 Broad beans, sprouted 21 Egg, hen 2 Garden Cress 12 Cow Pea 22 Chicken 3 “Masyaura” 13 Peas, dry 23 Fish, dried 4 Mustard leaves 14 Sugar unrefined “sakkar” 24 Liver, chicken 5 Mustard leaf “Gundruk” 15 Lentil 25 Liver, goat 6 Radish leaf “Gundruk” 16 Soya bean 26 Milk, Buffalo’s 7 Turnip greens 17 Bengal gram, roasted 27 Milk Cow’s 8 Tamarind pulp 18 Horse gram 28 Mutton 9 Watermelon 19 Finger millet 00 None on list mentioned 10 Onion Stalk 20 Rice, beaten 90 Other, Specify D4. How many days a week do you eat/consume following food category in your household? This is a follow of question of D3 to know the consumption of Iron rich foods in households. See lists of foods for the category? Frequency shouldn’t be greater than 7 (we are recalling 7 days before the day of interview). S.N Category Frequency D4a Organ meat D4b Dairy D4c Eggs D4d vegetables D4e Green vegetables and its products D4f Other E. WASH DATA E1. What are the times during the day when it is critical to wash your hands with soaps? Check all times mentioned by the respondent. For times mentioned but not on the list, select “Other” and write in the descriptions names. 1. ... after defecation 4. ... before eating or before feeding a child 2. ... after cleaning a young child 5. ... after working in the field or touching waste 3. ... before preparing food 00. None on list mentioned 90. Other, Specify: E.2. Did you constructed/rehabilitated/upgraded your toilet after PAHAL interventions? After PAHAL started its WASH related interventions. Probe: (Persons are counted as “gaining access” to a basic sanitation facility, either newly established or rehabilitated from a non-functional or unimproved state) 1. ....Yes 2. ....No E3. From whose assistance (awareness, motivation, counselling) did you construct/rehabilitated/upgraded your toilet? (Multiple choice answer) 1. PAHAL WASH interventions (HH monitoring, counselling, radio jingle, posters, phamplets) 2. VDCs support and campaign 3. Individual effort 4. Other organization support 5. Other E4. Ask if you can visit toilet. Record observations in E2 and E3. Are feces visible on floor, wall, or area immediately surrounding the facility? PAHAL ABCD FY18 Questionnaire 2018-06-01 EN_Updated 3 of 10 1. ....Yes 2. ....No E5. Type of toilet? Upon exiting the toilet verify the toilet type with the respondent if you cannot identify the type. 1. .... Flush to piped sewer system 5. ... Pit latrine with slab 9. ... Pit latrine with slab/open pit 2. .... Flush to septic tank 6. ... Flush to somewhere else 10. Bucket toilet 3. .... Flush to pit latrine 7. ... Composting toilet 00. No facility/bush/field 4. .... Ventilated pit latrine 8. ... Flush, don’t know where 90 .. Other, Specify: E6. What ways does your household treat water? 1. ... None 3. ... Boiling 5. .... Chlorination 2. ... Filtering 4. ... Solar water disinfection (SODIS) 90. .. Other, Specify: F. GOVERNANCE DATA Now I would like to ask you some questions about government and civil society. I am interested in the government and community services your household has used in the last year (village and/or district level). F1. For each kind of service, please say if you have used it in the last year, if you haven’t used it, if you wanted to use it but couldn’t or did not want to use the service. Write code in box preceding service. 1 .... Have used this in the last year 3 .... Wanted to use this but could not 2 .... Have not used this in the last year 4. .. Did not want to use the service in the last year F1a. VDC services (Vital registration, Vital records certificates, social services and development fund) F1b. Basic health and nutrition services (FCHV service, immunization, information and communication) F1c. Basic water and sanitation services (including safe water use, hand washing) F1d. Basic education services F1e. Agriculture extension services, including livestock (Training, inputs, subsidies, extension services etc.) F1f. Basic humanitarian relief to those most in need (support during disasters e.g NFI , Funds and/or materials for recovery and reconstruction post-disaster, rescue, infrastructure etc.) F1g. Preparedness to deal with possible disasters (e.g. flood, landslides, forest, pest, drought, Funds for disaster prevention infrastructure) F1h. Financial services (savings, loans and insurance F1i. Natural resources (Water, forest etc.) F1j. Alternate livelihood training F2. Can you describe the different methods that you know for contacting local government? Check all methods mentioned by the respondent. 1 .... Have used this in the last year 3 .... Wanted to use this but could not 2 ...
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