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 , 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 l