BARANGAY QUESTIONNAIRE
IDENTIFICATION BARANGAY CODE (M101) :
M102. Province ......
M103. Municipality ......
M104. Barangay ......
INTERVIEW DATA
M106a. Year of barangay survey: 2015 M106b. Month of barangay survey: ...... M106c. Date of barangay survey: ......
M107b. Code of M107a. Name of supervisor ______Supervisor
M108. Does the respondent want to proceed with the interview now, or reschedule for another time? RESULT
1 Proceed with Interview 2 Reschedule
CONSENT FORM NOTE: NEED TO GIVE ONE COPY OF THE CONSENT FORM TO THE BARANGAY CAPTAIN Good morning/afternoon, my name is ______(state name) with the firm Philippine Survey and Research Center (PSRC). You are being asked to participate in a research study. The study is being done by the World Bank in cooperation with the Department of Social Welfare and Development (DSWD). The purpose of the study is to better understand the conditions within your community in order to improve available social programs. Your barangay has been selected for the interview on the basis of the results of lot drawing.
You are not obliged to answer every question we pose to you. All answers are strictly for research purposes, and will be kept confidential. This interview will take about 1 hour. The information you provide will help your local government and international organizations design programs that will improve the existing sanitation conditions in your area.
Thank you for your participation.
M109. Principal respondents Fill in the following table with the names of potential interviewees as provided by the head of the village/barangay. Potential interviewees must be aware of and properly informed about government or other programs ongoing in the barangay. Include at least two local barangay leaders, including the captain, kagawads, secretary, parent leader, or any other knowledgeable staff.
M109a. How many interviewees have been provided by the head of the village/barangay?
Number_____
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M109b. What is the name of the [FIRST..] interviewee?
M109c. What is [NAME] role/position in the barangay?
INTERVIEWEE NAME ROLE/POSITION ROLE/POSITION CODE M109(1). 501 Barangay captain 502 Barangay Kagawad M109(2). 503 Barangay secretary 504 Purok leader M109(3). 505 Barangay Health Worker 506 Barangay treasurer 507 Barangay nutritionist M109(4). 508 Other (Specify: ______)
M109(5).
M109(6).
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Barangay Information
NUM Questions Response Codes Skip To
B101 How are the dwellings clustered? Crowded ...... 1 . 1 Dispersed………………………………….... 2 Other ...... 96 ...... 3 Refused (vol.) 98 Don’t know ...... 99
B102 Which is the closest important village or city? Refused ...... 98 B106 Don’t know ...... 99 B106
B103 What type of road connects this barangay with [LOCALITY Paved road ...... 1 MENTIONED IN QUESTION B102]? Non-paved road ...... 2 Dirt road open year round ...... 3 ...... Seasonal dirt road ...... 4 Trail ...... 5 ...... River or other waterway…………………… 6 NA…………………………………………… ………….97 Refused ...... 98 Don’t know ...... 99
B104 A) What is the distance between this barangay and B104a. Distance: ______[LOCALITY MENTIONED IN QUESTION B102]? \ NA…………………………………………… 997 Refused ...... 998 Don’t know ...... 999
B) What is the unit of the distance provided in the previous B104b. Units: question? Kilometers (KM) ...... 1 Meters ...... 2 NA…………………………………………… 97 Refused ...... 98 Don’t know ...... 99
B105 What type of transportation is most frequently used by the majority of Motorized vehicle ...... 1 citizens of this locality/barangay to go to [LOCALITY MENTIONED IN Motorbike/tricycle ...... 2 QUESTION B102]? Animal-pulled cart ...... 3 Bicycle ...... 4 Boat, canoe or similar ...... 5 None (walking) ……………………………. 6 NA………………………………………… 97 Refused ...... 98 Don’t know ...... 99
B106 Is there any bus service to the municipal poblacion? Yes ...... 1 ...... No ...... 2......
Refused ...... 98 .. Don’t know ...... 99
B107 On a typical week, how many buses or minibuses stop in this barangay? Number ______
8 Refused ...... 998 .. Don’t know ...... 999
B108 A) Is this barangay connected to a public water piped system? B108a.
Yes ...... 1 PR’CD No ...... 2 B109 Refused ...... 98 B109 Don’t know ...... 99 B109
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Barangay Information
NUM Questions Response Codes Skip To
B) B108b. Approximately what percent (%) of households are connected to this drainage system?
Percentage ______
NA ...... 97...... Refused ...... 98 Don’t know ...... 99
B109 What is the main source of water for the majority of the barangay Private tap connection ...... 1 dwellings? Public tap connection ...... 2 Non-protected well ...... 3 Protected well ...... 4 Water body (lake, river, etc,) ...... 5 ... Rain water ...... 6 Other ...... 96 ...... Refused ...... 98 Don’t know ...... 99
B110 Yes ...... 1 ...... Is there a centralized system, such as a water treatment plant, to treat No ...... 2......
drinking water in this barangay? Refused ...... 98 .. Don’t know ...... 99
B111 Is there a Water Committee to manage the maintenance and delivery Yes ...... 1 ...... of water in this locality/barangay? No ...... 2......
Refused ...... 98 .. Don’t know ...... 99
B112 A A) Is this barangay connected to a drainage system for the B112a. removal of household waste? Yes ...... 1 ...... PR’CD No ...... 2...... B113 Refused ...... 98 .. B113 Don’t know ...... 99 B113
B) Approximately what percent (%) of households are connected B112b. to this drainage system? Percentage ______
Not Asked ...... 97 Refused ...... 98 .. Don’t know ...... 99
B113 A) Does this barangay have access to electricity? B113a. PR’CD Yes ...... 1 ...... B114 No ...... 2...... B114 Refused ...... 98 .. B114 Don’t know ...... 99
B) Approximately what percent (%) of households have access B113b to electricity? Percentage ______
Not Asked ...... 97 Refused ...... 98 .. Don’t know ...... 99
B114 What is the primary garbage disposal method in the barangay? Garbage disposal then taken away ……... 1 In pit/burn …….…….…….…….…….……. 2 River …….…….…….…….…….…….……. 3
Other ………….…….…….…….…….……. 4 Refused ...... 98 .. Don’t know ...... 99
4 Page Barangay Information
NUM Questions Response Codes Skip To
B115 What is the primary waste water disposal system in the barangay? No proper drainage …….…….…….……. 1 Open drainage/gutters without any cover ... 2 Closed/underground drainage...... 3 Refused ...... 98 .. Don’t know ...... 99
B116 Are there any households in the barangay who defecate in: YES NO REF DK READ ALL THE OPTIONS 1. Pond/water-filled rice field 1……….2……98……99 2, River 1……….2……98……99
3. Lake 1……….2……98……99 4. Pit 1……….2……98……99 5. Farm/beach/field/yard 1……….2……98……99
B117 How many or what percentage of the households in the barangay have 1. ______% or private toilets? 2. ______(N) households
98. REFUSED 99. DON’T KNOW
B118 Has there ever been a public toilet in the barangay available for public Yes ...... 1 ...... PR’CD use? No ...... 2...... B123 Refused ...... 98 .. B123 Don’t know ...... 99 B123
B119 When was the public toilet built? Year ______97 Not Asked ...... 98 Refused ...... 99 .. Don’t know ......
B120 Who provided funds for the public toilet? Community members 1 Barangay’s own development fund 2 Government sanitation program 3 Donated 4 Pay and use toilet 5 Not Asked ...... 97 Refused ...... 98 .. Don’t know ...... 99
B121 Is this public toilet still used? Yes ...... 1 ...... PR’CD No ...... 2...... B123 Not Asked…………………………………… 97 PR’CD Refused ...... 98 .. PR’CD Don’t know ...... 99 PR’CD
B122 How would you describe the cleanliness of the public toilet(s)? Very clean ...... 1 Clean ...... 2 Dirty ...... 3 Very dirty ...... 4 Not Asked ...... 97 Refused ...... 98 .. Don’t know ...... 99
B123 A) Does this barangay have access to telephone/cell phone networks? B123a.
Yes ...... 1 ...... PR’CD No ...... 2...... B124 Refused ...... 98 .. B124 Don’t know ...... 99 B124
B) Approximately what percent (%) of households have access to Percentage ______telephone/cell phone networks? Not Asked ...... 97 Refused ...... 98 .. Don’t know ...... 99
B124 A) Does this barangay have access to local television networks such B124a. as ABS-CBN, GMA or TV5?
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Barangay Information
NUM Questions Response Codes Skip To
Yes ...... 1 ...... PR’CD No ...... 2...... B125 Refused ...... 98 .. B125 Don’t know ...... 99 B125
B) Approximately what percent (%) of households have access to Percentage ______television networks? Not Asked ...... 97 Refused ...... 98 .. Don’t know ...... 99
B125 Does this barangay receive written press such as newspapers on a Yes ...... 1 ...... regular basis? No ...... 2......
Refused ...... 98 .. Don’t know ...... 99
B126 Does this barangay have access to radio stations? Yes ...... 1 ...... PR’CD No ...... 2...... B128 Refused ...... 98 .. B128 Don’t know ...... 99 B128
B127 Could you tell me the name of the main radio channels you listen to?
1:______REF DK NA 98 99 97 2:______98 99 97 3:______98 99 97
B128 Could you tell me how many citizens and dwellings can be found in 1. Dwellings ______REF DK this locality/barangay? 98 99
2. Citizens ______98 99
B129 A) What is the surface area of this barangay excluding parks, forest, B129a lakes, rivers and other non-habitable areas? Surface Area ______
Refused ...... 98 .. B130 Don’t know ...... 99 B130
B) What is the unit of the surface area? B129b
Kilometers ...... 1 Hectares ...... 2 Other (specify) 96 ______Not Asked ...... 97 Refused ...... 98.. Don’t know ...... 99
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B130a B130b B131 B132 What is the distance between the place What is the unit of What is the type of transportation What is the average time of the interview and the closest locality this distance? most utilized by the majority of the taken to get to [SERVICE] by that has a [SERVICE]? residents of this locality / barangay the type of transportation most to access (travel to) the closest utilized by the residents of this [SERVICE]? locality / barangay? Write ‘00’ if the service is found within
SERVICE the barangay. >>next service Write '24' in hours for 24 hours and more. Write ‘90’ for 90 km and more. Motorized vehicle……….. .1 01 ┌──┬──┐ 1. Meters Motorcycle/tricycle…… 2 │░░│░░│─ IF '00’ >> Next Service 2. Kilometers Animal drawn cart……….. 3 Minutes...1 └──┴──┘ 97. Na Bicycle ……………………….. 4 >> next Primary/Elementary service 98. Refused Boat, canoe (or similar)…5 School 98. Refused Hours....2 99. Don’t know None (walking)………………6 99. Don’t know Refused………………………-98 Refused…………………-98 Don’t know………………….-99 Don’t know…………….-99 1. Meters Motorized vehicle……….. .1 02 2. Kilometers Motorcycle/tricycle……. 2 ┌──┬──┐ 97. Na Animal drawn cart……….. 3 Minutes...1 │░░│░░│─ IF '00’ >> Next Service 98. Refused Bicycle ……………………….. 4 High School Or >> next Professional School └──┴──┘ 99. Don’t know Boat, canoe (or similar)…5 service Such As Tesda None (walking)………………6 Hours....2 98. Refused Refused………………………-98 99. Don’t know Don’t know………………….-99 Refused…………………98 Don’t know……………. 99 1. Meters Motorized vehicle……….. .1 03 2. Kilometers Motorcycle/tricycle……. 2 ┌──┬──┐ 97. Na Animal drawn cart……….. 3 minutes...1 >> next │░░│░░│─ IF '00’ >> Next Service 98. Refused Bicycle ……………………….. 4 Daily Market Such As service A Flea Market └──┴──┘ 99. Don’t know Boat, canoe (or similar)…5 hours....2 (Tiangge) Or Bazaar None (walking)………………6 98. Refused Refused………………………-98 Refused…………………98 99. Don’t know Don’t know………………….-99 Don’t know……………. 99 1. Meters Motorized vehicle……….. .1 04 2. Kilometers Motorcycle/tricycle……. 2 minutes...1 ┌──┬──┐ 97. Na Animal drawn cart……….. 3 >> next service │░░│░░│─ if '00’ >> next service 98. Refused Bicycle ……………………….. 4 Weekly Market hours....2 └──┴──┘ 99. Don’t know Boat, canoe (or similar)…5 None (walking)………………6 Refused…………………98 98. Refused Refused………………………-98 Don’t know……………. 99 99. Don’t know Don’t know………………….-99 1. Meters Motorized vehicle……….. .1 05 2. Kilometers Motorcycle/tricycle……. 2 ┌──┬──┐ 97. Na Animal drawn cart……….. 3 MINUTES...1 │░░│░░│─ if '00’ >> next service 98. Refused Bicycle ……………………….. 4 >> Next Doctor’s Clinic/ └──┴──┘ Service Health Center 99. Don’t know Boat, canoe (or similar)…5 HOURS....2 None (walking)………………6 98. Refused Refused………………………-98 99. Don’t know Refused…………………98 Don’t know………………….-99 Don’t know……………. 99 1. Meters Motorized vehicle……….. .1
06 ┌──┬──┐ 2. Kilometers Motorcycle/tricycle……. 2 │░░│░░│─ IF '00’ >> Next Service 97. Na Animal drawn cart……….. 3 MINUTES...1 >> Next Hospital └──┴──┘ 98. Refused Bicycle ……………………….. 4 Service
99. Don’t know Boat, canoe (or similar)…5 HOURS....2 98. Refused None (walking)………………6 99. Don’t know Refused………………………-98 Refused…………………98 Don’t know………………….-99 Don’t know……………. 99
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1. Meters Motorized vehicle……….. .1
07 ┌──┬──┐ 2. Kilometers Motorcycle/tricycle……. 2 │░░│░░│─ IF '00’ >> Next Service 97. Na Animal drawn cart……….. 3 MINUTES...1 >> Next Pharmacy └──┴──┘ 98. Refused Bicycle ……………………….. 4 Service
99. Don’t know Boat, canoe (or similar)…5 HOURS....2 98. Refused None (walking)………………6 99. Don’t know Refused………………………-98 Refused…………………98 Don’t know………………….-99 Don’t know……………. 99
1. Meters Motorized vehicle……….. .1 08 ┌──┬──┐ 2. Kilometers Motorcycle/tricycle……. 2 Public │░░│░░│─ IF '00’ >> Next Service 97. Na Animal drawn cart……….. 3 MINUTES...1 >>Next Transportation └──┴──┘ 98. Refused Bicycle ……………………….. 4 Service
99. Don’t know Boat, canoe (or similar)…5 HOURS....2 98. Refused None (walking)………………6 99. Don’t know Refused………………………-98 Refused…………………98 Don’t know………………….-99 Don’t know……………. 99
1. Meters Motorized vehicle……….. .1 09 ┌──┬──┐ 2. Kilometers Motorcycle/tricycle……. 2 Hardware Store │░░│░░│─ IF '00’ >> B201 97. Na Animal drawn cart……….. 3 MINUTES...1 >> >>B201 └──┴──┘ 98. Refused Bicycle ……………………….. 4 HOURS....2 99. Don’t know Boat, canoe (or similar)…5 98. Refused None (walking)………………6 Refused…………………98 99. Don’t know Refused………………………-98 Don’t know……………. 99 Don’t know………………….-99
NUM Questions Response Codes Skip To
B201 Do you think people in the village are much wealthier, wealthier, the Much Wealthier ...... 1 same, poorer, or much poorer as they were 5 years ago? Wealthier ...... 2 The Same ...... 3 Poorer ...... 4 Much Poorer ...... 5 Refused ...... 98.. Don’t Know ...... -9
B202 In the last 5 years, have there been any natural disasters or adverse Yes ...... 1 PR’CD events that have affected the households in this village? No ...... 2 B204 Refused ...... B204 Don’t know ...... 98 B204 -9
B203 What were the three most important disasters or events and in what EVENT CODE YEAR (YYYY) year did they occur?
Event Code 1 Drought/lack of water 2 Flood 3 Earthquake 4 Volcanic eruption 5 Rainstorm/Hurricane 6 Insects 7 Rodents 8 Animals eating crops 9 Fire 10 Violence -96 Other (specify) -97 NOT ASKED -98 REFUSED -99 DON’T KNOW
B204 Is this village in a typhoon prone area? Yes ...... 1 ......
No ...... 2 ......
8 Page Refused ...... 98 .. Don’t know ...... 99......
B205 During the past 5 years, has this village received a [PROGRAM] B205b. program or assistance? B205c. B205a. In what year did this barangay How many [PROGRAM] receive Yes ……... 1 of this type did the [PROGRAM] or barangay receive? >> “B205b” assistance?
No……….. 2 (in most recent REF……….. -98 (If multiple rounds, round ) Year of most recent DK…………. -99 round) NA…………..-97 NA…………. -97 >> Next REF……….. -98 program (line) REF……….. -98 DK…………. -99 DK…………. -99
1 Health Care improvements or access
2 De-worming
3 Nutrition
4 Prenatal care
5 Housing Upgrades/Improvements
6 Water supply system
7 Water treatment
8 Sanitation (Supply side – building latrines, providing materials, etc)
9 Sanitation (Demand Side – education)
10 Hygiene
11 Credit/Financing
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SN Please list all the names and codes B206 B207 B208 B209 B210 How B211 for programs from Q.204: Did the [PROGRAM] provide When did the When did the How frequently was many What is the average any of the following benefits? [PROGRAM] start? [PROGRAM] end? assistance from the households amount or value of the CODES Finance…….…. …...… 1 [PROGRAM] distributed? in this received benefits from Health Care……………………..…....1 Materials……………… 2 Not barangay the [PROGRAM]? If De-worming……………………..……2 Housing.. …………..… 3 Asked…………97 Ongoing …..95 Every month……………1 benefited the benefit is in-kind, Nutrition………………………..…...... 3 Food……..………..….. 4 Refused…………98 Not Asked……97 Every 3 months………..2 from the record the value of it Prenatal Care…………………...……4 Work….. …………..…. 5 Don’t Know…….99 Refused …..-98 Every 6 months………..3 [PROGRAM] here. If the respondent Housing Upgrades…………..……....5 Training/Counseling. . 6 Don’t Know.... -99 Every 12 months………4 assistance? does not know the Water Supply System…………...... 6 Medical ……………….7 One time only………….5 value, work with them Water Treatment………………….…7 Other______..… -96 Every day ………………..6 to estimate it. Sanitation (Supply Side)……………8 Not Asked……………..97 Other (Specify 997. NA Not asked……97 Sanitation (Demand Side)………….9 Refused…….…. …..-98 >B212 ______)....-96 998. REF Refused………98 Hygiene…………………………...…10 Don’t know……….. -99 >B212 999. DK Don’t know….99 Credit/Financing…………………….11 Not Asked………………97 Multiple answers. Circle all the Refused……………..-98 answers that apply Don’t Know………...-99
Program Name CODE Month Year Month Year % Amount (Php)
1 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
2 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
3 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
4 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
5 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
6 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
7 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
8 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
9 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
10 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
11 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
12 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
13 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
14 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
10 Page 15 1 2 3 4 5 6 -96 1 2 3 4 5 -96 -99
B212 In general, whose services are used in this village to build new latrines or improve or repair existing Mason ……………...... 1 latrines? Local craftsman/ …………… 2 Unskilled laborer – ………………. 3 Read all options and circle all that apply Own household / relative / neighbor’s labor ………. 4 Community labor…………………...... 5 Other (specify, ______)………. -96 Refused……….………. Don’t know………. -98 -99
Access to construction materials
B213 B214 B215 Approximately how far away is the Approximately how long would it take you to get to If someone from the barangay needed to location to purchase [MATERIAL] from the location to purchase [MATERIAL] from the obtain [MATERIAL] for construction the barangay hall, traveling one-way? barangay hall, traveling one-way? materials, where would they purchase or acquire them? -97 Not Asked -97 Not Asked -98 Refused -98 Refused MATERIALS 1. Within the barangay -99 Don’t Know -99 Don’t Know 2. Outside of the barangay but within the municipality 3. Outside the municipality -98 Refused >>B216 -99 Don’t Know >>B216
Cement or ingredients for concrete (sand, gravel, etc.) 1 1 2 3 -99 ______kilometers ____ hours ______minutes Wood for construction 1 2 3 -99 2 ______kilometers ____ hours ______minutes Toilet pan/toilet bowl 1 2 3 -99 3 ______kilometers ____ hours ______minutes Pipes for water 1 2 3 -99 4 ______kilometers ____ hours ______minutes Paint 1 2 3 -99 5 ______kilometers ____ hours ______minutes Iron sheets 1 2 3 -99 6 ______kilometers ____ hours ______minutes Plastic sheets 1 2 3 -99 7 ______kilometers ____ hours ______minutes Bricks 1 2 3 -99 8 ______kilometers ____ hours ______minutes
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B216 What is the average daily / hourly wage for skilled masonry or craftsman labor in this barangay? Hourly wage ____Php Daily wage ____ Php Select one and enter wage 98 Refused 99 Don’t Know
B217 Are there skilled masons or local craftsmen that live in the barangay that are trained or experienced in 1 Yes 219 constructing or repairing latrines and toilets? 2 No Proceed 98 Refused Proceed 99 Don’t Know Proceed
B218 A) How far away is the nearest location where there are skilled masons or craftsman that are trained or experienced in constructing or repairing latrines? 218a. ______Km 98 Refused 99 Don’t Know
B) How long would it take for these skilled masons or craftsman to travel to this barangay one way? 218b.
______Hours ______min 98 Refused 99 Don’t Know
B219 In general, how do people get information about options available for types of latrines, supplies and Mason / local craftsman……………………… 1 costs? Local vendors………………………… 2 Neighbors/Family………………… 3 Read all options and circle all that apply Barangay official…………………………… 4 Barangay Health Worker/ ………… 5 Health Facility Staff (e.g. Nurse, doctor)...... 6 SMS…………………………………… 7 Radio / Television ...... 8 NGO…………… 9 Other (specify, ______) -96 Refused…………… -98 Don’t Know…………… -99
M110. INTERVIEWER: If you have any observations about the interview, how it went, or why it ended early, please add them below.
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ENDINT. The interview has been completed. Please thank the participants for their time and select "next" to exit the interview.
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