Literal question
443) Where did you get the condom last time?
IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME OF PLACE) ____________
PUBLIC SECTOR
HOSPITAL 11
HEALTH CENTER 12
HEALTH OUTPOST 13
FAMILY PLANNING CLINIC 14
COMMUNITY WORKER 15
OTHER PUBLIC (SPECIFY) _____ 16
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR 21
PHARMACY 22
AMO-CONGO 23
HEALTH AGENT 24
OTHER PRIVATE MEDICAL (SPECIFY) ____ 26
OTHER SOURCE
SHOP 31
BAR/NIGHTCLUB 32
KIOSK 33
TABLIER 34
FRIENDS/ACQUAINTANCES/RELATIVES 35
HOTEL/MOTEL 36
PARTNER HAD CONDOM 41
OTHER (SPECIFY) _____ 96
DON'T KNOW 98