Table 1 Household Screening Form
0.1 Is there a woman residing in the household who has given birth during the previous 12 months? | Yes 01 | If no, terminate interview |
|---|---|---|
No 02 | ||
0.2 Does this woman currently have any insurance cover or has she had cover in the previous 12 months? | Yes 01 | |
No 02 | ||
0.3 Which kind of insurance does this woman have/did she have? | 01 NHIF BIMA WAZAZI | Terminate interview if 01, 02, 03, 05, 06, 88 |
02 NHIF EMPLOYER CONTRIBUTION | ||
03 CHF/TIKA BIMA WAZAZI | ||
04 CHF/TIKA SELF CONTRIBUTION | ||
05 SHIB | ||
06 PRIVATE INSURANCE | ||
88 OTHER (SPECIFY) | ||
0.4 Interviewer instruction: | ||
Please score households from 1 to 3 depending on the nature of their house and their responses to the following questions. | ||
0.4a Nature of the house | 01 Mud house with thatched roof | Score |__|__| |
02 Mud house with iron sheet roof | ||
03 Brick house | ||
0.4b Distance to nearest health facility walking | 01 60 minutes or more | |__|__| |
02 between 30 and 60 minutes | ||
03 less than 30 minutes | ||
0.4c Water source | 01 River/stream/lake | |__|__| |
02 Shared well or tap | ||
03 Private well or tap | ||
0.4d Fuel for cooking | 01 Firewood or animal dung or no facilities | |__|__| |
02Charcoal | ||
03 Kerosene, gas or electricity | ||
0.4e Toilet facilities | 01 Bush | |__|__| |
02 Shared latrine | ||
03 Private latrine or toilet | ||
0.4f Daily income | 01 Less than 1500 Tsh per day | |__|__| |
02 Between 1500–3000 Tsh per day | ||
03 More than 3000 Tsh per day | ||
0.4 g Average number of meals per day | 01 1 meal per day | |__|__| |
02 2 meals per day | ||
03 3 meals per day | ||
0.4 h Number of children/vulnerable children in household | 01 More than 4 children or one of your children is disabled or suffers from a chronic disease. | |__|__| |
02 3 or 4 children | ||
03 Less than 3 children | ||
0.4i Total score for household | 01 Score 8–13 = poor | |__|__| |
ADD SCORES FROM 0.4a-0.4i | ||
02 Score 14–18 = average | ||
03 Score 19–24 = rich |