QUESTIONNAIRES FOR DATA COLLECTION ON H & ES.

HYGIENE AND ENVIRONMENTAL SANITATION SURVEY FOR ______________ (VILLAGE / QUARTER) INTERVIEWER: __________________________________________ QUESTIONAIRE NO.______________________________________
My name is ________________. I work for _______________. The Kumbo Rural Council is working on a new Programme, The Programme for Sustainable Water Supply and Sanitation Services supported by Helvetas Cameroon. For this year, six Rural Councils in the Northwest province are working on this programme. In order to better understand the existing situation in the field, We (I) are (am) commissioned us to carry out this survey so that it would facilitate the planning of the programme in the field of Hygiene and Sanitation in a better way. INTERVIEWEE ________________________________ Ethnic group___________________ 1st VISIT______ 2nd VISIT_____ 3rd VISIT_____ TIME:________ TIME:________ TIME:________ RESULT_____ RESULT______ RESULT______

Position of interviewee in the household________________________ No. of persons in the Household___________________________ A. HEALTH ASPECTS: 1. Which of the following illnesses do you consider as the greatest problem in your village? 1 Malaria 2 Diarhea 3 Dysentry 4 Typhoid 5 Filaria 6 other __________________________

2. Which class of persons suffer the most from these illnesses? 1 Children 2 Men 3 Women

4 Other

3.How often does some body in your household fall ill of any of the above illnesses?__________ (INDICATE FREQUENCY) 4. Which one of the diseases? _____________________________
_________

5. About how much does this household spend on the treatment on the above diseases yearly?

B. WATER USAGE 6. How close is your nearest potable water source? 7. What kind of source is it? 8. What do you mostly use water for? 9. How often do you wash your hands after defecating?_______ (FIND OUT MORE ABOUT OTHERS IN THE HOUSEHOLD)

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10. How do you collect water? 11. Who collects the water? 12. How is the water stored?

____________________________________________________ ___________________________________________________ ___________________________________________________ __________________________________________

13. Who serves water in your house?

14. How is it served?________________________________________________ 15. How often do you wash your hands before eating? C. LATRINE SITUATION 16. Does this household have a latrine? 1 Yes 2 No IF NO GOTO 20.

17. Do you share your latrine with neighbours? 1 Yes 2 No 18. How many persons use it regularly?____________(GIVE A FIGURE) 19. How far away is it from the house? ____________(APPROXIMATE DISTANCE IN METRES) 20. Can you describe it? (ASK IF YOU COULD SEE IT AND RECORD HIS OR YOUR OWN DESCRIPTION NATURE OF THE TOILET IN TERMS OF) (PLEASE INDICATE WHOSE DESCRIPTION IT IS) 1 Environmental pollution, 2 Material used for the walls and the nature, 3 Material used for the slab and the nature, 4 Location e.g near a water source etc. 5 Type of toilet e.g. Pit, Pit VIP, flush, 6 Depth of toilet, 7 Stench, 21. Where do you go to when you have to use a toilet?

22. How do you handle the faeces of babies? (FIND OUT WHERE BABIES DEFECATE HOW AND WHERE THEY DISPOSE OF THE FAECES)

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D. WASTE MANAGEMENT 23. Who takes care of the waste in your community? 1 the household 2 Community arrangement 4 other

3 council

24. For all the waste from your household, how much % of it is? 1 Degradable 2 Non-Degradable (Please specify type e.g plantain peelings, plastics, etc.)
% Type __________________________________________________

25. What do you do with the Non degradable waste? 1 Throw away 26. what do you do with the degradable waste? 1 throw away 27. Is there a place where you dump waste? 1 Yes 28. How far is it from the residential area? _________

2 burn

3 Other

2 burn 2 No

3 Other

(IF NO GOTO 29)

29. Who takes care of the area were the waste is dumped?_________________ 30. Where do you dump it?_____________________________ 31. Who takes care afterwards________________________ E. INTENTIONS 32. What do you think can be done to reduce the level of _________________ illness in this community (QUOTE THE ILLNESS AS IN QUESTION 1)

(GOTO 31)

33. If you have to construct a pit latrine, how would you like it to be?

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34. About how much would it cost you to build a pit latine?_________________ 35. How much can you afford?_________________________________ 36. Why don't you have a latrine? (ASK THIS QUESTION ONLY IF THERE IS NO LATRINE)

37. If there is a public latrine in this community how do you think it should be taken care of? (FIND OUT WHO SHOULD PAY FOR THE CLEANING AND GENERAL MAINTENANCE)

38. Do you have any other thing to add?

(OBSERVE THE SITUATION AS IT IS AND MAKE YOUR OWN GENERAL COMMENTS)

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HYGIENE AND ENVIRONMENTAL SANITATION SURVEY FOR _____________Market. INTERVIEWER: __________________________________________ QUESTIONAIRE NO.______________________________________
My name is ________________. I work for _______________. The Kumbo Rural Council is working on a new Programme, The Programme for Sustainable Water Supply and Sanitation Services supported by Helvetas Cameroon. For this year, six Rural Councils in the Northwest province are working on this programme. In order to better understand the existing situation in the field, We (I) are (am) commissioned us to carry out this survey so that it would facilitate the planning of the programme in the field of Hygiene and Sanitation in a better way. INTERVIEWEE ___________________________ Ethnic group___________________ Reason for visiting market F. WATER USAGE 39. Is there a source of potable water around this market? a. Yes b. No a.) buyer b.) Seller

c. Don't Know (IF NO GOO 42) 40. How far is it from this market?

41. Do you use it? 42. Where do you get water?

a. Yes

b. No

G. LATRINE SITUATION 43. Does this Market have a latrine? 1 Yes 2 No 44. Do you use it? 1 Yes IF NO GOTO 47 3 Don't Know

2 No

45. How far away is it from the Market? ___________(APPROXIMATE DISTANCE IN METRES) 46. Can you describe it? (VISIT IT AND MAKE A DESCRIPTION OF IT IN TERMS OF____) 1 Environmental pollution, 2 Material used for the walls and the nature 3 Material used for the slab and the nature, 4 Location e.g near a water source etc. 5 Type of toilet e.g. Pit, Pit VIP, flush, 6 Depth of toilet, 7 Stench, (GOTO 48)

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47. Where do you go to when you have to use a toilet? 48. What do you think about the idea of a good public toilet around the Market?

49. Who should take care of it?

50. Would you pay to use it?

a. Yes

b. No

If Yes how much?

51. What would you like the money to be used for?

52. Who should manage this money and why?

H. HANDLING OF WASTE 53. Where do you throw waste when your are in the Market? 54. Who takes care of the waste?

55. Is there anything you would like to be done about how waste is handled in this Market?

56. Do you have any other general comments?

(OBSERVE THE SITUATION AS IT IS AND MAKE YOUR OWN GENERAL COMMENTS)

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HYGIENE AND ENVIRONMENTAL SANITATION SURVEY FOR _____________ HOSPITAL/DISPENSARY INTERVIEWER: __________________________________________ QUESTIONAIRE NO.______________________________________
My name is ________________. I work for _______________. The Kumbo Rural Council is working on a new Programme, The Programme for Sustainable Water Supply and Sanitation Services supported by Helvetas Cameroon. For this year, six Rural Councils in the Northwest province are working on this programme. In order to better understand the existing situation in the field, We (I) are (am) commissioned us to carry out this survey so that it would facilitate the planning of the programme in the field of Hygiene and Sanitation in a better way. INTERVIEWEE ___________________________ POSITION___________________ I. GENERAL STATISTICS (COLLET INFORMATION FROM THE HOSPITAL OR DISPENSARY TO COMPLETE THE TABLE BELOW) Statistics of Patients who visit the hospital with various diseases. Year: __________

No. of patients/(month) Diarhe Dysentry Typhoid DISEASE Malaria a MONTHS Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. Annual % in relation to No. of patients Annual % in relation to Population - Number of toilets in the hospital _______________ - Average No. of attendants (ratio per toilet) _____________

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- Type of toilet (please describe it in relation to the material used for its construction)

- Location of the toilet (please describe it in terms of it's potential for environmental pollution, distance to the closest operational water point and type, the depth, and the level of stench around the toilet.

- Does the disposal of solid waste exist in an organised manner? - If No, describe otherwise how solid waste in the hospita is handled. - How often is it removed? - Does the Hospital have an incinerator? - If the hospital has no incinerator, describe otherwise how the hospital manages waste that is normally incinerated.

- What is the source of water in the hospital?

- Any other Comments?

(OBSERVE THE SITUATION AS IT IS AND MAKE YOUR OWN GENERAL COMMENTS)

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H. INSTITUTIONS COUNCIL - Does the Council have an instituition or individual in charge of hygiene and sanitation?_______________ - In the case of a committee, how many members are there in this committee?_________________________ - Who employed/appointed the member(s) or individual?_______________________ - What are their reponsibilities ( Please explain how this institution functions)

VILLAGE - Does the village have an instituition or individual in charge of hygiene and sanitation?_______________ - In the case of a committee, how many members are there in this committee?__________________ - How was this committee formed?_________________________________ - Are there any measures on defaulters in the village? - What are their reponsibilities ( Please explain how this institution functions)

- Any other comments

(OBSERVE THE SITUATION AS IT IS AND MAKE YOUR OWN GENERAL COMMENTS)

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J. CHECKLIST Environmental Checklist Part I: The village. (If the answer to any questions is NO, this indicates a possible health hazard.) PLEASE CHECK. 1. 2. Do people defecate so that their excreta is kept away from places where other people may walk, and If children leave faeces near their homes, are they immediately removed?

3. Do people defecate far away from the sources of drinking water? 4. Is the drinking water source different from the place where people and animals bathe, and women wash clothes? 5. Does the village have a protected water source, such as a protected spring, a well with a hand-pump, or a piped water supply? 6. 7. Do people use water from the protected source? Is there is a protected water source, is it conveniently placed for everybody?

If there are wells, are there enough of them? If there is a piped supply, are there enough taps? 8. Is the area around the wells or the public taps dry? 9. Do people try to ensure that stagnant water is drained away, so that the rain does not leave big puddles in the village? 10. Are there any compost pits or rubbish bins in the village?

Environmental Checklists Part II: The home and family. (PLEAS CHECK THE FOLLOWING) 1. 2. 3. If the household has a latrine, is it clean, and is there a cover or other means of keeping flies out? Is the house clean and free from flies? Does the family have clean drinking water?

4. Are there containers for storing water, and are there covered and clean? 5. Is there a bowl and soap for washing hands? 6. Do people regularly wash hands after defecation and before eating? 7. Are the preferred materials for anal cleaning (e.g. paper) always available? Or if water is used, is it available near the latrine or defecation site? 8. Is there provision for young children to defecate hygienically in or near the house (e.g. a pot)? 9. If the household has cattles or other animals, is the cow-shed clean? 10. Is there a compost pit or bin where animals droppings can be safely placed, and where childrens faeces can be put? 11. Does the housewife throw rubbish into a compost pit or bin? 12. Is it possible to prepare food in clean surroundings, and if there is a kitchen, is it convenient for the housewife?

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