if respondent is not head of household

81027-PVT Private Time (1 July, 2008) Page 1 of 63

Study ID

81027-PVT

(101-108)

Resp. No.

(109-112)

Interviewer No.

(116-119)

Interview Length

(120-121)

No. Of Queries

(122-123)

Reference No.

(124-127)

Nielsen Indonesia 15/F Mayapada Tower Jl. Jenderal Sudirman Kav. 28 Jakarta 12920 Indonesia Name of Respondent : ________________________ Address : __________________________________ __________________________________ __________________________________ Phone # : __________________________________ Interviewer's Name : _________________________ Date of Interview : ______ - __________ - ________ Start : ________ Finish : ________

SCREENING

IF RESPONDENT IS NOT HEAD OF HOUSEHOLD WHO ACTS AS A BREADWINNER THEN ASK POLITELY TO THE ELIGIBLE ONE

Q1 JOB S C R E E N I N G So we are sure that we are speaking to a broad cross section of the community, do you or any one in your family or any of your close friends work in any of the following industry sectors? [MA]

Code (128)

Route

Advertising Agency 1 CLOSE

Research Agency 2 CLOSE

Public Relations 3 CLOSE

Mass media 4 CLOSE

Manufacturer/distributor of toilets (WC) 5 CLOSE

Manufacturer/distributor of craft tools 6 CLOSE

Journalist 7 CLOSE

None of the above 8

Q2 ASK ALL Have you been interviewed like this in the past 6 months? [SA]

Code (129)

Route

Yes 1 CLOSE

No 2


Q3a SHOW CARD Which of the following monthly household expenditure groups do you belong to? (That is : total daily expenditure in a month on food, tuition, electricity, water, cigarettes, servants' salaries, gasoline, etc; excluding major purchases). [SA]

Q3b How much, approximately, is the monthly income of this household from all sources in the household? [SA]

Q3c And how much is approximately your monthly personal income ? [SA]

Q3a Q3b Q3c

Household Expenditure

Household Income

Personal Income

(130) (133) (136)

Less than Rp.50.000 01 01 01

Rp. 50.001 - 75.000 02 02 02

Rp. 75.001 - 100.000 03 03 03

Rp. 100.001 - 150.000 04 04 04

Rp. 150.001 - 200.000 05 05 05

Rp. 200.001 - 250.000 06 06 06

Rp. 250.001 - 300.000 07 07 07

Rp. 300.001 - 350.000 08 08 08

Rp. 350.001 - 400.000 09 09 09

Rp. 400.001 - 450.000 10 10 10

Rp. 450.001 - 500.000 11 11 11

Rp. 500.001 - 600.000 12 12 12

Rp. 600.001 - 700.000 13 13 13

Rp. 700.001 - 800.000 14 14 14

Rp. 800.001 - 900.000 15 15 15

Rp. 900.001 - 1.000.000 16 16 16

Rp. 1.000.001 - 1.250.000 17 17 17

Rp. 1.250.001 - 1.500.000 18 18 18

Rp. 1.500.001 - 1.750.000 19 19 19

Rp. 1.750.001 - 2.000.000 20 20 20

Rp. 2.000.001 - 2.250.000 21 21 21

Rp. 2.250.001 - 2.500.000 22 22 22

Rp. 2.500.001 - 3.500.000 23 23 23

Rp. 3.500.001 - 4.000.000 24 24 24

Rp. 4.000.001 - 5.000.000 25 25 25

Rp. 5.000.001 - 10.000.000 26 26 26

Above 10.000.000 27 27 27


Q4 TRANSFER FROM Q3 SEC classification [SA]

Code (139)

Route

A1 : More than Rp 3,500,000 1 CLOSE

A2 : Rp 2,500,001 - Rp 3,500,000 2 CLOSE

B : Rp 1,750,001 - Rp 2,500,000 3 CLOSE

C1 : Rp 1,250,001 - Rp 1,750,000 4

C2 : Rp 900,001 - Rp 1,250,000 5

D : Rp 600,001 - Rp 900,000 6

E : Less than Rp 600,000 7 CLOSE

DEMOGRAPHICS

Q5 Who is the main income earner in this household? [SA]

Code (140)

Route

Husband 01

Wife 02

Daughter 03

Brother 04

Grandfather 05

Grandmother 06

Others (specify _________________________ ) 07

None 98

Don't know 99

Q6 TANYAKAN KEPADA KEPALA RUMAH TANGGA YANG MENCARI NAFKAH May I know how old you are? RECORD: Date/Month/Year ____/____/____

(R1) Exact Age (150-151)

Q7 TRANSFER FROM Q6

Code (152)

Route

55 years old or above 01

50 - 54 years old 02









Q7 TRANSFER FROM Q6

Code (152)

Route


Q8 SHOW CARD Can you read, write, or both?[SA]

Code (153)

Route

Read fluently 1

Can read but having difficulty 2

Can not read 3

Q9a SHOWCARD What is the highest level of education you have completed ? [SA]

Q9b Among all member of this household, what is the highest education that have completed?[SA]

Q9a Q9b

Head of HH education

Highest education

among family member

(154) (155)

Doctoral (S3) 1 1

Post graduates (S2) 2 2

Bachelor (S1) 3 3

Academy/Diploma 4 4

Senior High 5 5

Junior High 6 6

Elementary 7 7

Elementary not finished 8 8

No formal education 9 9

Q10 ASK ALL What is your main occupation? [SA]

Code (156)

Route

Staff (administration, typist) 01

Skilled laborer (in the office) 02

Unskilled laborer (in the office) 03

Skilled laborer (in the factory/shop) 04

Unskilled laborer (in the factory/shop) 05

Farmer/fisherman 06

Student (college, high school) 07

Retiree 08

No job/looking for a job 09

Housewife 10


Q10 ASK ALL What is your main occupation? [SA]

Code (156)

Route

Refused to answer 11

Other specify _________ 12

_____________________ 13

_____________________ 14

Q11 Could you please tell me, how many hours you worked in the past 7 days. What we mean by working is that you received some form of payment for what you did. it can be salary or wages or you could have gained or exchanged from what you did (i.e.trading)

(R1) Total Hours (166-167)

Q12 How many people live in your house? (Including those staying at least 3 months in the past 12 months including children, adult relatives) INTERVIEWER: READ OUT EACH AGE INTERVALS & RECORD EXACT NUMBER OF PEOPLE

(R1) Number of people (168-170)

Q13a Please mention the number of male and female for each age group living in your household including you, other adults, children and infants but excluding helper or guests. INTERVIEWER: READ OUT EACH AGE INTERVALS & RECORD EXACT NUMBER OF PEOPLE a) MALE

Q13b b) FEMALE

Q13a Q13b

Male Female

(171-172) (240-241)

(R1) 0-4 _ _ _ _

(173-174) (242-243)

(R2) 5-9 _ _ _ _

(175-176) (244-245)

(R3) 10-14 _ _ _ _

(177-178) (246-247)

(R4) 15-19 _ _ _ _

(179-180) (248-249)

(R5) 20-24 _ _ _ _

(216-217) (250-251)

(R6) 25-29 _ _ _ _


Q13a Q13b

Male Female

(218-219) (252-253)

(R7) 30-34 _ _ _ _

(220-221) (254-255)

(R8) 35-39 _ _ _ _

(222-223) (256-257)

(R9) 40-44 _ _ _ _

(224-225) (258-259)

(R10) 45-49 _ _ _ _

(226-227) (260-261)

(R11) 50-54 _ _ _ _

(228-229) (262-263)

(R12) 55-59 _ _ _ _

(230-231) (264-265)

(R13) 60-64 _ _ _ _

(232-233) (266-267)

(R14) 65-69 _ _ _ _

(234-235) (268-269)

(R15) 70-74 _ _ _ _

(236-237) (270-271)

(R16) 75+ _ _ _ _

(238-239) (272-273)

(R17) Total _ _ _ _

Q14 May I know your religion?[SA]

Code (274)

Route

Moslem 1

Christian 2

Catholic 3

Buddha 4

Hindu 5

Other _____________ 6

HOUSING INFORMATION

Q15 ASK ALL Can you tell me the ownership status of the house you are living in right now?[SA]

Code (275)

Route

Rent 1

Owned, with my name on the land certificate 2

Owned, with my parents name on the land certificate 3


Q15 ASK ALL Can you tell me the ownership status of the house you are living in right now?[SA]

Code (275)

Route

Owned, with my family/ relative on the land certificate 4

Others, _____________________________ 5

Q16 ASK ALL What is the land size of the house you are living in at the moment?

(R1) Land size of house (m2) (276-279)

Q17 Does your house get some electricity supply?[SA]

Code (280)

Route

Yes 1 Q18

No 2 Q20

Q18 ASK Q18AND Q19IF CODE 1 IS CIRCLED IN Q17 SHOWCARD And from which source do you get electricity supply?[MA]

Code (316)

Route

PLN 1

Genset 2

Other household 3

Q19 SHOWCARD In past one month, which statement describe you the best about the electricity supply in your house?[SA]

Code (317)

Route

I always get electricity supply 01

I get electricity supply only in certain time 02

I can not predict when my house get electricity supply 03

Other _________________________ 04

Don't know 99

RESPONDENT CLASSIFICATION

Q20 ASK ALL Does this house own a toilet/ water closet? What we mean by toilet/ water closet is a place where you usually defecate. [SA]

Code (327)

Route

Yes 1 Q22

No 2 Q21


Q21 ASK IF RESPONDENT DON'T HAVE TOILET IN THEIR HOUSE (CODED 2 IN Q20 ) Where do you usually defecate? [SA]

Code (328)

Route

In the open 01 Q26

River 02 Q26

Wood 03 Q26

Bush 04 Q26

Other Open site (Please Mention 05

Public Place 41 Q26

Public Toilet 42 Q26

Toilet that belong to my neighbour/ 43 Q26

Q22 ASK IF RESPONDENT HAVE THEIR OWN TOILET/WC (CODED 1 IN Q20 ) You mentioned earlier that you have a toilet/ water closet. Does your toilet/ water closet have a septic-tank? What we mean by septic-tank is a proper facility to store feces. [SA]

Code (333)

Route

Yes 1 Q26

No 2 Q23

Q23 ASK IF CODED 2 IN Q22 Earlier you mentioned that the toilet/ water closet you own in your household do not have a septic-tank as a basin to store feces. If so, then where does the disposal channel lead to? [SA]

Code (334)

Route

to a digged hole 01 Q24

to the river 02 Q26

to the gutter 03 Q26

Others, _____________________ 04 Q26

Q24 ASK IF CODED 1 IN Q23 If you previously digged a hole, is the hole closed shut ? [SA]

Code (344)

Route

Yes 1 Q25

No 2 Q26

Q25 ASK IF THE HOLE CLOSED SHUT (CODE 1 IN Q24) What material do you use to shut the hole closed?[SA]

Code (345)

Route

Leaves (Unimproved) 1

Wood slab (Unimproved) 2

Bricks (Improved) 3

Rock Slab (Improved) 4

Cement Slab (Improved) 5


Q26 Classification using the Following procedure 1. If Q20 Code 2 and Q21 Code 1 - 40; Classified as Open Defecator (CODE 1) 2. If Q20 Code 2 and Q21 Code 41 etc Classified as Sharer (CODE 2) 3. If Q20 Code 1 and Q22 Code 1; Classified as Owner Improved (CODE 3) 4. IfQ20 Code 1 and Q22 Code 2; and Q23 code 1; and Q24 Code 1; and Q25 Code 3-5; Classified as Owner Improved (CODE 3) 5. If Q20 Code1 and Q22 Code 2; and Q23 code 2 and up; Classified as Owner Unimproved (CODE 4) 6. IfQ20 Code1 and Q22 Code 2; and Q23 Code 1; and Q24 Code 2; and Q25 Code 1-2; Classified as Owner Unimproved (CODE 4) [SA]

Code (346)

Route

Open Defecator 1

Sharer 2

Owner Improved 3

Owner Unimproved 4

Q27a ASK ALL I have a list of activities that someone might buy/ do whenever they have extra money. Should you have extra money, what will you do first? [SA]

Q27b And what next? what next?[MA]

Q27a Q27b

First Do Other Priorities

(347) (349)

Pay debt 01 01

Buy the necessity for my children 02 02

Buy the household appliances 03 03

Buy a Color TV 04 04

Buy a VCD/DVD player 05 05

Buy a Motorcycle 06 06

Buy a Computer 07 07

Buy a Mobile phone 08 08

Buy a Fixed-line telephone 09 09

Buy a Radio cassette 10 10

Renovate the House 11 11

Other Needs 12 12

Build/ Renovate the Toilet/ Water Closet 13 13

Q28 ASK ALL Had you or your family for any reasons, defecate and store the stools in a container before throw it away? [SA]

Code (351)

Route

Yes 1 Q29

No 2 Q32


Q29 ASK IF RESPONDENT EVER DEFECATE USING FLYING TOILET (CODE 1 IN Q28) When did the last time you/your family member do that? [SA]

Code (352)

Route

Today 1

Yesterday 2

Within this week 3

Within this month 4

A few months ago 5

Forgot 6

Q30 ASK IF RESPONDENT EVER DEFECATE USING FLYING TOILET (CODE 1 IN Q28) Why did you/ your family do that? [MA]

Code (353)

Route

It was in the middle of the night 01

I/ We were in the middle of a trip 02

It was rainy 03

Diarrhea 04

Afraid of the dark 05

Other (Specify ___________________________ ) 06

_____________________________ 07

_____________________________ 08

_____________________________ 09


Q31a Who did it in the past 1 month?[MA]

Q31b And who did it latest?[SA]

Q31a Q31b

Head of

Household

Husband/

Wife

Child Parents

Other Head of

Household

Husband/

Wife

Child Parents

Others

(363) (532)

(R1) Adult Woman 1 2 3 4 5 1 2 3 4 5

(364) (533)

(R2) School Aged Female 1 2 3 4 5 1 2 3 4 5

(365) (534)

(R3) Adult Man 1 2 3 4 5 1 2 3 4 5

(366) (535)

(R4) School Aged Male 1 2 3 4 5 1 2 3 4 5

(367) (536)

(R5) Pre School Child 1 2 3 4 5 1 2 3 4 5

(368) (537)

(R6)

Other ________________________

__

1 2 3 4 5 1 2 3 4 5

(369) (538)

(R7) 1 2 3 4 5 1 2 3 4 5

Q32 ASK ALL Speaking about your habit in defecate, where was the last time you defecate?[SA]

Code (666)

Route

At toilet/ water closet in my house 01

At toilet/ water closet in my neighbour 02

At public toilet/ water closet 03

In the river 04

In the bushes 05

In the woods 06

Other (Specify __________________________ ) 07

Tidak ada 98

Tidak tahu 99


SECTION 1 ASK THIS SECTION TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26 )

Q33 SHOWCARD How satisfied are you with your current habit in defecate? [SA]

Code (676)

Route

Very dissatisfied 1

Dissatisfied 2

Neither satisfied nor dissatisfied 3

Satisfied 4

Very satisfied 5

Q34 Do you share your toilet/ water closet (where you usually defecate) with your neighbor or other families?[SA]

Code (677)

Route

Yes 1 Q35

No 2 Q36

Q35 ASK IF CODED 1 IN Q34 Earlier you mentioned that you share toilet/ water closet with your neighbor or other families. According to you, how many families do you share that toilet/ water closet with?

(R1) Number of Family (678-679)

Q36 Within the past 1 year, Had you defecate in the open, such as in the river or woods? [SA]

Code (680)

Route

Yes 1 Q37

No 2 Q43

Q37 ASK IF EVER DEFECATE IN THE OPEN (CODED 1 IN Q36) Do you regularly defecate in the open?[SA]

Code (716)

Route

Yes 1 Q38

No 2 Q39

Q38 ASK IF DEFECATE REGULARLY IN THE OPEN (CODED 1 IN Q37) Why do you still defecate in the open regularly?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(717-766)


Q39 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 ) Where in the open do you usually defecate?[SA]

Code (767)

Route

In the river 01

In the woods 02

In the bushes 03

Others, ________________________ 04

Q40 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36) Where was the last time you defecate in the open?[SA]

Code (777)

Route

In the river 01

In the woods 02

In the bushes 03

Other (Specify ______________________________ ) 04

Q41 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 ) Earlier you mentioned that you have defecated in the open, when was the last time you defecated in the open?[SA]

Code (822)

Route

Today 1

Yesterday 2

Within this week 3

Within this month 4

A few months ago 5

Forgot 6

Q42 ASK IF RESPONDENT HAD DEFECATE IN THE OPEN (CODED 1 IN Q36 ) Can you tell me your reasons for defecating in open air?[MA] PROBE What other reason? What other reason?

Code (823)

Route

There's no toilet in the place where I work 01

Can not hold any longer 02

As a social time 03

My own toilet is dirty 04

Others ___________________________________________ 05


Q43 TANYAKAN SEMUA Earlier you mentioned that you have your own toilet/ water closet in the house. When did you build it?[SA]

Code (833)

Route

1 month ago 01 Q44

2-3 months ago 02 Q44



The toilet/ water closet is already in the house when we moved in 05 Q50

Others, ______________________________ 06

Q44a ASK THE FOLLOWING QUESTIONS AMONG THOSE WHO JUST RECENTLY BUILT THEIR TOILET (CODE 1-4 AT Q43 ) Can you tell me your main reason for building a toilet/ water closet for your house? [SA]

Q44b What other reason? What other reason?[MA]

Q44a Q44b

Main Reason Other Reasons

(843) (853)

Privacy 01 01

Avoid sharing with others 02 02

Avoid disturbing neighbours 03 03

Avoid embarrasment/ humiliation 04 04

Higher pride and status for my family 05 05

Accepted as part of the community in my area 06 06

My family is thought to have more cultural values 07 07

Personal discretion 08 08

Safety 09 09

Satisfaction 10 10

Can become a good host when guests visit 11 11

Convenience 12 12

Easy to defecate more cleanly 13 13

Cleaner and healthier living 14 14

Avoid contaminating the environment 15 15

For good health/ Avoid disease 16 16

Other (Specify ________________________ ) 17 17

________________________ 18 18

________________________ 19 19

________________________ 20 20

None 98 98

Don't Know 99 99


Q45 How much does the construction cost you?

(R1) Cost (Record in Thousands) (863-866)

Q46 Where did you know about different options for the toilet, such as the features, the types and other information before you make your toilet?[MA]

Code (867)

Route

Neighbourhood 01

Friends 02

Mason/ Building coolie 03

Building supplier 04

Government 05

Environmental Health Officer 06

Mass Media : TV 07

Radio 08

Newspaper 09

Other (Mention ____________________________ ) 10

Q47 Where did you know about different options for the toilet, such as the features, the types and other information before you make your toilet?[MA]

Code (877)

Route

Neighbourhood 01

Friends 02

Mason/ Building coolie 03

Building supplier 04

Government 05

Environmental Health Officer 06

Mass Media : TV 07

Radio 08

Newspaper 09

Other (Mention ____________________________ ) 10

Q48 How easy or difficult was it to make a new latrine? [SA]

Code (922)

Route

Very easy 1

Easy 2

Neutral 3

Difficult 4

Very difficult 5


Q49 You said earlier that it is ____________________ [INTERVIEWER: MENTION THE ANSWER FROM Q48 ] to build a latrine for your household. Why did you say it?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(923-972)

Q50 ASK TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26) Had you renovate/ add something to your existing toilet/ build new facility? [SA]

Code (973)

Route

Yes 1 Q51

No 2 Q53

Q51a ASK IF RESPONDENTS HAD RENOVATE/ BUILD NEW FACILITY FOR THEIR TOILET (CODE 1 IN Q50) What did you do to your toilet/ water closet? [MA]

Q51b ASK Q51b IF RESPONDENTS ANSWERS ARE MORE THAN 1 ANSWER And which one is the latest?[SA]

Q51a Q51b

Things that have been

done

The latest thing that has

been done

(974) (1019)

Install a new closet 01 01

Install the new tile for the toilet 02 02

Put the roof for the toilet 03 03

Build a new wall for the toilet 04 04

Paint the wall 05 05

Install a lockable door 06 06

Build a new "stool" storage 07 07

Shut the hole and dig a new one 08 08

Others (Specify ____________________ ) 09 09

____________________ 10 10

____________________ 11 11

____________________ 12 12


Q52 ASK TO THOSE WHO HAD RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q50) Why do you _______________________ (Interviewer: Respondent answer in Q51) ?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(1029-1078)

Q53 ASK TO THOSE WHO OWN IMPROVED/UNIMPROVED SANITATION (CODE 3-4 AT Q26) Do you plan to renovate/build new facilities to your toilet/ water closet?[SA]

Code (1079)

Route

Yes 1 Q54

No 2 Q58

Q54 ASK IF RESPONDENTS PLAN TO RENOVATE/ BUILD NEW FACILITY FOR THEIR TOILET (CODE 1 IN Q53) What will you do to your toilet/ water closet? [MA]

Code (1080)

Route

Install a new closet 01

Install the new tile for the toilet 02

Put the roof for the toilet 03

Build a new wall for the toilet 04

Paint the wall 05

Install a lockable door 06

Build a new "stool" storage 07

Shut the hole and dig a new one 08

Others (Specify ____________________ ) 09

____________________ 10

____________________ 11

____________________ 12


Q55 ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q53) Why do you want to _______________________ (Interviewer: Respondent answer in Q54) ?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(1125-1174)

Q56 ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q53) How much money would you be willing to spare if you intend to do the renovation? (Interviewer: record in thousands)

(R1) Actual budget (1175-1178)

Q57 ASK TO THOSE WHO PLAN TO RENOVATE/ ADD NEW FACILITIES (OR OTHER) IN THEIR TOILET (CODE 1 IN Q53) Earlier you had a plan to renovate for your toilet/ water closet? Approximately when do you think that plan can be realized? [SA]

Code (1179)

Route

In 1 month ahead 1

In 2-3 months ahead 2



In more than 1 year ahead 5

Could not say the exact time 6

Q58 Earlier you mentioned that you own a toilet/ water closet in your household. How often do you or your family members clean the toilet/ water closet?[SA]

Code (1180)

Route

Every time after using it 1

Everyday 2

4-5 times a week 3

2-3 times a week 4

Once a week 5

2-3 times in a month 6

Once a month 7

Rarely, only on certain occasions 8


Q59 ASK TO THOSE WHO HAVE SEPTIC TANK FOR THEIR TOILET (CODE 3 IN Q26) Have you ever emptying your septic tank/ feces storage?[SA]

Code (1216)

Route

Yes 1 Q60

No 2 Q61

Q60 ASK TO THOSE WHO HAVE EVER EMPTYING THEIR SEPTIC TANK (CODE 1 IN Q59) When was the last time you emptied your septic tank/ feces storage?[SA]

Code (1217)

Route

Within this week 1

Witihin this month 2

A month ago 3

2 months ago 4

3 months ago 5

6 months ago 6

1 year ago 7

More than 1 year ago 8

Q61 What is your opinion on people who still defecate in open air?[MA]

Code (1218)

Route

They are dirty 01

They are poor 02

They are Causing Disturbance - sometimes they use our latrine 03

They are uneducated 04

They are people that we should avoided 05

They are people that have a lower status than us 06

They are people that we feel sorry for 07

They are people that should be understand 08

They are like us 09

They do it because they accustomized to it 10

Nothing wrong with them 11

Other (Specify _____________________ ) 12

_________________________ 13

_________________________ 14

_________________________ 15

None 98

Don't Know 99


SECTION 2 ASK THESE QUESTIONS TO THE SHARER (CODED 2 IN Q26)


Code (1228)

Route

Very dissatisfied 1

Dissatisfied 2


Satisfied 4

Very satisfied 5

Q63 Earlier you mentioned that you/ your family member use the public toilet for defecate. May I know how many family who use that public toilet?

(R1) Number of Family (1229-1231)

Q64 In the last 1 year, had you defecate in the open, such as in the river or woods? [SA]

Code (1232)

Route

Yes 1 Q65

No 2 Q69

Q65 ASK TO RESPONDENTS WHO EVER DEFECATE IN OPEN (CODED 1 IN Q64) Where in the open do you usually defecate?[SA]

Code (1233)

Route

In the river 01

In the woods 02

In the bushes 03

Others, ________________________ 04

Q66 ASK TO RESPONDENTS WHO EVER DEFECATE IN OPEN (CODED 1 IN Q64) Where was the last time you defecate in the open?[SA]

Code (1243)

Route

In the river 01

In the woods 02

In the bushes 03

Others, ________________________ 04


Q67 ASK TO RESPONDENT WHO EVER DEFECATE IN OPEN (CODE 1 IN Q64) Earlier you mentioned that you have defecated in the open, when was the last time you defecated in the open?[SA]

Code (1253)

Route

Today 1

Yesterday 2

Within this week 3

Within this month 4

A few months ago 5

Forgot 6

Q68 Can you tell me your reasons for defecating in open air?[MA] PROBE What other reason? What other reason?

Code (1254)

Route

There's no toilet in the place where I work 01

Can not hold any longer 02

As a social time 03

Others, ___________________________________________ 04

Q69 What is your opinion on people who still defecate in open air?[MA]

Code (1264)

Route

They are dirty 01

They are poor 02

They are Causing Disturbance - sometimes they use our latrine 03

They are uneducated 04

They are people that we should avoided 05

They are people that have a lower status than us 06

They are people that we feel sorry for 07

They are people that should be understand 08

They are like us 09

They do it because they accustomed to it 10

Nothing wrong with them 11

Other (Specify _____________________ ) 12

__________________________________ 13

__________________________________ 14

__________________________________ 15

None 98

Don't Know 99


Q70 SHOWCARD What is your opinion on people who have their own toilet? [MA]

Code (1274)

Route

They are clean 01

They are reach 02

They think we are causing disturbance (We sometimes/ always use their latrine) 03

They are educated 04

They would shun us 05

They would look down on us 06

They would feel sorry for us 07

Others (Specify ____________________ ) 08

None 98

Don't know 99

Q71 Speaking of toilet/ water closet ownership in your household, can you tell me your reasons for not having your own toilet? [MA]

Code (1319)

Route

Tenant 01

No space 02

Don't have money 03

Can use neighbours 04

Others (Specify __________________________ ) 05

__________________________ 06

__________________________ 07

__________________________ 08

None 98

Don't Know 99

Q72 Does your house have an adequate land size to build a toilet/ water closet?[SA]

Code (1329)

Route

Yes 1

No 2

Q73 Do you wish to own a place to defecate/ toilet/ water closet/ for your household? [SA]

Code (1330)

Route

Yes 1 Q74

No 2 Q81


Q74a ASK Q74- Q79 IF RESPONDENT WISH TO OWN THEIR OWN TOILET (CODED 1 IN Q73 ) Earlier you mentioned that you intend to own a place to defecate/ toilet/ water closet for your household. Can you tell me your main reason? [SA]


Q74a Q74b


(1331) (1341)

Privacy 01 01








Safety 09 09

Satisfaction 10 10


Convenience 12 12





Other (Specify ________________________ ) 17 17

___________________ 18 18

________________ 19 19

________________ 20 20

None 98 98

Don't know 99 99

Q75 SHOWCARD What kind of latrine do you want to build? [SA]

Code (1351)

Route

Type 1 1

Type 2 2

Type 3 3

Type 4 4

Type 5 5

Type 6 6



Code (1351)

Route

Not yet decided 7

Q76 SHOWCARD What kind of feces disposal that you wish to build? [SA]

Code (1352)

Route

Type 1 1

Type 2 2

Type 3 3

Type 4 4

Type 5 5

Not yet decided 6

Q77 How much money would you be willing to spare if you intend to build a toilet/ water closet for your household?

(R1) Actual Budget (1353-1356)

Q78 Earlier you had a plan to build a toilet/ water closet. Approximately when do you think that plan can be realized?[SA]

Code (1357)

Route

In 1 month ahead 1






Q79 Will you borrow money to build this toilet/ water closet for your household?[SA]

Code (1358)

Route

Yes 1 Q80

No 2 Q81

Q80 ASK IF CODED 1 IN Q79 Earlier you mentioned that you will borrow money to build your toilet/ water closet, who will you borrow the money from?[MA]

Code (1359)

Route

Neighbor 01

Relative 02

Bank 03

Cooperation 04

Others ______________________ 05

________________________ 06


Q81 ASK ALL Are you aware that there is a SAVING SYSTEM to provide financial assistance to build a toilet/ water closet? [SA]

Code (1369)

Route

Yes 1 Q82

No 2 Q83

Q82 ASK FOR THOSE WHO KNOW ABOUT THE SAVING SYSTEM (CODE 1 IN Q81) Does the SAVING SYSTEM to provide financial assistance to build a toilet/ water closet exist in your neighbourhood?[SA]

Code (1370)

Route

Yes 1 Q83

No 2 Q83

Q83 ASK ALL Would you be interested in using this SAVING SYSTEM that provide financial assistance to build a toilet/ water closet? [SA]

Code (1371)

Route

Yes 1 Q84

No 2 Q84

Q84 ASK FOR THOSE INTERESTED AND NOT INTERESTED Earlier you mentioned that you are interested/ not interested (INTERVIEWER: REFER TO RESPONDENT ANSWER IN Q83) in using this SAVING SYSTEM, can you tell me your reasons?

(R1) Reason of interest

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(1372-1456)

(R2) Reason of not interested

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(1457-1541)


Q85a ASK ALL Does your local government provide subsidies for building materials to build a toilet/ water closet for the people in your area? [SA]

Q85b Does your local government care about sanitation and environmental health problems in your area? [SA]

Q85a Q85b

Subsidies Care

(1542) (1543)

(R1) Yes 1 1

(R2) No 2 2

(R3) Don't Know 3 3

Q86 What might prevent you from building a toilet/ water closet in your house? [MA]

Code (1544)

Route

Cost of the Latrine 01

Hard to Find a Mason 02

Hard to Find the Materials 03

Water Table/Soil Conditions 04

Don't Have the Money 05

Nothing 06

Don't Know 07

Other ( Specify _____________________ ) 08

______________________________ 09

______________________________ 10

______________________________ 11

Q87 ASK THIS QUESTION IF RESPONDENTS DO NOT WISH TO OWN THEIR OWN TOILET (Q73 CODE 2) Earlier you mentioned that you do not intend to own a toilet/ water closet for your household, can you tell me the reason?[MA]

Code (1554)

Route

Tenant 01

No Space 02

Don't have money 03

Can use Neighbours 04

Others (Specify ___________________ ) 05


SECTION 3 ASK THIS SECTION TO THE OPEN DEFECATOR (CODED 1 IN Q26)

Q88a What is your main reason why do you still defecate in the open?[SA]

Q88b What are the other reasons why do you still defecate in the open?[MA]

Q88a Q88b


(1564) (1574)

As a socialization time 01 01

Have become accustomed to defecate in the open 02 02

Never thought before to defecate in toilet/ water closet 03 03

I have no toilet/ water closet in my house 04 04

More practical 05 05

Still can use my neighbour's toilet 06 06

Other (Specify __________________ ) 07 07

_______________________________ 08 08

_______________________________ 09 09

_______________________________ 10 10


Code (1619)

Route

Very dissatisfied 1

Dissatisfied 2


Satisfied 4

Very satisfied 5


Q90 SHOWCARD What is your opinion on people who have their own toilet?[MA]

Code (1620)

Route

They are clean 01

They are reach 02

They think we are causing disturbance (We sometimes/ always use their latrine) 03

They are educated 04

They would shun us 05

They would look down on us 06

They would feel sorry for us 07

Others (Specify ____________________ ) 08

________________________ 09

________________________ 10

________________________ 11

None 98

Don't Know 99

Q91 Have you tried to use a toilet before? [SA]

Code (1630)

Route

Yes 1 Q92

No 2 Q95

Q92 ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91) When was the last time you used toilet? [SA]

Code (1631)

Route

Today 1

Within this week 2

Within this month 3

2-3 months ago 4

3-4 months ago 5

4-6 months ago 6

6 months ago or more 7

Forgot 8


Q93 ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91) Where the last time do you use the toilet? [MA]

Code (1632)

Route

One of my neighbour 01

Public toilet 02

Toilet in my working place 03

Other (Specify _____________________ ) 04

_______________________ 05

_______________________ 06

_______________________ 07

Q94 ASK IF RESPONDENT HAD TRIED TO USE TOILET BEFORE (CODE 1 IN Q91) SHOWCARD In the last time you used a toilet, what kind of toilet do you use? [MA]

Code (1642)

Route

Type 1 1

Type 2 2

Type 3 3

Type 4 4

Type 5 5

Type 6 6

Q95 TANYAKAN SEMUA Speaking of toilet/ water closet ownership in your household, can you tell me your reasons for not having your own toilet?[MA]

Code (1643)

Route

Tenant 01

No space 02

Do not have enough money 03

Can use neighbours 04

Others (Specify _________________________ ) 05

_____________________________ 06

_____________________________ 07

_____________________________ 08

None 98

Don't Know 99

Q96 ASK ALL Does your house have an adequate land size to build a toilet/ water closet?[SA]

Code (1653)

Route

Yes 1

No 2


Q97 Do you wish to own a toilet/ water closet for your household? [SA]

Code (1654)

Route

Yes 1 Q98

No 2 Q105

Q98a ASK Q98 - Q103 IF RESPONDENT WISH TO OWN THEIR OWN TOILET (CODED 1 IN Q97 ) Earlier you mentioned that you intend to own a toilet/ water closet for your household. Can you tell me your main reason? [SA]


Q98a Q98b


(1655) (1665)

Privacy 01 01








Safety 09 09

Satisfaction 10 10


Convenience 12 12





Other (Specify ________________________ ) 17 17

________________________ 18 18

________________________ 19 19

________________________ 20 20

None 98 98

Don't Know 99 99



Code (1675)

Route

Type 1 1

Type 2 2

Type 3 3

Type 4 4

Type 5 5

Type 6 6

Not yet decided 7

Q100 SHOWCARD What kind of feces disposal that you wish to build? [SA]

Code (1676)

Route

Type 1 1

Type 2 2

Type 3 3

Type 4 4

Type 5 5

Not yet decided 6

Q101 How much money would you be willing to spare if you intend to build a toilet/ water closet for your household? (Interviewer: record in thousands)

(R1) Actual budget (1677-1680)

Q102 Earlier you had a plan to build a toilet/ water closet. Approximately when do you think that plan can be realized?[SA]

Code (1716)

Route

In 1 month ahead 1






Q103 Will you borrow money to build this toilet/ water closet for your household?[SA]

Code (1717)

Route

Yes 1 Q104

No 2 Q105


Q104 ASK IF CODED 1 IN Q103 Earlier you mentioned that you will borrow money to build your toilet/ water closet, who will you borrow the money from?[MA]

Code (1718)

Route

Neighbor 01

Relative 02

Bank 03

Cooperation 04

Others ______________________ 05

_____________________ 06

. 07

. 08

. 09

. 10

Q105 ASK ALL Are you aware that there is a SAVING SYSTEM to provide financial assistance to build a toilet/ water closet? [SA]

Code (1728)

Route

Yes 1 Q106

No 2 Q107

Q106 ASK FOR THOSE WHO KNOW ABOUT THE SAVING SYSTEM (CODE 1 IN Q105) Does the SAVING SYSTEM to provide financial assistance to build a toilet/ water closet exist in your neighbourhood?[SA]

Code (1729)

Route

Yes 1 Q107

No 2 Q107

Q107 ASK ALL Would you be interested in using this SAVING SYSTEM that provide financial assistance to build a toilet/ water closet? [SA]

Code (1730)

Route

Yes 1 Q108

No 2 Q108


Q108 ASK FOR THOSE INTERESTED AND NOT INTERESTED Earlier you mentioned that you are interested/ not interested (INTERVIEWER: REFER TO RESPONDENT ANSWER IN Q107) in using this SAVING SYSTEM, can you tell me your reasons?

(R1) Reason of interest

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(1731-1780)

(R2) Reason of not interested

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(1816-1865)

Q109a ASK ALL Does your local government provide subsidies for building materials to build a toilet/ water closet for the people in your area? [SA]

Q109b Does your local government care about sanitation and environmental health problems in your area? [SA]

Q109a Q109b

Subsidies Care

(1866) (1867)

(R1) Yes 1 1

(R2) No 2 2

(R3) Don't Know 3 3


Q110 What might prevent you from building a toilet/ water closet in your house? [MA]

Code (1868)

Route

Cost of the Latrine 01

Hard to Find a Mason 02

Hard to Find the Materials 03

Water Table/Soil Conditions 04

No Access to Credit 05

Don't Have the Money 06

Nothing 07

Don't Know 08

Other ( Specify _____________________ ) 09

____________________________ 10

____________________________ 11

____________________________ 12

None 98

Don't Know 99

Q111 ASK THIS QUESTION IF RESPONDENTS DO NOT WISH TO OWN THEIR OWN TOILET ( Q97CODE 2) Earlier you mentioned that you do not intend to own a toilet/ water closet for your household, can you tell me the reason?[SA]

Code (1878)

Route

Tenant 01

No Space 02

Don't have enough money 03

Can Use Neighbours 04

Others (Specify ____________________ ) 05

________________________ 06

________________________ 07

________________________ 08

________________________ 09

None 98

Don't Know 99


SECTION 4 HABIT, KNOWLEDGE, AND ATTITUDE DAILY HABITS

Q112 ASK ALL On what occasions do you usually wash your hands?[MA] PROBE What other occasions? What other occasions?

Code (1923)

Route

After I urinate 01

After I defecate 02

Before eating 03

After eating 04

Before cooking 05

Others, _______________________________ 06

_____________________________ 07

Never 99

Q113a ASK IF NOT CODED 99 IN Q112 RECORD FIRST MENTION AND OTHER MENTIONS SEPARATELY Why do you wash your hands after these activities? INTERVIEWER: Write down separately between the first answer and other answer [SA]

Q113b What other reason? What other reason? [MA]

Q113a Q113b

1st Mention Other Mention

(1933) (1943)

Want to get rid of the smell 01 01

Want to be cleaned from dirt 02 02

Want to get rid of germs/ bacteria 03 03

To be protected from disease 04 04

Others, ______________________________ 05 05

________________________________ 06 06

________________________________ 07 07


Q114 Do you usually use other substances when washing your hands? If yes, what is the name of the substance you use?[SA]

Code (1953)

Route

Special soap to wash hand 01

Bath soap 02

"Sabun Colek"/ Cream soap 03

Others, _____________________________ 04

None 98

Don't Know 99

Q115 Where do you usually wash your hands?[SA]

Code (1963)

Route

Lavatory 01

Kitchen 02

Premises 03

Other _________________ 04

______________________ 05

______________________ 06

______________________ 07

. 08

. 09

. 10

Q116 Where else do you usually wash your hands?[MA] PROBE where else? where else?

Code (1973)

Route

Lavatory 01

Kitchen 02

Premises 03

Other __________________ 04

_______________________ 05

_______________________ 06

_______________________ 07

. 08

. 09

. 10

Q117 In those places that you usually wash your hands, do soap always available?[SA]

Code (2018)

Route

Yes 1

No 2


Q118 How do you clean yourself after you defecate? [MA]

Code (2019)

Route

Wipe with leaves 01

Wipe with paper 02

Wipe with fiber 03

Rinse with water that is in a container 04

Rinse with water that flows 05

Rinse with soap and water 06

Others, _________________________ 07

________________________________ 08

. 09

. 10

SOURCE OF WATER

Q119a ASK ALL What is the source of water that your household use for cooking and for drinking water during the rainy season? [MA]

Q119b What is the source of water that your household use for cooking and for drinking water during the dry season? [MA]

Q119a Q119b

Rainy season Dry season

(2029) (2039)

River 01 01

Well 02 02

Water pump 03 03

Dew 04 04

PAM, the municipal water supplier 05 05

Others, _____________________ 06 06

. 07 07

. 08 08

. 09 09

. 10 10

Q120 Does your source of water for cooking and drinking located around your house? [SA]

Code (2049)

Route

Yes 1 Q125

No 2 Q121

ASK Q121 - Q124 IF RESPONDENTS' SOURCE OF WATER FOR DRINKING AND COOKING IS NOT IN THEIR HOUSE/ PREMISES (CODED 1 IN Q120)


Q121 How long does it take from your house to reach the water supply, take the water and then go back to your house?

(R1) Distance (in Minute) (2050-2052)

Q122 And who usually get the water from the water supply for your household need?[SA]

Head of Household

Spouse Children Parents Other

(2053)

(R1) Adult Woman 1 2 3 4 5

(2054)

(R2) School Aged Female 1 2 3 4 5

(2055)

(R3) Adult Man 1 2 3 4 5

(2056)

(R4) School Aged Male 1 2 3 4 5

(2057)

(R5) Pre School Child 1 2 3 4 5

(2058)

(R6) Other __________________________ 1 2 3 4 5

(2059)

(R7) 1 2 3 4 5

(2060)

(R8) 1 2 3 4 5

(2061)

(R9) 1 2 3 4 5

(2062)

(R10) 1 2 3 4 5

Q123 In what type of container is the water carried from your main source?[MA]

Code (2222)

Route

Gallon 01

Bucket 02

Drum 03

Other ______________________ 04

___________________________ 05

_________________________________ 06

_________________________________ 07

_________________________________ 08

_________________________________ 09

_________________________________ 10


Q124 How many times in a week do you go to get the water for cooking and drinking from the water source?

(R1) Times in week (2232-2234)

Q125 ASK ALL Do you have any difficulties to obtain clean water during the dry season?[SA]

Code (2235)

Route

Yes 1 Q126

No 2 Q127

Q126 ASK IF CODED 1 IN Q125 Earlier you mentioned that have difficulties in obtaining clean water during the dry season. What actions do you undertake to overcome the water crisis during dry season?[MA]

Code (2236)

Route

Store water in a container during rainy season 01

Obtain water from dew 02

Use water from the river 03

Others, _____________________________ 04

____________________________________ 05

____________________________________ 06

None 98

Don't know 99

Q127 ASK ALL Does your water supply that your household use for bathing and washing is the same from your water supply for cooking and drinking? [SA]

Code (2246)

Route

Yes 1 Q134

No 2 Q128


Q128a ASK IF CODED 2 IN Q127 What is the source of water that your household use for bathing and washing during the rainy season? [MA]

Q128b What is the source of water that your household use for bathing and washing during the dry season? [MA]

Q128a Q128b

Rainy season Dry season

(2247) (2257)

River 01 01

Well 02 02

Water pump 03 03

Dew 04 04

PAM, the municipal water supplier 05 05

Others, _________________________ 06 06

07 07

08 08

09 09

10 10

Q129 ASK IF CODED 2 IN Q127 Does your source of water that your household use for bathing and washing is in your house/ premise? [SA]

Code (2267)

Route

Yes 1 Q134

No 2 Q130

ASK Q130 - Q133 IF SOURCE OF WATER FOR BATHING AND WASHING IS NOT IN THEIR HOUSE/ PREMISE (CODED 2 IN Q129 )

Q130 How long does it take from your house to reach the water supply, take the water and then go back to your house?

(R1) Distance (in Minute) (2268-2270)


Q131 And who usually get the water from the water supply for your household need?[SA]

Head of

Household

Spouse Children Parents Other

(2271)

(R1) Adult Woman 1 2 3 4 5

(2272)

(R2) School Aged Female 1 2 3 4 5

(2273)

(R3) Adult Man 1 2 3 4 5

(2274)

(R4) School Aged Male 1 2 3 4 5

(2275)

(R5) Pre School Child 1 2 3 4 5

(2276)

(R6) Other __________________________ 1 2 3 4 5

(2277)

(R7) 1 2 3 4 5

(2278)

(R8) 1 2 3 4 5

(2279)

(R9) 1 2 3 4 5

(2280)

(R10) 1 2 3 4 5

Q132 In what type of container is the water carried from your main source?[MA]

Code (2440)

Route

Gallon 01

Bucket 02

Drum 03

Other ______________________ 04

05

06

07

08

09

10

Q133 How many times in a week do you go to get the water for bathing and washing from the water source?

(R1) Times in a week (2450-2452)


Q134 ASK ALL Do you have any difficulties to obtain clean water for bathing and washing during the dry season? [SA]

Code (2453)

Route

Yes 1 Q135

No 2 Q137

Q135 ASK IF CODED 1 IN Q134 Earlier you mentioned that have difficulties in obtaining clean water during the dry season. What actions do you undertake to overcome the water crisis during dry season?[MA]

Code (2454)

Route

Store water in a container during rainy season 01

Obtain water from dew 02

Use water from the river 03

Others, _____________________________ 04

____________________________________ 05

____________________________________ 06

____________________________________ 07

____________________________________ 08

____________________________________ 09

____________________________________ 10

Q136 ASK IF CODED 1 IN Q134 When you experience water crisis during the dry season, does it affect any of your routine activities? If yes, can you tell me what activities are affected by the water crisis? [MA]

Code (2464)

Route

Take a bath less frequently 01

Do not take a bath during the water crisis 02

Defecate in the river or the woods 03

Wash clothes in the river 04

Do not wash clothes 05

Others, ________________________ 06

____________________________________ 07

____________________________________ 08

None 98

Don't Know 99

Q137 ASK ALL Does your area have a water source that is enough to supply water for your toilet/ water closet? [SA]

Code (2474)

Route

Yes 1

No 2


KNOWLEDGE ON HEALTH

Q138 ASK ALL Do you have a child below 5 year old in your household?[SA]

Code (2475)

Route

Yes 1 Q139

No 2 Q141

Q139 ASK IF HAVE CHILD UNDER 5 YEARS OLD The last time your youngest child defecate, how did you dispose your child's feces? [SA]

Code (2476)

Route

My child defecated in the toilet/ water closet 01

Dispose my child's feces in the toilet/ water closet 02

Dispose it into the gutter 03

Dispose it into the wastebasket 04

Bury it under ground 05

Dispose it outside the house 06

Others, _____________________________ 07

98

99

Q140 ASK IF HAVE CHILD UNDER 5 YEARS OLD Why do you do that, can you explain it to me? ( ___________________ INTERVIEWER: MENTION THE ANSWER FROM Q139 ) PROBE What other reason? What other reason?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(2521-2570)

Q141a Does your under 5 y.o child got diarrhea within past 2 weeks? [SA]

Q141b Does any child within your neighbourhood got diarrhea?[SA]

Q141a Q141b

Own children (in the last 2

weeks)

Neighbourhood children

(2571) (2572)

Yes 1 1

No 2 2

DK 3 3


Q142 ASK ALL According to you, what causes diarrhea? Please explain.

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(2573-2657)

Q143 In your opinion, how could you / someone prevented from diarrhea?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(2658-2742)

Q144 ASK ALL INTERVIEWERS: ASK THIS QUESTION CAREFULLY REFER TO RESPONDENT CATEGORY (CHECK Q26 ) (Ask if coded 1 in Q26) You mention earlier that you defecated in the open, do you think the feces might have impact to people around you? (Ask if coded 4 in Q26) You mention earlier that although you have toilet but the feces will go to the open, do you think the feces might have impact to people around you? (Ask if coded 2/3 in Q26) Some people still dispose in open, do you think the feces might have impact to people around you? [SA]

Code (2743)

Route

Yes 1 Q145

No 2 Q146

Don't Know 3 Q146


Q145 ASK IF RESPONDENT THINK THAT FECES WILL IMPACT ENVIRONMENT (Q144 CODE 1) What is the impact for people around you? PROBE What else? What else?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

(2744-2828)

Q146 Has anybody or any institution explained to you about sanitation issues, defecating in open air, and habits of clean living?[SA]

Code (2829)

Route

Yes 1

No 2

Q147a Where did you know/ get information about sanitation issues? [MA]

Q147b Where do you hope to get more information on sanitation issues? [MA]

Q147a Q147b

Source of information

Expected source of

information

(2830) (2840)

Husband 01 01

Wife 02 02

Child 03 03

Friend that visits house 04 04

Family that visits house 05 05

At school 06 06

At work 07 07

At RT/RW meeting 08 08

Through mass media (radio & TV) 09 09

From religious leader (ustad) 10 10

From village head 11 11

From heath officer 12 12

From construction coolie 13 13

Others, _____________________ 14 14

__________________________________ 15 15

__________________________________ 16 16

Tidak ada 98 98

Tidak tahu 99 99


ACCESS

Q148 If there's a plan to build toilet/ water closet for your household, Who will be the decision maker for the building process ?[SA]

Code (2850)

Route

Myself 01

Spouse 02

My children 03

Me with my spouse 04

All of the family member 05

Other _______________________ 06

Q149 If you decided to build a toilet for your household, who will build the toilet?[SA]

Code (2860)

Route

Myself 01

Spouse 02

My Children 03

Building Coolie 04

Other ___________________ 05

Q150a Are there masons who specialized in building the whole component of the toilet within the neighborhood? [SA]

Q150b Is there any building material shop within the neighborhood which provide the material for building the toilet? [SA]

Q150a Q150b

Mason availability

Material shop availability

(2870) (2871)

Yes 1 1

No 2 2

Don't Know 3 3

Q151a Do you think you have adequate land within your household to build the toilet? [SA]

Q151b Do you think that the neighbourhood have an adequate water supply for any toilet related activity (anal cleansing and pour flush) ? [SA]

Q151a Q151b

Adequate land Adequate water

(2872) (2873)

Yes 1 1

No 2 2


Q152a If you decide to build a toilet/ water closet, who will decide the type of the middle structure of the latrine such as the type of the slab and the material of the slab? [MA]

Q152b And who will decide the type of the sub structure of the latrine such as the type of the hole, the wall for the hole and others related to feces disposal? [MA]

Q152a Q152b

Middle Structure

Sub Structure

(2874) (2919)

Myself 01 01

My spouse 02 02

My child 03 03

Both with my spouse 04 04

Building coolie 05 05

Others _____________________ 06 06

Q153 SHOWCARD How is the selling price given by the building material, spare part and toilet supply in your area? [SA]

Code (2929)

Route

Very expensive 1

Expensive 2

Neither expensive nor reasonable 3

Reasonable 4

Very reasonable 5

Don't Know 6

Q154 In your opinion, how much is the minimum total cost for building a latrine for your household in this neighbourhood?

(R1) Minimum Cost (2930-2933)

Q155 SHOWCARD How is the product quality offered by the supplier for building material, spare part and toilet in your area?[SA]

Code (2934)

Route

Unacceptable 1

Fair 2

Acceptable 3


Q156 Where do you know about the best type of toilet/ water closet for your household?[MA]

Code (2935)

Route

Neighbor 01

Relative 02

Building coolie 03

Health officer 04

Others, ______________________ 05

__________________________ 06

__________________________ 07

None 98

Don't Know 99

HYGIENE PRACTICE ASK THIS SECTION TO RESPONDENTS WHO HAVE UNDER 5 y.o CHILD

Q157 In your opinion, if your child get sick, could it be caused by the drinking water? [SA]

Code (2945)

Route

Yes 1 Q158

No 2 Q159

Q158 ASK IF CHILD ILLNESS COULD BE CAUSED BY DRINKING WATER (CODED IN Q157 ) What illness/ disease that caused by the drinking water? INTERVIEWER: Do not read answers, circle all the respondents answer. [MA] PROBE What else? What else?

Code (2946)

Route

Diarrhea 01

Cholera 02

Thypoid 03

Influenza 04

Cough 05

Other (Specify ____________________ ) 06

_________________________________ 07

_________________________________ 08

_________________________________ 09

Tidak ada 98

Tidak tahu 99

Q159 In your opinion, if your child get sick, could it be caused by not washing hands?[SA]

Code (2956)

Route

Yes 1 Q160

No 2 Q161


Q160 ASK IF CHILD DISEASE CAUSED BY NOT WASHING HANDS (CODED 1 IN Q159 ) What illness/ disease that caused by not washing hands? INTERVIEWER: Do not read answers, circle all respondent answers.[MA] PROBE What else? What else?

Code (2957)

Route

Diarrhea 01

Cholera 02

Thypoid 03

Influenza 04

Cough 05

Other (Specify ____________________ ) 06

_________________________________ 07

_________________________________ 08

_________________________________ 09

Tidak ada 98

Tidak tahu 99

Q161 What can you do to prevent your child from diarrhea? INTERVIEWER: Do not read answers, circle all respondents answers. [MA] PROBE What else? What else?

Code (2967)

Route

Cook the water first before drinking 01

Drink water containing chlorine 02

Use other way/ certain way to clean the water 03

Clean the house 04

Clean the neighbourhood 05

Defecating in toilet 06

Wash hands with soap 07

Wash the fruits/ vegetables 08

Prepare a well cooked food 09

Other (Specify ________________________ ) 10

_____________________________________ 11

_____________________________________ 12

_____________________________________ 13

Tidak ada 98

Tidak tahu 99


Q162 In your opinion, could diarrhea be the caused of under 5 y.o. child death?[SA]

Code (2977)

Route

Yes 1

No 2

IMAGERY QUESTION

Q163a READ DAN ROTATE STATEMENT I will read you several statements. Please give a value according to the best condition you know/ see in your surroundings, where 1 means STRONGLY DISAGREE and a score of 5 means STRONGLY AGREE. You are free to give an assessment, there is no right or wrong answer. [SA]

Q163a

Strongly Disagree

Disagree Neither disagree or agree

Agree Strongly Agree

(2978)

(R1) (SC) It is very easy to get emptying service

within my neighbourhood

1 2 3 4 5

(2979)

(R2) (F) Having my own toilet/ water closet facility will avoid my family as the subject of gossip

1 2 3 4 5

(2980)

(R3)

(B) Those who defecate in the open have certain disadvantages, such as parts of the

body can be seen by others

1 2 3 4 5

(3016)

(R4)

(E) A toilet/ water closet facility will make a village resident much better because they will

not pollute the environment

1 2 3 4 5

(3017)

(R5)

(B) Those who defecate in the river becomes vulnerable towards disease because of the

contaminated water in the river

1 2 3 4 5

(3018)

(R6) (SC) I know a person who had a skill in deciding

where to site a latrine

1 2 3 4 5

(3019)

(R7) (S) Majority of those I know usually defecate in

the toilet/ water closet

1 2 3 4 5

(3020)

(R8) (B) Those who defecate in the open pollute the

environment

1 2 3 4 5

(3021)

(R9) (B) Those who defecate in the river can be in

danger, e.g. carried by the current

1 2 3 4 5

(3022)

(R10) (E) Having a toilet/ water closet facility at homes

means giving the best for the family

1 2 3 4 5

(3023)

(R11) (S) If our grandfathers/ parents/ ancestors

defecated in the open, then it is OK for us today 1 2 3 4 5

(3024)

(R12) (SC) Most the emptying service that I am aware of have an adequate facility and skill to do their

1 2 3 4 5


Q163a

Strongly Disagree



job

(3025)

(R13) (E) Having a toilet/ water closet facility will raise

our status by being a modern family

1 2 3 4 5

(3026)

(R14) (B) River is an ideal location to defecate

because there is water current

1 2 3 4 5

(3027)

(R15) (E) Having a toilet/ water closet facility will make

defecating process more pleasant 1 2 3 4 5

(3028)

(R16)

(S) Defecating in the river is common and acceptable because feces will be eaten by the

fish

1 2 3 4 5

(3029)

(R17) (F) Having my own toilet/ water closet facility

will bring comfort to me/ my family

1 2 3 4 5

(3030)

(R18)

(E) Having a toilet/ water closet facility will raise our status in the community by being an

educated family

1 2 3 4 5

(3031)

(R19) (S) It is not civilized to defecate in the open 1 2 3 4 5

(3032)


will add value to my house

1 2 3 4 5

(3033)

(R21) (SC) I know a person who is very good in

building a latrine sub-structure

1 2 3 4 5

(3034)

(R22) (S) Those who defecate in open air are very

dirty people

1 2 3 4 5

(3035)

(R23) (S) It is not acceptable to defecate in the open 1 2 3 4 5

(3036)

(R24) (SC) I control my own destiny (internal) 1 2 3 4 5

(3037)

(R25)

(F) Having my own toilet/ water closet facility will prevent me/ my family from disease such as

diarrhea

1 2 3 4 5

(3038)

(R26) (B) Water that flows in the river can clean dirt

after defecating in the river

1 2 3 4 5

(3039)

(R27) (S) Defecating in the river is common, and

everybody is doing so

1 2 3 4 5

(3040)

(R28) (S) Defecating in the open will not endanger

others

1 2 3 4 5

(3041)

(R29) (SC) One should not empty latrines into public

spaces

1 2 3 4 5

(3042)

(R30) (F) Having my own toilet/ water closet facility 1 2 3 4 5


Q163a

Strongly Disagree



will allow me to protect my family

(3043)

(R31) (S) It is acceptable for young children to

defecate in the open.

1 2 3 4 5

(3044)

(R32) (S) Those who defecate in open air will

endanger the community they live in

1 2 3 4 5

(3045)


will bring personal discretion to me/ my family 1 2 3 4 5

(3046)

(R34) (B) Defecating in the open is very

uncomfortable because you can catch the rain

1 2 3 4 5

(3047)

(R35) (S) It is acceptable to defecate in the open if

you can not access a toilet 1 2 3 4 5

(3048)

(R36) (B) Open air (river/ bushes/ woods) is a place to

comfortably defecate

1 2 3 4 5

(3049)

(R37) (F) Having my own toilet/ water closet allows

me to be a better host to guests 1 2 3 4 5

(3050)


will make my house become more comfortable

1 2 3 4 5

(3051)

(R39) (SC) It is very important that every house must

have a latrine 1 2 3 4 5

(3052)

(R40) (S) Those who defecate in open air will not be

accepted in the community they live in

1 2 3 4 5

(3053)

(R41) (SC) A good latrine must have a hand washing

station nearby

1 2 3 4 5

(3054)

(R42) (E) A toilet/ water closet facility will raise family's

pride, e.g. when guests visit

1 2 3 4 5

(3055)

(R43) (B) Those who defecate in the open can be in

danger, e.g. attacked or bit by animals

1 2 3 4 5


TANYAKAN KEPADA OPEN DEFECATOR, SHARER, OWNER UNIMPROVED (TERKODE 1 ATAU 2 ATAU 4 DI Q26) INTERVIEWER: Berikan setiap PHOTOCARD beserta dengan SHOWCARD skala, beri nilai untuk setiap nilai keinginan responden pada setiap kombinasi pada PHOTOCARD.

Q164a ASK TO OWNER UNIMPROVED AND OPEN DEFECATOR (OTHER THAN CODE 3 IN Q26) SHOWCARD AND PHOTOCARD Here I have several photocard describing about combinations of toilet and its septic tank. In every Photocard, there's a price to buy the material and cost for the mason. Please give your score about how much you want the toilet for your household, septic tank with the consideration about the price. You can give your score in 1 to 5 scale where 1 is you don't want it at all and 5 is you really want it for your household. [SA]

Q164a

Don't have

willingness at all

2 3 4 5 6 7 8 9 10 - Really have

willingness

(3056)

(R1) Photocard 1 01 02 03 04 05 06 07 08 09 10

(3057)

(R2) Photocard 2 01 02 03 04 05 06 07 08 09 10

(3058)

(R3) Photocard 3 01 02 03 04 05 06 07 08 09 10

(3059)

(R4) Photocard 4 01 02 03 04 05 06 07 08 09 10

(3060)

(R5) Photocard 5 01 02 03 04 05 06 07 08 09 10

(3061)

(R6) Photocard 6 01 02 03 04 05 06 07 08 09 10

(3062)

(R7) Photocard 7 01 02 03 04 05 06 07 08 09 10

(3063)

(R8) Photocard 8 01 02 03 04 05 06 07 08 09 10

(3064)

(R9) Photocard 9 01 02 03 04 05 06 07 08 09 10

(3065)

(R10) Photocard 10 01 02 03 04 05 06 07 08 09 10

(3066)

(R11) Photocard 11 01 02 03 04 05 06 07 08 09 10

(3067)

(R12) Photocard 12 01 02 03 04 05 06 07 08 09 10

(3068)

(R13) Photocard 13 01 02 03 04 05 06 07 08 09 10

(3069)

(R14) Photocard 14 01 02 03 04 05 06 07 08 09 10

(3070)

(R15) Photocard 15 01 02 03 04 05 06 07 08 09 10

(3071)

(R16) Photocard 16 01 02 03 04 05 06 07 08 09 10


Q165a ASK TO OWNER UNIMPROVED AND OPEN DEFECATOR (OTHER THAN CODE 3 IN Q26) SHOWCARD AND PHOTOCARD Here I have other several photocard describing about combinations of toilet and its septic tank. In every Photocard, there's a price to buy the material and cost for the mason. Please give your score about how much you want the toilet for your household, septic tank with the consideration about the price. You can give your score in 1 to 5 scale where 1 is you don't want it at all and 5 is you really want it for your household. [SA]

Q165a

1 - Don't have

willingness at all

2 3 4 5 6 7 8 9 10 - Really have

willingness

(3072)

(R1) Photocard 1 01 02 03 04 05 06 07 08 09 10

(3073)

(R2) Photocard 2 01 02 03 04 05 06 07 08 09 10

(3074)

(R3) Photocard 3 01 02 03 04 05 06 07 08 09 10

(3075)

(R4) Photocard 4 01 02 03 04 05 06 07 08 09 10

(3076)

(R5) Photocard 5 01 02 03 04 05 06 07 08 09 10

(3077)

(R6) Photocard 6 01 02 03 04 05 06 07 08 09 10

(3078)

(R7) Photocard 7 01 02 03 04 05 06 07 08 09 10

(3079)

(R8) Photocard 8 01 02 03 04 05 06 07 08 09 10

(3080)

(R9) Photocard 9 01 02 03 04 05 06 07 08 09 10


MEDIA EXPOSURE & COMMUNICATION CHANNEL

Q166 TANYAKAN SEMUA Do you like to listen to Radio?[SA]

Code (3116)

Route

Yes 1 Q167

No 2 Q169

Q167 ASK IF CODED 1 IN Q166 What time do you usually listen to the radio most often?[MA]

Code (3117)

Route

05.00 - 05.59 am 01

06.00 - 07.59 am 02

08.00 - 10.59 am 03

11.00 - 12.59 am 04

01.00 - 02.59 pm 05

03.00 - 04.59 pm 06

05.00 - 05.59 pm 07

06.00 - 06.59 pm 08

07.00 - 08.59 pm 09

09.00 - 09.59 pm 10

10.00 - 10.59 pm 11

11.00 - 11.59 pm 12

12.00 - 01.59 am 13

02.00 - 03.59 am 14

Q168a What is the name of the radio station you have ever listened to?[MA]

Q168b Name of radio station most often listened to?[SA]

Q168a Q168b

Ever listened to

Most listened to

(3119) (3129)

. 01 01

. 02 02

. 03 03

. 04 04

. 05 05

. 06 06

. 07 07

. 08 08

. 09 09

. 10 10

99 99


Q169 Do you like to watch Television? [SA]

Code (3139)

Route

Yes 1 Q170

No 2 Q172

Q170 ASK IF CODED 1 IN Q169 What time do you usually watch TV most often? [MA]

Code (3140)

Route

05.00 - 05.59 am 01

06.00 - 07.59 am 02

08.00 - 10.59 am 03

11.00 - 12.59 am 04

01.00 - 02.59 pm 05

03.00 - 04.59 pm 06

05.00 - 05.59 pm 07

06.00 - 06.59 pm 08

07.00 - 08.59 pm 09

09.00 - 09.59 pm 10

10.00 - 10.59 pm 11

11.00 - 11.59 pm 12

12.00 - 01.59 am 13

02.00 - 03.59 am 14

Q171a What is the name of the TV station you have ever watched?[MA]

Q171b Name of TV station most often watched?[SA]

Q171a Q171b

Ever watched Watched most often

(3142) (3152)

TVRI 01 01

RCTI 02 02

SCTV 03 03

TPI 04 04

Trans TV 05 05

Global TV 06 06

Trans 7 07 07

Indosiar 08 08

TV One 09 09

ANTV 10 10

Lativi 11 11

Metro TV 12 12

JTV 13 13

Space Toon 14 14

Deli TV 15 15

TV Borobudur/ TV B 16 16

Makassar TV 17 17

O Channel 18 18

STV 19 19

Other, specify ____________________________ 20 20

____________________________ 21 21

____________________________ 22 22

Tidak Ada 98 98

Tidak Tahu 99 99


Q172a What is the name of the newspaper you have ever read?[MA]

Q172b Name of newspaper that you read most often?[SA]

Q172a Q172b

Ever read Most often read

(3162) (3172)

Agrobur 01 01

Analisa 02 02

Banjarmasin Post 03 03

Berita Kota 04 04

Berita Kota Makasar ( BKM) 05 05

bina baru 06 06

Bisnis Indonesia 07 07

B'Post 08 08

Fajar 09 09

Galamedia 10 10

Jawa Pos 11 11

Kompas 12 12

Koran Pendidikan 13 13

Koran Tempo 14 14

Lampu Merah 15 15

Medan Pos 16 16

Media Indonesia 17 17

Merdeka 18 18

Meteor 19 19

Metro Bandung 20 20

Metro Banjar 21 21

Momerandum 22 22

Pedoman Rakyat 23 23

Pikiran Rakyat 24 24

Pos Kota 25 25

Pos Metro 26 26

Pos metro Medan 27 27

Radar Banjarmasin 28 28

Radar Surabaya 29 29

Republika 30 30

Seputar Indonesia 31 31

Serambi 32 32


Q172a Q172b

Ever read Most often read

Sinar Indonesia Baru 33 33

Suara Karya 34 34

Suara Merdeka 35 35

Suara Pembaruan 36 36

Sumut Pos 37 37

Surya 38 38

Terbit 39 39

Top Score 40 40

Tribun Jabar 41 41

Tribun Timur 42 42

Ujung Pandang Expres 43 43

Warta Kota 44 44

Waspada 45 45

Wawasan 46 46

Other, ___________________________ 47 47

___________________________________ 48 48

None 98 98

Don't Know 99 99


PRODUCT RANGE ASSESSMENT

Q173 ASK ALL SHOWCARD Of all the durables listed below, which ones does your household own? [MA] PROBE What else? What else?

Code (3217)

Route

Black & White TV 01

Colour TV 02

Bicycle 03

Motorcycle 04

Car 05

Livestock 06

VCD/ DVD Player 07

Radio 08

Radio Cassette 09

AC 10

Camera 11

Video Camera 12

Washing Machine 13

Credit Card 14

Computer 15

Microwave/ Oven 16

Handphone 17

Home Phone 18

Internet 19

Electric Fan 20

Electric Water Pump 21

Mixer/ Blender 22

Rice Cooker 23

Magic Jar 24

Refrigerator 25

Gas Stove 26

Kerosene Stove 27

INTERVIEW FINISHED. SAY THANK YOU TO RESPONDENTS


Q174 Quality Control done by : [MA]

Code (3220)

Route

Coordinator/RFM/FE 1

Supervisor 2

Team Leader 3

Quality Controller 4

Checker 5

Q175 Quality Control, action taken : [SA]

Code (3221)

Route

Witnessed 1

Recalled 2

Slip collected 3

Checked on the spot 4

Telephone 5

Checked Questionnaire 6

Q176 Start

(R1) Start (3222-3225)

Q177 Finish

(R1) Finish (3226-3229)

Q178 Date/month of interview

(R1) DATE/MONTH (3230-3233)

Q179 Day of interviewing [SA]

Code (3234)

Route

Monday 1

Tuesday 2

Wednesday 3

Thursday 4

Friday 5

Saturday 6

Sunday 7


Q180 INTERVIEWER : ASK YOUR SUPERVISOR TO FILL THIS CODE PSU [SA]

Code (3235)

Route

ORIGINAL 1

SUBSTITUTE 2

ADDITIONAL 3

Q181a Filled by Supervisor/ Leader/ Quality Control Witnessed/ Recalled [MA]

Q181b Spv/ Leader/ QC Number

Q181a Q181b

QC that has been done

4 Digits

(3236) (3237-3240)

(R1) Witness 1 _ _ _ _

(3241-3244)

(R2) Recall 2 _ _ _ _

(3245-3248)

(R3) Slip 3 _ _ _ _

(3249-3252)

(R4) On the spot 4 _ _ _ _

(3253-3256)

(R5) Check 5 _ _ _ _

Q182 FILLED IN BY CODERS/SPV/LEADER TYPE OF MISTAKES [MA]

Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Type 7 Type 8 Type 9 Type 10

(3257)

(R1) Mistakes 01 02 03 04 05 06 07 08 09 10

Q183 No PSU

(R1) No PSU (3258-3263)

Q184 Method[SA]

Code (3264)

Route

Random PSU 1

Substitute 2


Q185 Coders

(R1) R1 (3265-3267)

(R2) R2 (3268-3270)

Q186 Coder [SA]

Code (3271)

Route

. 1

Q187 coders [MA]

Code (3272)

Route

. 1

. 2

. 3

. 4

. 5

. 6

. 7

. 8

Q188 Interviewer Number

(R1) Interviewer No. (3277-3317)

"Herewith I declare that the interview done and recorded by me today, is correct and with accurate data, according to survey methods, given instructions, and to ESOMAR standard." Interviewer : Date of interview : time :

FIELD : THIS PAGE SHOULD BE COPIED SEPARATELY CODERS/DATA ENTRY : AFTER FINISH CODED AND ENTRY, THIS PAGE SHOULD BE SEPARATED

Q189 Would you like to participate in our future survey?[SA]

Code (3318)

Route

Yes 1 Q190

No 2 CLOSE

Q190 Do you have a phone number?[SA]

Code (3319)

Route

Yes 1

No 2 Q192


Q191a Ingatkan Responden bahwa semua data akan digunakan secara rahasia dan bukan untuk komersil RECORD : Respondent's Phone number Area code

Q191b Phone no.

Q191a Q191b

Area code Phone no.

(3320-3323) (3324-3333)

(R1) . _ _ _ _ _ _ _ _ _ _ _ _

_ _

Q192 Do you have a personal cell phone?[SA]

Code (3334)

Route

Yes 1 Q193

No 2 Q194

Q193 HP no.

(R1) Cellular Number (3335-3346)

(R2) Cellular Number (3347-3358)

Q194 Do you have a personal e-mail address?[MA]

Code (3359)

Route

Yes 1 Q195

No 2 Q196

Q195 Would you please tell me your personal email address that you access most often? RECORD : Respondent's e-mail address (if any) Only most often used address

(R1) Name (3360-3363)

Q196 What is your full name? RECORD : Respondent's Name

(R1) Name (3419-3422)

if respondent is not head of household

Documents