Please Wait...
Ewr Women Representatives -Form Fill
Background of the RESPONDENT
Q01
In what month and year were you born?
Q02
How old were you at your last birthday?
Q03
What is your religion?
Hindu
Muslim
Christian
Sikh
Buddhist/Neo-Buddhist
Jain
Jewish
Parsi/Zorastrian
No religion
Other (Specify)
Q04
What is your caste or tribe?
No caste or tribe
BRAHMIN
RAJPUT/THAKUR
BHUMIHAR
KAYASTH/SRIVASTAVA/LALA
CHAMAR
DUSADH/PASWAN
MUSAHAR
PASI
DHOBI
BHUIYA
CHAUPAL
BANTAR
RAJWAR
YADAV
VAISHYA/BANIA
KURMI
SHAH
OTHER CASTE OR TRIBE (SPECIFY)
Do not know
Q04A
Do you belong to a scheduled caste, a scheduled tribe, other backward class, or none of these?
SCHEDULED CASTE
SCHEDULED TRIBE
OTHER BACKWARD CLASS
NONE OF THEM
Q05
Have you ever attended school?
Yes
No
Q06
What is the highest standard or class you completed?
Q07
Do you know how to read or write?
Yes, read and write
Yes, read
Can sign only
No, cannot read and write
Q08
As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business. In the last seven days, other than being a Panchayat member, have you done any of these things or any other work?
Yes
No
Q09
Have you done any of these things or any other work in the last 12 months?
Yes
No
Q10
Other than being a Panchayat member, what is your occupation, that is, what other kind of work do you mainly do?
Farmer (crops)
Agricultural day labor
Herding animals
Non agricultural day labor
Maid servant
Cook
Child Care Provider
Service/Salaried Worker
Small/Cottage Industry
Business/Trader
Other Self-Employment
Skilled Worker
Other (specify)
Q11
What is your current marital status?
Currently married
Married, guana not performed
Widowed
Divorced
Separated
Deserted
Never married
Q12
Did your husband ever attend school?
Yes
No
Q13
What is the highest standard or class your husband completed?
Q14
In the past 12 months, has your husband been employed?
Yes
No
Q15
What is your husband’s main occupation?
Farmer (crops)
Agricultural day labor
Non agricultural day labor
Service/salaried worker
Small/cottage industry
Business/traders
Rickshaw/van pulling
Other self-employment
Maid servant
Skilled worker
Panchayat member
Works for political party
Government official
Don’t know
Other (specify)
Q16
Do you have children?
Yes
No
Q17
How many sons do you have?
Q18
How many daughters do you have?
Q19
How many members currently live in your household?
Q20
Do you have access to a mobile phone that you use for yourself?
Yes
No
Q21
Is the phone self-owned or shared? If shared, with whom is it shared?
Self-owned
Shared with husband
Shared with other family members
Shared with neighbors
Other (specify)
Q22
Are you able to read text (SMS) messages?
Yes, only Hindi SMS
Yes, only English SMS
Yes, both Hindi and English SMS
No
Roles & responsibilities as A Panchayat MEMBER
A01
How many elections have you contested thus far?
A02
How many times have you been elected?
A03
In which year were you first elected as a Panchayat member?
A04
Was your current Panchayat position reserved for a female candidate?
Yes
No
A05
Was your current Panchayat position reserved for an SC/ST candidate?
Yes
No
A06
Do you expect to contest for this or other positions in the Panchayat in the next election cycle?
Yes
No
A07
Before being elected as a Panchayat member, did you participate in Panchayat meetings and activities?
Yes
No
A08
Who, if anyone, encouraged you to become a Panchayat member?
My wish
Father
Mother
Father in-law
Mother in-law
Husband
Son
Daughter
Other family members (specify)
Villagers request
Previous ER
Other (specify)
A09
Was anyone in your family a Panchayat member in the last 15 years?
Self
Father
Mother
Father-in-law
Mother-in-law
Husband
Son
Daughter
Other family members (specify)
None
Other (specify)
A10
Does any member of your family help you in your work as a Panchayat member?
Yes
No
A11
If yes, who?
Spouse
Father
Mother
Brother
Sister
Son
Daughter
Other male relative (specify)
Other female relative (specify)
A12
What are your responsibilities as a Panchayat member?
Monitoring and implementation of various Government schemes
Identifying beneficiaries/recepients of schemes
Organising and participating in Panchayat level meetings
Organizing and participating in Ward level meetings
Raise ward level issues at the Gram Sabha or in Panchayat meetings
Ensure maintenance of accounts
Monitoring of/reporting on health services
Planning and proposing development work at the village/Panchayat level
Monitoring of Anganwadi center
Improving general health services
Improving RH/MH services
Infrastructure development
Ensuring availability of safe drinking water
Planning VHSNDs
Others (specify)
A13
How did you learn about your roles and responsibilities as a Panchayat member?
Trainings
Family members who have served/are currently serving as Panchayat members
Male Panchayat members
Other female Panchayat members
Former male Panchayat members
Former female Panchayat members
Newspaper
TV
Radio
Panchayat meetings
Block/district level meetings
Other (Specify)
A14
What issues do you care most about addressing in your role as a Panchayat member?
Healthcare
Drinking water
Agricultural problems
Electricity
Education
Roads
Irrigation
Sanitation/hygiene
Crime
Corruption/money waste
Land/property disputes
Caste/communal disputes
Political issues/debates
Livelihood/employment for women
Women’s groups/SHGs
Access to credit
Household and family/disputes (including domestic violence, dowry violence, molestations, public beatings or child marriage)
Poverty
Pension schemes
Housing schemes
Other social security scemes
Alcohol ban
Construction/installation of ponds, handpumps, street lights etc
Other (specify)
A15
Since becoming a Panchayat member in the most recent election cycle, have you received any training/orientation?
Yes
No
A16
Did you receive any training on health rights and entitlements?
Yes
No
A17
Did you receive any training on RH/MH rights and entitlements?
Yes
No
A18
Did you receive any training on monitoring of/reporting on public health services?
Yes
No
A19
Did you receive any training on your role under the National Rural Health Mission, an initiative undertaken by the Government of India to improve access to the health system for rural people, especially poor women and children, and provide equitable, affordable, accountable and effective primary health care?
Yes
No
A20
Who provided these trainings/orientations?
Panchayati Raj Department
Health Department
Other Govt. Department
Local NGOs (specify)
Others (specify)
A21
Were you allowed to attend the training/orientation alone?
Yes
No
A22
Who accompanied you to attend the training/orientation?
Other ERs from community
Previous ER
Husband
Son
Daughter
Other female relatives
Other male relatives
Others (Specify)
A23
If you served as a Panchayat member in the previous election cycle, did you receive any training/orientation at that time?
Yes
No
KNOWLEDGE OF RH/MH ENTITLEMENTS
B01
There are various methods that couples can use to avoid or delay pregnancy. Can you tell me such methods you are aware of?
B01_1
Female Sterilization
Yes
No
B01_2
Male Sterilization
Yes
No
B01_3
Mala-D or pill
Yes
No
B01_4
IUD or Loop or Copper-T
Yes
No
B01_5
Injectables
Yes
No
B01_6
Condoms (Nirodh)
Yes
No
B01_7
Female condoms
Yes
No
B01_8
Diaphragm
Yes
No
B01_9
Foam/jelly
Yes
No
B01_10
Rhythm method
Yes
No
B01_11
Withdrawal
Yes
No
B01_12
LAM/Lactational Amenorrhea Method
Yes
No
B01_13
Emergency Contraception
Yes
No
B02
Is [method] available to the women from your ward?
Yes
No
B03
Where is [method] currently available?
Anganwadi centre (other than during VHSND/Immmunization day)
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs/Immunization Days
Home visits by ASHA/AWW/ANM
NGO
Others (specify)
Do not know
B04
Which facilities/platforms are supposed to provide [method]?
Anganwadi centre (other than during VHSND/Immunization Day)
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs/Immunization Days
Home visits by ASHA/AWW/ANM
NGO
Others (specify)
Do not know
B05
If a woman in your ward wants more information on [method], who would be able to provide this information?
ASHA
ANM
AWW
Trained doctor at PHC
No one
Other (specify)
B06
Now, I would like to ask you about antenatal care services that you may be aware of. What are the key antenatal care services that pregnant women are supposed to receive?
B06_1
Registration of pregnancy
Yes
No
B06_2
Height measurement
Yes
No
B06_3
Weight measurement
Yes
No
B06_4
BP measurement
Yes
No
B06_5
Test for anemia/hemoglobin test
Yes
No
B06_6
Testing of urine sample
Yes
No
B06_7
Other blood tests
Yes
No
B06_8
Abdominal examination
Yes
No
B06_9
Iron and folic acid tablet
Yes
No
B06_10
TT injection
Yes
No
B06_11
Breast examination
Yes
No
B06_12
Treatment of anemia
Yes
No
B06_13
Nutritional supplements
Yes
No
B06_14
Referral for high-risk pregnancies
Yes
No
B07
How many antenatal check-ups is a woman supposed to receive over the course of her pregnancy?
B08
How many IFA tablets is a woman supposed to receive over the course of her pregnancy?
B09
Is there any health facility or place that provides [SERVICE] to women from your ward?
Yes
No
B10
What are the facilities/platforms that provide [SERVICE] to women from your ward?
Anganwadi centre (other than during VHSND)
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs/Immunization Days
Home visits by ASHA/AWW/ANM
NGO
Others (specify)
Do not know
B11
What are the facilities/platforms that should provide [SERVICE] to women from your ward?
Anganwadi centre (other than during VHSND/Immunization Day
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs
Home visits by ASHA/AWW/ANM
NGO
Others (specify)
Do not know
B12
Is there any facility/platform that provides delivery services to women from your ward?
Yes
No
B13
What are the facilities/platforms that provide delivery services to women from your ward?
Anganwadi centre (other than during VHSND/Immunization Day)
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs/Immunization Days
NGO
Others (specify)
Do not know
B14
What are the facilities/platforms that are supposed to provide delivery services to women from your ward?
Anganwadi centre (other than during VHSND/Immunization Day)
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs/Immunization Days
NGO
Others (specify)
Do not know
B15
Are you aware of any programs that are supposed to provide money or other types of support to pregnant women who deliver in a facility?
Yes
No
B16
What programs are you aware of?
Janani Suraksha Yojana
Janani Sishu Suraksha Karyakram
Other (specify)
B17
Which programs are currently available to pregnant women from your ward?
Janani Suraksha Yojana
Janani Sishu Suraksha Karyakram
Other (specify)
Do not know
B18
How much money are women who have an institutional delivery supposed to receive through these programs?
B19
What other support is supposed to be provided to women during and immediately after delivery through these programs?
B19_1
Free and cashless delivery
Yes
No
B19_2
Free Caesarean section
Yes
No
B19_3
Free drugs and consumables (health supplies that can’t be reused; for example, syringes, bandages, etc.)
Yes
No
B19_4
Free diagnostics (Blood, Urine tests and Ultra sonography etc.)
Yes
No
B19_5
Free food during stay at health facility (upto 3 days for normal delivery & 7 days for caesarean section)
Yes
No
B19_6
Free provision of blood
Yes
No
B19_7
Exemption from any user charges
Yes
No
B19_8
Free transport from home to health institutions
Yes
No
B19_9
Free transport between facilities in case of referral
Yes
No
B19_10
Free transport back from institutions to home after 48 hours stay
Yes
No
B20
How many postpartum home visits are women supposed to receive from an ASHA/AWW/ANM?
B21
If a woman would like to terminate a pregnancy, is it legal to do so?
Yes
No
B22
If a woman in your ward wants to terminate her pregnancy, can she do so safely?
Yes
No
B23
What are the facilities/platforms that are required to provide safe abortion services?
Anganwadi centre (other than during VHSND/Immunization Day)
Sub centre
Primary health centre
Community health centre
Sub district / district hospital
Private clinics/ hospitals
VHSNDs/Immunization Days
NGO
Should not be provided
Not provided though any
Do not know
Others (specify)
B24
If a woman would like to find out the sex of her fetus, is it legal to do so?
Yes
No
B25
If a woman in your ward wants more information on safe abortion services, who would be able to provide this information?
ASHA
ANM
AWW
Trained doctor at PHC
Doctor at district hospital
Doctor at CHC
Doctor/Nurse in private hospital
No one
Other (specify)
ACTIONS ON RH/MH ISSUES
C01
Since becoming a Panchayat member, have you provided information or supported anyone on RH/MH related issues?
Yes
No
C02
Who have you provided information to or supported on RH/MH related issues?
Adolescent boys
Adolescent girls
Women/mothers
Men
Couples
Others (Specify)
C03
What kind of information or support did you provide?
Delayed marriage
Condoms
Other FP methods
Sterilization
ANC visits
PNC visits
Newborn care
VHSND/Immunization Day services
Treatment for any RTI/STI symptoms
Menstrual problems
Institutional deliveries/deliveries by skilled personnel
Referred to ASHA
Referred to AWW
Referred to ANM
Referred to PHC
Monetary support
Transportation
Other (specify)
C04
Are you aware of VHSNDs being organized in your village?
Yes
No
C05
How many VHSNDs, if any, have been held in the last 6 months in your village?
C06
How many VHSNDs, if any, did you attend in the last 6 months?
C07
What were the types of services offered through VHSNDs/Immunization Days in the last 6 months?
Registration of pregnancy
ANC check ups
Condoms
Oral contraceptive pills
FP counselling
Referrals for other FP services
Counselling on RTI/STI
Treatment of communicable diseases
Supplemental nutrition for pregnant women
Supplemental nutrition for children
Immunization for children
Vitamin A solution for children
IFA tablets for pregnant women
TT injections for pregnant women
Blood pressure measurement for pregnant women
Anemia measurement/treatment for pregnant women
Height/weight measurement for pregnant women
Referrals for high risk pregnancies
Height/weight measurement for children
Anti TB drugs for TB patients
Health Education
Other (specify)
C08
In the last 6 months, have you talked to women in your ward about their experiences with RH/MH services provided through VHSNDs/Immunizations Days?
Yes
No
C09
In the last 6 months, have women in your ward provided feedback on the availability and/or quality of RH/MH services provided through VHSNDs/Immunization Days?
Yes
No
C10
What, if any, concerns were raised by women about the availability and/or quality of RH/MH services provided through VHSNDs/Immunization Days?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs
No concerns raised
Other (specify)
C11
Did you do anything with the information or feedback that was shared with you about the availability and/or quality of RH/MH services provided through VHSNDs/Immunization Days?
Yes
No
C12
What did you do with the information or feedback provided to you about services at VHSNDs/Immunization Days?
Presented at higher levels
Called into toll free number
Shared with community
Shared with other Panchayatmembers
Provided feedback to the providers (ASHA, AWW, ANM)
Did not do anything
Other (specify)
C13
How many times, if any, have you met with the ASHA to discuss her role in providing health services in the last 6 months?
C14
What topics related to health services did you discuss with ASHA during such meetings in the last 6 months?
Generating awareness about RH/MH issues and services
Registration of pregnant women
Improving availability and quality of RH/MH services
Distribution of JSY/JSSK money to the beneficiaries
Conducting counselling sessions on RH/MH issues and services
Organizing and conducting VHSNDs/Immunization Days
Community attendance at VHSNDs/Immunization Days
Distribution of take-home rations
Utilisation of untied funds
Supplies and/or equipment for VHSNDs/Immunization Days
Supplies/equipment for HSCs
Improving provider’s knowledge about RH/MH services
Distribution of nutrition supplements to mother and child
Others (specify)
C15
In the last 6 months, have you supported the ASHA in carrying out any of her duties?
Yes
No
C16
In what activities, did you support the []ASHA?
Awareness generation activities on RH/MH issues and services
Registration of pregnant women
Improving availability and quality of RH/MH services
Distribution of JSY/JSSK money to the beneficiaries
Motivate/facilitate in conducting counselling sessions on RH/MH issues and services
Organizing and conducting VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs,Immunization Days
Distribution of take-home rations
Utilisation of untied funds
Obtaining supplies and/or equipment for VHSNDs/Immunization Days
Obtain supplies and/or equipment for HSCs
Improving provider’s knowledge about RH/MH services
Distribution of nutrition supplements to mother and child
Others (specify)
C17
In the last 6 months, have you provided feedback to the []ASHA on the availability and/or quality of RH/MH services provided through home visits, VHSNDs/Immunization Days and/or health sub-centers?
Yes
No
C18
On what issues did you provide feedback to the []ASHA?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs/Immunization Days
Health subcenter operating hours irregular/ inconvenient
Lack of supplies/equipment at subcenter
RH/MH services not provided at health subcenter
Provider absenteeism at health subcenter
Feedback on other aspects of services at health subcenter
Untied funds not used effectively to improve health services
Conducting home visits
Other (specify)
C19
In the last 6 months, have you talked to women in your ward about their experiences with RH/MH services provided by the ASHA?
Yes
No
C20
In the last 6 months, have women in your ward provided feedback on the availability and/or quality of RH/MH services provided by the ASHA?
Yes
No
C21
What, if any, concerns were raised by women about the availability and/or quality of RH/MH services provided by the []ASHA?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs/Immunization Days
ASHA does not conduct home visits
ANM does not conduct home visits
AWW does not conduct home visits
No concerns raised
Other (specify)
C22
Did you do anything with the information or feedback that was shared with you about the availability and/or quality of RH/MH services provided by []ASHA?
Yes
No
C23
What did you do with the information or feedback provided to you about the ASHA?
Presented at higher levels
Called into toll-free number
Shared with community
Shared with other Panchayat members
Provided feedback to the provider
No action taken
Other (specify)
C23A
How many times, if any, have you met with the AWW to discuss her role in providing health services in the last 6 months?
C23B
What topics related to health services did you discuss with AWW during such meetings in the last 6 months?
Generating awareness about RH/MH issues and services
Registration of pregnant women
Improving availability and quality of RH/MH services
Distribution of JSY/JSSK money to the beneficiaries
Conducting counselling sessions on RH/MH issues and services
Organizing and conducting VHSNDs/Immunization Days
Community attendance at VHSNDs/Immunization Days
Distribution of take-home rations
Utilisation of untied funds
Supplies and/or equipment for VHSNDs/Immunization Days
Supplies/equipment for HSCs
Improving provider’s knowledge about RH/MH services
Distribution of nutrition supplements to mother and child
Others (specify)
C23C
In the last 6 months, have you supported the AWW in carrying out any of her duties?
Yes
No
C23D
In what activities, did you support the AWW?
Awareness generation activities on RH/MH issues and services
Registration of pregnant women
Improving availability and quality of RH/MH services
Distribution of JSY/JSSK money to the beneficiaries
Motivate/facilitate in conducting counselling sessions on RH/MH issues and services
Organizing and conducting VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs/Immunization Days
Distribution of take-home rations
Utilisation of untied funds
Obtaining supplies and/or equipment for VHSNDs/Immunization Days
Obtain supplies and/or equipment for HSCs
Improving provider’s knowledge about RH/MH services
Distribution of nutrition supplements to mother and child
Others (specify)
C23E
In the last 6 months, have you provided feedback to the AWW on the availability and/or quality of RH/MH services provided through home visits, VHSNDs/Immunization Days and/or health sub-centers?
Yes
No
C23F
On what issues did you provide feedback to the AWW?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs/Immunization Days
Health subcenter operating hours irregular/ inconvenient
Lack of supplies/equipment at subcenter
RH/MH services not provided at health subcenter
Provider absenteeism at health subcenter
Feedback on other aspects of services at health subcenter
Untied funds not used effectively to improve health services
Conducting home visits
Other (specify)
C23G
In the last 6 months, have you talked to women in your ward about their experiences with RH/MH services provided by the AWW?
Yes
No
C23H
In the last 6 months, have women in your ward provided feedback on the availability and/or quality of RH/MH services provided by the AWW?
Yes
No
C23I
What, if any, concerns were raised by women about the availability and/or quality of RH/MH services provided by the AWW?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs/Immunization Days
ASHA does not conduct home visits
ANM does not conduct home visits
AWW does not conduct home visits
No concerns raised
Other (specify)
C23J
Did you do anything with the information or feedback that was shared with you about the availability and/or quality of RH/MH services provided by AWW?
Yes
No
C23K
What did you do with the information or feedback provided to you about the AWW?
Presented at higher levels
Called into toll-free number
Shared with community
Shared with other Panchayat members
Provided feedback to the provider
No action taken
Other (specify)
C23L
How many times, if any, have you met with the ANM to discuss her role in providing health services in the last 6 months?
C23M
What topics related to health services did you discuss with ANM during such meetings in the last 6 months?
Generating awareness about RH/MH issues and services
Registration of pregnant women
Improving availability and quality of RH/MH services
Distribution of JSY/JSSK money to the beneficiaries
Conducting counselling sessions on RH/MH issues and services
Organizing and conducting VHSNDs/Immunization Days
Community attendance at VHSNDs/Immunization Days
Distribution of take-home rations
Utilisation of untied funds
Supplies and/or equipment for VHSNDs/Immunization Days
Supplies/equipment for HSCs
Improving provider’s knowledge about RH/MH services
Distribution of nutrition supplements to mother and child
Others (specify)
C23N
In the last 6 months, have you supported the ANM in carrying out any of her duties?
Yes
No
C23O
In what activities, did you support the ANM?
Awareness generation activities on RH/MH issues and services
Registration of pregnant women
Improving availability and quality of RH/MH services
Distribution of JSY/JSSK money to the beneficiaries
Motivate/facilitate in conducting counselling sessions on RH/MH issues and services
Organizing and conducting VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs/Immunization Days
Distribution of take-home rations
Utilisation of untied funds
Obtaining supplies and/or equipment for VHSNDs/Immunization Days
Obtain supplies and/or equipment for HSCs
Improving provider’s knowledge about RH/MH services
Distribution of nutrition supplements to mother and child
Others (specify)
C23P
In the last 6 months, have you provided feedback to the ANM on the availability and/or quality of RH/MH services provided through home visits, VHSNDs/Immunization Days and/or health sub-centers?
Yes
No
C23Q
On what issues did you provide feedback to the ANM?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs/Immunization Days
Health subcenter operating hours irregular/ inconvenient
Lack of supplies/equipment at subcenter
RH/MH services not provided at health subcenter
Provider absenteeism at health subcenter
Feedback on other aspects of services at health subcenter
Untied funds not used effectively to improve health services
Conducting home visits
Other (specify)
C23R
In the last 6 months, have you talked to women in your ward about their experiences with RH/MH services provided by the ANM?
Yes
No
C23S
In the last 6 months, have women in your ward provided feedback on the availability and/or quality of RH/MH services provided by the ANM?
Yes
No
C23T
What, if any, concerns were raised by women about the availability and/or quality of RH/MH services provided by the ANM?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies/equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND
Feedback on other aspects of services at VHSNDs/Immunization Days
Mobilizing women in the community to attend VHSNDs/Immunization Days
Health subcenter operating hours irregular/ inconvenient
Lack of supplies/equipment at subcenter
RH/MH services not provided at health subcenter
Provider absenteeism at health subcenter
Feedback on other aspects of services at health subcenter
Untied funds not used effectively to improve health services
Conducting home visits
Other (specify)
C23U
Did you do anything with the information or feedback that was shared with you about the availability and/or quality of RH/MH services provided by ANM?
Yes
No
C23V
What did you do with the information or feedback provided to you about the ANM?
Presented at higher levels
Called into toll-free number
Shared with community
Shared with other Panchayat members
Provided feedback to the provider
No action taken
Other (specify)
C24
How many times, if any, did you meet the Medical Officer (MO) at the PHC in the last 6 months?
C25
What all did you discuss with the MO during these meetings/interactions?
ANM visits
Regularity of VHSNDs/Immunization Days
ANM absenteeism
Facility operating hours
Supplies of IFA tablets
Supplies of contraceptives
Other supplies/equipment
Group discussions during VHSND/Immunization Day
On issues of Sub-Centre supervision
ANM skills
Availability and utilization of untied funds
Others (specify)
C26
Have you met the Civil Surgeon or other health representatives at the district level?
Yes
No
C27
What all did you discuss with the Civil Surgeon during these meetings/interactions?
ANM visits
Regularity of VHSNDs/Immunization Days
ANM absenteeism
Facility operating hours
Supplies of IFA tablets
Supplies of contraceptives
Other supplies/equipment
Group discussion during VHSND/Immunization Day
On issues of Sub-Centre supervision
ANM skills
Availability and utilization of untied funds
Availability of lady doctors
RKS meetings
Others (specify)
C28
In the last 6 months, has there been a ward sabha meeting in your ward?
Yes
No
C29
How long ago was the last ward sabha meeting?
More than 6 and less than 9 months ago
More than 9 and less than 12 months ago
More than 12 months ago
Never had a ward sabha meeting
C30
Have you attended a ward sabha meeting in your ward in the last 6 months?
Yes
No
C31
Have you organized a ward sabha meeting in your ward in the last 6 months?
Yes
No
C32
Based on your recollection, what were the main issues discussed at these meetings in the last 6 months?
Healthcare
Drinking water
Agricultural problems
Electricity
Education
Roads
Irrigation
Sanitation/hygiene
Crime
Corruption/money waste
Land/property disputes
Caste/communal disputes
Political issues/debates
Livelihood/employment for women
Women’s groups/SHGs
Access to credit
Household and family/disputes (including domestic violence, dowry violence, molestations, public beatings or child marriage)
Poverty
Housing schemes
Pension schemes
Other social security scemes
Alcohol ban
Construction/installation of ponds, handpumps, street lights etc
Do not remember
Other (specify)
C33
Based on your recollection, did you or someone else discuss RH/MH entitlements and services at these meetings in the last 6 months?
Yes
No
C34
Have you personally discussed RH/MH entitlements and services at these meetings in the last 6 months?
Yes
No
C35
Do you recall what specific RH/MH entitlements and services were discussed at these meetings in the last 6 months?
ANC services available to pregnant women
FP counselling and services available to women
Delivery services available at facility
JSY/JSSK program for pregnant women
Postpartum care services available to women
Vaccination for children
Other (specify)
C36
Based on your recollection, did you or someone else raise any healthcare or RH/MH issues at these meetings in the last 6 months?
Yes
No
C37
Have you personally raised any health care or RH/MH issues at these meetings in the last 6 months?
Yes
No
C38
Do you recall what specific healthcare or RH/MH issues were discussed at these meetings in the last 6 months?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies at VHSNDs/Immunization Days
Lack of equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSND
Provider absenteeism at VHSNDs/Immunization Days
Feedback on other aspects of services at VHSNDs/Immunization Days
Nearest public health facility operating hours irregular/inconvenient
Lack of supplies at nearest public health facility
Lack of equipment at nearest public health facility
RH/MH services not provided at nearest public health facility
Provider absenteeism at nearest public health facility
Feedback on other aspects of services at nearest public health facility
Untied funds not used effectively to improve health services
Public health facilities too far from the village
ANM does not conduct home visits
ASHA does not conduct home visits
AWW does not conduct home visits
Other (specify)
C39
What actions, if any, were taken based on the healthcare or RH/MH issues discussed?
Presented at higher levels
Called into IVRS/toll-free number
Shared with community
Shared with other Panchayat members
Provided feedback to the providers
No action taken
Other (specify)
C40
Did you organize or participate in any other types of meetings in your ward in the last 6 months?
Yes
No
C41
What kinds of meetings did you organize or participate in?
Women’s group meeting
VHSNC meeting
VPMC meeting
Self-help group meeting
Political party group meeting
Caste-based council or committee meeting
Agricultural organization meeting
Other trade union meeting
Religious group meeting
Other (Specify)
C42
Based on your recollection, what were the main issues discussed at these meetings in the last 6 months?
Healthcare
Drinking water
Agricultural problems
Electricity
Education
Roads
Irrigation
Sanitation/hygiene
Crime
Corruption/money waste
Land/property disputes
Caste/communal disputes
Political issues/debates
Livelihood/employment for women
Women’s groups/SHGs
Access to credit
Household and family/disputes (including domestic violence, dowry violence, molestations, public beatings or child marriage)
Other (specify)
C43
Based on your recollection, did you or someone else discuss RH/MH entitlements and services at any of these meetings in the last 6 months?
Yes
No
C44
Have you personally discussed RH/MH entitlements and services at any of these meetings in the last 6 months?
Yes
No
C45
Do you recall what specific RH/MH entitlements and services were discussed at these meetings in the last 6 months?
ANC services available to pregnant women
FP counselling and services available to women
Delivery services available at facility
JSY/JSSK program for pregnant women
Postpartum care services available to women
Vaccination for children
Other (specify)
C46
Based on your recollection, did you or someone else raise any healthcare or RH/MH issues during any of these meetings in the last 6 months?
Yes
No
C47
Have you personally raised any health care or RH/MH issues at these meetings in the last 6 months?
Yes
No
C48
Do you recall what specific health care or RH/MH issues were discussed during these meetings in the last 6 months?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies at VHSNDs/Immunization Days
Lack of equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSND
Provider absenteeism at VHSND/Immunization Day
Feedback on other aspects of services at VHSNDs/Immunization Days
Nearest public health facility operating hours irregular/inconvenient
Lack of supplies at nearest public health facility
Lack of equipment at nearest public health facility
RH/MH services not provided at nearest public health facility
Provider absenteeism at nearest public health facility
Feedback on other aspects of services at nearest public health facility
Untied funds not used effectively to improve health services
Public health facilities too far from the village
ANM does not conduct home visits
ASHA does not conduct home visits
AWW does not conduct home visits
Other (specify)
C49
In the last 6 months, has there been a Gram Sabha meeting in your Panchayat?
Yes
No
C50
How long ago was the last Gram Sabha meeting?
More than 6 and less than 9 months ago
More than 9 and less than 12 months ago
More than 12 months ago
Never had a Gram Sabha meeting
C51
Have you attended a gram sabha meeting in your Panchayat in the last 6 months?
Yes
No
C52
Have you organized a gram sabha meeting in your Panchayat in the last 6 months?
Yes
No
C53
Based on your recollection, what were the main issues discussed at these meetings in the last 6 months?
Healthcare
Drinking water
Agricultural problems
Electricity
Education
Roads
Irrigation
Sanitation/hygiene
Crime
Corruption/money waste
Land/property disputes
Caste/communal disputes
Political issues/debates
Livelihood/employment for women
Women’s groups/SHGs
Access to credit
Household and family/disputes (including domestic violence, dowry violence, molestations, public beatings or child marriage)
Other (specify)
C54
Based on your recollection, did you or someone else discuss RH/MH entitlements and services at these meetings in the last 6 months?
Yes
No
C55
Have you personally discussed RH/MH entitlements and services at these meetings in the last 6 months?
Yes
No
C56
Do you recall what specific RH/MH entitlements and services were discussed at these meetings in the last 6 months?
ANC services available to pregnant women
FP counselling and services available to women
Delivery services available at facility
JSY/JSSK program for pregnant women
Postpartum care services available to women
Vaccination for children
Other (specify)
C57
Based on your recollection, did you or someone else raise healthcare or RH/MH issues at these meetings in the last 6 months?
Yes
No
C58
Have you personally raised any health care or RH/MH issues at these meetings in the last 6 months?
Yes
No
C59
Do you recall what specific healthcare or RH/MH issues were discussed at these meetings in the last 6 months?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies at VHSNDs/Immunization Days
Lack of equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSND/Immunization Day
Provider absenteeism at VHSND/Immunization Day
Feedback on other aspects of services at VHSNDs/Immunization Days
Nearest public health facility operating hours irregular/inconvenient
Lack of supplies at nearest public health facility
Lack of equipment at nearest public health facility
RH/MH services not provided at nearest public health facility
Provider absenteeism at nearest public health facility
Feedback on other aspects of services at nearest public health facility
Untied funds not used effectively to improve health services
Public health facilities too far from the village
ANM does not conduct home visits
ASHA does not conduct home visits
AWW does not conduct home visits
Other (specify)
C60
What actions were taken based on the healthcare or RH/MH issues discussed?
Presented at higher levels
Called into toll-free number
Shared with community
Shared with other Panchayast members
Provided feedback to the providers
No action taken
Other (specify)
C61
Have you attended a gram sabha meeting in your Panchayat in the last 12 months?
Yes
No
C62
Based on your recollection, did you or someone else discuss RH/MH entitlements and services at these meetings in the last 12 months?
Yes
No
C63
Based on your recollection, did you or someone else raise any healthcare or RH/MH issues at these meetings in the last 12 months?
Yes
No
C64
Are you aware of various standing committees at the Panchayat level?
Yes
No
C65
Name the standing committees at the Panchayat level
Finance Planning Coordination Committee
Production Committee
Social Justice Committee
Education Committee
Public Works Committee
Financial Audit & Planning Committee
Village Health Sanitation and Nutrition Committee
Other (specify)
C66
Have any Panchayat meetings been organized in your Panchayat in the last 6 months?
Yes
No
C67
Have you attended any Panchayat meetings in the last 6 months?
Yes
No
C68
Based on your recollection, were any healthcare or RH/MH issues raised during any of these meetings in the last 6 months?
Yes
No
C69
Have you personally raised any RH/MH or other healthcare issues or demanded action on any RH/MH or other healthcare issues at Panchayat meetings in the last 6 months?
Yes
No
C70
Do you recall what specific RH/MH or other healthcare issues were discussed?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies at VHSNDs/Immunization Days
Lack of equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSNDs/Immunization Days
Provider absenteeism at VHSND/Immunization Day
Feedback on other aspects of services at VHSNDs/Immunization Days
Nearest public health facility operating hours irregular/inconvenient
Lack of supplies at nearest public health facility
Lack of equipment at nearest public health facility
RH/MH services not provided at nearest public health facility
Provider absenteeism at nearest public health facility
Feedback on other aspects of services at nearest public health facility
Untied funds not used effectively to improve health services
Public health facilities too far from the village
ANM does not conduct home visits
ASHA does not conduct home visits
AWW does not conduct home visits
Other (specify)
C71
What actions, if any, were taken based on the RH/MH or other healthcare issues discussed?
Presented at higher levels
Called into toll-free number
Shared with community
Provided feedback to the providers
No action taken
Other (specify)
C72
Have you heard of VHSNCs?
Yes
No
C73
If yes, can you tell me what the role of a VHSNC is?
Create awareness about nutritional issues
Carry out survey on nutritional status
Identify locally available food stuffs of high nutrient value
Inclusion of nutritional needs in village plans
Monitor the Village Health Sanitation and Nutrition Day
Hold Village Health Sanitation and Nutrition Day
Facilitate early detection of malnourished children in the community
Supervise the AWC
Act as a grievance redressal forum on health and nutrition issues
Recommend use of untied funds
Other(specify)
C74
Is there a functional VHSNC in your village?
Yes
No
C75
Have you tried to activate the VHSNC in your village?
Yes
No
C76
Are you a member of the VHSNC in your village?
Yes
No
C77
Have any VHSNC meetings been organized in your village in the last 6 months?
Yes
No
C78
Have you attended any VHSNC meetings in your village in the last 6 months?
Yes
No
C79
Have you personally raised any RH/MH or other healthcare issues or demanded action on any RH/MH or other healthcare issues at VHSNC meetings in the last 6 months?
Yes
No
C80
Do you recall what specific RH/MH or other healthcare issues were discussed at VHSNC meetings in the last 6 months?
ANM lack of knowledge/skills
ASHA lack of knowledge/skills
AWW lack of knowledge/skills
Irregular occurrence of VHSNDs/Immunization Days
Lack of supplies at VHSNDs/Immunization Days
Lack of equipment at VHSNDs/Immunization Days
RH/MH services not provided at VHSND/Immunization Day
Provider absenteeism at VHSND/Immunization Day
Feedback on other aspects of services at VHSNDs/Immunization Days
Nearest public health facility operating hours irregular/inconvenient
Lack of supplies at nearest public health facility
Lack of equipment at nearest public health facility
RH/MH services not provided at nearest public health facility
Provider absenteeism at nearest public health facility
Feedback on other aspects of services at nearest public health facility
Untied funds not used effectively to improve health services
Public health facilities too far from the village
ANM does not conduct home visits
ASHA does not conduct home visits
AWW does not conduct home visits
Other (specify)
C81
What actions, if any, were taken based on the RH/MH or other healthcare issues discussed?
Presented at higher levels
Called into toll-free number
Shared with community
Provided feedback to the providers
No action taken
Other (specify)
Satisfaction, Confidence and Perceptions of PANCHAYAT members
D01
Do you feel like your work or efforts as a Panchayat member are recognized by others?
Yes
No
D02
Who recognizes your work or efforts?
Female community members
Male community members
Other female Panchayat member
Male Panchayat members
Husband
Son
Daughter
Other female relatives
Other male relatives
Block/district level officials
Others (Specify)
D03
Do you feel respected by other Panchayat members?
Respected by male community members only
Respected by female community members only
Respected by both male and female community members
Not respected by other Panchayat members
D04
Do you feel respected by your community?
Respected by male community members only
Respected by female community members only
Respected by both male and female community members
Not respected by other Panchayat members
D05
Do you feel like you have the skills, information, and knowledge needed to perform your responsibilities as a Panchayat member, or do you feel you need more skills, information, and knowledge?
I have the skills, information, and knowledge needed to perform my duties
I need additional skills, information, and knowledge kills
Do not know
D06
What kind of additional skills, information, and knowledge do you need?
Additional information on the roles and responsibilities of Panchayat members
Effective leadership skills
Financial skills
Public speaking skills
Literacy skills
Knowledge about health rights and entitlements and the NRHM
Other training (specify)
Do not know
D07
From your experience, would you say you have the necessary authority to perform your role effectively?
Yes
No
D08
From your experience, would you say you have the necessary resources to perform your role effectively?
Yes
No
D09
Do you receive sufficient support from the government (or other higher levels of the PRI system?) to perform your responsibilities?
Yes
No
D10
Do you think your work can help improve conditions in your community?
Yes
No
D11
Do you receive sufficient support from the community to perform your responsibilities?
Yes
No
D12
Do you face any special problems in discharging your duties because you are a woman?
Yes
No
D13
What kinds of problems have you faced?
Resentment/jealousy from family/friends
Unreasonable requests from family/friends
Lack autonomy to make decisions
Pressure from political parties
Lack of cooperation by government officials
Distrust by community members
Lack of respect from colleagues
Other (specify)
D14
Since becoming a Panchayat member, what are changes have you seen in your public life?
Improved knowledge of roles and responsibilities as a PRI
Knowledge of RH/MH issues
Engagement with govt. officials and health service providers
Engagement during PRI meetings
Engagement with community
Ability to raise issues during meetings
Ability for decision making in public life
Confidence in public speaking
No change
Other (specify)
D15
Since becoming a Panchayat member, what changes have you seen in your personal life?
Mobility
Recognition among community
Economic status
Ability for decision making in personal life
Ability to make decisions for household
Increased respect within household/among family members
No change
Others (specify)
D16
How frequently do you interact with male Panchayat members?
Every week
Every 2 weeks
Every month
Less than monthly
Never
D17
How frequently do you interact with other female Panchayat members?
Every week
Every 2 weeks
Every month
Less than monthly
Never
D18
Do you feel confident discussing and negotiating about issues related to village development with other male and female Panchayat members?
Male Panchayat members only
Female Panchayat members only
Male and female Panchayat members
Neither male or female Panchayat members
D19
Do you feel confident discussing healthcare related issues with other male and female Panchayat members?
Male Panchayat members only
Female Panchayat members only
Male and female Panchayat members
Neither male or female Panchayat members
D20
Do you feel confident discussing RH/MH related issues with other male and female Panchayat members?
Male Panchayat members only
Female Panchayat members only
Male and female Panchayat members
Neither male or female Panchayat members
D21
Do you think the male and female Panchayat members you interact with are typically knowledgeable about healthcare issues?
Male Panchayat members are knowledgeable
Female Panchayat members are knowledgeable
Male and female Panchayat members are both knowledgeable
Neither male or female Panchayat members are knowledgeable
D22
Do you think other Panchayat members are knowledgeable about RH/MH issues?
Male Panchayat members are knowledgeable
Female Panchayat members are knowledgeable
Male and female Panchayat members are both knowledgeable
Neither male or female Panchayat members are knowledgeable
D23
Do you work/Have you worked with any male Panchayat members to monitor and advocate for improved RH/MH services in the ward?
Yes
No
D24
Would you work with a male PRI member to monitor and advocate for improved RH/MH services in the ward?
Yes
No
D25
Do you think male Panchayat members are informed about RH/MH services and issues in the ward?
Yes
No
D26
Do you think male Panchayat members are proactive at advocating for RH/MH services for ward members?
Yes
No
D27
Do you think working with male Panchayat members will help you raise issues or demand actions to address issues faced by ward members at Panchayat or other higher level meetings?
Yes
No
D28
Do you think working with male Panchayat members will help you raise issues or demand actions to improve RH/MH services in the ward at Panchayat or other higher level meetings?
Yes
No
D29
Do you think working with male Panchayat members will help you generate action to address issues faced by ward members?
Yes
No
D30
Do you think working with male Panchayat members will help you generate action to improve RH/MH services in the ward?
Yes
No
Interviewer Observations
E01
Please record the time when you end the interview.
E02
Please record presence of others at this point (present and listening, present but not listening, or not present)
E03
Was truthful, accurate
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
E04
Answered questions on her own
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
E05
Was able to understand the interview well
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
E06
Was interviewed without interruptions
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
E07
Please rate your opinion about the overall quality of the data.
Very low
Somewhat low
Neither low nor high
Somewhat high
Very high
Dear user, please upgrade your plan to access this feature
See Plans
Please Wait