Exit this survey Women's Experiences under GWI Snapshot 2012 1. BASIC INFORMATION SECTION The GWI and women's experiences snapshot asks a set of questions that reveal issues around the differentiated experiences of women regarding the GWI initiative so far. The tool provides a quantitative-scoring based way of documenting differently positioned women's experiences, i.e. those with and without infants or older children, comparing relative wealth and capturing disabled women's views. As well as the quantititive assessment, many questions allow for additional narrative details and there are also a few questions requiring a narrative response and finally, at the end of the survey there is room for qualitative comments/feedback. Question Title * 1. Where is the interviewee and scheme you are reporting on? Ethiopia: Bora Ethiopia: Miyo Ethiopia: Dugda Kenya: Garissa Kenya: Tana North Tanzania:Same Uganda Otuke/Olilim sub-county Uganda Otuke/Ogor sub-county Uganda Otuke/Orum sub-county Other (please specify) Question Title * 2. Data basics Name of person putting data on surveymonkey Name of key data inputer (in the field) Date data was collected(approximate(DD/MM/YY) This snapshot number Name over person interviewed Approximate age of person interviewed Name of sub-village Name of village Name of sub-district Question Title * 3. Marital status single Married Divorced Widowed Question Title * 4. Position in the household Old parent/relative living in the household Head of household, (e.g. female headed household) Wife of head of household Other adult within the household (over approx 15) Young dependant of head of household (school aged girl) Question Title * 5. Number and age bracket of children living in the household No of young children (under approx 5) No in the middle bracket (between 5 and 15) No older children (over approx 15) Question Title * 6. Your level of education no education limited informal education less than 5 years primary school Finished primary school Finished secondary school Tertiary education Currently at school (specify grade/level below) If currently at school please specify grade/level Question Title * 7. Relative to the other households in your community what status do you think your household is? relatively rich (top 25%) In the middle (middle 50%) relatively poor (bottom 25%) Question Title * 8. Are you disabled? Yes No Don't know If yes please specify in terms of form of disability Question Title * 9. Do you have access to clean water from a community water point or other system supported by the GWI initiative? Yes No (if no do not proceed with interview) Don't know (clarify and if no do not proceed with interview) Other (please specify) Question Title * 10. Does your household have a latrine which has been built by you or others as a consequence of the GWI initiative? Yes No Don't know Other (please specify) Question Title * 11. Does your household have hand-washing facilities by your latrine as a consequence of the GWI initiative? Yes No Don't know Other (please specify) Question Title * 12. Does your household use the water constructed/renovated by the GWI initiative for livestock watering? Yes No Don't know Question Title * 13. Does your household benefit from the GWI initiative in terms of water for irrigation? Yes No Don't know Question Title * 14. Does your household benefit from the GWI initiative in terms of water in other ways - if so please specify Yes No Don't know Please specify additional benefit Next