Facility and provider overview

 
 8% of survey complete.
This survey is collecting information from health facilities that conduct surgical fistula repairs with support from the Fistula Care Plus project. The survey asks questions about fistula backlog and current demand and capacity for pelvic organ prolapse (POP) services. Data gathered through this survey will assist FC+ in planning program activities in the coming year. We anticipate that it will take 30-45 minutes to complete this survey. The FC+ project sincerely appreciates your contribution to this process. 

The survey should be completed by a senior clinician or administrator-in-charge with detailed information about current fistula treatment services. If this person does not have information about current POP needs/services, he or she should consult with clinical colleagues overseeing POP services to complete the survey. 

On this first page, please provide background information about this health facility and primary survey respondent.

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* 1. Please provide the name of the primary respondent who is completing this survey on behalf of the facility.

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* 2. Select the primary respondent's cadre/clinician title.

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* 3. What is the primary respondent's relationship to this facility?

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* 4. What is the name of the health facility for which this survey is being completed?

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* 5. What country is this health facility in?

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* 6. Where is your facility located? (Please provide the town/city and state/province)

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* 7. What type of facility is this?

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* 8. Since when has your facility been supported by the EngenderHealth Fistula Care Plus Project and/or Fistula Care Project?

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