questionnaire covid-19 impact analysis

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JNA Phase 1 – Upazila Assessment Format (Feb 2014) NAWG-Multi Sectoral Anticipatory Impact Analysis of COVID-19 Key Informants Level Assessment Format The objective of Multi Sectoral Anticipatory Impact Analysis is to provide a rapid overview of the impact on other sectors and the need for assistance. Information collected through this format is the basis for decision making in the initial stages of a lock down, including the need for more detailed assessments. In the country plan, it is clear that everyone who is affected by Corona virus are dire needs of health support. But other than these due to the current lock down situation, the multi-dimensional impacts prevailed over marginalized people. Data collection process: This format is not a survey, rather it: combination of key informant interviews, field visits, and direct observation: When there is conflicting information, the team or person should fill the format in using their best idea at the time, based on their understanding of scenarios, their own professional experience, secondary data, and lessons learned from similar disasters When accessibility is challenged, but where phone communication is possible, the format can be completed over the phone with the permission of the organization/team coordinating the assessment. Conduct Survey of- 05 health personnel from selected city corporation and municipality (Can be government and Non-Government) 05 public representatives or administrative ( GoB officials ) Outlines how the impact is likely to unfold in the days and weeks to follow Uses information based on local knowledge and past experiences Basic Information 1. Name of the District: 2. Name of the Upazila/city corporation/municipality: 3. Name of the Union/ward 4. Contact information for person completing this report (Team Leader): 5. Date of this format (DD/MM/YY): Name: Designation/ organization: Contact number: 6. Category of the area (Predominantly): City Corporation Paurashava Rural/Upazila 7. Description of the Key respondent ( please multiple if there is any) Health Professional (Doctors) Nurse, Midwife Local Administration (DC/ADC/UNO/DRRO/PIO) Public Representative leader of Social service group Other service provider (GoB) Others : About Respondent and general impact 8. Do your area following the staying at home: Yes fully Some people are going out Most of the people going out Not at all 9. From which date you area is following the advised to stay in the home:

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JNA Phase 1 – Upazila Assessment Format (Feb 2014)

NAWG-Multi Sectoral Anticipatory Impact Analysis of COVID-19 Key Informants Level Assessment Format

The objective of Multi Sectoral Anticipatory Impact Analysis is to provide a rapid overview of the impact on other

sectors and the need for assistance. Information collected through this format is the basis for decision making in the

initial stages of a lock down, including the need for more detailed assessments. In the country plan, it is clear that

everyone who is affected by Corona virus are dire needs of health support. But other than these due to the current lock

down situation, the multi-dimensional impacts prevailed over marginalized people.

Data collection process:

This format is not a survey, rather it:

combination of key informant interviews, field visits, and direct observation:

When there is conflicting information, the team or person should fill the format in using their best idea at the time,

based on their understanding of scenarios, their own professional experience, secondary data, and lessons learned

from similar disasters

When accessibility is challenged, but where phone communication is possible, the format can be completed over

the phone with the permission of the organization/team coordinating the assessment.

Conduct Survey of-

05 health personnel from selected city corporation and municipality (Can be government and Non-Government)

05 public representatives or administrative ( GoB officials )

Outlines how the impact is likely to unfold in the days and weeks to follow

Uses information based on local knowledge and past experiences

Basic Information

1. Name of the District: 2. Name of the Upazila/city corporation/municipality:

3. Name of the Union/ward

4. Contact information for person completing this report (Team Leader): 5. Date of this format (DD/MM/YY): Name: Designation/ organization: Contact number:

6. Category of the area (Predominantly):

City Corporation Paurashava Rural/Upazila

7. Description of the Key respondent ( please multiple if there is any)

Health Professional (Doctors)

Nurse, Midwife

Local Administration (DC/ADC/UNO/DRRO/PIO)

Public Representative

leader of Social service group

Other service provider (GoB)

Others :

About Respondent and general impact

8. Do your area following the staying at home:

Yes fully Some people are going out Most of the people going out

Not at all

9. From which date you area is following the advised to stay in the home:

Page 2 of 9

10. What are the most common top 3 occupations in your area?(rank 1.2.3

Day laborer Rickshaw/van puller Transport worker

Small business Domestic Worker Beggar

Business Services

Informal service (who has no income now) sex worker, transgender group

Any other (Please mention)

Small Business = peddlers, local grocery shop kipper/worker, rickshaw mechanics, street

food/vegetable sellers, beauty salon/parlor, tailoring, small garments, transport worker, sex

worker, transgender group….)

11. Due to this current situation , do you think people’s livelihood are impacted

Yes No Do not Know

12. Which livelihood are being impacted or has no income now? Select Top 3 3

Day laborer Rickshaw/van puller Transport worker

Small business/hawker Domestic Worker Beggar

Business Services

sex worker, transgender group

Any other (Please mention)

Small business/wage earners: Peddlers, local grocery shop kippers, Farmer who sells vegetables, rickshaw mechanics, street food/vegetable sellers, beauty salon/parlor, tailoring, small garments,

13. Are there any hygiene or cleaning or

distancing measures taken or being applied in

the markets?

Yes fully In some market

Most of the market Not at all

Don’t Know

14. Do you anticipate (or already happening)

increase of social unrest, theft, robbery,

abduction?

Already happening Happening (very limited cases

Wil increase No Probability in future

Medium Risk in Future Very High Risk in future

15. Whats are the current major challenges for your area now?

Financial accessibility Physical accessibility Price of daily essential is too high People has no work People are not aware Basic services are not available General health service are hindered Daily Income of the Small business/wage earners People are not staying at Home

Other……………………………….

Health Service Provider Only

16. Are you or your organization still open and treating patient?

Yes, except patient with COVID-19 symptoms

Yes, for all patients

No

Currently not providing any services, but will start very soon.

17. Do you know how highly contagious COVID-19 is?

Yes No

Page 3 of 9

18. Has your organization provided you with PPE (Personal Protective Equipment)?

Yes No Not applicable

19. has the number of patients accessing you or your facility changed?

Similar as before

less than normal time

Higher than normal time

Others…

20. Do you feel safe while you are serving people as

the COVID-19 situation is evolving. Not at all

Somehow

Totally safe

I am confused

Not Applicable 21. Do you have these facilities? Are you using them

as instructed by WHO?

Washing Hands with soap for 20 seconds

Have hand sanitizer

Keep social and physical distances

Maintain cold and cough time hygiene Universal screening of all patients for fever and respiratory

symptoms and separating those possibly contagious from those who seem healthy

Provided PPE

Provided mask

All of these

I don’t know

22. Are you interested/comfortable to serve COVID-19 affected people?

Yes, If I have proper PPE

No, its too risky

Depends on the decision of higher authority

I don’t know

Others

23. Are you treating COVID-19 or people with COVID-19 Symptoms?

Yes No Not applicable

24. Have you ever been trained or given guidance on COVID19 infection control and prevention measures when caring for patients?

Yes No Not applicable

25. Number of people from Different age group Hospitalized or quarantined at facility. (Only ask to Government Hospital or staff from Civil Surgeon office)

0 to 59 month 5 to 18 Years

18 to 49yrs 49 to60 years

Above 60 years

Don’t Know

26. Number of people affected by corona virus? (Only ask to Government Hospital or staff from Civil Surgeon office)

0 to 59 month 5 to 18 Years

18 to 49yrs 49 to60 years

Above 60 years

Don’t Know

29. Any other concern

Page 4 of 9

WASH (Ask both Health Professional and Public representatives)

30. Do you think that water supply, sanitation will be disrupted in your areas due to the lock down restriction?

Yes No Do not know

32. Do the people in your areas know about the proper hygiene and practices to stay safe from COVID-19?

Washing Hands with soap for 20 seconds Wash hand with soap when we arrive home. Wash hands after touching anything that might get touched

by other people. Use hand sanitizer when go out After coming home keep your shoes in different box, wash

your hands first, then clean the parts of the house you have touched (door lock, light switch, keys), clean the packets you brought from outside, then get a clean shower with chlorinated water.

Avoid touching eyes, nose and mouth with bare hands. Wash hands after touching money Keep money into a different disposable packet temporarily

for this period. (If money carries virus, it might infect the moneybag and other things attached)

Keep social distance Don't go to public places Maintain cold and cough time hygiene Use properly chlorinate water Drink purified water Clean the toilet at least once a day with bleaching powder.

Clean the toilet of a sick person twice a day with bleaching powder. Use reusable hand-gloves while cleaning.

Flash your toilets properly.

33. Are hygiene materials easily accessible? Yes No Do not know

30.1 If No, please mention the reason like closed shop, cost etc

Closed shops

There are no hygiene materials in market

Price is too high

People are not aware and sensitive to buy

People don’t have financial solvency to buy

Other

Do not know

Shelter and Essential Non-food Items( Ask both Health Professional and Public representatives)

35. Do you have information about floating or displaced people?

Yes No Do not know

36. Do you think people have sufficient living space at their home?

Yes No Do not know

37. Is there any need or plan to prepare safe site which can be used as quarantine or isolation facilities? (e.g setup a camp in open ground, transform indoor stadium/ auditorium, hall room

Yes No Do not know

Page 5 of 9

into temporary isolation facilities)

34. Is there any need of essential Non Food Items (Bed, uthesil

Yes No Do not know

35. If yes, what are the NFIs Bed

Mosquito Net

Kitchen utensils

Other (Please mention)

Food Security and Livelihoods (Ask only Public representatives)

38. Do you think people have sufficient food at their home?

Yes No Do not know

Some People don’t have

39. If No, which income group are lacking with food?

Day laborer Rickshaw/van puller Transport work

Small business Beggar Business

Services (GoB) Services (Non-GoB)

Domestic Worker) Sex worker, transgender group…

Other (Please mention)

Small Business = peddlers, local grocery shop kippers, rickshaw mechanics, street

food/vegetable sellers, beauty salon/parlor, tailoring, small garments, ,.)

40. If No, What type of challenges you they are facing

for food? Don’t have money to purchase food

Market is close

Food item is not available in the market

Transportation is closed (can’t go to the market)

Other (Please mention)

41. Are markets in the affected area generally functioning?

Fully Partly

Not functioning Do not know

42. Do markets have stocks of food? Yes No Do not know

43. Are markets generally accessible by the local community?

Yes No Do not know

44. What is the status of the price in your local market?

Price of Daily essential food remain same

Price of Daily essential food is very high

Price is low

Price of hygiene materials is high

Don’t know

Other (Please mention)

Page 6 of 9

Gender-based Violence (Ask both Health Professional and Public representatives)

If possible ask (appropriate for Officials from DWA, Police, Legal Aid Service Provider, Women CBOs Leader, Loal Government)

45. Are the One Stop Crisis Center / centers in your locality functional?

Yes No Do not know

46. Are the Women Help Desk at police station open?

Yes No Do not know

47. Are you receiving incidences/reports of domestic violence, child abuse, child marriage and violence against women since the past two weeks?

Yes No Do not know

48. Has the occurrence increased due to the COVID19 outbreak situation?

Yes No Do not know

49. Are you aware of any incidences of gender based violence/ violence against women and girls in your locality?

Yes No Do not know

50. How are you monitoring the safety of women, girls and the persons with disability, third gender and ethnic minority?

We having regular updates

We are not monitoring

Do not know

51. Has there been any incidences of stigma and discrimination associated with COVID19 against women, girls, persons with disability, third gender and ethnic minority?

Yes No Other

Child Protection (Ask both Health Professional and Public representatives)

52. Are children staying at home in your areas? Yes No, they are playing with other kids

Do not know

53. Do you think cases of children abused, violence, neglect, abandoned increased as a result of coronavirus Yes No Do not know

54. Do you think beating by parents or guardians have increased due to this lock down?

Yes No Sometimes Do not know

Health and Nutrition (Ask both Health Professional)

55. Do all people know where to contact if you show COVID-19 symptoms?

Yes No Do not know

56. Are all the health facilities are providing similar support like normal time?

No Yes Do not know

57. Is/are health/nutrition facilities accessible by all? Yes No Do not know

Page 7 of 9

58. Are the people facing mental stress due to this situation?

Yes No Do not know

SRHE (Ask both Health Professional Only)

59. What is the status of the regular SRH and birth services pregnant and/ or lactating mothers are receiving ?

Remains the same, meeting the need

This service is not enough now, not meeting the need

women are not coming to the health care facility

Do not know

60. Are there stock or availability of sufficient personal dignity items (ex. Underwear, Essential Covering Garments, Menstrual hygiene kit)?

Yes No Do not know

61. Do you 24/7 availability of EmONC (emergency obstetric and newborn care ) services?

Yes No Do not know

62. Have you heard of any mothers dying during last week birth in your area?

Yes No Do not know

Logistics

63. Do all the road are accessible in you areas? Yes No Do not know

64. Are the market is accessible in your areas? Yes No Do not know

Early recovery

65. Does small business/organization get affected I your area due to this situation?

Fully Partially Not

significantly 66. What are your most important SMEs/business functions and how quickly can they resume?

a Name: 1

Week

2 Weeks 3 Weeks Longer

B Name:

C Name:

D Name:

E Name:

F Name:

G Name:

Available Resources, Coping Strategies and Support Required

67. Outline resources available at the Upazila level in the following sectors:

Sector Is extra assistance required?

Comment on what assistance is required.

a. WASH

Yes

No

Do not know

b. Shelter and non-food items

Yes

No

Do not know

Page 8 of 9

c. Food

Yes

No

Do not know

d. Livelihoods Yes

No

Do not know

e. Education

Yes

No

Do not know

f. Gender-based Violence

Yes

No

Do not know

g. Health

Yes

No

Do not know

h. Nutrition Yes

No

Do not know

i. SRH Yes

No

Do not know

j. General Protection and Security

Yes

No

Do not

68. How do you describe the immediate overall relief needs in this area (needs in coming days and weeks):

Serious need of assistance

Some need of assistance

Needs can be managed with resources available at Upaziladistrict level

69. Which appear to be the highest priority for immediate assistance? (rank up to, but no more than three)

Water Sanitation and Hygiene

Shelter Bedding and blankets

Clothing Food

Livelihoods Education

Health Gender-based Violence

Information Child Safety

SRH Others

70. How would you describe the recovery needs in this area (needs in coming three or more months):

Serious need of assistance

Some need of assistance

Upazila and communities coping strategies will be enough

71. Any further comments or observations:

72. Information sources (please indicate the sources of information used in compiling this report)

Deputy Commissioner Upazila Parishad Chairman

DRRO

Upazila Parishad/ Ward Member

Civil Surgeon

Other………………………………………………………………………

UNO (please name agency)

Zila Parishad Chairman

PIO

Government Hospital Doctor

Doctor, Non-Government Hospital

Page 9 of 9

Multi Sectoral Anticipatory Impact Analysis of COVID-19 Community Level Format

The objective of Multi Sectoral Anticipatory Impact Analysis is to provide a rapid overview of the impact on other

sectors and the needs for assistance. Information collected through this format is the basis for decision making in the

initial stages of a restricted movement and social distances, including the need for more detailed assessments. In the

country plan, it is clear that everyone who is affected by Corona virus are dire needs of health support. But other than

these due to the current lock down situation, the other impacts prevailed over marginalized people.

Data collection process:

Target people who lost their livelihood (wage earners, small business, peddlers, local grocery shop kippers &

workers, women domestic workers, workers in eatery/hotel business, carpenter, tanner/shoemaker,

rickshaw/van/CNG puller, rickshaw/van/CNG/automobile mechanics, bus/truck drivers, street food/vegetable

sellers, beggar, beauty salon/parlor, tailoring, small garments, transport worker, sex worker, transgender group….)

If possible, please interview the people in the hard to reach areas

Fill in one format for each family

When there is conflicting information, the team or person should fill the format in using their best idea at the time,

based on their understanding of scenarios, their own professional experience, secondary data,

When accessibility is challenged, but where phone communication is possible, the format can be completed over the phone with the permission of the organization/team coordinating analysis First Introduce yourself and then make it clear that we are only collecting information for understanding the situation. Never promise them about the support.

Basic Information

1. Name of the District: 2. Name of the Upazila/Municipality

3. Name of the Union/Municipal ward

4. Contact information for person completing this report (Team Leader): 5. Date of this format (DD/MM/YY): Name: Designation/ organization: Contact number:

6. Category of the area (Predominantly):

City Corporation Paurashava Rural/Upazila

7. Description of the household ( please multiple if there is any)

Male Headed Female headed

Elderly headed Child head

PWD(Disable HH) Marginal occupation

Ethnic/ minority Floating

Others :

About Respondent and general impact

8. Are you following govt advised lockdown

Yes No

9. From which date you are advised to stay at home):

10. What’s are the occupation of your household head

Day laborer Rickshaw/van puller Transport worker

Small business Domestic Worker Beggar

Business Services

Sex worker, transgender group

Any other (Please mention)

Page 2 of 10

Small Business = peddlers, local grocery shop kipper/worker, rickshaw mechanics, street

food/vegetable sellers, beauty salon/parlor, tailoring, small garments, transport worker, sex

worker, transgender group….)

11. Due to this current situation , is your livelihood affected?

Yes No

12. How much is your household income affected?

I have no income now

I have less income than before

My income is not affected

13. Does you or your family have saved money in your hand.

Yes No Other………………………………………………………………………..

13.1 If yes, how long your family can survive with that saving. (Meeting basic needs)

Can survive more than one month Can survive only one month Can survive only 15 days Can survive only 7 days Other………………………………………………………………………..

14. What’s is the current major challenges for you and your family now?

Financial accessibility Physical accessibility Price of daily essential is too high Family members are not following

stay at home Not getting medical treatment Other……………………………….

15. Do you have any family members who work in the city/abroad and came back to your home or to your village/town

Yes No Other………………………………………………………………………..

16. Are you maintaining the stay home rules or maintaining social distance?

Yes No

16.1 No, please state ? For livelihood For purchasing groceries

For Prayer Don’t like to stay in the home

For treatment I don’t believe this

Others (Please mention)

17. Are there any hygiene or cleaning or distancing measures taken or being applied in the markets?

Yes fully In some market

Most of the market Not at all

Don’t Know 18. Do you anticipate (or already

happening) increase of social unrest, theft, robbery, abduction?

Already happening Happening (very limited cases

Will increase No Probability in future

Very High Risk Very High Risk

WASH

19. Do you have a water point? If yes is it functional? What to do if not functional?

Yes No Limited accessibility to WASH facilities Non availability of hygiene products Insufficient number of water point in the community

Page 3 of 10

Water point is too far

Higher que or waiting time at water point

others

21. Do you know the barrier measures to prevent against COVID-19?

Washing Hands with soap for 20 seconds

Wash hand with soap when we arrive home.

Wash hands after touching anything that might get touched by other people.

Use hand sanitizer when go out Use mask when go out After coming home keep your shoes in different box, wash

your hands first, then clean the parts of the house you have touched (door lock, light switch, keys), clean the packets you brought from outside, then get a clean shower with chlorinated water.

Avoid touching eyes, nose and mouth with bare hands. Wash hands after touching money Keep money into a different disposable packet temporarily

for this period. (If money carries virus, it might infect the moneybag and other things attached)

Keep social distance Don't go to public places Maintain cold and cough time hygiene Use properly chlorinate water Drink purified water Clean the toilet at least once a day with bleaching powder.

Clean the toilet of a sick person twice a day with bleaching powder. Use reusable hand-gloves while cleaning.

Flash your toilets properly. Keep the required distance with the sick people. Be very careful while disposing the waste of the sick people. Keep your house and latrine clean Avoid spitting, as it spreads potentially infected water

particles Know all of these I don’t have to I do not know

22. Do you maintain proper hygiene practice? Washing Hands with soap for 20 seconds Use hand sanitizer when go out Have bleaching powder/detergent or any alkali materials. Maintain cold and cough time hygiene Keep your house and latrine clean Don’t wash hands Don’t have soap or hand sanitizer Others

23. Are hygiene materials (soap/ hand sanitizer) easily accessible? If No, please mention the reason like closed shop, cost etc

Yes No

Shelter and Essential Non-food Items

26. Do you have sufficient living space at their home in consideration to stay at home ?

Yes No Do not know

Page 4 of 10

27. Is there any need or plan to prepare safe site which can be used as quarantine or isolation facilities? (e.g setup a camp in open ground, transform indoor stadium/ auditorium, hall room into temporary isolation facilities)

Yes No Do not know

28. Is there any need of essential Non Food Items Yes No Do not know

29. If yes, what are the Non Food Items Bed

Mosquito Net

Kitchen utensils

Other (Please mention)

Food Security and Livelihoods

30. Do you have sufficient food at your home?

Yes No Do not know

If Yes How many days _____ Rice ____Days, Oil______ Days, Pulses /Lentil _____ Days

31. How many food item do you have in a meal? Number of meal

32. If you do not have sufficient food, What type of challenges you are having for food

Don’t have money to purchase food

Market is closed

Food item is not available in the market

Transportation is banned (can’t go to the market)

Other (Please mention)

33. Are markets functioning for procuring food items?

Fully Partly

Not functioning Do not know

34. Are markets functioning for procuring agriculture inputs (seeds, fertilizer, animal feed, veterinary medicine, vaccines, tools etc.)?

Fully Partly

Not functioning Do not know

35. Can you sell your products at the market Yes No

Partly N/A

If no why _________

37. What is the status of the essential food (prices of

rice, lentils and oil)price in your local market? Price of Daily essential food remain same

Price of Daily essential food is very high

Price is low

Don’t know

Other (Please mention) 38. What is the status of the vegetable price in your

local market? Price of Daily essential food remain same

Price of Daily essential food is very high

Price is low

Don’t know

Other (Please mention) 39. What is the status of the protein food price in

your local market (eg. Milk Egg, Chicken, Fish? Price of Daily essential food remain same

Price of Daily essential food is very high

Price is low

Don’t know

Other (Please mention)

Page 5 of 10

40. Is cooking fuel for households are available (supply gas, LPG, wood)?

Yes No Partly

Education

41. Do you have any school going children at your home?

Yes No Do not know

42. Have you heard of any home-based remote learning initiatives (TV, online, radio, mobile) for your children?

Yes No Do not know

42.1 If Yes, Which One( TV, online Radio

mobile Other

43. Does your child attend any learning activities

while at home through above mentioned platforms?

Yes No Do not know

43.1. If Yes, Which One( TV online Radio mobile Other

44. Do you (as parent) support your child for his/her continuous learning (homework, school lessons etc)

Yes No Do not know

45. Have you engaged any private tutor to assist your children in these school closer days?

Yes No Do not know

46. Is there any regular communication from school/college to your family about learning continuity of your children;

Yes No Do not know

47. Are there children of the early grades (PPE. Lower primary education) in your family?

Yes No Do not know

48. What kind of support do you think would be most

beneficial to support continuation of your

children’s education/learning?

_______________________________

Gender Relation Gender-based Violence ( ask female member of the households and please ensure interview take place without presence of husband on interview time)

47. Is the safety and security of women and girls an issue in this current lock down situation?

Yes No Do not know

48. Do you have sufficient personal hygiene item?

Yes No Do not know

49. If no, what items do you need? Please mention.

Page 6 of 10

50. Do you know where to ask for help in case of personal health/ women health issues?

Yes No Do not know

51. Do you know where to ask for support / help, in case you are abused or ill-treated by someone in the family or outside anywhere?

Yes No Do not know

52. If yes, where do you seek help? Please mention.

53. Do you have access to phone or internet to call someone for support?

Yes No Other

54. As a result of COVID19, has the number of hours devoted to the following activities increased?

Cooking Cleaning

Taking care of children Taking care of

sick/disabled/elderly

Collecting/buying food and other essential items

Remain Same

Child Protection

63. Is child staying at home? Yes No, they are playing with other kids

64. Do you think beating by parents or guardians have increased due to this lock down?

Yes No Sometimes Do not know

Health and Nutrition

65. Do you know where to contact if you show COVID-19 symptoms?

Yes No

66. Do you know if the health facilities are providing

regular services, as they did prior to covid-19? No Yes Do not know

67. Is/are health/nutrition facilities accessible? Yes No Do not know

68. Are there any underlying health concerns at you households?

(information should come from normal knowledge; if other, please specify)

Malnutrition Communicable diseases

Do not know Asthma Respiratory tract issues infections No underlying concerns Other……………………………………………………………………………….

69. Are there facing mental stress due to this situation? Yes No Do not know

70. If there is lactating woman in the house, are they

able to breastfeed their child?

Yes No Do not know

71. If you have a small child between 6-23 months are you able to provide diverse food (give example)

Yes No Do not know

Example: 72. Are women and children able to access health and

nutrition services at the health facilities

Yes No Do not know

73. If you have a small child between 0-23 months, when did you last went for immunization -

Yes No Do not know

Page 7 of 10

Sexual Reproductive health in Emergency (SRHE)

74. Do you have any family member who is pregnant or lactating mother ?

Yes No Not Applicable

75. If yes, do they need regular checkup or have critical condition?

Yes No Not Applicable

76. Do you have accesss to Doctor or medical if any health support required?

Yes No We depend on local doctor

Local birth attendant

77. Are women likely to be without sufficient personal dignity items (ex. Underwear, Essential Covering Garments, Menstrual hygiene kit)?

Yes No Do not know

Logistics

17. Do all the roads are accessible by you? Yes No

18. Are the markets are accessible by you? Yes No

Early recovery

19. Does your business/organization get affected due to this situation?

Fully Partially Not

significantly 20. What are your most important SMEs/business functions and how quickly can you resume?

Name: 1

Week

2 Weeks 3 Weeks Longer

21. Household average Monthly Income in January-February 2020

22. Household total Monthly Expenditure in January-February 2020

Communication 23. What type of information do you need to help you

to cope up with the current situation? This would be a multiple response questions. (Tick on the appropriate)

24. Where are you currently getting information to cope with the situations? (Tick on the appropriate)

How to stay safe from COVID-19

General news on what is happening here

Security here

Where to contact if I have COVID-19 Symptoms

What are treatment for COVID-19

What is Corona Virus

How to communicate with people who are in a different

place

How to register for aid

Information on health

Food prices

Local crop/livestock prices

Weather

How to get healthcare/medical attention

How to stay safe to prevent attack, sexual violence or

harassment

How to stay safe to from Domestic Violence

How to access education

How to find work

How to get transport

Television

Newspaper

Mobile Phone (Call or SMS)

Facebook Pages

Community/religious leaders

Local Government Leaders

NGO workers

SW/FM Radio

Community Radio

Sign Boards

Internet

Word of Mouth (friends, family, neighbors)

Other (please specify)

___________________

Page 8 of 10

How to get money/financial support

Information about relocation

Do not know

Other (please specify)

_______________________

Assistance, Unmet needs and current Priorities (overall)-8 Question

Questions Option / Checklist Observations/ Other

25. Since the movement shut down or lock down, has there been any assistance provided your areas.

Yes No I don’t need support

26. If yes, by whom? (Tick all that are appropriate)

Religious group Government

NGO / UN / BDRCS Other groups (e.g. neighbor, CBO, nearby village, local philanthropist)

Do not know

27. If you received any What Type of supports/assistances you received?

Food Cash Education Livelihood

Health Shelter Community infrastructures

Water Sanitation and Hygiene (Soap. Detergent etc.) Other (Please specify)…

I didn’t receive any

28. Were the supports /assistances timely and enough to meet the needs in your household?

Fully met the needs for now Partially met the needs

Only met some needs Not at all

80. If you didn’t receive any support, how your household managed to meet those needs or what were the challenges? Or what were the Negative coping mechanism.

Put tick all that apply and Rank accordingly: 1st, 2nd, 3rd, 4th, Only………………….. )

Distress selling of livestock Migrate to other place

Distress selling of land Skip meal

didn’t access medical treatment Child labor / daily labor

Start begging Seeking support from neighbor

Unhygienic life Taking Loan (micro Credit)

Borrowing Money Selling other resources (E.g. shop, household materials) Sell transport Vehicle Reduce meal portion Others (Please specify)…………

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81. What are the top priorities (needs) right now for this community? (Put tick of utmost need and Rank accordingly: 1st, 2nd, 3rd, 4tt, 5th, 6th , 7th 8th ………………….. )

Food support Hygiene support

Restoration of livelihood activities Access to markets to sell

Access to markets to buy goods Health care services (incl.

reproductive health )

Support for safety and security (feelings of fear and insecurity)

Alternative education for children Transport and access to

markets

Health and hygiene materials/commodities (incl. menstrual hygiene materials) Protection of children and adolescent girls and women from violence and exploitation

Clothing, footwear, bedding Feed for livestock

Fuel and cooking materials Information about COVID-19

Other (specify)………………………………………………………

Please write others here and ranked accordingly…

82. Should lockdown continue for longer, what do you anticipate to be your top priorities?

Rank accordingly: 1st, 2nd, 3rd, 4tt, 5th, 6th , 7th 8th ………………….. )

Food support Hygiene support

Restoration of livelihood activities Access to markets to sell

Access to markets to buy goods Health care services (incl.

reproductive health )

Support for safety and security (feelings of fear and insecurity

Children returning to school Transport and access to

markets

Health and hygiene materials/commodities (incl. menstrual hygiene

materials) Protection of children and adolescent girls

and women from violence and exploitation

Clothing, footwear, bedding Feed for livestock

Fuel and cooking materials Information about COVID-19

Other (specify)………………………………………………………

Please write others here and ranked accordingly…

83. What types of intervention modalities would be more effective?

Direct money Mobile based money

In kind food support In kind NFI support

Hints: Don’t

tell them the

options

84. How would you describe the needs in this household(needs in coming three or more months):

Serious need of assistance

Some need of assistance

No Need, Communities coping strategies will be enough

34. Any further comments or observations:

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35. Information sources (please indicate the Household head name an name of the person you interviewed.)