(04) pkk(cf)
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EDITOR:__________________________CONFIDENTIAL
INTERVIEWER:______________________
INDONESIANFAMILYLIFESURVEY2000COMMUNITYANDFACILITYSURVEY
DESA/KELURAHANWOMENSGROUP(PKK)
SECTIONS: LK, KR, I, J, PM, KSR,CP
COMMID00
NAMEOF DESA/KELURAHAN : _____________________________________
INTEVIEWBOOKPKK
INTERVIEWI INTERVIEWII INTERVIEWIII Interviewlanguagecode:
DATE:/
DAY/MONTH
/
DAY/MONTH
/
DAY/MONTH
CK1. Interview was entirely/mostly conducted in
what language?
00. Indonesian
01. Javanese
02. Sundanese
03. Balinese04. Batak
05. Bugis
06. Chinese07. Maduranese
08. Sasak
09. Minang10. Banjar
11. Bima
12. Makassar
13. Nias
14. Palembang
15. Sumbawa
16. Toraja17. Lahat
18. Other South Sumat
19. Betawi20. Lampung
96. No other
91. Other____________
TIMEBEGIN:/
HOUR/MINUTE
/
HOUR/MINUTE
/
HOUR/MINUTE Other___________________
TIMEFINISHED:/
HOUR/MINUTE
/
HOUR/MINUTE
/
HOUR/MINUTE
CK2.Other language used (if any):
INTERVIEWRESULTS:
Other___________________
INTERVIEWRESULTSCODE FP5. EDITEDSTATUSBYEDITOR FP6. MONITORINGBYLOCALSUPERVISOR FP7. DATAENTRYSTATUS
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1. Completed
2. Partially completed___________________________
4. Refused
1. Edited, no correcton necessary
2. Edited and corrected
3. Edited, but not corrected
4. Not edited,___________________________
Yes No
a. Observed....... .................. ..... 1 3
b. Edited........ .................. ......... 1 3
1. Entered, no correction necessary
2. Entered and corrected
3. Entered, but not corrected________
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SECTIONLK: CONTROLSHEET
SAMPLINGINFORMATION CODE
LK01. Province_____________________________________
LK02. Kabupaten/Kotamadya_____________________
LK03. Kecamatan ___________________________________
LK04. Village/Township ______________________________
LK05. Region : 1. Urban 2. Rural
SUPERVISION CODE
LK15. Name of Interviewer : _______________
LK16. Name of Editor : ____________________________________
LK17. Name of Local Supervisor : ____________________________
LK18. Name of Assistant Field Coordinator: ____________________
LK19. Name of Field Coordinator : ___________________________
PKK BOOKPKK- 3 COM
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SECTIONKR:IDENTITYOFRESPONDENT
(KRTYPE) RespondentA RespondentB RespondentC
KR01. Name of respondent_____________________________________ _____________________________________ __________________________________
KR02. AgeYears Years Years
KR03. Position in Village/Township PKK1 2 3 4 __________________ 1 2 3 4 __________________ 1 2 3 4 __________________
KR04. Length of tenure in position
Years
Years
Years
KR05. Highest level of education attended 01 02 03 04 05 06 60 61 62 63
11 12 13 14 72 73 90 98 10
01 02 03 04 05 06 60 61 62 63
11 12 13 14 72 73 90 98 10
01 02 03 04 05 06 60 61 62
11 12 13 14 72 73 90 98 1
KR06. Highest class/grade of education completed00 01 02 03 04 05 06 07 96 98 00 01 02 03 04 05 06 07 96 98 00 01 02 03 04 05 06 07 96
KR07. Length of time residing in this village/townshipYears Years Years
(KRTYPE) RespondentD RespondentE RespondentF
KR01. Name of respondent_____________________________________ _____________________________________ __________________________________
KR02. AgeYears Years Years
KR03. Position in Village/Township PKK1 2 3 4 __________________ 1 2 3 4 __________________ 1 2 3 4 __________________
KR04. Length of tenure in positionYears Years Years
KR05. Highest level of education attended 01 02 03 04 05 06 60 61 62 63
11 12 13 14 72 73 90 98 10
01 02 03 04 05 06 60 61 62 63
11 12 13 14 72 73 90 98 10
01 02 03 04 05 06 60 61 62
11 12 13 14 72 73 90 98 1
KR06. Highest class/grade of education completed00 01 02 03 04 05 06 07 96 98 00 01 02 03 04 05 06 07 96 98 00 01 02 03 04 05 06 07 96
KR07. Length of time residing in this village/townshipYears Years Years
CodeKR03:
1. Head of PKK
2. Organizer of PKK
3. Cadre of PKK
4. Other, mention ___________________
CodeKR06:
Never completed class/grade 1............... 00
1 .............................................................. 01
2 ............................................................. 02
3 .............................................................. 034 .............................................................. 04
5 .............................................................. 05
6 .............................................................. 06Graduated ............................................... 07
CodeKR05:
No school............................................. 01
Elementary School (SD) ..................... 02Junior High School General............. 03
Junior High School - Vocational.......... 04
Senior High School - General.............. 05
Senior High School - Vocational.......... 06
University S1 (Bachelor).......................61
University S2 (Masters)........................ 62University S3 (Doctorate)......................63Kejar Paket A (Adult Educ. A)...............11
Kejar Paket B (Adult Educ. B)...............12
Open University.................................... 13Islamic School (Pesantren)...................14
Islamic Junior/Senior High School
(Madrasah Tsanawiyah)....................Kindergarten.........................................DONT KNOW......................................
Other, mention_____________________
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SECTIONKR:IDENTITYOFRESPONDENTNo school................................................. 96
DONT KNOW.......................................... 98D1, D2, D3 (Junior College)................ 60 Islamic Elementary School
(Madrasah Ibtidaiyah).........................72
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SECTIONI: HISTORYOFTHEPRESENCEOFSCHOOLS
Now,wewouldliketo askaboutthehistoryof thepresenceof educationfacilitiesin thisvillage.
A. ELEMENTARYSCHOOL B. JUNIORHIGHSCHOOL C. SENIORHIGHSCHOOL
I11. When was the first [] open in this
village/township or the neighboring
village/township?
1. I13 THISCOLUMN8. DONT KNOW
1. I13 THISCOLUMN8. DONT KNOW
1. I13 THISCOLUMN8. DONT KNOW
I12. Approximately how many years agohas the first [] open in this
village/township or the neighboring
village/township?
years................................... 1
DONT KNOW.................................... 8
years................................... 1
DONT KNOW.................................... 8
years................................... 1
DONT KNOW.................................... 8
I13. With regards to the [] available to
the community in this
village/township, how many [] can
be used by the people from this
village/township?
facilities............................... 1
DONT KNOW.................................... 8
facilities............................... 1
DONT KNOW.................................... 8
facilities............................... 1
DONT KNOW.................................... 8
I14. What are the names of the []? 1._________________________________________
2._________________________________________
3._________________________________________
4._________________________________________
5._________________________________________
6._________________________________________
7._________________________________________
8._________________________________________
9._________________________________________
10.________________________________________
11.________________________________________
12.________________________________________
13.________________________________________
14.________________________________________
I11 NEXTCOLUMN
1._________________________________________
2._________________________________________
3._________________________________________
4._________________________________________
5._________________________________________
6._________________________________________
7._________________________________________
8._________________________________________
9._________________________________________
10.________________________________________
11.________________________________________
12.________________________________________
13.________________________________________
14.________________________________________
I11 NEXTCOLUMN
1.___________________________________
2.___________________________________
3.___________________________________
4.___________________________________
5.___________________________________
6.___________________________________
7.___________________________________
8.___________________________________
9.___________________________________
10.__________________________________
11.__________________________________
12.__________________________________
13.__________________________________
14.__________________________________
RESPONDI. INTERVIEWERNOTE:
PKK,PKK_I BOOKPKK- 6 COM
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SECTIONI: HISTORYOFTHEPRESENCEOFSCHOOLS
CIRCLETHELETTERTHATCORRESPONDSTOTHERESPONDENTTHATANSWEREDSECTIONI A B C D E F
PKK,PKK_I BOOKPKK- 7 COM
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SECTIONJ: HISTORYOFTHEPRESENCEOFHEALTHFACILITIES
Now,wewouldliketo askabouthistoryof theexistenceof healthfacilitiesin thisvillage.
J10a. Is there a Village Midwife (Bidan
Desa) located in this village?
Yes...................................................1J10b
No..................................................... 3
J10a1. Has there ever been a village midwife
in this village?No..................................................... 3J11
Yes...................................................1
J10a2. When did the village midwife leave
this village?1./
Month Year
8. DONT KNOW
J10cJ10b. How many village midwives are
located in this village?1. people
8. DONT KNOW
J10c. In what year did the first village
midwife begin to practice in this
village?
Year..........................1J10e
DONT KNOW..................................8
J10d. How many years has the village
midwife practiced in this village? Years.................................. 1
DONT KNOW..................................8
J10e. What type of support does/did the
village midwife (the first one) receive
from the local people or the village
office?
NONE...............................................A
Housing............................................B
Food.................................................C
A place to practice............................D
Salary/cash...................................... F
Other,________________________E
J19. In this village is there a Delivery Post
(Pos Bersalin Desa/Polindes)?No..................................................... 3 J11
Yes...................................................1
J19a. In what year was the first Polindes
established in this village?Year ........................1J19c
DONT KNOW..................................8
J19b. How many years has the Polindes
operated in this village? years..................................1
DONT KNOW..................................8J19c. How many beds does the Polindes
have? beds................................... 1
DONT KNOW..................................8
J11. How many Health Posts (Posyandu)
exist in this village? ............................................1
DONT KNOW..................................8
PKK BOOKPKK- 8 COM
J13. How many times have staff from
Health Centers (Puskesmas) visited
the Posyandu in the last year?
times.................................... 1
DONT KNOW......................................... 8
J13a. In comparison to the previous years,
have visits in the past 12 months from
the Puskesmas staff changed?
Increased................................................. 1
Decreased...............................................2
No change...............................................3
DONT KNOW......................................... 8
J16. How many Family Planning Assistants
(PPKBD) are located in this village? PPKBD
b. sub PPKBD
J18. In the last year, how many times has a
Family Planning Field Worker (PLKB)
come to this village?
times..................................... 1
DONT KNOW......................................... 8
J18a. In comparison to the previous years,
have the number of visits in the past
12 months by PPKBD changed?
Increased................................................. 1
Decreased...............................................2
No change...............................................3
DONT KNOW......................................... 8
J20. Is there a Medicine Post (Pos Obat
Desa) in this village?No............................................................3
Yes.......................................................... 1
J24. Since 1995, have there ever been any
mass immunization/vaccination for the
people in the village?
No............................................................3
Yes.......................................................... 1
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SECTIONJ: HISTORYOFTHEPRESENCEOFHEALTHFACILITIES
PKK BOOKPKK- 9 COM
J25.
In what year were mass immunization/vaccination and what were the types of mass immunization/vaccination conducted since 1995?
JA25A. YEAR JA25B. Types of mass immunization/vaccination.
[SEECODEJ.25,CIRCLETHEAPPROPRIATEANSWERCODE,THERECANBEMORETHANONEANSWER]CodeJ25:
1.
A1 A2 B C D E F G __________________________________ A1. Measles
A2. Smallpox
B. BCG
C. Polio
D. DPT
E. Tetanus Toxoid
F. Hepatit is B
G. Other, _________________
2.
A1 A2 B C D E F G __________________________________
3.
A1 A2 B C D E F G __________________________________
4.
A1 A2 B C D E F G __________________________________
5.
A1 A2 B C D E F G __________________________________
6.
A1 A2 B C D E F G __________________________________
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SECTIONJ: HISTORYOFTHEPRESENCEOFHEALTHFACILITIES
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SECTIONJ: HISTORYOFTHEPRESENCEOFHEALTHFACILITIES
Aa. IntegratedCommunityHealth
Post(Posyandu)
A. HealthCenters(Puskesmas)
andHealthSub-centers
(PuskesmasPembantu/Pustu)
B. Privatehealthpractitionersuch
as doctors,clinics,medical
posts,maternityclinics,
nurses,midwives,medical
assistants,andother
paramedicalworkers
C. Traditionalhealthworkers,
suchas midwives,Chinese
healer(sinshe),shaman,etc.
D. Publicor privatehospit
J26. With regards to the []
available to the community
in this village/township, how
many [] can be used bythe people from this
village/township?
1. facilities
8. DONT KNOW
1. facilities
8. DONT KNOW
1. facilities
8. DONT KNOW
1. facilities
8. DONT KNOW
1. facilities
8. DONT KNOW
J27. What are the names of the
facilities?
1._______________________
2._______________________
3._______________________
4._______________________
5._______________________
6._______________________
7._______________________
8._______________________
9._______________________
10.______________________
11.______________________
12.______________________
13.______________________
14.______________________
J26COLUMNA
1._______________________
2._______________________
3._______________________
4._______________________
5._______________________
6._______________________
7._______________________
8._______________________
9._______________________
10.______________________
11.______________________
12.______________________
13.______________________
14.______________________
J26COLUMNB
1._______________________
2._______________________
3._______________________
4._______________________
5._______________________
6._______________________
7._______________________
8._______________________
9._______________________
10.______________________
11.______________________
12.______________________
13.______________________
14.______________________
J26COLUMNC
1._______________________
2._______________________
3._______________________
4._______________________
5._______________________
6._______________________
7._______________________
8._______________________
9._______________________
10.______________________
11.______________________
12.______________________
13.______________________
14.______________________
J26COLUMND
1.___________________
2.___________________
3.___________________
4.___________________
5.___________________
6.___________________
7.___________________
8.___________________
9.___________________
10.__________________
11.__________________
12.__________________
13.__________________
14.__________________
RESPONDJ. INTERVIEWERNOTE:
CIRCLETHELETTERTHATCORRESPONDSTOTHERESPONDENTTHATANSWEREDSECTIONJA B C D E F G H I J K L
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SECTIONPM:CITIZENPARTICIPATION
Now,wewouldlike to askaboutpeople'sprograms/activitiesin this village/kelurahan
(PMTYPE) PM02. PM03a. PM03b. PM04.
COMMUNITYPROGRAMSOR
ACTIVITIES
(THEHIGHESTLEVELIS THEVILLAGE)
In this village is [] program
conducted?1. It is presentlyconductedona routinebasis.
2. It hasbeenconducted,butpresentlyit is not
conductedin a routinemanner.
3. It hasneverbeenconducted
In what year was the []
program began to be conducted
in this village/township?
In what year was the []
program ended in this
village/township?
Approximately how many
people from this community
are members/usersof this
[] program?
1. Save and Borrow group 3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
2. Village cooperatives 3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
3. Pharmacy Garden 3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
5. Child Development Group
(Bina Keluarga Balita)3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended8. DONT KNOW
1. ,
8. DONT KNOW
6. Adolescents Group (Bina
Keluarga Remaja)3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
7. Senior Citizens Group
(Program Lansia)3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
8. Youth Group (Karang
Taruna)3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
SECTIONPM BOOKPKK- 12 COM
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SECTIONPM:CITIZENPARTICIPATION
9. Health Fund (Dana Sehat) 3 1
2
1. Year
8. DONT KNOW
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
11. Ten Household Program
(Dasa Wisma)3 1
2
1. Year
3. Program has not ended
8. DONT KNOW
1. ,
8. DONT KNOW
SECTIONPM BOOKPKK- 13 COM
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SECTIONPM:CITIZENPARTICIPATION
Now,wewouldlike to knowaboutassistancereceivedby thecommunityin thisvillageeitherfromgovernmentor non-governmentorganizationsoverthelast6 months.
KSR01. KSR02. KSR03. KSR06.
TYPEOFASSISTANCE
(KSR1TYPE)
In the last 12 months were there any programs by local
government or community organizations in your community to
distribute []?
What was the
source of this
assistance []?
In the last 12 months, in what
months was [] offered by these
programs?
(CIRCLEALLTHATAPPLY)
For which groups was assis
available?
A. Cash 3. No 1. Yes A B C
D _____________ Y
A B C D E F
G H I J K LA B C ____________
B. Rice 3. No 1. Yes A B CD _____________ Y
A B C D E FG H I J K L
A B C ____________
J. Cooking Oil 3. No 1. Yes A B C
D _____________ Y
A B C D E F
G H I J K LA B C ____________
K. Kerosene 3. No 1. Yes A B C
D _____________ Y
A B C D E F
G H I J K LA B C ____________
KSR02:
A. Government
B. Non-government
C. Community self-relian tD. Other, _______________
Y. DONT KNOW
KSR03:
A. January
B. February
C. MarchD. April
E. May
F. June
G. July
H. AugustI. September
J. October
K. NovemberL. December
KSR06:
A. Low-income
B. Everyone
C. Other, _______________
Now,wewouldliketo knowaboutwhethertherewereopportunitiesto purchasefoodat belowmarketpricethroughMarketOperation(OperasiPasar)or CheapPrice(PasarMurah)markets.
KSR07. KSR08. KSR09. KSR11. KSR12.
TYPEOFASSISTANCE
(KSR2TYPE)
In the last 12 months, were there any programs
by regional or national government in your
community to sell [] at below market price?
What was the
source of the
assistance []?
In the last 12 months, in what
months was [] offered by this
program?
Approximately what was the
average savings per unit of
[]?
For which groups was assis
available []?
B. Rice 3. No 1. Yes A B
C Y
A B C D E F
G H I J K L ,Rp/kg A B C ____________
D. Sugar 3. No 1. Yes A B
C Y
A B C D E F
G H I J K L ,Rp/kg A B C ____________
J. Cooking oil 3. No 1. Yes A B
C Y
A B C D E F
G H I J K L ,Rp/kg A B C ____________
M. Other foods/goods
__________________
3. No 1. Yes A B
C Y
A B C D E F
G H I J K LA B C ____________
KSR08:
A. Bulog/Dolog
B. Other government agencies
C. Non-government
KSR09:
A. January
B. February
C. March
E. May
F. JuneG. July
I. September
J. OctoberK. November
KSR12:
A. Low-income
B. Everyone
C. Other, _______________
PKK_PM BOOKPKK- 14 COM
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SECTIONPM:CITIZENPARTICIPATIONY. DONT KNOW D. April H. August L. December
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SECTIONKSR:WELFARE
QUESTIONNUMBER NOTES
CP1. Questions with doubtful answers
CP2. Questions needing conversion of measurement unit
CP3. Questions using secondary data source, data unclear
CP4. Other problems
INTERVIEWERNOTE
PKK_KSR1,PKK_KSR2 BOOKPKK- 16 COM
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SECTIONKSR:WELFARE
PKK_KSR1,PKK_KSR2 BOOKPKK- 17 COM