questionnaire for providers_eng

8/13/2019 QUESTIONNAIRE for Providers_eng

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QUESTIONNAIRE FOR REPRODUCTIVE HEALTH CARE SERVICE PROVIDERS

Statement of the Study

This survey covers the issues of womens reproductive health and human rights and isconducted within framework of Project Reproductive Health and Rights: ey !hallenges"#$nternational Policy %ellowship Program& 'e would very much appreciate your participationin this illustrative survey&

Participation in this survey is voluntary# however we hope that you will complete this(uestionnaire since your views are very important& This information will help to identifyurgent reproductive health issues and assess the awareness of rights in relation toreproduction# within family and health care)services delivery so that the government and

other organi*ations respectively implement projects in future in promotion of human rightsand improve delivery of family planning)maternal health services in our Repu+lic&

'e assure you that whatever information you provide will +e kept strictly confidential and willnot +e shown to other people, any of health providers at this facility# your supervisor# etc& , soplease +e (uite sincere in your answers&

THANK YOU VERY MUCH FOR YOUR

PARTICIPATION AND COOPERATION!


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IPF Fellow: AIDA GHAZARYANINTERNATIONAL POLICY FELLOWSHIP 2003-2004

Proje! N"#e: Re$ro%&!'(e R')*!+ A,% He"l!* ', Ar#e,'": e. C*"lle,)e+

1. Position at this hath "a#iit$%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

Pas &i' ()i" *s#)i+tion o" $o,) -o( ho,)s/02 on a')a& n,3() o"+atints $o, s in on *a$4

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

5. Do $o, o"") th "oo0in& s)'i#s6 Ti# o"" 0hi#h is a++)o+)iat.

.ntenatal care

Postnatal care

ST/ information

%amily,planning 0%P1 services# including emergency contraception

!ounseling 0infertility# se2uality1

Simple diagnostic tests for infertility

/iagnosis

.+ortion services

Screening for reproductive cancers

Treatment

3ther--------------------------

7. Ho0 3an$ $a)s o" 8+)in# *o $o, ha' in $o,) +a)ti#,a) s+#iat$6

%%%%%%%%%%%%

9. Ha' $o, +a)ti#i+at* in a s+#iai:* t)ainin&/#ontin,in& *,#ation

+)o&)a3s4/s3ina)s6

45S 63

;hn ast ti3 MM/YY4 an* 0h) #o,nt)$46

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international organi*ation& Specify------------------------------------------seminars)courses 0underline the option# which suits1&

during vocational training on,jo+,trainingother%%%%%%%%%%%%%%%%%%%%%%%%%%

>. Di* an$ o" th t)ainin&s/#o,)ss $o, #o3+t* "o#,s on o) 3ntion h,3an )i&hts6

45S 63

$f 45S# please descri+e&------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

?. ;o,* $o, #onsi*) to ( t)ain* o) " th n* to ( t)ain* on a++i#ation o"h,3an )i&hts to )+)o*,#ti' hath6

45S 63

@. A) $o, a 33() o" a +)o"ssiona asso#iation/,nion/o)&ani:ation6

45S 63

$f 45S# please provide its name and period of mem+ership&

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3


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1. Do $o, no0 a(o,t )i&hts )at* to )+)o*,#ti' hath6

45S 63

I" $s2 na3 so3 )i&hts.

--------------------------------------------------------------------

5. Do $o, no0 a(o,t h,3an )i&hts int)nationa inst),3nts6

45S 63

$f yes# please specify at least two&

--------------------------------------------------------------------------

7. ;hat is th so,)# o" in"o)3ation on h,3an )i&hts6 Ti# o"" 0hi#h is a++)o+)iat.

5ducational esta+lishmentTelevision

Radio

Printed media 0+ooks# newspapers# maga*ines# +rochures# etc&1Please underline----------------

%amily

Spouse 0partner1

!olleagues

Peers

3ther------------------------

9. Do $o, thin 0o3n an* 3n a) ,a6

45S 63

Please e2plain&

4

Section II Human Rights


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@. Do $o, "in* it i3+o)tant to no0 a(o,t h,3an )i&hts6

45S 63

I" $s2 0h) 0o,* $o, +)") to &t that in"o)3ation/no0*&6

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

B. ;hat is $o,) attit,* to0a)*s th "oo0in& stat3nts6 Un*)in th ans0) that(st s,its.

There is a myriad of risk factors affecting reproductive health resulting from the inade(uatelevel of education)awareness and hindered access to information on se2ual and reproductivehealth and rights& Therefore# education on se2ual health and related rights should +eincluded in the school curriculum&"

Totally agree

Partially agree

/isagree

/o not know

3ther---------------------------------------------------------------------------------------------------------------------------------------------

1.Do $o, no0 that th) is RA La0 on R+)o*,#ti' Hath an* Ri&hts6

45S 63

I" $s2 ho0 *i* $o, a)n a(o,t it6 Ti# o"" 0hi#h is a++)o+)iat.

5ducational esta+lishment

Television

Radio

Printed media 0+ooks# newspapers# maga*ines# +rochures# etc&1 Pleasespecify----------------

%amily

Spouse 0partner1

!olleagues

Peers

3ther------------------------

11.O" 0hi#h (o0=3ntion* )i&hts o" +atints/#ints ha' $o, ha)*60e&g& right to access# right to choice# right to information# right to confidentiality# right to dignityright to privacy# etc&1


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78&D,)in& $o,) #ons,tation 0ith a +atint/#int *o $o, +)o'i* s,""i#int in"o)3ation3at)ia to th #hoi# that a 0o3an has to 3a 0ith )s+#t to +)o#*,)/3tho*/int)'ntion/3*i#ation/oth)6 Ti# o"" 0hi#h is a++)o+)iat

6ature of the procedure)method)intervention)medication)other

Side effects of the procedure)method)intervention)medication)otherReasona+le alternatives to the proposed procedure)method)intervention)medication)other

9enefits and uncertainties related to each alternative

Risks associated

$f applica+le# appointment of su+se(uent visit

3ther----------------------------------------------------------

11.Do $o, ha' 0)ittn IEC in"o)3ation2 *,#ation an* #o33,ni#ations4 3at)iasa'aia( "o) #ints6

45S

63

/escri+e:----------------------------------------------------------------------------------------------------------------------------------------------------

15. Ha' $o, ') ha)* a(o,t th a#ti'itis o" an int)nationa o)&ani:ation 0ith)s+#t to )+)o*,#ti' hath an* )i&hts6

45S 63

Specify the name the organi*ation and the source of information&%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

17.Ha' $o, ') ha)* a(o,t th 1BB9 Cai)o Con")n# on Po+,ation an*D'o+3nt an* 1BB< 9th;o)* Con")n# on ;o3n in Gi-in&6

45S 63

6ame the source of information------------------------------------------------

19.Do $o, no0 that in 1BB7 A)3nia )ati"i* th Con'ntion on th Ei3ination o" A

Fo)3s o" Dis#)i3ination A&ainst ;o3n a*o+t* ($ UN n)a Ass3($ in1B?746

45S 63

1


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