Strengthen PSNP4 Institutions and Resilience (SPIR) Development Food Security Activity (DFSA)

BASELINE SURVEY: Household Questionnaire – February 7, 2018

DRAFT: For Research Purpose only

Outline: Module A: Household Identification and consent

Part 1: Household identification, location, and consent Part 2: Sample verification

Module B: Household Composition and Characteristics Part 1: Household Roster Part 2: Child Schooling (age 6-18)

Module C: Result of Randomization Part 1: Result of Randomization

Universal Codes (Include with all CAPI options):

97=Refuse to respond 98=Don’t know 99= Not applicable

ENUMERATOR INSTRUCTIONS: For this survey, use the following definitions of a household, household member, and household head:

• Household: a group of people who live and eat together, share resources and form a common decision-making unit. Often, a household is composed of a head of household, spouse(s), their unmarried children, and possibly their relatives or other persons to whom they are unrelated. The household can be limited to only one person or a person with his or her children. In a polygamous household where all the spouses do not live in the same compound as their husband, each of the spouses living elsewhere will be listed as a separate household with the persons they live with (the spouse being the head of that household). A tenant who does not take his meals where he lives is considered as a separate household. In a case where a household head lives in a compound with a spouse or spouse(s) and their children, among which some are married, each of the married children with their spouse(s) and own children and other unmarried dependents under their responsibility are all part of the same single household. In this case, all three generations (and other unmarried dependents) belong to one household. In a group of unmarried people living together where everyone has his own means of livelihood, each member of the group will form his own household.

• Household member: anyone who met the criteria for being part of the household more than six of the last twelve months, as well as anyone who recently entered the household through birth or marriage to a household member.

• Household head: the individual who plays a leading role in household decision-making, particularly concerning farming, household economic activity and expenditures. Generally, the person identified by the household as the household head is accepted in this role for the survey.

• Index child: The index child for this study will be a randomly selected child in the household between the ages of 0-36 months.

• Primary female respondent: The primary female respondent for this study will be mother of the index child. If the mother of the index child is not a member of the household, the primary female respondent will be the primary female caregiver of the index child.

• Primary male respondent: The primary male respondent for this study will be the spouse or partner of the mother of the index child. If the mother of the index child is not a member of the household, the primary male respondent will be the spouse or partner of the primary female caregiver of the index child. If the mother or primary female caregiver of the index child does not have a spouse or partner who is a member of the household, the primary male respondent will be an adult male household member who plays a leading role in household decision-making, particularly concerning farming, household economic activity and expenditures.

Module A, Part 1: Household Identification and consent ENUMERATOR: Ask the questions below of the household head. If the household head is not available for interview, ask the spouse of the head or the next most responsible household member.

No. Household Identification Response No. Household Identification Response

HHID Household Census ID (10-digit number)

A00a GPS coordinates, Latitude (minutes)

A07 Code of Interviewer

A00b GPS coordinates, Longitude (minutes)

A08 Code of Supervisor

A00c Accuracy

A09 Name of household head Prefilled

A01/A01a Region (code and name)

A09a Is [A09] the same household head in the listing?

1. Yes >> skip to A10

2. No

A02/A02a Zone (code and name)

A09b What is the name of the household head? If different

from listing HH head.

A03/A03a Woreda (code and name)

A10 Religion of household head

1. Orthodox

2. Muslim

3. Protestant

4. Catholic

5. Traditional religion

6. Wake Feta

7. Other

A04/A04a Kebele (code and name)

A11 Main language of household head

Code a

A05/A05a Village (code and name)

A12 Ethnic group of household head

Code b

A05b Is the village the same as in the listing?

A13

What is the relationship of the respondent to the

household head?

Code c

>>if 1 then skip to A15d

A05 [Enumerator: Are you able to track the household?]

Yes, found and able to start

interview……1

Yes, found but refused to

start interview…2

Yes, found but no one at

home for interview……3

Yes, but household is

ineligible………..4

No………………5

If 2, 3, 4 or 5 >> end

A14 Name of respondent (if different from household

head)

4

No. Household Identification Response No. Household Identification Response

interview and find

replacement

A06d Day of the first visit (dd)

A15d Day of the second visit (dd)

A06m Month of the first visit (mm)

A15m Month of the second visit (mm)

Code a

Language Code Language Code Language Code Language Code Language Code

A Afarigna 01 Burjugna

(Dashegna,Bambaligna,

Algagna)

16 G Gedeogna 31 K Konsogna(Karate

gna,Komsogna,G

arategna)

46 N Naogna

(Nahogna,Tologna)

64

Agew-Awigna

(Konfeligna)

02 Gidichogna 32 Nuwerigna

(Abigarigna)

65

Agew-Hemrigna

(Kamingigna)

03 Benagna 17 Gidolligna

(Darshatigna,Dirashagna

,Dirayitigna,Durategna)

33 Koregna 47 Gnongatomigna

(Turkanagna,Bumegn

a,Menn,Bum,Rogegeg

no,Tobola)

66

Albigna 04 C Chrigna

(Tsrigna,Zaragna)

18 Koyigogna

(Mugujigna)

48

Amharic 05 D Dasenech

(Gelebigna,Marlegna)

19 Gofigna 34 Koyirigna

(Amarogna,Amar

ichogna,Baditign

a)

49 O Oromigna 67

Agnuwakigna

(Yembogna)

06 Dawrogna

(Ometegna,Dometegna,

Kulogna)

20 Gumuzigna

(Ganzagna,Ganzogna,Be

gagna,Bagagna,Sayigna,

Sesegna)

35 Oyidigna 68

Kunamigna 50 Q Kebenegna 69

Argobigna 07 Debasegna /Gewadegna

(Gobezegna.Werzegna,A

lgna)

21 Guraghegna(Sebat

Bet,Chehagna,Nedegagn

e,Nerigna,Nemorigna,Zh

agna,Gumerrigna,Gura

36

Karogna 51 Kechemigna

(Kechenogna,Gatsami

gna,Harurogna)

70

Arigna

(Bakogna,Shangamogna)

08 Kusumegna 52 Kewamigna 71

Arborigna (Arboregna,

Ouldegna)

09 Derashegna 22 M Malegna 53 S Shekato (Mochagna) 72

B Bachagna (Ganjuligna) 10 Dimigna 23 Maogna

(Anfilogna,Gewa

migna,Mabanign

a,komagna)

54 Shekogna (Hakogna) 73

Shinakana

(Borogna,Shinichogna

,Dengebogna)

74

Basketegna

(Mesketegna,Anjiligna,D

olegna,Tamigna)

11 Dezigna 24 Marekogna

(Lubudogna)

55 Sidamigna 75

Dongigna 25 Mashelegna 56 Silitigna

(Azernet,Berbere,Nek

origna,Alichogna,Wer

76

Benchigna (Benchenon) 12 Demegna 26 Negugna (Kuagugna) 37 Meregna 57

Berigna 13 F Felashigna 27 H Hadiyigna 38 Me'enigna 58

5

(Jeblawigna,Benshanguli

gna,Wutawutigna,Shogal

igna,Meyu

gna,oundugna,Gebto

39 (Me'entigna,Mek

enegna,Damigna)

iro,Werabegna)

Hararigna (Aderegna) Somaligna 77

Fedashigna 28 Hamerigna (Bashadigna) 40 Mezhengerigna 59 Surmagna

(Surigna,Tirmagna,Da

magna,Chimagna)

78

G Gamogna

(Dorzigna,Zargulagna)

29 I Erobigna

(Sahogna,Shahogna)

41 Mosigna

(Busagna)

60 Shigna 79

Gebatogna 30 K Keficho (Kefagna) 42 Mosigna

(Busagna)

61

Bodigna (Tumerigna) 14 Kembatigna 43 Mursigna(Munig

na,Murzugna,mur

di,Pikalabongign

a)

62 T Tigrigna 80

Berayiligna 15 Kontigna 44 Tembarogna 81

Komigna

(Hayahayagna,Medinign

a,Akuamigna)

45 Tsemayigna

(Tsamagna,Kuweligna

)

82

Merulegna 63 U Oupo 83

Language Code Language Code Language Code

Language

Cod

e

Language Code

W Welayitegna 84 Werjigna 85 Y Yamsagna (Yemigna,

Yangarogna) 86

Z Zeyisegna 87

Zilmamigna (Bele) 88

Shigna

(Ligna,Langogna)

90

Other Ethiopian

Languages 91 English 92

Other Foreign

Languages 93

Code b

Ethnic group Code Ethnic group Code Ethnic group Code Ethnic group Code Ethnic group Code

A Afar 01 Burju(Dashi,Bambala,Al

ga)

16 G Gedeo 31 K Konso

(Karate,Komso,G

arate)

46 N Nao (Naho,Tolo) 64

Agew-Awi (Konfele) 02 Gidicho 32 Nuwer (Abigar) 65

Agew-Hemra (Kameng) 03 Bena 17 Gidole (Dirashat,Dirasha

Dirayt,Durate)

33 Kore 47 Gnangatom

(Turkana,Bume,Men,

Bum,Rogegegna,Tobo

la)

66

Alaba 04 C Chara (Tsara,Zara) 18 Koyigo (Muguji) 48

Amhara

(Gondere,Gayinte,Sayin

te,Farte,Gojame,Dawint

e,Wadle,Laste,Shewe,T

egulete

05 D Dasenech

(Geleb,Geleba,Marle)

19 Gofa (Gene,Mulu) 34 Koyira

(Amaro,Amarich

o)

49 O Oromo(Gujji,Borena,

Tulema,Kereyu,Gelan,

Lika,Becho.Abichu,Se

lale,Arsi,Raya,Mecha,

67

Agnuwak (Yembo) 06 Dawro(Omete,Domete,

Kulu)

20 Gumez

(Ganza,Ganzo,Bega,Bag

a,Say,Sese)

35 Ayida 68

Kunama 50 Q Kebina 69

Argoba 07 Debale/Gewada

(Gobeze,Werze,Ale)

21 Guraghe (Sebat bet

(Cheha,Nedegagn,Ener,

Nemor,Zha,Gumer,Gura

,Megareb,Muger,Mehur

36

Karo 51 Kechem

(Kecheno,Gatsam,Har

uro)

70

Ari(Bako,Ara, 08 Kusume 52 Kewama 71

6

Shangamo)

Erbore (Arbore,Oulde) 09 Derashe 22 M Mali 53 S Shekacho (Mocha) 72

B Bacha (Ganjule) 10 Dimi 23 Ma'o

(Anfilo,Gewami,

Mambishi,koman

)

54 Shako (Hako) 73

Shinasha

(Boro,Shinicho,Denge

bo)

74

Basketo

(Mesketo,Anjila,Dolo,T

ama)

11 Dizi 24 Mareko (Libido) 55 Sidama 75

Donga 25 Mashole 56 Silte

(Azernet,Berbere,Nek

or,Alichona

Weriro,Werabe)

76

Bench 12 Dime 26 Guagu (Kuagu) 37 Mer 57

Ber

(Jeblawi,Benshangul,W

utawit,Shogo,Undu,Me

yu,Gebto,Fakaro,Fakash

i,Fukemkum)

13 F Felasha 27 H Hadiya 38

39

Me'enit

(Meken,Dayim)

58

Harari (Adere) Somali 77

Fedashe 28 Hamer (Bashada) 40 Mesengo(Majang

,Oujang)

59 Surma

(Suri,Tirma,Dama,Chi

ma)

78

G Gamo (Dorze,Zargula) 29 I Erob (Saho,Shaho) 41 Mezhenger 60 Shi 79

Gebato 30 K Keficho (Kefa) 42 Mosiye (Busa) 61

Bodi (Tumer) 14 Kembta 43 Mursi(Mursu,Mu

n,Murdi,Murzu,P

ikalabong)

62 T Tigre (Tigraway) 80

Berayile 15 Konta 44 Tembaro (Kambara) 81

Komo(Koma,Hayahaya,

Medin,Akuama)

45 Tsemay

(Tsamay,Kuwale)

82

Merule 63 U Oupo 83

Ethnic group Code Code

Ethnic group

Cod

e

Ethnic group Code

Welayita 84 86 Zeyse 87 Zelmamo/Bele 88

Other Ethhiopian

Nationalities 91 93

Djboutian 94

Somlian 95

Kenyan 96 98

7

Code c: Relationship to household head

Household head.................................. 1

Spouse of household head .................. 2

Son/daughter ...................................... 3 Daughter/son -in-law ......................... 4

Grandson/daughter ............................. 5

Father/mother ..................................... 6 Brother/sister...................................... 7

Niece/Nephew ................................... 8

Household head’s cousin ................... 9 Father-in-law/mother-in-law .............. 10

Brother/Sister-in-law.......................... 11

Spouse’s niece/nephew ...................... 12 Spouse’s cousin ................................. 13

Primary caregiver....…………………14

Other .................................................. 15

Module A, Part 2: Sample verification

A2_01 Does this household have at least one member that is currently participating in the PSNP (any of Public Works, Permanent Direct

Support or Temporary Direct Support)?

1. Yes

2. No

A2_02 Does this household have at least one member age 0-35.9 months (under 3 years of age)? 1. Yes

2. No

A2_03 Is the mother or adult female primary caregiver of at least one child age 0-35.9 months a member of this household? 1. Yes

2. No

A2_04 [Enumerator: If the answers to questions A2_01, A2_02, and A2_03 are ALL yes, this household is eligible to be included in the study

and should be interviewed. If the answer is no for ANY of questions A2_01, A2_02, and A2_03, this household cannot be included in

the study and will not be interviewed. Enumerator, is this household eligible to be included in the study (answered Yes to questions 1, 2

AND 3)?

1. Yes

2. No >> end CAPI program

8

CONSENT OF RESPONDENT

DD MM YY

__________________________

Signature of the Enumerator: ________________________ Date: /_______/_______/__________/

Please tick mark on the right box

depending on the respondent’s consent

Consent given:

Yes No

9

Module B: Household Composition and Education Module B, Part 1: Household Roster ENUMERATOR: Ask the questions below of the household head. If the household head is not available for interview, ask the next most responsible male household member.

Member

ID

What is the member’s [NAME]?

What is

[NAME]’s

sex?

Male ... 1

Female 2

What is the

relationship of

[NAME] to the

household

head?

What is

[NAME]’s age?

(in years)?

If >=5, skip to

B1_05

What is

[NAME]’s

age in

months?

What is

[NAME]’s

birth mother’s

name/ID? If

the birth

mother is not

a member of

the household

what is the

name/ID of

the primary

female

caregiver of

[NAME]?

What is

[NAME]’s

marital status?

(ages 12 and

older)

What is the

highest class

that [NAME]

passed in

school?

(Only for

individuals 6

years and

older)

What is the

main current

activity of

[NAME]?

>> skip for

those under

12 years of

age

Name Code a Code↑ Code b Code c Code d

ID B1_00 B1_01 B1_02 B1_03a B1_03b B1_04 B1_05 B1_06 B1_07

10

[ENUMERATOR: IF THERE ARE NO CHILDREN BETWEEN 0-35.9 MONTHS PLEASE “ACCORDING TO THE MEMBERS YOU JUST LISTED, THERE IS NO CHILD 0-35.9 MONTHS IN

THIS HOUSEHOLD, PLEASE CONFIRM THIS IS CORRECT”. IF THE CHILD UNDER 36 MONTHS DOES NOT HAVE A BIOLOGICAL MOTHER OR PRIMARY FEMALE CAREGIVER

IN THE HOUSE PLEASE SAY “ACCORDING TO THE MEMBERS YOU JUST LISTED, THERE IS NO MOTHER OR PRIMARY FEMALE CAREGIVER OF THE CHILD 0-35.0 MONTHS IN

THIS HOUSEHOLD, PLEASE CONFIRM THIS IS CORRECT.”

IF CONFIRMED PLEASE END SURVEY.

Code a: Relationship to household head

Household head.................................. 1

Spouse of household head .................. 2 Son/daughter ...................................... 3

Daughter/son -in-law ......................... 4

Grandson/daughter ............................. 5 Father/mother ..................................... 6

Brother/sister...................................... 7

Niece/Nephew ................................... 8 Household head’s cousin ................... 9

Father-in-law/mother-in-law .............. 10

Brother/Sister-in-law.......................... 11 Spouse’s niece/nephew ...................... 12

Spouse’s cousin ................................. 13

House help....…………………14

Other .................................................. 15

Code b: Marital status code

Unmarried (never married) ......... 1 Married, monogamous ................ 2

Married, polygamous .................. 3

Widow/widower.......................... 4 Divorced ..................................... 5

Separated/Deserted ..................... 6

Code c: Education (Highest class passed)

Never attended school................. 96

Reads in class I ........................... 0

Completed class I ....................... 1

Completed class II ...................... 2

Put number of highest completed class.

For example, if currently in class IV, put 3 (class III completed)

Completed class X ...................... 10 Completed Senior High School/Completed

Prep/TVEI/Grade 12 ................... 12

BA/BSC ...................................... 14 Higher National Diploma............ 15

MA/MSC and above ................... 16 Certificate ................................... 22

Preschool class (general) ............ 66

Religious school ......................... 67 Literacy/Adult programs ............. 68

Other ........................................... 76

Code d: Activity

Crop Production.......................... 1

Livestock .................................... 2 Commerce or other business ....... 3

Skilled labor ............................... 4

Employee .................................... 5

Student ........................................ 6

Unpaid housework ...................... 7

Retired ........................................ 8 Volunteer/unpaid apprentice ....... 9

Looking for work ........................ 10

Other ........................................... 11 None ........................................... 12

11

Module B, Part 2: Child Schooling (Age 6-18 years) ENUMERATOR: Ask the questions below of the household head. If the household head is not available for interview, ask the next most responsible household member. For each individual between the age of 6 and 18 years old, ask the following questions.

ID Code

(Prefilled from

Module B Part 1

ID)

Name of child aged

6 – 18 years.

(Prefilled from

B1_00)

Is the biological

mother of [NAME] a

member of the

household?

1. Yes

2. No

At what age did

[NAME] start

school?

(If never attended

school, write 99 and

skip to next child.

Is [NAME]

currently enrolled in

school?

1. Yes

2. No >> skip to

B2_06

Since the start of the

school year

[Meskerem EC 2010]

how often has

[NAME] attended

school?

1. Always

2. More than half time

3. Half time

4. Less than half time

5. Rarely or never

In the last seven days,

how many days has

[NAME] attended

school?

(If school not

operating, enter “not

applicable” code 97)

>> skip to next child

What year (E.C.) did

[NAME] stop going

to school?

Code↑ Years Code↑ Code (b)

ID B2_00 B2_01 B2_02 B2_03 B2_04 B2_05 B2_06

Module C, Part 1: Result of Randomization

C1_01 ID of Index Child ID

C1_02 Name of Index Child Name

12

C1_03 ID of biological mother or primary caregiver of index child ID

C1_04 Name of biological mother or primary caregiver of index child Name

C1_04a Is [C1_04] the biological mother or the primary caregiver of the index child? 1. Biological mother

2. Primary caregiver

C1_05 Does [C1_04] have a spouse or partner who is a member of the household? 1. Yes>> skip to C1_06

2. No

C1_05a Is there an adult male member in the household? 1. Yes

2. No >> end survey

C1_06 What is the name of [C1_04]’s spouse or partner? Name

C1_06a What is the name/ID of the adult member? Name

C1_07 LIST status 1. LIST A

2. LIST B

3. LIST C

4. LIST D

5. No LIST