Greater Monrovia Healthcare Assessment Form

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This form is intended to find out basic information about the healthcare situation in Monrovia and its environs. The information you provide will remain anonymous as no personally identifiable information is required. This is a preliminary step in finding out about healthcare issues in Liberia a decade after a brutal war destroyed the country and its people. The goal is to acquire information to be able to make program and policy recommendations in addressing the healthcare needs of Liberians starting with the Greater Monrovia area.

Where do you live?

Liberia

Other Parts of Africa

USA or Canada

Europe

Asia or other parts of the World

Clear selection

What is your age?

What is your Gender?

Male

Female

Clear selection

What is your level of education?

College or beyond

Vocational or Some college

High school

Elementary or Junior high

No Formal Education

Clear selection

What is your involvement with healthcare in Liberia?

Doctor/Nurse/healthcare worker

Treated at hospital or clinic at least once in last 5 years

Bought drugs at least once in last 5 years

Health education teacher or trainer

Other

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What do most people do when they are sick?

Go to the hospital or clinic

Buy drugs to treat themselves

Pray or go to prayer person/Healer

Take herbs

Do nothing

Clear selection

How do people get to the hospital or clinic in emergency situations?

Take commercial vehicles

Carried in wheelbarrow

Carried on the shoulders or backs of others

In ambulance or police car

Walk

Clear selection

Where do most births take place?

Home or residence

Home of a nurse or midwife

Clinic

Hospital

Other

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How do most people pay for medical care?

Goverment or private insurance

Pay out of pocket

Get treatment on credit

Stay away from hospitals

Pay in kind

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How do doctors and nurses make money?

From their pay or salary

By setting up their private clinics or drugstores

By selling drugs and other hospital supplies

By taking bribes for care

By treating government officials

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What are some of the healthcare issues?

Lack of trained doctors or nurses

Few or no hospitals or clinics nearby

People cannot afford the cost of treatment

No drugs, medical equipments,electricity and water supply in hospitals or clinics

Hospitals or clinics are death traps or lack quality standards

Clear selection

What are some of the major causes of death?

All kinds of Diseases

Neglect or mistakes by medical staff

Lack of medical attention

Witchcrafts

It's their time to die

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Which conditions describe most hospitals and clinics in Greater Monrovia?

Well equipped with trained staff and medical supplies

Poorly equipped with trained staff and medical supplies

Filthy

Overcrowded

Not so caring staff

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What make people in Greater Monrovia sick the most?

Witches and wizards

Poor sanitation

Diseases

Alcohol and drug use

Hunger or no proper nutrition

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On a scale of 1-10, how bad is the issue of garbage and waste disposal in Greater Monrovia?

Not an issue

Extremely deplorable

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On a scale of 1-10, what is your personal assessment of healthcare in Greater Monrovia?

Very bad or Horrible

Excellent

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If there is one thing that you want to change in healthcare in Liberia, what will that be?

Have hospitals and clinics everywhere

Have the money or health insurance to pay for care

Have more trained healthcare professionals to provide care

Have clean and well equipped hospitals and clinics

Send everyone overseas for better care

Clear selection

Any additional comments?

Today's Date

YYYY

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