1. INTRODUCTION

Ethiopia is a second populous country in Africa with a total population of 82.8 million, birth rate

of 39 and death rate of 12 per 1000 population. Ethiopia is the least develop country and has

poor health status as dictated by low per capita income and high infant mortality rate 1.

The health policy of the Federal Government of Ethiopia uses decentralization and

democratization as a tool to address the problem of under privileged rural people 2. The Policy

has been realized after formulation of health sector development program. The 1 st health sector

development program HSDP-I (1997/8 to 2002) and the 2nd health sector development program

HSDP-II (2003-2005) had been completed with encouraging results and potential experiences

gained which was an in put for the development of HSDP. HSDP- II took a stock of experiences

from HSDP-I and further aimed to the delivery of cost effective preventive and promotive health

care services through an integrated and articulated plan of health extension program (HEP)

which will be implemented almost through HSDP-III (2005/6- 2009/10) 3.

HEP is a new initiative, and defined package of basic and essential promotive, preventive and

selected high impact curative health services targeting households which had been started in

HSDP-II in response to HSDP-I findings. It is an initiative community based health care delivery

system aimed at creating healthy environment as well as healthy living using cadres of health

extension workers 4. It was introduced in recognition of failure of essential services to reach

communities in remote areas. HEP services have been customized to meet the needs, demands

and expectations of the pastoralist, agrarian and urban population.  It is considered as the most

important institutional framework for achieving the Millennium Development Goals (MDGs) 5.

HEP is based on the concept and principles of PHC. It is designed to improve the health status of

families, with their full participation, using local technologies and the community's skill and

wisdom. HEP is similar to PHC in concept and principle, except HEP focuses on households at

the community level, and it involves fewer facility-based services. The philosophy of HEP is that

if the right knowledge and skill is transferred to households they can take responsibility for

producing and maintaining their own health. The HEP is the main vehicle for bringing key

maternal, neonatal and child health interventions to the community. It is expected that almost all

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of the activities listed in the National Child Survival Strategies are to be implemented through

the HEP 6.

The main objectives of HEP are shifting health care resources from predominantly urban to rural

areas; improving access and equity of essential health services at the village and household

levels; ensuring ownership and participation among community members; promoting gender

equality; improving the utilization of peripheral health services by bridging the gap between

communities and health facilities through Health Extension Workers (HEWs); reducing maternal

and child mortality and to promote an overall healthy lifestyle 5,7. HEP is designed to achieve

significant basic health care coverage in Ethiopia through the provision of a staffed health post to

serve every 5000 people. Every health post is being staffed by two female HEWs who had been

under gone one year training and receive salary from the government at the end of the month in

order to provide 16 major packages under four components 6, 8, 9, 10, 11. These are:

1. Disease Prevention and Control (HIV/AIDS and other sexually transmitted infections (STIs)

and TB prevention and control, Malaria prevention and control, and First Aid emergency

measures)

2. Family Health (Maternal and child health, Family planning, Immunization, Nutrition, and

Adolescent reproductive health)

3. Hygiene and Environmental Sanitation (Excreta disposal, Solid and liquid waste disposal,

Water supply and safety measures, Food hygiene and safety measures, Healthy home

environment, Control of insects and rodents, and Personal hygiene)

4. Health Education and Communication (Health education and communication).

The word health extension worker is not common in many countries other than Ethiopia.

Therefore, in this literature review other terms like community health workers, community health

agents, community health representatives, community health volunteers, nurses, doctors and

health workers/health professional are used for reviewing the literature on issues related to health

extension workers. And it is a timely issue to assess the motivation of health extension workers

who are the most important cadre for the implementation of health services extension program,

the utilization of health extension program and the impact of the program.

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2. LITERATURE REVIEW

2.1. Motivation of Community Health Workers and Other Health Professionals

Motivation is an internal psychological process that can be defined as an individual’s degree of

willingness to exert and maintain an effort towards organizational goals. People cannot be

motivated directly; it needs to create an environment conducive to high degrees of motivation.

Motivation by itself is not an observable phenomenon; it is only possible to observe either the

results of the motivational process (such as improved performance) or perhaps, some of the

determinants of motivation. The results of the internal process of motivation reflect the specific

individual’s situation and environment. Thus it is often said that motivation is a transactional

process: it depends upon the relationship between the individual and the organizational context

within which they work, and the broader societal context. Worker motivation is critical issue in

the health sector since health care delivery is highly labor-intensive and service quality,

efficiency and equity is directly affected by worker motivation 12, 13.

Work motivation is often mentioned as a major problem to health systems performance in

developing and middle-income countries. Motivational determinants of health worker motivation

at several levels can be seen as 14: individual level (goals, self-concept, and expectations for

consequences of work behavior); work context or organizational level (organizational structure

and processes, organizational culture, and human resource management inputs); and broad socio-

cultural factors (community expectations, peer pressure, societal values). Generally, as a

specialty in the broader field of human motivation, work motivation refers to the psychological

processes that have direct implications for individual behavior in the context of work, and in

particular those processes that influence the individual’s achievement of workplace goals and

tasks. Emphasis is placed on a narrower set of person and situational factors than is considered in

broader theories of human motivation.

Different studies have been conducted by different researchers on motivation of health workers

and factors influencing motivation especially on community health workers, nurses, doctors and

other health workers. The findings of motivational studies can be seen as incentives versus

disincentives, and also motivating factors versus de-motivating factors.

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Incentives versus Disincentives

Motivation can be influenced by different factors. These motivating factors can be generally

classified in to two: incentives and disincentives.

Incentives: satisfactory remuneration: material incentives, financial incentives, possibility of

future paid employment; community recognition and respect, acquisition of valued skills,

personal growth and development, accomplishment, peer support, and clear role; community

involvement in selection; visible change; policies or legislation that support health workers are

some incentives that could lead to motivation of health workers 15.

Disincentives: on the other hand, inconsistent remuneration financial; change in tangible

incentives; inequitable distribution of incentives among different and community workers;

CHWs from outside community; inadequate refresher training, inadequate supervision; lack of

respect from health facility staff; inappropriate selection of CHWs, lack of community

involvement in CHW selection, training, and support, and unclear role and, failure to take

community needs into account; and inadequate staff and supplies can lead health workers to

dissatisfaction 15.

Motivating factors versus De-motivating factors

Motivation can also be influenced by motivating and demotivating factors.

Motivating factors: Altruism, prestige, professionalism, job security, commitment of managers

to improve staff conditions, recognition and appreciation 16, 17. For example, A survey done on

work satisfaction of professional nurses in South Africa indicated that overall, professional

nurses in South Africa expressed greatest satisfaction in their relationship with patients and the

gratification they obtained from patient care, their relationship with their nursing colleagues, and

doctors and their sense of belonging in the communities within which they work 16.

De-motivating Factors: Unmet expectations, challenged by the demands of clients, lack of

fairness, lack of incentives, poor inter-professional relations poor communication system, poor

salaries, lack of promotions, and poor access to training opportunities17, low salary, working

conditions and inadequate facilities for performing expected duties, lack of concern by

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employers for staff welfare, lack of participation in decision making, poor information flow to

and from hospital management 18.The same study in South Africa indicated that professional

nurses and doctors were most dissatisfied with their pay, the workload, their career development

opportunities and the resources available to them 16.

A systematic review of motivation and retention of health workers in developing countries

(Africa and Asia) 19 revealed seven major themes regarding motivational factors were identified:

financial in terms of salary or allowances (90%); career development in regards to the possibility

to specialize or be promoted (85%); continuing education - having the opportunity to take classes

and attend seminars (80%); hospital infrastructure (the physical condition of the health facility,

in papers often described as 'work environment' (5%); resource availability (refers to equipment

and medical supplies that are necessary for health workers to perform their job (75%); hospital

management - refers to having a positive working relationship with the management with whom

the health workers work (70%); and personal recognition or appreciation - either from managers,

colleagues of the community (45%).

A study conducted to examine experiences with various incentives for CHWs and their impact

on retention and sustainability of CHW programs indicated that the motivation and retention of

CHWs is influenced by who they are in the community context. The inherent characteristics of

CHWs, such as their age, gender, ethnicity, and even economic status, will affect how they are

perceived by community members and their ability to work effectively. Monetary incentives can

increase retention. But monetary incentives often bring a host of problems because the money

may not be enough, may not be paid regularly, or may stop altogether. Non-monetary incentives

such as supportive supervision, appropriate training and relatively small things, such as an

identification badge, appropriate job aides such as counseling cards and regular replenishment of

supplies, peer support, and refresher training are critical to the success of any CHWs and are

very crucial to motivate CHWs 15.

In other study in Kenya, factors that appear to influence the motivation and work of CORPs

include: hopes for better life through continuous development of life skills and opportunities;

personal interests (values, characteristics), giving reason for volunteerism; administrative

environment (government regulations, laws, procedures, conditions, support, logistics supplies

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available for the work leading to motivation); community factors (acceptance, understanding and

involvement); political and policy environment (creation of supportive structure); the strength of

the governing structures linking the community with the health system; training of the health

workers, supervisors, and mangers in participatory skills; and supportive supervision by a

multidisciplinary team of professionals 20.

A study conducted to assess the role of non-financial incentives and human resource

management tools on health worker motivation in Africa showed health workers in Benin

strongly referred to vocation and professional conscience, i.e. their personal professional values.

Among Kenyan respondents, vocation was equally very dominant. Also, healing patients,

professional satisfaction and recognition were considered important. These aspects nurture health

workers' goals. Both dimensions – values and goals – indicate a strong professional ethos and

commitment and strongly appear to translate into the "will-do" component of the motivation

process. Likewise, the wish to help patients and professional satisfaction were frequently

mentioned 21.

A study on retention of health workers in Malawi indicated that health workers were encouraged

to take jobs as health professionals within the districts because of the opportunity and ability to

assist mankind, coupled with a spirit of patriotism. They were specifically motivated to remain in

the districts because of the lower cost of living, the significant impact they made within the

communities they served and the fact that they learnt faster on their jobs in the districts compared

to their other colleagues in the urban areas. One major demotivating factor mentioned by all

cadres of health workers was monetary. Other demotivating factors mentioned were lack of

proper assistance from the Ministry of Health and poor human resource management practices,

including lack of supervision and continuous education. In addition, poor housing and the

absence of basic amenities such as water and electricity were considered to negatively affect

work performance 22.

A study on the match between motivation and performance management of health sector workers

in Mali on 370 health workers identified motivating and demotivating factors. The motivating

factors include: feeling responsible, salary increment, receiving training, holding responsibility,

appreciation, receiving recognition, receiving promotion, receiving incentives, working within a

team spirit, receiving financial benefits from user fees, having your partner, living near the

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workplace, and having good colleagues. Factors that de-motivate health workers include: lack of

material, lack of recognition, difficult living conditions, lack of a job description, subjective

performance appraisal, poor management, partner living far away, poor functioning of the health

committee, living far away from an urban centre and living far away from places where decisions

are being made 23.

Overall, in the above literature, it can be concluded that incentives and disincentives or

motivating and demotivating factors are mostly similar for different categories of health workers

though majority of motivational studies are qualitative. These factors can be categorized under

work-itself, co-workers, management, work load, promotion, organizational structure, working

conditions, and payment and benefits 24. Other noteworthy points emerged from this literature is

that a person can be relatively satisfied with some aspect of his or her job and dissatisfied with

others, either because they fail to fulfill his or her needs and values or because they do not meet

his or her expectations; and there is a clear understanding that improving management,

workload, promotion opportunities, organizational structure, working conditions, and pay and

benefits are factors that can motivate or demotivate health workers.

2.2. Utilization of Community Health and Other Health Interventions Program

Health Service Utilization denotes an individual demand and use of health care resources and

services and indicates the way customers (patients) interaction with health care providers.

Therefore health service utilization (utilization of health care services) is a proxy of health status

of a population and use of health care services. Health care service utilizations are provided by

public, private or public-private facilities 25.

Studies in Uganda, Ecuador and Pakistan identified different factors that influence healthcare

utilization. The studies indicated that service acceptability depended on the health worker

attitudes and practices, perceived gender discrimination, local illness and treatment perceptions.

Fear and stigma were also identified as barriers in the health seeking process. Availability,

adequacy, acceptability and affordability of services; and ownership of material, human and

social resources were reported as determinants of health care service use 26, 27, 28.

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In Uganda barriers to healthcare utilization were reported for all the wealth categories (poor,

medium, and rich) along three different axes (the health seeking process; health services

delivery; and the ownership of livelihood assets) regardless of wealth category. Income source,

ownership of means of transport, and health literacy were reported as centrally useful in

facilitating use of healthcare utilization for the 'least poor' and 'medium' wealth categories.

However, the lack of these was a barrier for the poorest wealth category. The poorest' wealth

category were keen to utilize public health services which are provided free of charge. This study

suggests that in addition to income, physical resources and free public health services, social

resources were perceived as important in overcoming some of the existing barriers 25.

A study conducted focusing on developing countries revealed that utilization of health service

can be influenced by the type and mix of health professional working in the health care facilities.

For example, higher doctor concentration was significantly associated with greater use of

measles immunization and higher nurse concentration was associated with greater use of skilled

birth attendants. Aggregate health worker concentration was positively and significantly

associated with use of skilled birth attendants and measles immunization 29.

A study on Utilisation of Health Care in North Bengal, India indicated that demographic factors

like age and family size have been important determinants of utilization of care. The regression

analyses indicate that children in the 5-14 age groups are by and large neglected. Probability of

utilisation is seen higher in small families. As of ‘normal out-of-door trips’, those households

whose heads make frequent trips, have a tendency to utilise care more 30.

The demand for public health facilities is tremendously high as compared to that of private

health facilities in rural areas of the districts. The effect is too strong to hold well in the area as a

whole (combined category) also. Probability of utilisation is very high in rural areas when the

preference for the system of medicine is Homeopathy. Availability of health facilities is seen to

have negative impact towards utilisation of a care. The underlying assumption was that in the

urban areas health facilities are available. However, the result indicates that as compared to the

people of the rural areas, urban dwellers are likely to avoid utilizing a care from modern source.

Cost of treatment seems to affect utilisation of care positively. The question of financing of

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health care is, therefore, drawing attention 30. Cost sharing overall reduces utilization of services

i.e., after the introduction of cost sharing reduction of service utilization amounts to 21.3% for all

cases and 12% for malaria cases 31, and insurance system also affect utilization of health care

services 32.

A study on determinants of health care utilization by immigrants in Portugal, in Lisbon indicated

that barriers to appropriate and timely access were identified as waiting times (50.2%), providers'

attitudes (17.9%), cost (3.4%), distance and transportation (2.2%), and language (1.3%). The

logistic regression analysis allowed the identification of age, length of stay, legal status and

economic situation as positively associated with the use of health services. More than 10 years of

school education or being born in Eastern European or South American countries were

significantly associated with a lower probability of using health services, both for males and

females33.

In Bangladesh, a cross-sectional study was conducted to investigate the pattern of utilization of

child health care services provided by the Thana Health Complex (THC) of Keraniganj and to

identify the factors that are affecting the use of Child Health care (CHC) services. The study

focuses on socio-economic factors, knowledge and attitude of people and demographic factors

that are affecting the use of CHC facilities at the THC level and information about the children

under 5 years of age. Family income and mother`s education was found to have positive effect

on the rate of child vaccination. The percentage of vaccinated children (97% approximately)

among sample population was found close to that of the recorded percentage (98.6%)) at the

Keraniganj. It was found in the study that higher level of knowledge of the respondents about the

CHC service provision of the use of the THC increases the use of THC 34.

A qualitative study on utilization of maternal health care services in the department of

Matagalpa, Nicaragua was conducted to investigate women’s maternal health care- seeking

behaviors and perceptions using an analytic induction approach. The overwhelming majority of

women interviewed (31 out of 37, or 84%) reported seeking prenatal care at health facilities.

Though 31 women reported they accessed prenatal care services, only 19 (61%) of them

delivered in health facilities. The study identified different factors that affect for utilization of

maternal health care services 35: Logistical barriers to seeking care; Value of health care:

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Security of health facilities: Communication: Traditional practices: Previous experiences:

Shared information: Gender and power issues.

A study conducted on health service utilization in Amhara Region of Ethiopia in 1998 showed

59% of the people who died in a period of 12 months preceding the survey were taken to health

institutions for the disease, which killed them while the rest 41% did not visit health institutions.

The two most frequent reasons for not taking patients who died for the disease was fast course of

the disease (34.1%) and the deceased would not benefit from the services of modern health

institutions (31.7%). Over the two weeks period preceding the survey, 995 (5.6%) people

claimed that they were sick. The number of sick people who visited health institutions for

treatment was 385 (38.7%) while the rest 610 (61.3%) did not visit health institutions for their

perceived sickness. The most important reasons were believed that the disease did not need

treatment in health institutions (31.9%), bought drugs from drug vendors (27.2) and visited

traditional healers (20.2%). Secondary education or above (OR =2.1, 95%CI 1.2, 3, 4) were

significantly related to utilization of modern health institutions.36.

From the above literature on service utilization we can conclude that characteristics of the health

workers (professional mix, training and conduct of workers towards the client), characteristics of

the community/study subjects such as family characteristics (age, gender, household size, marital

status), social structure (education, employment, ethnicity), assets / affordability (land, livestock,

cash income), and perceptions about modern health care services; enabling factors such as

availability of health facilities, accessibility to health care, quality of care, and costs; and

characteristics of disorder (intensity of illness and number of spells ) can affect utilisation of

health care services 26-29,31,33-36.

2.3. Outcome of Community Health and other Health Interventions Program

Community health workers (CHWs) improve access to and increase utilization of primary health

care, reduce costs of care, improve quality of care, and reduce health disparities. They achieve

these goals by serving as the bridge between clients in need and needed health care and human

services 37, 38.

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In the United States of America, community health workers contributed to the delivery of

primary and preventive care by increasing access to health care, improving the quality of care,

reducing the costs of care, and by making broader social contributions. CHW programs can

enable low-skilled unemployed workers and welfare recipients to pursue a new occupation and

career advancement. These programs could also be tied to national service programs and high

school enrichment programs, allowing young people exposure to health careers. CHW programs

can also assist health profession schools in better preparing their graduates for the realities of

practice 38, 39.

In many Africa countries CHWs have fulfilled generalist health functions, specialist health roles,

in of areas as nutrition, reproductive health, and malaria control, and wider roles as community

advocates and change agents. Evidence suggests that these workers have increased coverage of a

range of services over the last 30 years 40. Yet the effectiveness of CHW programs on the

continent has often been constrained by a lack of government support, the inattention to primary

health care, and the reduced role of CHWs in national health care systems, particularly during

political transition. And also the key to successful community-based programs may lie in the

effective training and continuing education of its CHWs and their acceptance by the community.

The types of tasks where CHWs have been successful include (but are not limited to)

communication within communities, improving the health environment, supporting health

programs such as EPI, and diagnosis and/or treatment of diseases such as pneumonia and TB.

There is generally a clear consensus that in many aspects of health care, CHWs have a vital role

in the achievement of MDGs relating to health, that more CHWs are needed, and that they are

trained. It was believed that universal health coverage could be achieved through implementation

of health extension program 41.

Ideally, the CHW combines service function and developmental/promotional function that are

also ideally, not just in the field of health, perhaps the most important developmental or

promotional role of the CHW is to act as a bridge between the community and the formal health

services in all aspects of health development, the bridging activities of CHWs may provide

opportunities to increase both the effectiveness of curative and preventive services and, perhaps

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more importantly, community management and owner ship of health related program. CHWs

may be the only feasible and acceptable link between the health sector and the community that

can be developed to meet the goal of improved health in the near term 42.

As available literatures indicate community health worker programs have come about as a result

of dramatic political transformation, as part of health sector reform processes, as the initiative of

NGO and faith based organizations. Ghana and Niger are some of examples of countries that

introduce CHWs as part of health sector reform initiatives aiming to enhance accessibility and

affordability of health services to rural and poor communities with in a PHC approach 43.

A study done to assess the performance of CHWs in the promotion of basic child heath services

in rural Mali indicated that of the 401 households suppose to receive a visit by a CHW, 219

(54.6%) had received at least one visit in the last three months prior to the study period and of

these 162 (73.9%) had received a visit the month before the survey (April, 2006). Regarding

knowledge of the child caregiver on home management of child illness, 40% mentioned to have

treated fever with the correct regimen. Seventy-nine percent of the visited households had a bed

net. A high percentage of households had iodized salt (98.7%). Comparison between households

with and without CHWs showed no statistically significant difference concerning socio-

demographic characteristics. When compared on knowledge and practice, a positive influence of

CHWs on specific essential family health practices by the households was found, namely

knowledge on the management of child fever (p = < 0.001), use (p = < 0.001) of bed net and,

utilization of iodized salt (p = 0.05) 44.

A community-based intervention study was conducted using a pre-post comparison of the same

group; which was implemented in three phases: situational analysis June 2004; intervention

October 2004 to October 2006 and the post-intervention assessment in November 2006, showed

a significant improvement in the utilization of a skilled attendance with variation across the

villages. Deliveries with skilled attendants significantly increased from 34.1% to 51.4% in 2006

(r < 0.05). The proportion of women who were assisted by traditional birth attendants (TBAs)

decreased from 35.7% to 29.9% while those assisted with relatives went down from 30.2% to

17.3%. Some of the observed positive effects during the course of the study as expressed by

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community leaders, health providers, safe motherhood promoters (SMPs) and villagers during

monitoring and in the final assessment were the following 45: improved involvement of

community leaders at sub-village level in promoting safe motherhood; increased involvement of

religious leaders in community health activities; and the intervention has built linkages between

health providers, SMPs and pregnant women and TBAs.

Often performance is measured in terms of improvement in health status of the population that

CHWs serve, increase in the utilization of services provided by them, reduction in the wastage of

resources, the presence and accessibility of CHWs to the community members. Computing each

of these measures is data intensive and also requires careful effort in documentation and analysis

over a period of time. However, the degree of trust and confidence of the community members

that CHWs have gained over a period of time is important in sustaining the motivation of CHWs

to function with commitment and effectiveness 46.

In Papua New Guinea, an outcome evaluation was conducted to investigate the long-term impact

community intervention activities on maternal and child health and identified reduced incidence

of illness and improved physical health in families of those villagers who made behavioral and

environment changes to improve their health. Individuals reported experiencing benefits from

simple, small and inexpensive changes that motivated changing traditional ways. Positive

benefits from these changes have resulted in people accepting a more hygienic environment and

improved sanitation practices as the social norm. Changes in one community have influenced

nearby communities because they see the benefits to family health in their neighbours 47.

In the literature review, it was very difficult to get published researches on health extension

program and health extension workers and those researches done on health extension program

related issues such as health extension workers access to information, continuing education and

reference materials 48; assessment of the training of the first intake of health extension workers 49,

and working conditions of health extension workers in Ethiopia 50 did not assess the motivation

of health workers, utilization and impact of the health extension program. The retention of health

extension workers and the outcome of the health extension program are yet to be evaluated 20.

3. JUSTIFICATION OF THE STUDY

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Health service extension program is an innovative approach which is encompassed under the

Health Sector Development Program to meet the millennium Development Goals (MDGs).

While the program is innovative and is supposed to bring better health status of population

especially in peripheral areas, studies done concerning program are rare. This study will be

conducted with the aim of assessing motivation of health extension workers (HEWs), utilization

of health extension program (HEP) by the community and outcome of health extension program.

Therefore the findings of this study will have a substantial contribution in maximizing utilization

of health service, improving healthy practice, and enhancing motivation of HEWs and overall

reduction of morbidity and mortality. It will also give insight for health care planners and policy

makers whether the policy change is required or not.

4. OBJECTIVES

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4.1. General Objective

The general objective of this dissertation is to assess the Implementation of Health Extension

Program (HEP) in West Gojjam Zone, Amhara National Regional State, Ethiopia.

4.2. Specific Objectives of the Study

To assess the motivation of Health Extension Workers (Paper I)

To assess the utilization of Health Extension Program by the community (Paper II)

To assess the outcome of being graduated households/kebeles on maternal

and child health, family planning and immunization (Paper III)

5. CONCEPTUAL FRAMEWORK

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Figure 1: Conceptual Framework for Motivation of HEWs, Utilization of HEP by the

Community and Outcome of HEP.

This conceptual framework is the modification of conceptual framework used in the research done by Franco M., Kanfer R., Milburn L., Qarrain Reem., and Stubblebine P. (2000): An In-depth Analysis of Individual Determinants and Outcomes of Health Worker Motivation in Two Jordanian Hospitals14, and a conceptual framework used in the research done by Amlan Majumder (2006): Utilisation of Health Care in North Bengal: A Study of Health Seeking Patterns in an Interdisciplinary Framework30.

6. METHODOLOGY

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6.1. Study Area

Amhara National Regional State (ANRS) is one of the eleven regions of the country and is

administratively divided into 10 zones, 1 special zone and 1 special district. It is borderd by the

Tigray Region in the North, the Afar Region in the East, the Oromia Region in the South and the

Benshagul Gumuz Region and Sudan in the West. The region has 166 districts (128 rural

districts and 38 urban district administrations), 3,466 kebeles (3,157 rural kebeles and 309 urban

kebeles) with a total population of 17,221,976 (8,641,580 males and 8,580,396 females)

according to 2007 CSA survey 51.

The study area, West Gojjam Zone, is one of the 10 zones of Amhara National Regional State

and is bordered on the North by Lake Tana, on the Northwest by North Gondar Zone, on the

Northeast by Bahir Dar and Abay River which separates it from South Gondar Zone, on the

South by Abay River which separates it from Oromia Region, on the East by East Gojjam and on

the West by Agew Awi Zone. The zone has 18 districts (13 rural districts and 5 urban district

administrations), 397 kebeles (364 rural kebeles and 33 urban kebeles) with a total population of

2,106,596 (1,058,272 males and 1,048,324 females) according to 2007 CSA survey 51.

In the region, there are 6,530 health extension workers (6,401 rural and 129 urban health

extension workers) and there are 782 health extension workers (772 rural and 10 urban health

extension workers) in the Wesst Gojjam zone working in all districts and kebeles of the zone.

The coverage of graduate heads of households is 57% (2,069,610), 32% (150,914) for Amhara

Region and West Gojjam zone respectively 52.

6.2. Study Design

Study Design for Paper I: Across-sectional study design will be employed in which health

extension workers will be interviewed using structured questionnaire to assess motivation of

Health Extension Workers.

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Study Design for Paper II: A community based cross-sectional study design will be used to

collect data for assessment of utilization of HEP services/packages by the community.

Paper III: A multi-methods approach to collecting qualitative and quantitative data will be

employed to assess outcome of being graduated households on maternal and child health, family

planning and immunization. For quantitative data, retrospective cohort study design will be used,

in which graduated households will be compared with non-graduated households in terms of

maternal health, family planning and immunization services. Qualitative data will be collected

through in-depth interviews, and focus groups discussion.

6.3. Source Population and Study Population

The source population for assessment of:

Motivation of health extension workers will be all health extension workers who are

currently working in West Gojjam Zone;

Utilization of health service extension program by the community will be all households

in West Gojjam Zone; and

Outcome of health extension program on maternal and child health, family planning and

immunization will be all households in West Gojjam Zone.

The study population for:

Measuring motivation of health extension workers will be all health extension workers in

each selected kebeles of West Gojjam Zone.

Assessing health service utilization of Health Service Extension Program by the

community will be heads of households from selected kebeles.

Assessing the outcome of Health Services Extension Program on maternal and child

health, family planning and immunization will be heads of households from randomly

selected kebeles; Officials of Regional Health Bureau, Zonal Health Department, and

District Health Offices and HEWs.

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6.4. Sample Size

The number of health extension workers to be included in the study for measuring their

motivation will be determined using single population proportion formula. The assumption in the

calculation of the sample size is 95% confidence interval (CI), marginal error (d) of 5 %, and

50% of HEWs may be satisfied.

n = Zα 2 p (1-p)

d2

Where, n = sample size, p = proportion of HEWs who may be satisfied, and d = assumed

marginal error (5%)

n = (1.96) 2 (0.50) (0.50) = 384 HEWs

(0.05)2

Since the total number of HEWs in West Gojjam Zone is less than 10,000, the correction formula

nf = ______n______ is used.            

1+ n/N

Where, nf = sample size after correction, N = total HEWs      

 nf = ____384_______ = 256 HEWs

1+ 384/772

Ten percent non-response rate = 10% x 256 = 26 HEWs

Therefore, the final sample size will be 256 + 26 = 282 HEWs.

Paper II: The number of heads of households to assess the utilization of HEP services/packages

by the community to be included in the study will be determined using single population

proportion formula. The assumption in the calculation of the sample size is 95% confidence

interval (CI), marginal error (d) of 5 %, and 50% utilization of HEP by the community.

n = Zα 2 p (1-p)

d2

Where, n = sample size, p = proportion of community HEP services utilization, and d = assumed

marginal error (5%)

n = (1.96) 2 (0.50) (0.50) = 384

(0.05)2

In this case, a design effect of 3 is needed. n = 3 x 384 = 1152 heads of households.

19

Ten percent non-response rate = 10% x 1152 = 116 heads of households.

Therefore, the final sample size will be 1152 + 116 = 1268 heads of households.

Paper III: To assess the outcome of HEP on maternal and child health, family planning and

immunization, the number of heads of households to be included in the study will be determined

using Epi-info 2002 statcalc software for sample size and power determination for cohort or

cross-sectional studies.

Assumption

α = the level of significance (Type I error) i.e., 95% confidence interval (1- α)

β = the chance of not detecting the relative risk (Type II error) i.e., 80% power (1- β)

P1 = 50% of immunization coverage for participants in non-graduated households

P2 = 60% of immunization coverage in graduated house hold

Ratio = unexposed: exposed = 1:1

Risk Ratio (RR) = 1.20

The software produces an output of sample size 407 for unexposed (non graduated households)

and sample size of 407 for exposed (graduated households).

In this case, a design effect of 3 is needed. n = 3 x 407 = 1221 heads of households.

Ten percent non-response rate = 10% x 1221 = 123 heads of households.

Therefore, the final sample size will be 1221 + 123 = 1344 for unexposed (non graduated

households) and sample size of 1344 for exposed (graduated households) i.e., a total of 2688

households/ heads of households.

In addition, for in-depth interviewing, 18 health officials and program coordinators (3 from

Regional Health Bureau, 3 from Zonal Health Department, 12 from District Health Offices) and

24 HEWs will be included in the study. For focus group discussions, individuas from the

community which will consist of 8-12 individuals will be included.

20

6.5. Sampling Procedures

The sampling technique for all the three papers will be multistage sampling with simpe random

sampling.

The sampling procedure for assessment of motivation of health extension workers will start with

random selection of districts in the zone. Six districts will be randomly selected among the 13

rural districts of West Gojjam Zone. All (282) HEWs in 141 kebeles of those 6 districts will be

included in the study.

For utilization of HEP by the community and outcome of HEP on the community, the sampling

procedure again will start with random selection of districts in the zone. In this case, 6 districts

will be randomly selected and from these 6 districts 141 kebeles will be selected. The study

participants for assessment of utilization (1268 households) and outcome of HEP (2688

households i.e., 1344 graduated households and 1344 non-graduated households) will be selected

using simple random sampling technique from each selected kebele proportional to the number

of the households of each kebele.

21

22

6.6. Data Collection Procedures

Individual HEWs questionnaire data will be collected during group sessions where health

extention workers hold monthly meeting at common place (usually one common site for three

kebeles i.e., six health extension workers). The questionnaire will be introduced by data

collection facilitator, and then self-administered. Sessions at the five study districts will be run

by data collection facilitator, in collaboration with district health office manager or district health

extension supervisor (if available). Participation in the study will be voluntary. Completing the

Individual HEWs questionnaire will take about 40 minutes.

For utilization of HEP by the community, an interview-administered face-to-face questionnaire

consisting mainly of close-ended questions will be applied. Trained interviewers who are trained

for this purpose will administer the questionnaire. Data collectors and supervisors will be

diploma and degree holder health professionals respectively and will be trained for two days by

the principal investigator. It will take approximately half an hour to complete the questionnaire.

Quantitative data for assessment of the outcome of HEP will be collected through administering

structured questionnaire to mothers or heads of households.The relationship between Health

Extension Program outcomes and being graduated (exposed) and non-graduated households is a

critical issue since it has been given emphasis by the Ministry of Health. A retrospective cohort

design will be used to examine the hypothesis that graduated households have better HEP

outcome in terms of immunization (fully immunized versus non-fully immunized), family

planning (family planning users versus non-users) and maternal and child health (institutional

deliveries versus home deliveries, and vitamin A supplementation versus no -supplementation).

In this study, a cohort of households who were given health extension program services between

2007 and 2010 will be selected from district health office reports/documents at six districts of

West Gojjam Zone, Amhara National Regional State.

In this cohort, 2688 households which will meet the selection criteria will be selected for the

study. Of these households, the HEP outcomes of 1344 graduated households will be compared

with 1344 non-graduated households.

23

Qualitative date for assessment of HEP outcomes will be collected by in-depth interviewing

officials of Regional Health Bureau, Zonal Health Department, and District Health Offices, who

are responsible for implementation of HEP, and HEWs; and by conducting focus group

discussions with community.

6.7. Data Quality

Before data collection, for qualitty purpose, the structured questionnaire will be pre-tested two

weeks before the study period in kebeles which will not be included again in the actual study.

The pre-test will be done on about 5% of the study participants and the questionnaire will be

assessed for its completeness, clarity and length.

During data collection, the data quality will be kept by using a structured questionnaire that has

been applied in other areas, performing a daily check-up of the questionnaires filled by data

collectors and by double entry. There will be strict supervision by the principal investigator and

supervisors. Five percent of questionnaire will be checked every day by the supervisors and

finally by principal investigator for its completence and consistency. Incomplete or incorrectly

filled questionnaires will be given to the data collectors so that they could correct it by revisiting

the respondent.

After data collection, double data entry will be used to see whether there is any inconsistency of

data and to avoid any problem through the data entry processes.

24

6.8. Variables

Objectiv

e

Dependent

Variable

Independent Variables

Paper I Motivation

of HEWs

Age and sex;

Expectations, values/work ethic , personality factors related to work,

personality factors related to emotions, and individual differences;

Organizational culture, and organizational/task characteristics;

Resources, processes, and human resources management;

Community expectations, peer pressure, and societal values

Paper II Utilization

of HEP

Age, gender, household size, marital status, education, employment,

religion, income, and perceptions about modern health care services;

HEWs` Training and conduct towards the community;

Type and severity of illness;

Availability, accessibility, affordability, quality and preference of

health care facilities/health posts

Paper III Outcome

of HEP

Motivation of HEWs, Utilization of HEP, Age, gender, household

size, marital status, education, employment, religion, income, and

perceptions about modern health care services

6.9. Data Management and Statistical Analysis

Quantitative data will be entered, edited; cleaned, and coded into computer using EPI Info 2002

and will be analyzed using SPSS 17. The analysis will be divided into two stages: a descriptive

analysis of the socio-economic characteristics of study participants, and multivariate analyses for

identifying factors associated to motivation of health extension workers, utilization of health

extension program by the community and outcome of health extension program in terms of

maternal and child health, family planning and immunization. For observational studies like this

PhD project, where total control is never possible, multivariate analysis is advantageous.

Multivariate analysis examines interactions and relations between a large number of

determinants and the esponse variable simultaneously.

25

For paper I and II, multiple regression models will be used. The regression equation acts as a

compact summary of a complex state of affairs. In assessment of motivation of HEWs and

utilization of HEP by the community a variety of factors like demograghics, and socio-economic

factors interact with extraneous influences in causing an outcome, and regression modeling of

data will help provide an insight into a compex situation with this it is possiple to predict the

outcomes. Another advantage of multiple regression analysis is that by taking into account

simultaneously several explanatory variables it helps to correct for any possible confounding.

For paper III logistic regression method will be employed to describe how many times more

likely the outcome of HEP in graduated households compared to non-graduated households is in

terms of maternal and child health, immunization and family planning.

The analysis of qualitative data will be based on an inductive approach geared to identifying

patterns in the data by means of thematic codes i.e., themes, and categories of analysis come

from the data. The grounded theory method will be employed in this study. A grounded theory is

one that is inductively derived from the study of the phenomenon it represents.

In the analysis, verbatim transcript of the entire focus group discussion and in-depth interview

will be produced first, and secondly, the discussion and interview that are recorded in Amharic

will be translated to English, the language in which the analysis will be taken place. The

complete transcript should then be compared with the handwritten notes taken by the note-taker

to fill in the gaps. Once the transcribing is done, the next step will be coding the data in the

transcripts, which involves sorting the data and assigning them to categories. Open Code

software will be employed for coding data to categories and for analyzing qualitative data.

The actual data analysis process will be classified into two levels. The basic level of analysis i.e.,

a descriptive account of the data: explanation of what is said and no assumption is made. The

second level of analysis is interpretative, which will involve the comprehension of the themes (or

perspectives), creates links between the themes, demonstrates how those themes emerged and

generates a theory grounded in the data53.

26

6.10. Ethical Considerations

Ethical approval will be obtained from university of Gondar Ethical Review Board of School of

Public Health, College of Medicine and Health Sciences, University of Gondar. A written

consent will be requested from Amhara National Regional State Health Bureau. The West

Gojjam Zone Health Department and the selected Districts Health Offices will be communicated

through formal letter obtained from the Regional Health Bureau.

During field work, information sheets in Amharic about the study will be given out, explaining

why it will be done, by whom, and what it will involve. In the household survey, written and

verbal consent of all study participants will be sought. Privacy of study participants during data

collection time and confidentiality of their information to all study participants will be assured.

The right of the respondent to withdraw from the interview or not to participate will be

respected.

If participants and/or their family are in need of any medical care, they will be advised to visit

the nearest health institution. Results of the research will be communicated to government

offices and most importantly to the study subjects and members of the community through the

primary care assistant technicians at there local level. In this manner it is hoped that the

community can be educated so that health problems of the community can be alleviated and

study participants may benefit personally by being able to given emphasis by higher officials (for

HEWs) and by having improved health service strategies (for the community).

27

7. WORK PLAN OF THE STUDY

Year 1

October, 2009 Enrolment

October-November, 2009 Confirmation of advisor and supervisorCommencement of course work

January - May, 2010 Research thesis proposal preparation (Paper I, II and III)Paper I: Assessment of Motivation of HEWsPaper II: Assessment of Utilization of HEP by the CommunityPaper III: Assessment of Outcome of HEP on Maternal and Child Health, Family Planning and Immunization

June, 2010 Research thesis proposal defence (Paper I, II and III)

June - July, 2010 Submission of research thesis proposal for consideration by School of Public Health, University of Gondar

July - August, 2010 Working on research proposal and incorporating comments

Year 2

Course work continuesSeptember – October, 2010 Obtaining ethical clearance from School of Public Health,

University of GondarNovember - December, 2010 Data collection - Paper I

Submission of Research Plan for the next 12 monthsFebruary, 2011 Submission of research progress report- Paper I March, 2011 Finalization - Paper IApril - May , 2011 Data Collection - Paper II

Manuscript Preparation for publication - Paper IJuly , 2011 Submission of research progress report- Paper IIAugust, 2011 Finalization - Paper II

Year 3Course work continues

October - December, 2011 Data collection - Paper IIISubmission of Research Plan for the next 12 monthsManuscript Preparation for publication - Paper II

March, 2012 Submission of research progress report- Paper III June - August, 2012 Finalization - Paper III

Manuscript Preparation for publication - Paper IIIYear 4

September - October, 2012 Synthesis of the dissertation papers (Paper I, II, and III)November, 2012 Identification of examinersDecember, 2012 Submission of thesis for examinationDecember, 2012 Final dissertation defence

8. COST OF THE PROJECT

28

Cost Category

Quantity

Unit Cost

Total Cost

Unit Cost Total Cost

RemarkPersonnel Cost for Training

Birr Cent Birr Cent

Principal Investigator 1 PI for 4 days for 6 districts1 PI for 4 days for 6 district1 PI for 4 days for 6 districts

100100100

000000

2,4002,4002,400

000000

Paper IPaper IIPaper III

Supervisors 6 supervisors for 2 days 6 supervisors for 2 days6 supervisors for 2 days

808080

000000

960960960

000000

Paper IPaper IIPaper III

Data Collectors 12 data collectors for 2 days12 data collectors for 2 days12 data collectors for 2 days

808080

000000

1,9201,9201,920

000000

Paper IPaper IIPaper III

Sub-total 15,840 00Personnel Cost for Data Collection

Quantity Birr Cent Birr Cent Remark

Advisors 2 advisors 4,000 00 8,000 00 All PapersPrincipal Investigator 1 PI for 60 days

1 PI for 60 days1 PI for 70 days

100100100

000000

6,0006,0007,000

000000

Paper IPaper IIPaper III

Supervisors 6 supervisors for 10 days6 supervisors for 10 days6 supervisors for 20 days

808080

000000

4,8004,8009,600

000000

Paper IPaper IIPaper III

Data Collectors 12 data collectors for 10 days12 data collectors for 10 days12 data collectors for 20 days

808080

000000

9,6009,600

19,200

000000

Paper IPaper IIPaper III

Data Clerks 282 questionnaires1268 questionnaires2688 questionnaires

666

000000

1,6927,608

16,128

000000

Paper IPaper IIPaper III

Sub-total 110,028 00Transport Quantity Birr Cent Birr Cent RemarkAdvisors 3 advisors 6,000 00 All PapersInvestigator 1 investigator 15,000 00

Sub-total 21,000 00Equipment/Supplies Quantity Birr Cent Birr Cent RemarkPaper 25 rims 80 00 2,000 00 All PapersToner 8 pieces 1,000 00 8,000 00Flash Disk 8 pieces(4 GB) 500 00 4,000 00CD-R 25 pieces 4 00 100 00CD-W 20 pieces 10 00 200 00Binder/folder 15 pieces 30 00 450 00Stapler 5 pieces 40 00 200 00Notebook 15 pieces 30 00 450 00Pen 45 pieces 4 00 180 00Binding  36 bindings 10 00 360 00

Sub-total 15,940 00Miscellaneous Quantity Birr Cent Birr Cent RemarkRefreshments For 6 districts 12,000 00 All papers

Subtotal 12,000 00Total 174,808 00Contingency (10%) 17,480 80Grand Total 192,288 80

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29

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10. ANNEXES

32

10.1 Individual Health Extension Worker Questionnaire

The Principal Investigator and University of Gondar and Addis Continental Institute of Public

Health are jointly conducting this study on health extension worker motivation, focusing on West

Gojjam Zone and Bahir Dar Special Zone of Amhara National Regional State.

This survey is part of a PhD dissertation aimed at better understanding the beliefs, attitudes, and

work conditions that contribute to employee motivation and job satisfaction. By gathering

information from many HEWs, we hope to learn what factors are most important in affecting

worker motivation, satisfaction, and job performance.

This booklet contains a series of brief questionnaires that take about 40 minutes to complete.

Please answer EVERY question in the booklet. Instructions for how to respond to the different

questionnaires in the booklet are provided at the top of each page. Please note that there is no

right or wrong answers, just what YOU think and how YOU perceive your work situation.

All the information that you provide in this session will be held in confidentiality. Your

responses will be kept by the researchers, and we will aggregate responses from all interviews so

that no one individual will be identifiable. The aggregated information we collect from these

interviews will be used to: (1) identify strengths and weaknesses in the current administrative

system with respect to enhancing worker motivation, (2) assist us in developing

recommendations to enhance motivation, satisfaction, and job performance among HEWs in

West Gojjam Zone and in particular and Amhara National Regional State in general.

Subject Number: ____________

ID.No.: ____________

Kebele: ____________

Section One: Health Extension Workers Motivation Questionnaire (for HEWs)

District: ____________

33

Zone: _____________

I. Background InformationFor each question below, either write in your answer or put an “X” beside the best response option.1. How many years of experience do you have working in this profession? _____ yrs2. Are you ____ Male or ____ Female?3. How long have you been working for this health post? ____ Years and ____ months4. How long have you been in your current job? ______ Years and ______ months5. What is your age? _________ Years old6. Do you supervise any other workers? ______ Yes _____ No7. If the answer to question 6 is yes, approximately how many workers do you supervise? ______

II. ValuesDirections: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. Remember there are no right or wrong answers, only what is TRUE of you.Scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = sgree, 5 = strongly agreeSer.No.

Questions Scale

1 Dedication to work is a virtue. 1 2 3 4 52 Cooperation is a virtue in work. 1 2 3 4 53 Work should be done with sufficient effort 1 2 3 4 54 One should strive to achieve better results. 1 2 3 4 55 Work is a source of self-respect. 1 2 3 4 5 6 Consultation allows one to overcome obstacles and avoid mistakes. 1 2 3 4 57 Work is not an end in itself but a means to foster personal growth. 1 2 3 4 58 Devotion to quality work is a virtue. 1 2 3 4 59 Progress on the job can be obtained through self-reliance. 1 2 3 4 510 A successful person is one who meets deadlines at work. 1 2 3 4 511 A person can overcome difficulties in life and better him/herself by doing

his/her job well.1 2 3 4 5

12 A job is what you make of it. 1 2 3 4 513 On most jobs, people can pretty much accomplish whatever they set out to

accomplish.1 2 3 4 5

14 If you know what you want out of a job, you can find a job that gives it to you.

1 2 3 4 5

15 If employees are unhappy with a decision make by their boss, they should do something about it.

1 2 3 4 5

16 Getting a job you want is mostly a matter of luck. 1 2 3 4 517 Making money is primarily a matter of good fortune. 1 2 3 4 518 Most people are capable of doing their jobs well if they make the effort. 1 2 3 4 5

34

19 In order to get a really good job you need to have family members or friends in high places.

1 2 3 4 5

20 Promotions are usually a matter of good fortune. 1 2 3 4 521 When it comes to getting a really good job, who you know is more important

than what you know.1 2 3 4 5

22 Promotions are given to employees who perform well on the job. 1 2 3 4 523 To make a lot of money you have to know the right people. 1 2 3 4 524 It takes a lot of luck to be an outstanding employee on most jobs. 1 2 3 4 525 People who perform their jobs well generally get rewarded for it. 1 2 3 4 526 Most employees have more influence on their supervisors than they think

they do.1 2 3 4 5

27 The main difference between people who make a lot of money and people who make a little  money is luck

1 2 3 4 5

28 If I were known as a difficult worker, this would bring shame to my family. 1 2 3 4 529 If I do not put in a full day’s work, I would feel bad even if no one else

notices.1 2 3 4 5

30 If my supervisor told me I did a poor job, I would feel ashamed. 1 2 3 4 531 If co-workers had to redo my work, I would feel ashamed. 1 2 3 4 532 If everyone were to know that I was not reliable, it would bring shame to my

family.1 2 3 4 5

33 If I do not do well, I feel bad, even if no one else notices. 1 2 3 4 534 If there were a goal I did not achieve at work, my family would feel shame. 1 2 3 4 5

III. Organizational CultureDirections: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. Remember there are no right or wrong answers, only what is TRUE of you.Scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agreeSer.No.

Questions Scale

35 I feel comfortable saying what I really think to health posts/ district health management about how things are going at the health post.

1 2 3 4 5

36 It would be difficult for me to say something that my supervisor might disagree with.

1 2 3 4 5

37 This health post has a good reputation in the community. 1 2 3 4 538 The majority of my co-workers in this health post are proud to work here. 1 2 3 4 539 Co-workers at this health post pride themselves in providing good services to

patients.1 2 3 4 5

40 My co-workers in this health post regard their work as boring. 1 2 3 4 541 My co-workers help others if they fall behind in their work 1 2 3 4 542 My co-workers willingly [without complaint] share expertise and skills with

other members of the unit.1 2 3 4 5

43 My co-workers try to act like peacemakers when co-workers have disagreements.

1 2 3 4 5

44 My co-workers take steps to prevent problems with other co-workers. 1 2 3 4 5

35

45 My co-workers willingly give time to co-workers who have work-related problems.

1 2 3 4 5

46 My co-workers talk to co-workers before taking action that might affect them. 1 2 3 4 547 My co-workers provide constructive suggestions about how the unit can

improve its effectiveness.1 2 3 4 5

48 My co-workers are willing to risk disapproval in order to express beliefs about what is best for the unit.

1 2 3 4 5

49 My co-workers attend and actively participate in (team) meetings [related to their work].

1 2 3 4 5

50 My co-workers find fault [criticize] with what other co-workers are doing. 1 2 3 4 551 My co-workers discourage co-workers from complaining about trivial

matters.1 2 3 4 5

52 My co-workers focus on what is wrong with the situation, rather than the positive side.

1 2 3 4 5

53 I feel comfortable saying what I really think [my true opinion] to my supervisors about how things are happening in my work unit.

1 2 3 4 5

IV. Workplace ConditionsDirections: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. Remember there are no right or wrong answers, only what is TRUE of youScale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agreeSer.No.

Questions Scale

54 The work I do provides me with direct feedback about the effectiveness (e.g., quality and quantity) of my performance.

1 2 3 4 5

55 My managers and co-workers provide me with feedback about the effectiveness (e.g., quality and quantity) of my performance.

1 2 3 4 5

56 My job provides the opportunity for social interaction such as teamwork or co-worker assistance.

1 2 3 4 5

57 My job duties, requirements, and goals are clear and specific. 1 2 3 4 558 I have a variety of duties, tasks, and activities in my job. 1 2 3 4 559 My job requires a high level of knowledge and skills. 1 2 3 4 560 My job requires a variety of knowledge and skills. 1 2 3 4 561 My job permits me to get information and talk to people about things that

affect my work.1 2 3 4 5

62 My job provides opportunities for advancement to higher level jobs. 1 2 3 4 563 My job gives me a feeling of achievement and accomplishment. 1 2 3 4 564 My job gives me the opportunity to participate in decisions that affect my job. 1 2 3 4 565 My job offers adequate pay compared with the job requirements and with pay

in similar jobs.1 2 3 4 5

66 My job offers job security as long as I do a good job. 1 2 3 4 567 There is much variety in my job. 1 2 3 4 568 My duties are very repetitious. 1 2 3 4 569 I am left on my own to do my own work. [I can do my work the way I want,

without interference]1 2 3 4 5

36

70 I often see projects or jobs through to completion. 1 2 3 4 571 It is easy for me to find out how well I am doing on the job as I am working. 1 2 3 4 572 I am able to do my job independently of others. 1 2 3 4 573 I have freedom to do pretty much what I want on my job. 1 2 3 4 574 I receive frequent feedback from individuals other than my supervisor. 1 2 3 4 575 I usually have the opportunity to complete work I start. 1 2 3 4 576 I have control over the pace of my work. 1 2 3 4 577 I usually have the opportunity to do a job from the beginning to end (i.e., the

chance to do a whole job)1 2 3 4 5

78 I have a lot of opportunity for independent thought and action. 1 2 3 4 5

Directions: use the scale below to indicate how much the following items are important or not important for you in your work. Place the number that best corresponds to your response in the space next to the question number.Scale: 1 = very unimportant to me, 2 = unimportant, 3 = neither unimportant nor important 4 = important, 5 = very importantSer.No.

Questions Scale

79 Being able to do a complete piece of work. [Opportunity to do the job from beginning to end]

1 2 3 4 5

80 Have considerable freedom to adopt my own approach to the job. 1 2 3 4 581 Being able to judge my work performance, right away, when actually doing

the job.1 2 3 4 5

82 Have a job that gives me a feeling of doing something really worthwhile. 1 2 3 4 583 Being able to achieve something that I really value. 1 2 3 4 5

V. Personality

Directions: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number.Remember there are no right or wrong answers, only what is TRUE of you.Scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agreeSer.No.

Questions Scale

84 I am confident about my ability to handle work problems. 1 2 3 4 585 I effectively cope with any important changes that occur in my work life 1 2 3 4 586 I feel that at work things are going the way I would like them to. 1 2 3 4 587 I feel that I have control of things concerning my work. 1 2 3 4 588 Even when my work is boring, I can keep focused on my tasks. 1 2 3 4 589 I consider myself to have self-control. 1 2 3 4 590 On difficult tasks, I check my progress frequently. 1 2 3 4 591 I am easily distracted in my job. 1 2 3 4 5

37

92 I like to set specific work goals for myself. 1 2 3 4 593 When I am worried about something, I can not do my work. 1 2 3 4 594 I do not let my emotions interfere with my work. 1 2 3 4 595 It is easy for me to keep myself from being distracted. 1 2 3 4 596 I prefer to put off more difficult tasks to the end. 1 2 3 4 597 I have a difficult time concentrating when I am upset (bothered by

something).1 2 3 4 5

98 When I have a boring task to do, I make a game of it. 1 2 3 4 599 I do not like to quit a task until it’s done. 1 2 3 4 5100 It is important for me to do my work as well as I can even doing it well isn’t

popular with my coworkers.1 2 3 4 5

101 I find satisfaction in working as well as I can. 1 2 3 4 5102 There is satisfaction in a job well done. 1 2 3 4 5103 I find satisfaction in exceeding my previous performance even if I don't

outperform others.1 2 3 4 5

104 I like to work hard. 1 2 3 4 5105 Part of my enjoyment in doing things [my work] is improving my past

performance.1 2 3 4 5

VI. Organizational Constraints/ObstaclesDirections: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. Remember there are no right or wrong answers, only what is TRUE of you.Scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agreeSer.No.

Questions Scale

106 This health post provides everything I need to do my job effectively. 1 2 3 4 5107 A fundamental reason I do not do my job properly is that I do not have the

equipment, supplies and/or materials I need.1 2 3 4 5

108 I have the necessary materials, supplies and equipment to do a good job. 1 2 3 4 5109 My work is rarely disrupted due to bureaucratic processes. 1 2 3 4 5110 There are few instructions that obstruct and delay work. 1 2 3 4 5111 I am often prevented from getting my work done effectively and efficiently

by bureaucracy and unneeded processes.1 2 3 4 5

VII. Performance Consequences of MotivationThink about your job activities over the past six months. For each statement below, indicate howYOU have performed your job. Place the number that best corresponds to your answer to the left of the statement.

38

Scale: 1 = very true of me, 2 = usually true of me 3 = sometimes true of me 4 = rarely true of me 5 = not at all true of meSer.No.

Questions Scale

112 I am punctual about coming to work. 1 2 3 4 5113 I am reliable and dependable at work. 1 2 3 4 5114 I always finish my work on time. 1 2 3 4 5115 My work is of high quality. 1 2 3 4 5116 I am a hard worker. 1 2 3 4 5117 I do things that need doing without being asked or told. 1 2 3 4 5118 I am very knowledgeable about my job. 1 2 3 4 5119 I do not get defensive or upset when criticized. 1 2 3 4 5120 I get upset at work. 1 2 3 4 5121 I am careful not to make errors. 1 2 3 4 5122 I keep updated on new equipment and procedures. 1 2 3 4 5123 I get along well with my co-workers. 1 2 3 4 5124 I get along well with my supervisor. 1 2 3 4 5125 I maintain a positive attitude toward my work. 1 2 3 4 5126 My work attendance record is very good. 1 2 3 4 5127 I am rarely absent from work. 1 2 3 4 5128 I am a fast worker. 1 2 3 4 5129 I spend my time at work on work-related activities. 1 2 3 4 5

VIII. Affective Consequences of MotivationDirections: Use the scale below to indicate how satisfied you are with the following aspects of your job; by placing the number which best indicates your response in the space beside the question number.Scale: 1 = very satisfied, 2 = moderately satisfied, 3 = neither satisfied nor dissatisfied 4 = moderately satisfied, 5 = very satisfiedSer.No.

Questions Scale

130 All in all, how satisfied are you with your co-workers in your work unit? 1 2 3 4 5131 All in all, how satisfied are you with your supervisor? 1 2 3 4 5132 All in all, how satisfied are you with your job? 1 2 3 4 5133 Considering your skills and the effort you put into your work, how satisfied are you

with your pay?1 2 3 4 5

134 How satisfied are you with the management in your work unit? 1 2 3 4 5135 How satisfied are you with your opportunity to use your abilities in your job? 1 2 3 4 5136 How satisfied are you with the chances you have to learn new things? 1 2 3 4 5137 How satisfied are you with the chances you have to accomplish something

worthwhile?1 2 3 4 5

138 How satisfied are you with the chances you have to do something that makes you feel good about yourself as a person?

1 2 3 4 5

139 How satisfied are you with the fringe benefits you receive? 1 2 3 4 5140 How satisfied are you with the educational/training opportunities you get? 1 2 3 4 5141 How satisfied are you with the physical working conditions (space, lighting, and

ventilation)?1 2 3 4 5

Directions: use the scale below to indicate how much you agree or disagree with each statement by placing the number that best corresponds to your answer in the space next to the question number. Remember there are no right or wrong answers, only what is TRUE of you.

39

Scale: 1 = strongly disagree 2 = disagree 3 = neither agree nor disagree 4 = agree 5 = strongly agreeSer.No.

Questions Scale

142 I am willing to put in a great deal of effort beyond that normally expected in order to ensure that our work at this health posts is successful.

1 2 3 4 5

143 I often tell my friends that this health post is a great organization to work for. 1 2 3 4 5144 I feel very little commitment to this health post. 1 2 3 4 5145 I find that my values and this health post’s values are very similar. 1 2 3 4 5146 I am proud to tell others that I am part of this health post. 1 2 3 4 5147 This health post really inspires me to do my very best on the job. 1 2 3 4 5148 I am extremely glad I work for this health post, as opposed to other health posts I

might have worked for.1 2 3 4 5

149 It would take very little change in my present personal circumstances to cause me to leave this health post.

1 2 3 4 5

150 There is not too much to be gained professionally by working for this health post (indefinitely)  [permanently].

1 2 3 4 5

151 Often, I find it difficult to agree with this health post’s policies on important matters relating to its employees.

1 2 3 4 5

152 For me, this is the best of all possible health posts to work for. 1 2 3 4 5153 Accepting to work for this health posts was a definite mistake on my part. 1 2 3 4 5

IX. Cognition Consequences of Motivation

Directions: Use the scale below to indicate how satisfied you are with the following aspects of your job by placing the number which best indicates your response in the space beside the question number.

Scale: 1 = very satisfied 2 = moderately satisfied 3 = neither satisfied nor dissatisfied 4 = moderately satisfied 5 = very satisfiedSer.No.

Questions Scale

154 How satisfied are you that you have been given enough authority by your superiors to do your job well?

1 2 3 4 5

155 How satisfied are you with your present job when you compare it to similar positions in Ethiopia?

1 2 3 4 5

156 How satisfied are you with the progress you are making toward the goals which you set for yourself in your present situation?

1 2 3 4 5

157 On the whole, how satisfied are you that your superior accepts you as a professional expert to the degree which you are entitled by reason of your position, training and experience?

1 2 3 4 5

158 On the whole, how satisfied are you with your present job when you consider the expectations you had when you started working here?

1 2 3 4 5

159 How satisfied are you with your present job in light of (career) [ future professional] expectations?

1 2 3 4 5

Section Two: Health Extension Workers Motivation (Supervisory Assessment of Worker Performance)

40

Think about the performance of Health Extension workers in your district over the past six months. For each statement below, indicate how each one has performed his/her job. Place the number that best corresponds to your answer to the left of the statement.

Scale: 1 = always true of this person, 2 = usually true of this person 3 = sometimes true of this person, 4 = rarely true of this person 5 = not at all true of this personSer.No.

Questions (Performance Component) Scale

1 punctual about coming to work 1 2 3 4 52 reliable and dependable at work 1 2 3 4 53 always finish his/her work on time 1 2 3 4 54 work is of high quality 1 2 3 4 55 a hard worker 1 2 3 4 56 does things that need doing without being asked or told 1 2 3 4 57 very knowledgeable about his/her job 1 2 3 4 58 does not get defensive or upset when criticized 1 2 3 4 59 gets upset at work 1 2 3 4 510 Is careful not to make errors 1 2 3 4 511 keeps updated on new equipment and procedures 1 2 3 4 512 gets along well with co-workers 1 2 3 4 513 gets along well with supervisor 1 2 3 4 514 maintains a positive attitude toward his/her work 1 2 3 4 515 work attendance record is very good 1 2 3 4 516 rarely absent from work 1 2 3 4 517 a fast worker 1 2 3 4 518 Spends his/her time at work on work-related activities 1 2 3 4 5

10.2. Questionnaire for Utilization of Health Extension Program (Packages) by the Community

41

General Information

Name of Household Head …………………………………………………………………………Name of Kebele ………………………...House No.………………………………………………Name District………………………………………………………………………………………Zone………………………………. ……Region…………………………………………………

Section One: Respondent`s Background

Informed consent

Hello. My name is _______________________________________. I am working with University of Gondar/Addis Continental Institute of Public Health. We are doing a survey that is part of a PhD research by the University of Gondar/Addis Continental Institute of Public Health in West Gojjam, Amhara National Regional State. We study the Implementation of Health Extension Program (Utilization of Health extension Program by the Community) which has been implemented by the Government of Ethiopia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 40 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions? May I begin the interview now?

Signature of interviewer: ……………………………….. Date: ……………………….…

Respondent agrees to be interviewed . . . 1 respondent does not agree to be interviewed . . . 2 end

Section One: Socio-Economic and Demographic Characteristics for Utilization of HEP Services by the Community

42

No QUESTIONS AND FILTERS CODING CATEGORIES SKIP101 How old are you? Years……………………………………..…..__ __

I don’t know……………………………………98Refused to tell……………………………….....99

102 What is your sex? Male………………………………….…………...1Female………………………………….………...2

103 What is your marital status? Single (never been married)……………………...1 Married…………………………………………...2Separated………………………………………....3Widowed………………………………………....4Divorced……………………………………….....5Other (specify)____________________________6

104 What is your educational status? Illiterate…………………………………………...1Read and write only……………………………....2Grade 1-6 (primary education)...……………...….3Grade 7-8 (junior secondary education)………….45. Grade 9-12 (senior secondary education)...........56. College, university……………………………..67. Other (specify)__________________________7

105 What is your main occupation (Past twelve months)?

Unemployed……………………………………...1Retired……………………………………………2Pupil/ student……………………………………..3Disabled/ sick…………………………………….4House wife………………………………………..5Merchant…………………………………………6 Daily laborer……………………………………..7Employed by government………………………..8 Employed private for profit sector………………9Employed by NGO……………………………...10Self-employed, business with employees……….11Self-employed, business no employees…………12Self-employed, farmer/ fishing………………….13Other (specify___________________________ 14

106 What is the monthly income of your family?

_______ Birr…………………………….........….1I do not know………………………….………..98Refuse to tell…………………………………....99

107 Number of people living in your family?

Number…………………………..………….__ __Refused to tell………………………………...…99

108 What is your religion? Ethiopian Orthodox Tewahdo…………………….1Muslim…………………………………………....2Catholic…………………………………………...3Protestant…………………………………….…....4Other (specify)…………………………………....5

109 What is your ethnicity? Amhara……………………………..……….…….1Agaw……………………………….…………......2Tigrie……………………………….......................3

43

Oromo………………………………………….....4Other (specify)………………………………...….5

110 How many rooms in this household are used for sleeping?

Rooms . . . . . . . . . . . . . . . . . .

111 Does any member of your household own: A watch? A bicycle? A motorcycle or motor scooter? An animal-drawn cart? A car or truck? A boat with a motor?

Yes NoWatch 1 2Bicycle 1 2Motorcycle/scooter 1 2Animal-drawn cart 1 2Car/truck 1 2Boat with motor 1 2

112 How do you see the health services given at the health post?

It is very good………………………………....….1It is good………………………………………….2Neither good nor bad…………………………......3It is bad………………………….………………..4It is very bad……………………………………...5

113 How do you see the conduct of health extension workers towards their client (you)?

It is very good…………………………..……..….1It is good………………………………..……..….2Neither good nor bad………………………..…....3It is bad……………………………………………4It is very bad…………………………………...….5

Section Two: Predisposing Factors for Utilization of HEP Services by the CommunityNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP201 Have ever heard about health

extension program? Yes………………………………………………….1No……………………………………………….…..2

201 From where did you get the information about HEP?

Health extension workers…………………………..1Other health workers……………………………….2Community…………………………………………3Radio………………………………………………..4Other (specify)____________________________98

203 Have you had an understanding about HEP components?

Yes………………………………………………….1No……………………………………………….…..2

204 If you already know about HEP, how many components do the HEP have?

________ components……………………………...1I do not know……………………………………...98Refuse to tell………………………………………99

205 Which HEP you are familiar with?

HIV/AIDS and other sexually transmitted infections (STIs) and TB prevention and control…………….1 Malaria prevention and control………….….…......2First Aid emergency measures……………..….......3Maternal and child health………………….............4Family planning…………………….……………...5Immunization………………………….….…..........6Nutrition……………………………………............7Adolescent reproductive health…………….............8Excreta disposal……………………….……………9Solid and liquid waste disposal…………..………..10Water supply and safety measures…………...........11Food hygiene and safety measures…………..........12

44

Healthy home environment……………….............13Control of insects and rodents…………….............14Personal hygiene……………………………..........15Health education and communication……………..16

206 Which HEP component(s) have you used (implemented)?

HIV/AIDS and other sexually transmitted infections (STIs) and TB prevention and control……………...1 Malaria prevention and control………….….…........2First Aid emergency measures……………..….........3Maternal and child health…………………...............4Family planning…………………….……………....5Immunization………………………….….…...........6Nutrition…………………………………….............7Adolescent reproductive health……………..............8Excreta disposal……………………….……………9Solid and liquid waste disposal…………..………..10Water supply and safety measures…………...........11Food hygiene and safety measures…………..........12Healthy home environment……………….............13Control of insects and rodents…………….............14Personal hygiene……………………………..........15Health education and communication……………..16

207 Which HEP component(s) have not you used (implemented)?

HIV/AIDS and other sexually transmitted infections (STIs) and TB prevention and control……………...1 Malaria prevention and control………….….….......2First Aid emergency measures……………..…........3Maternal and child health…………………..............4Family planning…………………….……………....5Immunization………………………….….…...........6Nutrition…………………………………….............7Adolescent reproductive health……………..............8Excreta disposal……………………….……………9Solid and liquid waste disposal…………..………..10Water supply and safety measures…………...........11Food hygiene and safety measures…………..........12Healthy home environment……………….............13Control of insects and rodents…………….............14Personal hygiene……………………………..........15Health education and communication……………..16

208 For above question, what are the major reasons for not using HEP components?

We did not understand the benefit………………….1The HEWs did not teach us……………...…………2Economic problem……………………………….…3We are occupied by other business…………………4The health post is very far…………………………..5Very long waiting time in the health post…………..6HEWs are not approachable………………………...7Community perception is not good…………………8Previous experiences……………………………….9Other(specify _____________________________________________________________________________________________________________98

45

Section: Enabling factors (Characteristics of the service) for Utilization of HEP services by the CommunityNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP301 If you or a family member were

required to seek health services, what would be your preferred location?

Health Post………………………………………….1Health Center……………………………………….2Hospital……………………………………………..3Private Health facilities…………………………….4Traditional Healers…………....................................5Others ___________________________________98 (Specify)

…302

302 Have HEWs ever visited you or your home?

Yes………………………………………………….1No……………………………………………….…..2

303 How often do HEWs visit you or your home?

More than once per week………………………..….1Once per week……………………………………....2Once per fortnight………………………………..…3Once per month…………………………………..…4 Once every six weeks……………………………….5Other ____________________________________6 (Please specify)

304 What do HEWs do when they come to your home?

Teach health extension packages…………………...1Demonstrate health extension packages……………2Other (specify) _____________________________________________________________________98

305 If HEWs visited you, what did they teach and/or demonstrate you about?

HIV/AIDS, STIs and TB …………………………...1 Malaria ………….….…............................................2First Aid emergency measures……………..….........3Maternal and child health…………………...............4Family planning…………………….……………....5Immunization………………………….….…...........6Nutrition…………………………………….............7Adolescent reproductive health……………..............8Excreta disposal……………………….……………9Solid and liquid waste disposal…………..………..10Water supply and safety measures…………...........11Food hygiene and safety measures…………..........12Healthy home environment……………….............13Control of insects and rodents…………….............14Personal hygiene……………………………..........15Other (specify_______________________________________________________________________98

306 Have you ever visited a health post?

Yes………………………………………………….1No……………………………………………….…..2

307 How often do you have to travel to Health Post for health services/medical treatment?

More than once per week………………………..….1Once per week……………………………………....2Once per fortnight………………………………..…3Once per month…………………………………..…4 Once every six weeks……………………………….5Other ____________________________________6 (Please specify)

308 How do you travel? Private vehicle………………………………………1

46

Community Transport…………….………………...2Public Transport……………….…...……………….3On mule/horse back………………..……………….4On foot…………………………..………………….5Other ____________________________________6 (Please specify)

309 How far do you travel (return trip)?

Kilometers………………….………………..__ __I do not know……………………………………..98

310 What services did you get at the health post provided by the HEWs?

Immunization………………………………….……1Family planning…………………………………….2Antenatal care………………...…………………….3Delivery……………………………………………..4Postnatal care……………………………………….5Diagnosis and treatment…………………………….6Other (specify) _____________________________ ____________________________________________________________________________________98

311 Do you think that the quality of care/services provided in the health post is good enough?

Yes………………………………………………….1No……………………………………………….…..2

312 If the answer to question X is No, what are the problems? Probe.

313 Have you ever paid for health services you got from the health post?

Yes………………………………………………….1No……………………………………………….…..2

314 How do you see the cost you paid for the health services you got?

Very expensive……………………………………...1Expensive…………………………………………...2Neither expensive nor cheap………………………..3Cheap……………………………………………….4Very cheap………………………………………….5

Section Four: Need Factors (Characteristics of disorder) for Utilization of HEP by the CommunityNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP401 For what type of illnesses, you usually visit health

post or consult health extension workers? Child illness……………………1Family planning………………..2Pregnancy………………………3Delivery………………………..4Postnatal………………………..5Family illness…………………..6Other (specify)………………..98

402 At what stage of the illness do you usually visit the health post when you or your family gets sick?

Soon after the illness stats……...1If there is no improvement……..2If the sick person unable to drink and eat………………………….3Other (specify)………………..98

10.3. Questionnaire for Assessment of Outcome Health Extension Program in terms of Family Planning, Maternal Health and Child Health

47

General Information

Name of Household Head …………………………………………………………………………Name of Kebele ………………………...House No.………………………………………………Name District………………………………………………………………………………………Zone………………………………. ……Region…………………………………………………

Section One: Respondent`s Background

Informed consent

Hello. My name is _______________________________________. I am working with (University of Gondar/Addis Continental Institute of Public Health)). We are doing a survey that is part of a PhD research by the University of Gondar/Addis Continental Institute of Public Health in West Gojjam, Amhara National Regional State. We study the Implementation of Health Extension Program which has been implemented by the Government of Ethiopia. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 30 to 40 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.

In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.

Do you have any questions? May I begin the interview now?

Signature of interviewer: ……………………………….. Date: ……………………….…

Respondent agrees to be interviewed . . . 1 respondent does not agree to be interviewed . . . 2 end

Socio-Economic and Demographic Characteristics (for Women Aged 15-49) No QUESTIONS AND FILTERS CODING CATEGORIES SKIP

48

101 How old are you? Years…………………………………..……..__ __I don’t know………………………….…………98Refused to tell………………………….…….....99

102 How old were you at your last birthday?

Years……………………………….………..__ __I don’t know……………………….……………98Refused to tell……………………….……….....99

103 What is your marital status? Single (never been married)……………..………..1 Married…………………………………..………..2Separated………………………………..………...3Widowed………………………………..…….…..4Divorced…………………………………..……....5Other (specify)____________________________6

104 What is your educational status? Illiterate…………………………………………...1Read and write only……………………………....2Grade 1-6 (primary education)...…………………3Grade 7-8 (junior secondary education)………….45. Grade 9-12 (senior secondary education)...........56. College, university……………………………..67. Other (specify)__________________________7

105 What is your main occupation (Past twelve months)?

Unemployed……………………………………...1Retired……………………………………………2Pupil/ student……………………………………..3Disabled/ sick…………………………………….4House wife………………………………………..5Merchant…………………………………………6 Daily laborer……………………………………..7Employed by government………………………..8 Employed private for profit sector………………9Employed by NGO……………………………...10Self-employed, business with employees……….11Self-employed, business no employees…………12Self-employed, farmer/ fishing………………….13Other (specify__________________________ 14

106 Number of people living in your family?

Number…………………………..…………__ __Refused to tell………………………………...…99

107 What is your religion? Ethiopian Orthodox Tewahdo…………………….1Muslim……………………………........................2Catholic…………………………………………...3Protestant………………………………………....4Other (specify)……………………........................5

108 What is your ethnicity? Amhara……………………………………………1Agaw……………………………………………...2Tigrie……………………………………………...3Oromo…………………………………………….4

49

Other (specify)……………………….5109 How many rooms in this household

are used for sleeping?Rooms . . . . . . . . . . . . . . . . . .

110 Does any member of your household own: A watch? A bicycle? A motorcycle or motor scooter? An animal-drawn cart? A car or truck? A boat with a motor?

Yes NoWatch 1 2Bicycle 1 2Motorcycle/scooter 1 2Animal-drawn cart 1 2Car/truck 1 2Boat with motor 1 2

Family Planning (for Women Aged 15-49)

Section One: ReproductionNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP101 Now I would like to ask about all the births

you have had during your life. Have you ever given birth?

Yes ………………………………………1No ……………………………................ 2 106

102 Do you have any sons or daughters to whom you have given birth who are now living with you?

Yes ……………………………..………. 1No ……………………………..….......... 2 104

103 How many sons live with you?And how many daughters live with you?IF NONE, RECORD '00'.

Sons at home . . . . . . . . . ……………........Daughters at home . . . . ………………….

104 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?

Yes ………………………………………1No …………………………….................2 106

105 How many sons are alive but do not live with you?And how many daughters are alive but do not live with you?IF NONE, RECORD '00'.

Sons elsewhere . . . . . . . ………………….Daughters elsewhere………………..……

106 Have you ever given birth to a boy or girl who was born alive but later died?IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?

Yes ………………………………………1No …………………………….................2 108

107 How many boys have died?And how many girls have died?IF NONE, RECORD '00'.

Boys dead . . . . . . . . . . . . …………….. .Girls dead . . . . . . . . . . . . ……………….

108 Sum answers to 103, 105, and 107, and enter total.If none, record '00'.

Total births . . . . . . . . . . . ……………….

109 Check 108:Just to make sure that i have this right: you have had in total _____ births during your life. Is that correct?Yes….. __ __ No….. No correct 101-108 as necessary

50

110 Check 108: One or more births…. __ __No births…… 116

111. Now I would like to record the names of all your births, whether still alive or not, starting with the first one you had. Record names of all the births in 212. Record twins and triplets on separate rows. (if there are more than 12 births, use an additional questionnaire, starting with the second row).112 What name was given to your (first/next)

baby?Last birth………………………………….Next to last birth…………………………..Second to last birth………………….……

113 Is (NAME) a boy or a girl?Last birth……………………………….

Next to last birth………………………..

Second to last birth…………………….

Boy …………..……………………...…..1Girl ……………..……………................ 2Boy …………..…………………...……..1Girl ……………..…………….................2Boy …………..………………………….1Girl ……………..…………….................2

114 In what month and year was (NAME) born? Probe: When is his/her birthday?Last birth………………………………..

Next to last birth……………………….

Second to last birth…………………….

Month ………….……….………....__ __Year..……………................. __ __ __ __Month ………….…………………..__ __Year..…………….................. __ __ __ __Month ………….…………………..__ __Year..…………….................. __ __ __ __

115 Is (NAME) still alive?Last birth……………………………….

Next to last birth………………………..

Second to last birth…………………….

Yes …………..…………………………..1No.……………..…………….................. 2Yes …………..…………………………..1No.……………..……………...................2Yes …………..…………………………..1No.……………..……………...................2

116 Are you pregnant now? Yes ………………………………………1No ……………………………….............2Unsure ………….……………………….8

Section Two: Contraception201 Now I would like to talk about family planning - the

various ways or methods that a couple can use to delay or avoid a pregnancy. Have you ever heard of (method)?

202. Have you ever used (Method)?

01 Female Sterilization. Women can have an operation to avoid having any more children.

Yes…..1No...... 2

Have you ever had an operation to avoid having any more childrenYes…….……………………..........1No….…...........................................2

02 Male Sterilization. Men can have an operation to avoid having any more children.

Yes…..1No...... 2

Have you had a partner who had an operation to avoid having any more childrenYes…….……………………..........1No….…............................................2

03 Pill: Women can take a pill every day to Yes…..1 Yes…….……………………..........1

51

avoid becoming pregnant. No...... 2 No….…...........................................204 IUD: Women can have a loop or coil placed

inside them bya doctor or a nurse.

Yes…..1No...... 2

Yes…….……………………..........1No….…............................................2

05 Injectables: Women can have an injection by a health provider that stops them from becoming pregnant for one or more months.

Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

06 Implants: Women can have one or more small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years.

Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

07 Condom: Men can put a rubber sheath on their penis before sexual intercourse.

Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

08 Female Condom: Women can place a sheath in their vagina before sexual intercourse.

Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

09 Lactation Amenorrhea Method (LAM) Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

10 Rhythm Method: Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant.

Yes…..1No...... 2

Yes…….…………………….........1No….…...........................................2

11 Withdrawal: Men can be careful and pull out before climax.

Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

12 Emergency Contraception. As an emergency measure, within three days after they have unprotected sexual intercourse, women can take special pills to prevent pregnancy.

Yes…..1No...... 2

Yes…….……………………..........1No….…...........................................2

13 Have you heard of any other ways or methods that women or men can use to avoid pregnancy?

Yes___1specifyNo____2specify

Yes…….……………………..........1No….…............................................2Yes…….……………………..........1No….…............................................2

203 Check 202 Not a single ‘‘yes’’ (never used) … go to 304At least one used ‘‘yes’’ (ever used)………………………. ……………………………….206

No QUESTIONS AND FILTERS CODING CATEGORIES SKIP204 Have you ever used anything or tried in any

way to delay or avoid getting pregnant?Yes ……………..…………………...1No …………..……………................2 …211

205 What have you used or done? Correct 202 and 203 (and 201 if necessary)

206 Check 202(01) Woman not sterilized…………………Women sterilized…………………...... .209A

207 Check 116: Not pregnant or unsure…………….…Pregnant….………..……………….... …211

208 Are you currently doing something or using any method to delay or avoid getting pregnant?

Yes ……………..…………………...1No …………………..……................2 …211

209 Which method are you using?Circle all mentionedIf more than one method mentioned, follow skip instruction for highest method on list.

Female sterilization…………………AMale sterilization……………………B Pill......................................................CIUD……………………………........D

52

Injectables…………………………..EImplants……………………………..FCondom……………………………..GFemale condom……………………..HLactational Amenorrhea Method…….IRhythm method……………………...JWithdrawal………………………….KOther (specify)…………...…..……..X

…301…301

210 Where did you obtain (current method) the last time?

If more than one method circled in 209, Ask about method

If unable to determine if public or private sector, write the name of the place.

Name of Place

If method is sterilization, do not circle code for pharmacy, fieldworker, shop, friend /relative

Public sectorGovernment Hospital……………....11Government Health center………....12Family planning clinic……………..13Public or private mobile clinic……..14Fieldworker………………………...15Other public ___________________16 (specify)Private medical sectorPrivate hospital/clinic……………....21Pharmacy…………………………...22Private doctor……………………....23 Mobile clinic……………………….24Fieldworker………………………...25Other private medical____________26 (specify)Other sourceShop…………………………….….31Church……………………………..32Friend/relative………………….…..33Other ________________________96 (specify)

…301

211 Do you know of a place where you can obtain a method of family planning?

Yes ……………..…………………...1No …………..……………................2 …301

212 Where is that?

Any other place?

Probe to identify each type of source and circle the appropriate codes.

If unable to determine if public or private sector, write the name of the place.

Name of Place

Public sectorGovernment Hospital…………..…...AGovernment Health center…..……...BFamily planning clinic……………....CPublic or private mobile clinic……...DFieldworker…………………….…...EOther public ___________________ F (specify)Private medical sectorPrivate hospital/clinic……………....GPharmacy…………………………...HPrivate doctor………………………..I Mobile clinic………………………...JFieldworker………………………....KOther private medical ____________L (specify)Other sourceShop………………………………..MChurch……………………………....NFriend/relative……………………....O

53

Other ________________________ X (specify)

Section Three: Marriage and Sexual ActivityNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP301 Are you currently married or living together

with a man as if married?Yes, currently married ……………...1Yes, living with a man ……………...2No, not in union …………………….3

…304

302 Have ever married or lived together with a man as if married?

Yes, formally married ……….……...1Yes, lived with a man ….…………...2No, …………... …………………….3 …304

303 What is your marital status now: are you married? Divorced? Separated?

Widowed……………………………1Divorced………….............................2Separated…………………………....3

304 Check for presence of others. Before Continuing, make every effort to ensure privacy305 Now I need to ask you some questions about

sexual activity in order to gain a better understanding of some family life issuesHow old were you when you had sexual intercourse for the very first time?

Never had sexual intercourse ……...00

Age in Years………………….... __ __

…401

306 When was the last time you had sexual intercourse?If less than 12 months, answer must be recorded in days, weeks or months.If 12 months (one year) or more, answer must be recorded in years

Days ago…………………….….__ __Weeks ago…………………..….__ __Months ago………………….__ __Years ago………………...….__ __

Section Four: Fertility PreferencesNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP401 Check 104:

Neither sterilized ………………………………………………………………. Go to 402He or she sterilized ………………………………………………………………………… …409

402 Check 116:Not pregnant or unsure ______Now I have some questions about the future:Would you like to have (a/another) child, or would you prefer not to have any (more) children?Pregnant ______Now I have some questions about the future: After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?

Have (a/another) child……………….1No more/none………………………..2Says she cannot get pregnant………..3Undecided/do not know: And pregnant………………………4 And not pregnant or unsure………..5

…404…409

…405…404

403 Check 116:Not pregnant or unsure ______How long would you like to wait from now before the birth of (a/another) child?Pregnant__________After the birth of the child you are expecting

Months……….…………….…1__ __ Years…………..………….…..2__ __Soon/now…………………………993 Says she can't get pregnant……….994 After marriage…………………….995Other _______________________ 996

…409

54

now, how long would you like to wait before the birth of another child?

(specify)Don't know……………………….998

404 Check 203: using a contraceptive method? Not asked….………………go to 405No, not currently…………..go to 405Yes, currently using………………….. …409

405 Do you think you will use a contraceptive method to delay or avoid pregnancy at any time in the future?

Yes ……………..……………….…. 1No …………..……………............... 2Do not know………………….……..8

…407…407

406 Which contraceptive method would you prefer to use?

Female sterilization…………….…..01Male sterilization…………………...02 Pill.....................................................03IUD………………………………....04Injectables…………………….........05Implants………………...………….06Condom……………………….........07Female condom…………………….08Lactational Amenorrhea Method…..09Rhythm method…………………….10Withdrawal………………………....11Other (specify)________________ 96Unsure……………………………...98

…409…409…409…409…409…409…409…409…409…409…409…409…409

407 What is the main reason that you think you will not use a contraceptive method at any time in the future?

Not Married……………………..…11Fertility related reasons: Infrequent sex/no sex…………….21 Menopausal/hysterectomy…….…22 Subfecund/infecund…………...…23 Wants as many children as possible………………………….24Opposition to use Respondent opposed……………..31 Husband/partner opposed………..32 Other opposed……………………33 Religious prohibition…………….34Lack of knowledge Knows no method………………..41 Knows no source…………………42Method related reasons: Health concerns…………………..51 Fear of side-effects……………….52 Lack of access/to far……………..53 Costs too much…………………..54 Inconvenient to use………………55 Interferes with body`s normal process ………………………….56Other (specify)________________ 96Unsure……………………………..98

…409

408 Would you ever use a contraceptive method if you were married?

Yes ……………..……………….…. 1No …………..……………............... 2

55

Do not know………………….……..8409 Check 103 and 105:

Have living children __________If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?

No living children ______________If you could choose exactly the number of children to have in your whole life, how many would that be?Probe for a numeric response

None ………………………….……00Number………………………... __ __Other(specify)…………………..….96

None ………………………….……00Number……………………….. __ __Other(specify)…………………..….96

…End

…End

…End

…End

410 How many of these children would you like to be boys, to be girls and for how many would be the sex not matter?

Boys Girls EitherNumber……. _ _ _ _ _ _Other(specify)…………………..….96

Maternal Health (for Women Aged 15-49)

Section Three: Antenatal and Delivery CareNo. Questions and Filters Last Birth

Name___________Next to Last BirthName___________

Second to Last BirthName___________

101 Check 114:One or more births in 2005 ______....................................... go to 102No births in 2005 ______________.............................................................. ……………………..201

102 Check 114: Enter in the table the name of each birth in 2005 or later. Ask the questions about all of these births. Begin with the last birth. Now I would like to ask some questions about your children born in the last five years. (We will talk about each separately.)

103 From 212 (Reproduction Part)

Last BirthName___________

Next to Last BirthName___________

Second to Last BirthName___________

104 For last birth onlyDid you see anyone for antenatal are for this pregnancy?

If Yes: Whom did you see? Anyone else?Probe to identify each type of person and record all mentioned.

Health personnelDoctor………………ANurse/Midwife……..BAux. Midwife……....COther personTBAs……………….DCom. Heal. Worker..EOther ___________ X (specify)No one………..……Y

105 Where did you receive antenatal care for this pregnancy? Anywhere else?

Probe to identify each type(s) of source and circle the appropriate

Home……………… AGovernment FacilityGovt. Hospital….......BGovt. Health Center...CGovt. Health Post…..DOther Public Sector ____________E (specify)

56

code(s).

If unable to determine if public or private sector, write the name of the place.

Name of Place

Private Medical SectorPvt. Hospital/Clinic...FOther Private Medical Sector ___________ G (specify)Other ____________ X (specify)

106 How many months pregnant were you when you first received antenatal care for this pregnancy?

Months………....__ __Don't know………...98

107 How many times did you receive antenatal care during this pregnancy?

Number of times…………...__ __Don't know………...98

No. Questions and Filters Last BirthName___________

Next to Last BirthName___________

Second to Last BirthName___________

108 As part of your antenatal care during this pregnancy, were any of the following done at least once:Were you weighed?Was your blood pressure measured?Did you give a urine sample?Did you give a blood sample?

Yes NoWeight……1 2

BP………...1 2

Urine… …..1 2

Blood…..…1 2

109 During (any of) your antenatal care visit(s), were you told about the signs of pregnancy complications?

Yes ………….……1No ………………..2Do not know……...8

110 Were you told where to go if you had any of these complications?

Yes ………….……1No ………………..2Do not know……...8

111 Who assisted with the delivery of (NAME)? Anyone else?Probe for the type(s) of person(s) and record all mentioned. If respondent says no one assisted, probe to determine whether any adults were

Health personnelDoctor……………ANurse/Midwife…...BAux. Midwife…….COther personTBAs……………..DRelative/friend…....EOther __________ X (specify)

Health personnelDoctor……………ANurse/Midwife…...BAux. Midwife…….COther personTBAs……………..DRelative/friend…....EOther __________ X (specify)

Health personnelDoctor……………ANurse/Midwife…...BAux. Midwife…….COther personTBAs……………..DRelative/friend…....EOther __________ X (specify)

57

present at the delivery. No one assisted…..Y No one assisted…..Y No one assisted…..Y112 Where did you give birth

to (NAME)?Probe to identify each type(s) of source and circle the appropriate code(s).

If unable to determine if public or private sector, write the name of the place.

Name of Place

Home………………11 ……… skip to 314Government FacilityGovt. Hospital….....21Govt. Health Center.22Govt. Health Post….23Other Public Sector ___________26 (specify)Private Medical SectorPvt. Hospital/Clinic..31Other Private Medical Sector ___________36 (specify)Other ___________ 96 (specify)

Home………………11 ……… skip to 314Government FacilityGovt. Hospital….....21Govt. Health Center.22Govt. Health Post….23Other Public Sector ___________26 (specify)Private Medical SectorPvt. Hospital/Clinic..31Other Private Medical Sector ___________36 (specify)Other ___________ 96 (specify)

Home………………11 ……… skip to 314Government FacilityGovt. Hospital….....21Govt. Health Center.22Govt. Health Post….23Other Public Sector ___________26 (specify)Private Medical SectorPvt. Hospital/Clinic..31Other Private Medical Sector ___________36 (specify)Other ___________ 96 (specify)

113 Was (NAME) delivered by Caesarean?

Yes ………….……1No ………………..2

Yes ………….……1No ………………..2

Yes ………….……1No ………………..2

114 In the first two months after delivery, did you receive a vitamin A dose like (this/any of these)?Show vitamin A capsule

Yes ………….……1No ………………..2Do not know……...8

Child Health (for Mother/Caregiver of Children under 5)

Section One: Child`s BackgroundNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP101 I would like to ask you some questions

about (Name of child from cover page).What is your relation ship to (Name of Child)

Biological Mother…………………..…..01Biological Father...…………………..…02Stepmother…………………………..….03Stepfather…………………………….....04Grandmother…………………………....05Grandfather……………………………..06Adoptive Parent………………………...07Sister/brother…………………………...08Other Relative……………………….…09Not Related...…………………………..10

102 What is (Name)`s date of birth? Day…………………………………__ __Don't know month………………….….98Month……………………………...__ __Don't know month………………….….98Year………………………………...__ __Don't know year……………………..9998

103 How old is (Name)?Compare and correct 102 and/or 103 if necessary.

Age in completed years…………__ __

Section Two: Breastfeeding

58

201 Was (Name of Child) ever breastfed? Yes ………….…………………………...1No …………………………….................2 …203

202 Is (Name) still being breastfed? Yes ………………………………………1No …………………………….................2

203 Did (Name) drink anything from a bottle with a nipple yesterday or last night?

Yes ………………………………………1No …………………………….................2Do not know... …………………………..8

204 Yesterday or last night, did (Name) eat or drink Plain water? Baby formula or other milk? Juice, soda, tea or rice water? Any solid or mushy foods?

Yes No DKWater………………1 2 8Milk………………..1 2 8Juice/soda/tea……...1 2 8Any food…………..1 2 8

Section Three: Child HealthNo QUESTIONS AND FILTERS CODING CATEGORIES SKIP301 Do you have a card where (NAME)'s vaccinations are

written down?If yes: May I see it please?

Yes, Seen….………………………1Yes, Not seen …………...…..2No Card..……………….……3

?…305

302 (1) Copy dates from the card.(2) Write ‘66' in ‘day' column if card shows that a dose was given, but no date is recorded.(3) If more than two vitamin “a’ doses, record dates for most recent and second most recent doses.

DAY MONTH YEAR

BCG                                                                                               

POLIO 0 (POLIO GIVEN AT BIRTH)

                                                                                              

POLIO 1

                                                                                              

POLIO 2

                                                                                              

POLIO 3

                                                                                              

DPT 1

                                                                                              

DPT 2

                                                                                              

DPT 3

                                                                                              

MEASLES                                                                                               

VITAMIN A                                                (MOST RECENT)                                                VITAMIN A (2nd                                                MOST RECENT                                                

303 Check 302Not all from BCG to Measles recorded………………….……………. Go to 304BCG to Measles all recorded…………………………………………………….. ...307

304 Has (NAME) had any vaccinations that are not recorded on this card, including vaccinations given in a national immunization day

Yes …………………………………..1No ………….......................................2Do not know... ...…………………….8

...307

...307

...307

59

campaign?

Record ‘yes’ only if the respondent mentioned BCG, Polio 0-3, DPT 1-3, and/or measles vaccines.If yes write ‘66’ in question 302 in the day column for the corresponding vaccine.

305 Did (NAME) ever have any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign?

Yes …………………………………..1No ………….......................................2Do not know... ...…………………….8

…?..307

306

06A

306B

306C

306D

306E

306F

306G

Please tell me if (NAME) had any ofthe following vaccinations:A BCG vaccination against tuberculosis, which is, an injection in the arm or shoulder that usually causes a scar?

Polio vaccine, that is, drops in the mouth?

Did (Name) receive the first polio vaccine during the first two weeks after birth or later?

How many times was the polio vaccine given?

A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

How many times did (Name) receive the DPT vaccine?A measles injection or an MMR injection - that is, a shot in the arm at the age of 9 months or older – to prevent him/her from getting measles?

Yes …………………………………..1No ………….......................................2Do not know... ...…………………….8

Yes …………………………………..1No ………….......................................2Do not know... ...…………………….8

First two weeks………………………1Later…………………………………2

Number of times…_ _

Yes …………………………………..1No ………….......................................2Do not know... ...…………………….8

Number of times…_ _

Yes …………………………………..1No ………….......................................2Do not know... ...…………………….8

…?306E

…?306G

307 Check 302, date for most recent vitamin A dose recordedNo date for most recent vitamin A dose...………. Go to 308Date for most recent vitamin A dose……………………….

………………………………………. ..310

308 Has (Name) ever received vitamin A dose?Show capsule

Yes ………………………………….1No …………...................................... 2Do not know... ………………………8

…?...310

309 Did (Name) receive vitamin A dose with in the last 6 months?

Yes …………………………………. 1No …………...................................... 2Do not know... ………………………8

310 Has (Name) had diarrhea in the last two weeks?

Yes …………………………………..1No ………….......................................2 …?

60

Do not know... ………………………8 ..316311 Now I would like to know how much (NAME)

was given to drink during the diarrhea (including breast milk).Was he/she given less than usual to drink, about the same amount, or more than usual to drink?If less, Was he/she given much less than usual to drink or somewhat less?

Much less…………………………….1 Somewhat less……………………….2 About the same……............................3 More………………............................4 Nothing to drink……………………..5 Don't know…………………………..8

312 When (NAME) had diarrhea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?If less, PROBE: Was he/she given much less than usual to eat or somewhat less?

Much less………………….…….…...1 Somewhat less……………….….…...2 About the same…………………........3 More………………………………....4Stopped food………………………...5 Never gave food……………………..6 Don't know…………………………..8

313 Did you seek advice or treatment for the diarrhea from any source?

Yes …………………………………..1No ………….......................................2 ..315

314 Where did you seek advice or treatment?Anywhere else?If unable to determine If public or private sector, write the name of the place. ___________________________ Name of Place

Public SectorGovt. Hospital…................................AGovt. Health Center…………………BGovt. Health Post………………........CMobile Clinic……………………......DField Worker………………….……..EOther Public Sector ________________________F (specify)Private Medical SectorPvt. Hospital/Clinic…………….…...GPharmacy…………………….……...HPrivate Doctor………………………..IMobile Clinic………………….…......JField Worker………………....……...KOther Private Medical Sector _________________L (specify)Other SourceShop………………………………...MTraditional Practitioner…………….NOther ________________________ X (specify)

315 Was he/she given any of the following to drink at any time since he/she started having the diarrhea:a). A fluid made from a special packet called (local name for ORS packet)?b). A pre-packaged ORS liquid?c). A government-recommended homemade fluid?

Yes No DKFluid from ORS Packet……………..…...1 2 8ORS Liquid………….......1 2 8Homemade Fluid………...1 2 8

316 The lat time (Name) passed stools, what was done to dispose of the stools?

Child used toilet or latrine.………...01Put/rinsed into toilet or latrine……..02

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Put/rinsed into drain or ditch………03Thrown into garbage...………….….04Buried………………………….…...05Left in the open...………………..…06Other ________________________96 (specify)

10.4. Focus Group Discussion Guide

Introductions:I am __________. I will be moderating this discussion. ___________ will be recording the discussion and taking notes. (Have each participant introduce him or herself by name.)

Directions for Participants:Thank you for agreeing to help us with this PhD project. We appreciate your willingness to share your time and expertise. We are with the University of Gondar/Addis Continental Institute of Public Health and are working on a project entitled Implementation of Health Extension Program (Outcome of Health Extension Program on Maternal and Child Health, Immunization and Family Planning) in West Gojjam Zone, Amhara National Regional State, Ethiopia.

You are the experts on this topic: the information you give us will help us develop/improve health extension programs to help you and others.

What you say here is confidential. We are interested in hearing your experiences: your name will not be included in any reports. If you have any questions about this interview or the project after we leave, you can call us at +251 918 056668 OR +251 920 252761, or you can talk to Mr. Mezgebu Yitayal Mengistu (the principal investigator), who can get in touch with us.

I want you to talk to each other rather than to me. I will start the conversation out with a question, but after that I will just jump in to get us back on track if we have gotten off the topic, or to bring up something we are interested in that you have not covered. Feel free to disagree with what others have said or give another opinion: the more different ideas we hear, the more information we will have to work with. Again, we are interested in hearing your experiences, how you remember them.

I will let you know when we are near the end of our time. If you have to go to the bathroom, just slip out quietly and come back as quickly as you can.

Are there any questions before we begin?

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Focus Group Discussion Guide Questions:1. What is health extension program to you? (PROBES: How do you see the program?

What does it look like in your village/community?)

2. What were the key health problems in your community before the implementation of health extension program? (PROBE: What were the main reasons that you had this health problem?)

3. What are the key health problems in your community currently (after the implementation of health extension program)? (PROBE: What are the main reasons that you have this health problem?)

4. What changes are occurring regarding the health of the community? (Probes: what are the changes on maternal and child health? What are the changes on immunization? And what are the changes on family planning?)

5. When is a household said to graduated?

6. Are there differences between graduated households and non-graduated households? (Probes: in terms of maternal and child health, immunization, and family planning?)

7. Do graduated households continue to be a model for non- graduated households for a long period of time? [sustainability]

8. If graduated households fail to be a model for non-graduated households, in your view, what are the major reasons?

9. Could you tell me more about the health extension program benefits? Are there any misconceptions about the program in the community?

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10.5. In-depth Interview Guide

I want to thank you for taking the time to meet with me today. I am __________. I will be in-depth interviewing you, recording the interview and taking notes.

Directions for Participants:Thank you for agreeing to help us with this project. We appreciate your willingness to share your time and expertise. We are with the University of Gondar/Addis Continental Institute of Public Health and are working on a project entitled Implementation of Health Extension Program (Outcome of Health Extension Program on Maternal and Child Health, Immunization and Family Planning) in West Gojjam Zone, Amhara National Regional State, Ethiopia.

I would like to talk to you about your experiences of health extension program (outcome of health extension program). Specifically, as one of the objectives of our PhD project we are assessing the program outcome on maternal and child health, immunization and family planning in order to capture lessons that can be used in future interventions.

The interview should take less than an hour. I will be taping the session because I don’t want to miss any of your comments. Although I will be taking some notes during the session, I can’t possibly write fast enough to get it all down. Because we’re on tape, please be sure to speak up so that we don’t miss your comments.

All responses will be kept confidential. This means that your interview responses will only be shared with research team members and we will ensure that any information we include in our report does not identify you as the respondent. Remember, you don’t have to talk about anything you don’t want to and you may end the interview at any time.

Are there any questions about what I have just explained?

Are you willing to participate in this interview?

_____________________________ _______________________________ ________________ Interviewee Witness Date

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Individual In-Depth Interview Guide: Health Officials (Regional, Zonal, and District) and Health Extension Workers)

Interviewer code: _______________________________________________________________

Respondent Code: ______________________________________________________________

Region: ____________ Zone: _____________ District: _____________ Kebele: ___________

Name(s) and role(s) of respondent(s): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Interviewer Comments: __________________________________________________________

Date: ____________________Time: from: ____________________to_____________________

In-depth Interview Questions:

1. What is the status of the HEP currently? (Probe about the coverage and utilization of HEP).

2. What effect/ outcome, if any, do you feel the HEP had on the community in which you work? (Increased use of services by community? Increased knowledge of HEP services by the community? Improved health status of the community?)

3. How do you see the graduated households compared with non-graduated households? (When is a household said to be graduated? What are the criteria for being a graduated household? Do graduate households sustain their status after sometimes?)

4. What is the outcome of HEP on maternal and child health? (Do mothers get antenatal service? Do mothers attend health care facilities during delivery? Do mothers get postnatal services? Is a child exclusively breastfed? Do children receive vitamin A supplementation?)

5. What is the outcome of HEP on immunization? (What does look like the coverage of immunization? Are children fully immunized?)

6. What is the outcome of HEP on family Planning? (Does the community utilize family planning services frequently? What is the attitude of males/husbands about family

65

planning services? Which family planning methods are frequently used by the community?)

7. Is there a difference between graduated and non-graduated households? (Probe about differences about outcome of HEP on maternal and child health, immunization and family planning?)

8. What do you think are the most important outcome of HEP that should be addressed included here other than the above mentioned outcomes? (Probe for hygiene and environmental sanitation, HIV/AIDS other STDs, etc,.)

9. What are/were some of the barriers, if any, that you see/encounter in the implementation of health extension program? (Lack of key support? Lack of technical assistance? Staff turnover? Community perception?)

10. How did you overcome the barrier(s)?

11. What packages of HEP would you recommend be sustained and/or scaled up? Please provide a justification for your response.

12. What packages of HEP should be discontinued? Please provide a justification for your response.

13. What factors do you think affect the outcome of HEP? (Do concerns about quality of care/treatment by health posts prevent use of services? Do costs or travel distances limit use of services? Do lack of knowledge about when to see care prevent use of services?)

14. In your view, in the future, what would be the most effective way to improve the outcome of HEP? (Probe for suggestions for addressing community themselves, as well as other important household decision-makers).

Thank you for answering all our questions about the outcome of HEP. Maybe you have thought of something that we have left out. Is there anything else that you’d like to tell me/ us about your experience regarding HEP?

Thank You Very Much for Taking the Time to Talk to Me/Us.

66

}ÁÁ´ ðÃKA‹

10. G. ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ SÖÃp (KÖ?“ ›?¡e}”i” W^}™‹)

ÃI” Ø“ƒ ¾T>Á}Ÿ<[¬ uU°^w ÔÍU µ” በአማራ ብሔራዊ ክልላዊ መንግስት ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ c=J” ¾Ø“~ ª“ }S^T] (S´Ñu< ÃÁM S”Ó� e~) “ ¾� “ጎንደር ዩኒቨርሲቲ

¾›Ç=e ¢”+’”M ¾Ö?“ ›Övup ›=”e+~ƒ uÒ^ Á”H>ÆM::� �

ÃI Ø“© Çcd ¾ú.›?‹.Ç= U`U` ›ŸM c=J” U’ƒ& ›SKŸŸƒ& “ ¾Y^ G<’@� � � �‹ uW^}™‹ }’di’ƒ“ ¾Y^ `Ÿ LÃ� � ¾T>ÁeŸƒK<ƒ” }ê°• KS[ǃ ¾T>Å[Ó Ø“ƒ ’¬:: Ÿw²< ¾Ö?“ ›?¡e}”i” W^}™‹ Là S[Í uScwcw U” G<’@ �‹ uY^ }’di’ƒ& `Ÿ “ ¾Y^ ›ðéçU Là U” }ê°• ÁeŸƒLK< ¾T>K¬” KT¨p Ã[Ç“M wK” }eó� � � “Å`ÒK”::�

ÃI u<¡K?ƒ 40 Åmn ÑÅT ¾T>¨eÆ }Á´’ƒ ÁL†¬ SÖÃq‹ ò<›M:: vŸ¨” u� u<¡K?ƒ ¬eØ ÁK¬” Á”ǔƔ� ØÁo ÃSMc<:: KÁ’Ç”Æ SÖÃp SS]Á u¾Ñë‹ ^eÑ@� }cØ~›M:: u¡� ƒ¡¡K— ¨ÃU ƒ¡¡K— ÁMJ’ SMe ¾KU:: ¾T>cÖ<” SMe eK^e ¾Y^ G<’@ ¾T>Áeu<ƒ”“ ¾T>Ñ’²u<ƒ” ’¬::�

G<K<U ¾T>cÖ<” S[Í uT>eØ` ÃÁ³M:: G<K<U ¾T>cÖ<” SMf‹ u}S^T]‹ ¾T>Öul c=J” G<K<U Ÿ}ÖÁm‹ ¾T>Ñ–<ƒ SMf‹ ¾T>ªHÆ eKJ” ¾`e T”’ƒ ›Ã¨pU:: ŸG<K<U nKSÖÃp ¾}Ö’k[¬ S[Í� KG<Kƒ ’Ña‹ ÃÖpTM::

1—. ¾›G<’< ›e}ÇÅ` e`¯ƒ ¾W^}™‹” }’di’ƒ TÔMuƒ u}SKŸ} ÁK¬” Ö”Ÿ^“ ÅŸT Ô” KT¨p&

2—. በአማራ ብሔራዊ ክልላዊ መንግስት u}KÃU uU°^w ÔÍU µ” ¾Ö?“ ›?¡e}”i” W^}™‹” ¾Y^ }’di’ƒ& `Ÿ “� � � ¾Y^ ›ðéçU KTÔMuƒ SõƒH@ Gdw KTp[w Ã[ÇM::

¾}ÖÁm lØ`: ---------------------------------------------- SKÁ lØ`: ----------------------------------------------------

¡MM: ------------------------- µ”: ------------------------- ¨[Ç: --------------------------- kuK?: --------------------------

67

¡õM ›”É: ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ SÖÃp (KÖ?“ ›?¡e}”i” W^}™‹)

I. ¾ÓM S[Í/ Background InformationŸ²=I u‹ LK¬ Á’”Ç”Æ ØÁo }Ñu=¬” SMe ¨Ã”U ¾#� � ×$ UM¡ƒ ŸSMc< Ô” Ãéñ::1. u²=I S<Á e”ƒ ¯Sƒ ¾e^ MUÉ ›Kƒ:: ------------¯Sƒ2. ï& ¨”É--------------------------1 c?ƒ-----------------------------2�3. K²=I Ö?“ Ÿ?L e”ƒ ¯Sƒ c`}ªM:: ------¯Sƒ“-------¨^ƒ4. u›G<’< e^ Ke”ƒ Ñ>²? q¿:: ----------------¯Sƒ“-------¨^ƒ5. °ÉT@&---------------- ¯Sƒ6. K?L W^}™‹ Ãq×Ö^K<:: ›---------------------1 ¾KU-----------------------27. KØÁo 6 SMe ›” ŸJ’& e”ƒ W^}™‹” Ãq×Ö^K<::-------W^}™‹

ƒ°³´: KÁ”Ç”Æ� ¯[õ} ’Ñ` U” ÁIM SeTTƒ” ¨Ã”U ›KSeTTƒ” KTSMŸƒ Ÿ²=I u‹ u}SKŸ~ƒ SKŸ=Á lØa‹� uSÖkU ŸÁ”Ç”Æ ØÁo òƒ Kòƒ }Ñu=¬” lØ` Á¡wu</ÃS´Óu<:: K`e ¬’ƒ ¾J’ ”Ï ƒ¡¡K— ¨ÃU ƒ¡¡K— ÁMJ’� � SMe ¾T>vM ”ÅK?K Áe¬c<::� �

II. c?„‹/ � ValuesSKŸ=Á: 1 , u×U MeTTU& 2 , ›MeTTU& 3 , uG<K~U ›MeTTU� 4 , eTTKG<& 3 , u×U ›eTTKG<� �lØ` ØÁo SKŸ=Á1 KY^ SƒÒƒ c?‹” ’¬::� � 1 2 3 4 52 S}vu` ¾e^ c?‹” ’¬::� � 1 2 3 4 53 Y^ uum Ø[ƒ Sc^ƒ ›Kuƒ& 1 2 3 4 54 T“U c¬ ¾}hK ¬Ö?ƒ KTÓ–ƒ SÑM ›Kuƒ� & 1 2 3 4 55 Y^ ¾^e ¡w` U”ß ’¬& 1 2 3 4 5 6 U¡¡` Sc“¡KA‹” KTe¨ÓÉ“ eI}„‹” KSŸLŸM Ã[ÇM&. 1 2 3 4 57 Y^ u^c< SÚ[h dÃJ” K›”É c¬ °Éу TÔMu‰ SX]Á ’¬& 1 2 3 4 58 Ø^ƒ LK¬ Y^ SƒÒƒ vIL‹” ’¬& 1 2 3 4 59 ¾Y^ Là U` u^e wnƒ K=ј ËLM� � & 1 2 3 4 510 eŸ?T c¬ ¾e^ ¾Ñ>²? ÑÅw ¾T>Öwp/¾T>ÁŸw` ’¬&� 1 2 3 4 511 ›”É c¬ uQèƒ ¾T>ÁÒØS< ‹Óa‹” uTe¨ÑÉ“ Y^¬” Ø\ ›É`Ô uSe^ƒ

^c<(œ)” ThhM ËLM/ƒ‹LK‹&1 2 3 4 5

12 Y^ TKƒ ›”}/ˆ ¾Uƒc^¬/¾Uƒc]¬ ’¬ 1 2 3 4 513 u›w³—‹ Y^‹ c‹ T“†¬”U ¾ËS\ƒ” Y^ uÅ”w TŸ“¨” ËLK<& 1 2 3 4 514 Ÿe^¬ ¾UƒðMÑ(Ñ>)¬” ’Ñ` Ÿ¨pI K›”}/ˆ e^ TÓ–ƒ ƒ‹LKI& 1 2 3 4 515 W^}™‹ u �KòÁ†¬ ¬d’@ ¾TÃÅc~ ŸJ’ ›’É ’Ñ` TÉ[Ó ›Kv†¬& 1 2 3 4 516 ¾U}ðKÑ(Ñ>)¬” Y^ TÓ–ƒ u›w³—¬ ¾°ÉM Ñ<Çà ’¬& 1 2 3 4 517 Ñ”²w TÓ–ƒ uª“’ƒ ¾Ø\ °ÉM/°× Ñ<Çà ’¬& 1 2 3 4 518 ›w³—‹ c‹ Ø[ƒ ŸÅ[Ñ< e^†¬” uÅ”w ¾Se^ƒ ›pU ›L†¬& 1 2 3 4 519 Ø\ e^ KTÓ–ƒ uŸõ}— x � ¾u?}cw ›vM/²SÉ/ÕÅ— K=•`I ÃÑvM& 1 2 3 4 520 �ÉÑ„‹ u›v³—¬ Ñ>²? ¾Ø\ °ÉM/°× Ñ<Çà “†¬& 1 2 3 4 521 Ø\ e^ KTÓ–ƒ ŸU¬k¬ e^ � ÃMp ¾U¬k¬ � c¬ ¾uKÖ ÖnT> ’¬& 1 2 3 4 522 �ÉÑ„‹ Y^†¬” uÅ”w KT>ÁŸ“¬’< W^}™‹ Ãc×K<& 1 2 3 4 5

68

23 w²< Ñ”²w KSe^ƒ/KTÓ–ƒ c‹” T¨p ›KwI/i& 1 2 3 4 524 u›w³—‹ Y^‹ Ôu´ W^}— KSJ” w²< ÉM ÃÖÃnM� & 1 2 3 4 525 u›ÖnLà Y^†¬” uÅ”w ¾T>Ÿ“¬’< c‹ ¾Y^†¬” ªÒ ÁÑ—K<& 1 2 3 4 526 ›w³™‡ W^}™‹ ŸT>Áeu<ƒ uLà uLò� ‰†¬ Là }ê°• ›L†¬& 1 2 3 4 527 w²< Ñ”²w“ ƒ”g Ñ”²w uT>ÁÑ–< c‹ SŸŸM ÁK¬ ª“ M¿’ƒ °ÉM ’¬& 1 2 3 4 528 ”Å‹Ó` ð×] W^}— ¾U¨p wJ” � � ’<a Ku?}cxŠ õ[ƒ ÁS× ’u`& � 1 2 3 4 529 U”U ”Ÿ<� › K?KA‹ vÁ¬lƒU S<K< ¾e^ Ñ>²?¾” ŸM}ÖkUG< SØö eT@ƒ

ÃcT—M&1 2 3 4 5

30 Kò SØö Y^ Se^}” u=’Ó[˜ •a õ[ƒ ÃcT˜ ’u`&� � 1 2 3 4 531 ¾Y^ vKÅ[xŠ ¾’@” Y^ ”ÅÑ“ u=c� \ƒ ’<a Nõ[ƒ ÃcT˜ ’u`& 1 2 3 4 532 �U’ƒ ¾TÃ×Mw˜ c¬ ”Å’u`G< � �Á”Ç”Æ c¬ ¾T>Á¬p u=J” ’<a Ku?}cxŠ

õ[ƒ ÁS× ’u`& �1 2 3 4 5

33 U”U ”Ÿ<� › K?KA‹ vÁ¬lƒU uÉ”w ŸMc^G< SØö eT@ƒ ÃcT—M& 1 2 3 4 534 uY^ Là ÁMðìUG<ƒ Ów/¯LT u=•` ’<a u?}cu<† Áõ\ ’u`& 1 2 3 4 5

III. É`Ï© vIM/ � Organizational CultureSKŸ=Á: 1 , u×U MeTTU& 2 , ›MeTTU& 3 , uG<K~U ›MeTTU� 4 , eTTKG<& 5 , u×U ›eTTKG<� �lØ` ØÁo SKŸ=Á35 uÖ?“ Ÿ?L¬ ’Ña‹ ”� ȃ �¾}Õ²< ”ÅJ’ KÖ?“ Ÿ?L¬ T’@ÏS’ƒ � ¾Teu¬” KS“Ñ`

‹Ó` ¾Kw˜U&1 2 3 4 5

36 �Lò K=eTTuƒ ¾TËM” ’Ñ` S“Ñ` ›e†Ò] K=J”w˜ ËLM& 1 2 3 4 537 Ö?“ Ÿ?L¬ uIw[}cu< ²”É Ø\ ´“/eU ›K¬& 1 2 3 4 538 ›w³—¨‡ vMÅ[x† �²=I Ö?“ Ÿ?L uSe^†¬ ¡w` ÃcT†ªM&� 1 2 3 4 539 uÖ?“ Ÿ?L¬ ÁK< vKÅ[vŠ Kui}™‹ uT>cÖ<ƒ Ø\ ›ÑMÓKAƒ â^K<& 1 2 3 4 540 u²=I Ö?“ Ÿ?L ÁK< vMÅ[x† e^†¬” ”Å›cMˆ � ’Ñ` ÃkØ\M� & 1 2 3 4 541 vMÅ[x† K?KA‹ ue^†¬ ¨ÅL ¾k\ƒ” ÁÓ³K<� & 1 2 3 4 542 vMÅ[x† KK?KA‹ ¾¡õK< ›vLƒ ¬k� �†¬”“ ¡IKA†¬” uðnŘ’ƒ ÁŸõLK<::� 1 2 3 4 543 vMÅ[x† K?KA‹ vKÅ[x‹ ›KSÓvvƒ c=•^†¬/c=ðØ\ ”Å›e^m KTÑ� � MÑM

ÃV¡^K<&1 2 3 4 5

44 vMÅ[x† ŸK?KA‹ vMÅ[x‹ Ò` ‹Ó` ¬eØ �”ÇÃÑu< KSŸLŸM `UÍ� ‹” èeÇK<&

1 2 3 4 5

45 vMÅ[x† Ÿe^†¬ Ò` u}Ñ“– ‹Óa‹ LKv†¬ vMÅ[x‹ Ñ>²? Ãc×K<& 1 2 3 4 546 vMÅ[x† }ê°• K=ÁS× ¾T>‹M `UÍ ŸS¬cdž¬ uòƒ ŸvMÅ[x‹/ � ŸuKÑ<ÇÄ‹

Ò` èÁÁK<&1 2 3 4 5

47 vMÅ[x† ¾e^ ¡õK< ”ȃ ¬Ö?T’~� � ” ThhM ”ÇKuƒ Ñ”� u= ›e}Á¾ƒ Ãc×K<& 1 2 3 4 548 vMÅ[x† Ke^ ¡õK< Ø\ ¾J’ ›SKŸŸ†¬” KSÓKê c=K< ›KS� eTT†¬” KSÓKê�

ðnÅ— “†¬&1 2 3 4 5

49 vMÅ[x† Ÿe^†¬ Ò` u}Ñ“– ewcv Là ÃÑ—K<& u”nƒU Ãd}óK<& 1 2 3 4 550 vMÅ[x† K?KA‹ vKÅ[x‹ ¾c\ƒ” e^ Ã}‰K</c}ƒ ÃðMÒK<& 1 2 3 4 551 vMÅ[x† K?KA‹ vMÅ[x‹ Ønp” ’Ñ` ›u?~ ”Ç=Ák[u<� � ›Áu[~U&� 1 2 3 4 552 vMÅ[x† u›’É ’Ñ` uÔ Ô’< ÃMp eI}~ Là Á}Ÿ<^K<& 1 2 3 4 553 uY^ ¡õK? ’Ña‹ ”� ȃ �¾}Ñ<œ²< ”ÅJ’ KLò � � ¾Teu¬” ƒ¡¡K— Gdw KS“Ñ`

‹Ó` ¾Kw˜U&1 2 3 4 5

IV. ¾Y^ Là G<’@ �‹/ Workplace ConditionsSKŸ=Á: 1 , u×U MeTTU& 2 , ›MeTTU& 3 , uG<K~U ›MeTTU� 4 , eTTKG<& 5 , u×U ›eTTKG<� �lØ` ØÁo SKŸ=Á54 ¾Uc^¬ Y^ eKe^ ¬Ö?T’ƒ (Ø^ƒ“ v³ƒ) Ów[SMe)� ÃcÖ—M& 1 2 3 4 555 Lò“ vMÅ[x† eKe^ ¬Ö?� T’ƒ (Ø^ƒ“ v³ƒ) Ów[SMe)� ÃcÖ<—M& 1 2 3 4 556 Y^ KTIu^© Ó”–<’ƒ TKƒU uu<É” Se^ƒ ¨ÃU vMÅ[v” S`ǃ °ÉM ÃcÖ— 1 2 3 4 5

69

M&57 ¾Y^ }Óv^ƒ&}ðLÑ> ‹KA“ Óx‹ ÓMî“ ¾}K¿ “†¬� & 1 2 3 4 558 uY^ ¾}KÁ¿ }Óv^ƒ“ Y^‹ ›K<˜& 1 2 3 4 559 e^ Ÿõ}— ¾J’ °¬kƒ“ eMƒ/²È ÃÖÃnM& 1 2 3 4 560 e^ ¾}KÁ¾ °¬kƒ“ eMƒ/²È ÃÖÃnM& 1 2 3 4 561 Y^ ue^ Là }î°• uT>ÁSÖ< ’Ña‹ Là S[Í ”Çј“ Ÿc� ‹ Ò` ”ɨÁÃ�

ÃðpÉM—M&1 2 3 4 5

62 e^¾ ¨Å Ÿõ}—/¾}gK ¾e^ Å[Í ÇÉÓ � °ÉM ÃcÖ—M& 1 2 3 4 563 ue^¾ ›”É” ’Ñ` ŸÓw ¾TÉ[e“ ¾SðçU eT@ƒ ÃcT—M& 1 2 3 4 564 e^¾ ue^¾ Là K¬Ø uT>ÁS× ¬d’@ Là ”Éd}õ ÉM � � ÃcÖ—M& 1 2 3 4 565 ŸK?KA‹ }Sddà e^‹ Ò` c=¨ÇÅ` c^¾ um ¡õÁ ÁeјM—M& 1 2 3 4 566 Ø\ eŸc^G< É[� e e^¾ ¾e^ ªeƒ“ ÃcÖ—M& 1 2 3 4 567 u’@@ e^ ¾}Á¿ Y^� ‹ ›K<& 1 2 3 4 568 Y^¾ ÉÓVi Ãu³ªM& 1 2 3 4 569 uY^¾ ×Mn ¾T>Ñv ÂKU& 1 2 3 4 570 G<MÑ>²? ýaË¡„‹/e^‹ KõéT@ c=É`c< ›ÁKG<& 1 2 3 4 571 uUc^uƒ Ñ>²? e^” ”ȃ uÅ� ”w ¾c^G< ”ÅJ’ T¨p K’@ kLM ’¬&� � 1 2 3 4 572 ŸK?KA‹ ’é J– e^¾” Se^ƒ ‹LKG<::� 1 2 3 4 573 ue^ ¾UðMѬ” uÅ”w ¾Se^ ’é’ƒ ›K˜& 1 2 3 4 574 ŸLò¾ u}ÚT] ŸÓKcx‹ }ÅÒÒT> Ów[SMe kSLKG<� � & 1 2 3 4 575 G<MÑ>²? ¾ËS`G<ƒ” e^ ¾SÚ[e °ÉM ›K˜& 1 2 3 4 576 e^¾” uðKÓG<ƒ Ñ>²? ¾SÚ[e e×’< ›K˜& 1 2 3 4 577 G<MÑ>²? e^¾” ŸSËS]Á¬ eŸ SÚ[h¬ ¾Se^ƒ °É� M ›K˜& 1 2 3 4 578 u’é’ƒ KTcwU J’ KSðçU w²< �ÉM ›K˜& 1 2 3 4 5

SKŸ=Á: 1 , u×U ÖnT> ›ÃÅKU& 2 , ÖnT> ›ÃÅKU & 3 , uG<K~U ›MeTTU 4 , ÖnT> ’¬& 5 , u×U ÖnT> ’¬lØ` ØÁo SKŸ=Á79 S<K< ¾J’ e^ Se^ƒ S‰M (ŸSËS]Á cŸ SÚ� [h ¾Se^ƒ °ÉM)& 1 2 3 4 580 ue^ Là ¾^c? ¾J’ ›k^[w/²È ue^Là ¾TªM ’é’ƒ S•`& 1 2 3 4 581 e^” ¾c^G< � ¨Ç=Á¬’< ¾e^ ¡”¬’@” SÑUÑU/õ`É SeÖƒ S‰M& 1 2 3 4 582 ÖnT> ’Ñ` c`†uKG< ¾UK¬� (cT@ƒ ¾T>cÖ˜) e^ S•`& 1 2 3 4 583 ªÒ ¾UcÖ¬ ’Ñ` TÓ–ƒ/ŸÓu< TÉ[e S‰M& 1 2 3 4 5

V. ew°“/ PersonalitySKŸ=Á: 1 , u×U MeTTU& 2 , ›MeTTU& 3 , uG<K~U ›MeTTU� 4 , eTTKG<& 5 , u×U ›eTTKG<� �lØ` ØÁo SKŸ=Á84 e^’¡ ‹Óa‹” KSq×Ö` u^c? ‹KA }TS“KG<� � & 1 2 3 4 585 ue^ ²S’@ ¾T>•\ƒ” T“†¬”U ª“ K¬Ù‹ u›Óvu< �ssTKG<& 1 2 3 4 586 ue^ Là ’Ña‹ ’@ uUðMѬ S”ÑÉ � �¾}Ñ<œ²< ”ÅJ’ ÃcT–“M� & 1 2 3 4 587 e^¾” u}SKŸ} ’Ña‹” Sq×Ö` ‹LKG< w¾ ›evKG<� & 1 2 3 4 588 e^¾ ›cMˆ uT>J”uƒ Ñ>²? �”Ÿ<ª ue^¾ Là T}¢`” kØLKG<� & 1 2 3 4 589 �^c?” ^c<” ¾T>q×Ö` ›É`Ñ@ �qƒ^KG<& 1 2 3 4 590 u›e†Ò] e^ Ñ>²? `U;” u}ÅÒÒT> Ÿ}LKG</›[ÒÓ×KG<&� � 1 2 3 4 591 ue^¾ ukLK< [uhKG<� & 1 2 3 4 592 K^c? ¾}K¿ ¾e^ Óx‹” T²Ò˃/TkÉ ¨ÇKG<� & 1 2 3 4 593 U›”É ’Ñ` u}[uiG< Ñ>²? eE^” Se^ƒ ›M‹MU& 1 2 3 4 594 ÓL© eT@‚ ue^¾ Là ×Kn ”Ç=Ñv ›MðpÉU&� 1 2 3 4 595 ŸS[ui ^c?” SÖup K’@ kLM ’¬� & 1 2 3 4 596 u×U ›e†Ò] e^‹” ¨Å%EL S}¬” S`×KG<� & 1 2 3 4 5

70

97 uU“ÅÉuƒ/SU[uiuƒ Ñ>²? ƒŸ<[ƒ ¾T׃ ‹Ó` ›Kw˜& 1 2 3 4 598 ¾Uc^¬ ›cMˆ e^ c=•[˜ ”ÅÚª qØ[ªKG<� � � & 1 2 3 4 599 ›”É e^ eŸ=ÁMp É[e e^¾” Tl›[Ø ›M¨ÉU&� 1 2 3 4 5100 U”U ”Ÿ<ª uÅ”w Se^� ‚ uvMÅ[xŠ ²”É vèpU eŸ‰MG< É[e e^”� �

Se^ƒ K’@ Ø\ ’¬&�1 2 3 4 5

101 �eŸ‰MG< É[e e^” ue^ƒ `� Ÿ ›Ñ—KG<� & 1 2 3 4 5102 Ø\/uÅ”w u}c^ e^ `� Ÿ� ÃÑ–“M& 1 2 3 4 5103 U”U ”Ÿ<ª K?KA‹” v� MuMØU Ÿuò~ ¡”¬”/e^ ¾uKÖ ec^ `Ÿ ›Ñ—KG<� � & 1 2 3 4 5104 Ö”¡a Se^ƒ ¨ÇKG<&� 1 2 3 4 5105 ’Ña‹”/e^” ec^ ›”Æ Åe ¾u� ò~” ¡”¬’@”/e^” ThhM ’¬& 1 2 3 4 5VI. É`Ï© Sc“¡KA‹/ � Organizational Constraints/ObstaclesSKŸ=Á: 1 , u×U MeTTU& 2 , ›MeTTU& 3 , uG<K~U ›MeTTU� 4 , eTTKG<& 5 , u×U ›eTTKG<� �lØ` ØÁo SKŸ=Á106 ÃI Ö?“ Ÿ?L e^¾” uõèU KSe^ƒ ¾T>ÁeðMј” ’Ñ` uS<K< ¾cÖ—M& 1 2 3 4 5107 e^” u›Óvu< KSe^ƒ ª“¬ U¡”Áƒ KSe^ƒ ›eðLÑ> ldlf‹& ›p`xƒ“ Sd]Á‹

cK?KK<˜ ’¬&1 2 3 4 5

108 Ø\ e^ KSe^ƒ ›eðLÑ> ldlf‹& ›p`xƒ“ Sd]Á‹ ›K<˜& 1 2 3 4 5109 e^¾ uu=aŸ^c=Á© H>Å„‹ ¾}’d w²<U ›Ãl›[ØU& 1 2 3 4 5110 Ke^ ”póƒ ¨ÃU e� ^” ¾T>Á²Ñ¿ ƒmƒ ƒ°²²<‹ ›K<& 1 2 3 4 5111 uu=a¡^c=“ uLeðLÑ> H>Å„‹ w²< Ñ>²? e^” uõì<U“ u}Ñu=¬ S”ÑÉ

”ÇMc^ ŸKŸLKG<� � &1 2 3 4 5

VII. }’di’ƒ ¾T>ÁeŸƒL†¬ ¾Y^ ›ðéçU G<’@ �‹/ Performance Consequences of Motivationƒ°³´: u›Kñƒ eÉeƒ ¨^ƒ ¾e^ ”penc?� Áeu<:: Ÿ²=I u‹ LK¬� KÁ”Ç”Æ� ¯[õ} ’Ñ` ”ȃ Y^� ” ÁŸ“¬’< ”Å’u`� KTSMŸƒ Ÿ²=I u‹ u}SKŸ~ƒ SKŸ=Á lØa‹ uSÖkU ŸÁ”Ç”Æ ØÁo òƒ Kòƒ }Ñu=¬” lØ` Á¡wu</ÃS�´Óu<:: K`e ¬’ƒ ¾J’ ”Ï ƒ¡¡K— ¨ÃU ƒ¡¡K— ÁMJ’ SMe ¾T>vM ”ÅK?K Áe¬c<::� � � �SKŸ=Á: 1 , u×U ’@” ÃSKŸM& 2 , G<MÑ>²? ’@” ÃSKŸM& 3 , ›”Ç”É Ñ>²? ’@”� � � � � ÃSKŸM& 4 , ›Mö ›Mö? ’@” ÃSKŸM& 5 , uõì<U ’@” ›ÃSKŸƒU&� � � �lØ` ØÁo SKŸ=Á112 ¨Å e^ eS× c¯ƒ ›Ÿw^KG<& 1 2 3 4 5113 Y^ Là ›e}TT˜“ ¾T>SŸ<w˜ ’˜& 1 2 3 4 5114 G<MÑ>²?U e^¾” uÑ>²? Ú`dKG<� & 1 2 3 4 5115 ¾’@ Y^ Ÿõ}— Ø^ƒ ›K¬& 1 2 3 4 5116 Ö”Ÿ^ W^}— ’˜& 1 2 3 4 5117 dMÖ¾p/dM’Ñ` Sc^ƒ ÁKv†¬” ’Ña‹ c^KG<� & 1 2 3 4 5118 eK e^Ä u×U °¬kƒ ›K˜& 1 2 3 4 5119 uU}‹uƒ Ñ>²? ›MŸLŸMU ¨Ã”U ›MudßU& 1 2 3 4 5120 Y^ Là udÝKG<� & 1 2 3 4 5121 eI}ƒ LKSe^ƒ Ö’knKG<� & 1 2 3 4 5122 ›Ç=e Sd]Á‹“ ýac=Ëa‹ KT¨p ^c?” ›²ÒÍKG<& 1 2 3 4 5123 Ÿe^ vMÅ[x† Ò` }Óuvw† c^KG<� & 1 2 3 4 5124 Ÿp`w ›KnÄ Ò` }Óuvw† c^KG<� & 1 2 3 4 5125 eK Y^Ä uÔ ›SKŸŸƒ ›K˜& 1 2 3 4 5126 uY^ Là ¾SÑ–ƒ ]Ÿ`È u×U Ø\ ’¬& 1 2 3 4 5127 Ÿe^ w²< ›Kk`U& 1 2 3 4 5128 ð×” W^}— ’˜& 1 2 3 4 5129 Y^ Là Ñ>²?¾” ue^ ’¡ ”penc?� ‹ Là ›¬LKG<& 1 2 3 4 5

VIII. }’di’ƒ ¾T>ÁeŸƒL†¬ }ê°•‹ ([Ÿ& Seª°ƒ’ƒ)/ � � Affective Consequences of Motivation (Satisfaction; Commitment)SKŸ=Á: 1 , u×U [¡‰KG<& 2 , uSÖ’< u=J” [¡‰KG<& 3 , uG<K~U ›MeTTU� �

71

4 , uSÖ’< u=J” M[ŸG<U& 5 , u×U ›M[ŸG<U�lØ` ØÁo SKŸ=Á130 ÖpKM vK SMŸ< ue^ uMÅ[v U” ÁIM [¡}ªM& 1 2 3 4 5131 ÖpKM vK SMŸ< uLò� U” ÁIM [¡}ªM& 1 2 3 4 5132 ÖpKM vK SMŸ< ue^ U” ÁIM [¡}ªM& 1 2 3 4 5133 ue^ Là ¾T>Á¬K<ƒ” eMƒ/²È“ Ø[ƒ ŸÓUƒ ¬eØ uTeÑvƒ u¡õÁ U” ÁIM

[¡}ªM&1 2 3 4 5

134 ue^ ¡õM vK¬ T’@ÏS”ƒ/›e}ÇÅ` U” ÁIM [¡}ªM& 1 2 3 4 5135 ÁKƒ” ‹KA � Ke^ ¾SÖkU °ÉM U” ÁIM [¡}ªM& 1 2 3 4 5136 ›Ç=e ’Ñ` uST` °ÉM U” ÁIM [¡}ªM& 1 2 3 4 5137 ÖnT> ¾J’ ’Ñ` uSðìU °ÉM U” ÁIM [¡}ªM& 1 2 3 4 5138 �’ÅÓKcw ^e” Ø\ eT@ƒ ”Ç=cT� uT>c\ƒ e^ °ÉM U” ÁIM [¡}ªM& 1 2 3 4 5139 uT>ÁÑ–<ƒ ØpTØpU U” ÁIM [¡}ªM& 1 2 3 4 5140 uT>ÁÑ–<ƒ ¾ƒUI`ƒ/¾eMÖ“ °ÉM U” ÁIM [¡}ªM& 1 2 3 4 5141 uò²=ŸM ¾e^ G<’@ �‹(x&w`G”“ � ›¾` ´¬¬`) U” ÁIM [¡}ªM& 1 2 3 4 5

SKŸ=Á: 1 , u×U MeTTU& 2 , ›MeTTU& 3 , uG<K~U ›MeTTU� 4 , eTTKG<& 5 , u×U ›eTTKG<� �lØ` ØÁo SKŸ=Á142 u²=I Ö?“ Ÿ?L ¾— e^ ¬Ö?T SJ’<” KT[ÒÑØ � ŸT>Öupw˜ SÅu— e^ uLÃ

Ÿð}— Ø[ƒ KTÉ[Ó ðnÅ— ’˜:1 2 3 4 5

143 ÃI Ö?“ Ÿ?L K=c\uƒ ¾T>Ñv ƒMp É`σ ”ÅJ’ G<MÑ>²? KÕÅ™Š� ’Ñ^†ªKG<� &

1 2 3 4 5

144 K²=I Ö?“ Ÿ?L u×U ƒ”i ¾J’ ƒÒƒ ”ÅTÅ`Ó ÃcT—M:� 1 2 3 4 5145 ¾ �’@ �c?„‹“ ¾²=I Ö?“ Ÿ?L c?„‹ � }Sddà G<’¬ ›Ó˜‰†ªKG<& 1 2 3 4 5146 ¾²=I Ö?“ Ÿ?L ›ŸM SJ’@” KK?KA‹ e“Ñ` Ÿ<^ƒ ÃcT—M& 1 2 3 4 5147 ÃI Ö?“ Ÿ?L ue^ Là ¾}‰K˜” �”Éc^ Á’dd—M& 1 2 3 4 5148 ec^v†¬ Ÿ’u\ƒ K?L Ö?“ Ÿ?L‹ u}n[’ SMŸ< K²=I Ö?“ Ÿ?L uSe^} u×U

Åe}— ’˜& 1 2 3 4 5

149 u²=I G<’@Â� u×U ƒ”i K¬ØÃI” Ö?“ Ÿ?L KSMkp U¡”Áƒ ÃJ’—M& 1 2 3 4 5150 K²Ko¬ � K²=I Ö?“ Ÿ?L uSe^ƒ uS<Á Là ¾T>eÑ–¬ ’Ñ` w²<U ¾KU& 1 2 3 4 5151 G<MÑ>²? W^}™‹” u}SKŸ} ª“ Ñ<ÇÄ‹ ¾²=I Ö?“ Ÿ?L þK=c=‹ KSeTTƒ

›e†Ò] J• ›Ñ–ªK<&1 2 3 4 5

152 K’@ � KSe^ƒ ÃI ŸG<K<U Ö?“ Ÿ?L‹ u×U ¾}hK ’¬& 1 2 3 4 5153 u�’@ uŸ<M u²=I Ö?“ Ÿ?L Se^ƒ” SkuK? eI}ƒ ’u`& 1 2 3 4 5

IX. }’di’ƒ ¾T>ÁeŸƒL†¬ eT@„‹/ Cognition Consequences of Motivation

SKŸ=Á: 1 , u×U [¡‰KG<& 2 , uSÖ’< u=J” [¡‰KG<& 3 , uG<K~U ›MeTTU� � 4 , uSÖ’< u=J” M[ŸG<U& 5 , u×U ›M[ŸG<U�lØ` ØÁo SKŸ=Á154 Y^” uÉ”w ”� Ç=c\ uLò� c=cبƒ u’u[ eM×” U” ÁIM [¡}ªM; 1 2 3 4 5155 ›=ƒÄåÁ ¬eØ ŸK< K?KA‹ }Sddà e^‹ Ò` ¾`e” e^ c=¨ÇÉ\ƒ U” ÁIM

[¡}ªM;1 2 3 4 5

156 u›G<’< G<’@ � SËS]Á Là K^e ŸkÇD†¬ Óx‹ KSÉ[e u›Å[Ñ<ƒ U` U”� � ÁIM [¡}ªM;

1 2 3 4 5

157 u›ÖnLà ueM×”& ueMÖ““ MUÉ U¡”Áƒ uT>c؃ S<Á SÖ” u`e L� ò ›kvuM U” ÁIM [¡}ªM;

1 2 3 4 5

158 u›ÖnLà SËS]Á e^” Se^ƒ c=ËU\ ŸÖulƒ ’Ñ` ›Ÿ<›Á u›G<’< e^ U” ÁIM [¡}ªM;

1 2 3 4 5

159 ¨Åòƒ uT>Öwlƒ e^ �à � u›G<’< e^ U” ÁIM [¡}ªM; 1 2 3 4 5

72

¡õM G<Kƒ: ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ( ¾W^}™‹ ¡”¬” ¾Lò� ‹ ›cd)

ƒ°³´: u›Kñƒ eÉeƒ ¨^ƒ u¨[Ç ÁK< ¾Ö?“ ›?Ÿe}”i” W^}™‹ ¾e^ ›ðéçU Áeu<:: Ÿ²=I u‹ LK¬� KÁ”Ç”Æ� ¯[õ} ’Ñ` ¾Ö?“ ›?Ÿe}”i” W^}™‹ ”ȃ Y^¬”/Y^ª” ÁŸ“¬’</Ÿ“¬” ”Å’u` KTSMŸƒ Ÿ²=I u‹� � � � u}SKŸ~ƒ SKŸ=Á lØa‹ uSÖkU ŸÁ”Ç”Æ ØÁo òƒ Kòƒ }Ñu=¬” lØ` Á¡wu</ÃS´Óu<:: K`e ¬’ƒ ¾J’ ”Ï� � ƒ¡¡K— ¨ÃU ƒ¡¡K— ÁMJ’ SMe ¾T>vM ”ÅK?K Áe¬c<::� �SKŸ=Á: 1 , u×U ÃSKŸªM/ÃSKŸM& 2 , G<MÑ>²? ÃSKŸªM/ÃSKŸM& � �� � �� 3 ,›”ǔɠÑ>²? ÃSKŸªM/ÃSKŸ}ªM 4�  , ›Mö ›Mö? ÃSKŸ}ªM/ ÃSKŸM& �� 5 , uõì<U ›ÃSKŸ}¬U/›ÃSKŸƒU&�lØ` ØÁo (¾›ðéçU ¢Uþ’@”ƒ) SKŸ=Á1 ¨Å Y^ c=S×/eƒS× c¯ƒ ÁŸw^M/Ÿw^K‹� & 1 2 3 4 52 uY^ Là ›e}TT˜“ ¾T>SŸ<u(v)ƒ ’¬/“ƒ& 1 2 3 4 53 G<KÑ>²?U e^¬”/e^ª” uÑ>²? ÃÚ`dM/ƒÚ`dK‹& 1 2 3 4 54 Ÿõ}— ¾Y^ Ø^ƒ& 1 2 3 4 55 Ö”Ÿ^ W^}—& 1 2 3 4 56 U”U dÃ(ƒ)Ö¾p Sc^ƒ ÁKv†¬” ’Ña‹ Ãc^M/ƒc^K‹& 1 2 3 4 57 eK Y^¬(ª) Ÿõ}— °¬kƒ ›K¬/›Lƒ& 1 2 3 4 58 uT>}‹uƒ/uUƒ}‹uƒ Ñ>²? ›ÃŸLŸMU/›ÃudßU& 1 2 3 4 59 Y^ Là ÃudÝM/ƒudÝK‹& 1 2 3 4 510 eI}ƒ LKSe^ƒ Ö”nn ’¬/’‹& 1 2 3 4 511 ›Ç=e Sd]Á‹“ ýac=Ëa‹ KT¨p ^c<” Á²ÒÍM/²ÒÍK‹� & 1 2 3 4 512 Ÿe^ vMÅ[u¬(ª) Ò` }Óuvw„/}Óvw Ãc^M/ƒc^K‹� & 1 2 3 4 513 Ÿp`w ›Kn¬(ª) Ò` }Óuvw„/}Óvw Ãc^M/ƒc^K‹� & 1 2 3 4 514 eK Y^¬(ª) uÔ ›SKŸŸƒ ›K¬/›Lƒ& 1 2 3 4 515 uY^ Là ¾SÑ–ƒ ]Ÿ`É u×U Ø\ ’¬& 1 2 3 4 516 ŸY^ w²< ›Ãk`U/›ƒk`U& 1 2 3 4 517 ð×” W^}—& 1 2 3 4 518 ue^ x Ñ>²?¬(ª)” ue^-’¡ ”penc?¨† ÁdMóM/dMó� � � K‹& 1 2 3 4 5

73

10. K. ¾Iw[}cu<” ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï) }ÖnT>’ƒ ¾T>Çee SÖÃp

›ÖnLÃ S[Í

¾u?ƒ ›v¬^ YU-------------------------------------------------------------------------------------------¾u?ƒ lØ`?--------------------------------------------------- kuK?------------------------------------------¨[Ç----------------------------- µ”-------------------------- ¡MM------------------------------------------

¡õM ›”É: ¾}ÖÁm¬ S[Í

eUU’ƒÖ?“ ÃeØM˜! eT@ ----------------------------------- ÃvKM:: u “ ›ጎንደር ዩኒቨርሲቲ Ç=e ¢”+’”}M ¾Ö?“ ›Övup ›=”e+~ƒ የድህረ ምረቃ (ú.›?.Ç=) ተማሪና u “ ›ጎንደር ዩኒቨርሲቲ Ç=e ¢”+’”}M ¾Ö?“ ›Övup ›=”e+~ƒ uU°^w ÔÍU µ” በአማራ ብሔራዊ ክልላዊ መንግስት ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ U” ”ÅT>SeM KT¨p� uT>"H@Ũ< Ø“ƒ Là }d �ò ’˜::

u›=ƒÄåÁ ôÅ^K© Ç=V¡^c=© K?ùwK=¡ S”Óeƒ ¾}}Ñu[¬” ¾Ö?“ ›?¡e}”g” ýaÓ^U ¾Iw[}cu<” ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï) }ÖnT>’ƒ ¾U“Ö“ c=J” Ÿ`e ¾T>Ñ–¬ S[Í S”Óeƒ ¾}hK ¾Ö?“ ›ÑMÓKAƒ ”Ç=ÁpÉ“ ”Ç=}Ñw` Ã[ÇM:: � �

¾`e u?ƒ K²?I c=uM u°ÉM ¾}S[Ö c=J” K²=I Ø“ƒ Ã[Ç” ²”É 30 eŸ 40 Åmn ÑÅT ¾T>¨eÉ ØÁo� ‹” M”ÖÃkƒ ”ðMÒK”:: ¾T>cÖ<” SMe uUeÖ=` ¾T>Öup c=J” ŸU`U\ }dò� � ‹ ¬ß KT”—¬U c¬ ¾cÖ<”” S[Í ›dMð” ›”cØU:: uØ“~ Là ¾ÓÉ Sd}õ ¾KwƒU:: ’Ñ` Ó” ¾`e ›e}Á¾ƒ ¨ÃU SMe ÖnT> eKJ’ uØ“~ Là Ãd}óK< wK” }eó “Å`ÒK”::� u²=I Ø“ƒ Là Sd}õ u`e S<K< ðnŘ’ƒ Là ¾}Sc[} c=J” ›”É ØÁo ¨ÃU G<K<”U ØÁo‹” ›KSSKe ËLK<:: U” ›Mvƒ }ÚT] S[Í ŸðKÑ< Ÿ²=I uòƒ ucÖ”ƒ Ÿ`É/¨[kƒ Là ¾}Ökc<ƒ/¾}²[²\ƒ c‹ T’ÒÑ` ËLK<::

74

›G<” eK Ø“~ T“†¨<”U ’Ñ` K=ÖÃl˜ ÃðMÒK<; ›G<” SÖÃl” SËS` ‹LKG<”;�

SËS]Á c¯ƒ ----------------- SÚ[h c¯ƒ -------------------- k” --------------------------------------SMe cܨ< (ª) }eTU}ªM -----------------1 SMe cܨ< (ª) ›M}eTS<U ----------------2¾S[Í cwdu=¨< eU ------------------------------------------ò`T ------------------ k” ----------------------¾}q××]¨< (ª) eU -----------------------------------------ò`T ------------------ k” ----------------------

¡õM ›”É: ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï) }ÖnT>’ƒ ¾Iw[}cu< TIu^©& ›=¢•T>Á©“ e’Q´v© SÑKÝ lØ` ØÁo ¢É ´KM101 °ÉT@ e”ƒ ’¬; ¯Sƒ----------------------------------------------------------

-›L¨<k¨<U-------------------------------------------------98SSKe ›MðMÑ<U -------------------------------------99

102 ë� U”É” ’¬; ¨”É----------------------------------------------------------1c?ƒ------------------------------------------------------------2

103 ¾Òw‰ G<’@ � U”É” ’¬; ÁKÑv(‹)------------------------------------------------------1 ÁÑv(‹)--------------------------------------------------------2}KÁÃ}¬ ¾T>•\----------------------------------------3 vLD (T>e~) ¾V}uƒ-------------------------------------4¾ð (‹)----------------------------------------------------�--5K?L(ÃÑKî)----------------------------------------------------6

104 ¾ƒUI`ƒ Å[Í U”É” ’¬; ÁM}T[(‹)-------------------------------------------------1 T”uw“ Síõ w‰----------------------------------------2 Ÿ1—-6— ¡õM-----------------------------------------------3 Ÿ7—-8— ¡õM-----------------------------------------------4 Ÿ9—-12— ¡õM----------------------------------------------5

75

¢K?Ï& ¿’>y`e+--------------------------------------------6K?L(ÃÑKî)----------------------------------------------------7

105 K›Kñƒ 12 ¨^ƒ ª’— e^ U”É” ’¨<; Y^›Ø-------------------------------------------------------1 Ö<[}—-------------------------------------------------------2 }T]----------------------------------------------------------3 ›ŸM Ñ<Ç}—-------------------------------------------------4 ¾u?ƒ Su?�ƒ------------------------------------------------5 ’ÒÈ-----------------------------------------------------------6 ¾k” W^}—------------------------------------------------7 ¾S”Óeƒ }k×]------------------------------------------8¾ÓM É`σ }k×]--------------------------------------9 ¾ S.Á.É }k×]-----------------------------------------10 ¾^c< É`σ c^}— ÁK<ƒ----------------------------11 ¾^c< É`σ c^}— ¾K?K<ƒ-------------------------12 u^c< }k×] Ñu_ /›d ›eÒ]------------------------13 K?L(ÃÑKî)--------------------------------------------------14

106 ¾u?}cw ›ÖnLà ¨`G© ¾Ñu= SÖ” e”ƒ ’¨<;

w`--------------------------------------------------------------›L¨<k¨<U-------------------------------------------------98SSKe ›MðMÑ<U -------------------------------------99

107 uu?}cw ¨<eØ ¾T>Ñ–< ¾c‹ w³ƒ e”ƒ ’¬;

lØ`------------------------------------------------------------SSKe ›MðMÑ<U -------------------------------------99

108 °U’ƒ U”É” ’¬; ¾›=ƒÄåÁ *`„Ê¡e }ªQÊ---------------------------1eMU“-----------------------------------------------------�

-2 Ÿ„K=¡---------------------------------------------------------3ýa}e ”ƒ-------------------------------------------------4�K?L(ÃÑKî)----------------------------------------------------5

109 wN?` U”É” ’¬; ›T^----------------------------------------------------------1›Ñ¬-----------------------------------------------------------2ƒÓ_---------------------------------------------------------

76

-3*aV----------------------------------------------------------4 K?L(ÃÑKî)----------------------------------------------------5

110 u²=I u?ƒ e”ƒ ¡õKA‹ KS˜ ÃJ“K<;� ¡õM------------------------------------------------------------

111 Ÿu?}cw SHM c¯ƒ& XáM& _ÉÄ& eM¡/VvÃM ÁK¬ ›K;

› ¾KU c¯ƒ 1 2 XáM 1 2 _ÉÄ 1 2eM¡/VvÃM 1 2

112 uÖ?“ Ÿ?L¬ ¾T>cÖ¬” ¾Ö?“ ›ÑMÓKAƒ ”ȃ Á¿ M;� �

u×U Ø\ ’¬----------------------------------------------1Ø\ ’¬------------------------------------------------------2Ø\U SØöU ›ÃÅKU---------------------------------3SØö ’¬---------------------------------------------------4 u×U SØö ’¬------------------------------------------5

113 ¾Ö?“ ›?¡e}”i” W^}™‹ K}ÑMÒ¿ ¾T>Ád¿ƒ” ìvà ”ȃ Á¿ M;� �

u×U Ø\ ’¬----------------------------------------------1Ø\ ’¬------------------------------------------------------2Ø\U SØöU ›ÃÅKU---------------------------------3SØö ’¬---------------------------------------------------4 u×U SØö ’¬------------------------------------------5

Section Two: Predisposing Factors for Utilization of HEP Services by the CommunitylØ` ØÁo ¢É ´KM201 eKÖ?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï)

cU}¬ Á¬”K<”;›----------------------------------------------------------------1¾KU--------------------------------------------------------------2

201 eKÖ?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï) S[Í Ÿ¾ƒ ›Ñ–<;

ŸÖ?“ ›?¡e}”i” W^}™‹--------------------------------1ŸK?KA‹ ¾Ö?“ W^}™‹------------------------------------2ŸIw[}cu<------------------------------------------------------3Ÿ_ÉÄ------------------------------------------------------------4 K?L(ÃÑKê)-----------------------------------------------------98

203 eKÖ?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï) um Ó”³u? ›Kƒ”;

›----------------------------------------------------------------1¾KU--------------------------------------------------------------2

204 eKÖ?“ ›?¡e}”i” ýaÓ^U ¾T>Á¬l ŸJ’ e”ƒ ûŸ?Ћ ›K<ƒ;

________ ûŸ?Ћ----------------------------------------------1›L¨<k¨<U----------------------------------------------------98SSKe ›MðMÑ<U------------------------------------------99

¾ƒ™‡” ¾Ö?“ ›?¡e}”i” ›?‹.›Ã.y=/›?.É.e“ K?KA‹ ÁvL²` ui � ‹ “ �

77

ýaÓ^U(ûŸ?Ï‹) Á¬nK<; +.y= SŸLŸM“ Sq×Ö`-----------------------------1¨v SŸLŸM“ Sq×Ö`------------------------------------2›e†Ÿ<›Ã ¾SËS]Á `Ç -----------------------------3� �¾ “„‹“ Q铃 Ö?“ --------------------------------------4�¾u?}cw U×’@--------------------------------------------------5¡ƒvƒ------------------------------------------------------------6e’UÓw----------------------------------------------------------7c’ }ªMÊ Ö?“------------------------------------------------8cÑ^ ›¨ÒÑÉ---------------------------------------------------9¾Å[p“ õdi qhh ›¨ÒÑÉ-------------------------------10¾¬H ›p`xƒ“ ›Övup------------------------------------11¾UÓw ”êQ““ ÅI”’ƒ------------------------------------12Ö?“T ¾u?ƒ ›Ÿvu= ›ÁÁ´---------------------------------13}vÓ aÅ”ƒe lØØ`------------------------------------14¾ÓM ”êQ“ ›Övup---------------------------------------15¾Ö?“ ƒUI`ƒ“ ¢S<’>Ÿ?i”------------------------------16

205 ¾ƒ™‡” ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï‹) }ÖpSªM/}Ów[ªM;

›?‹.›Ã.y=/›?.É.e“ K?KA‹ ÁvL²` ui � ‹ “ � +.y= SŸLŸM“ Sq×Ö`-----------------------------1¨v SŸLŸM“ Sq×Ö`------------------------------------2›e†Ÿ<›Ã ¾SËS]Á `Ç -----------------------------3� �¾ “„‹“ Q铃 Ö?“ --------------------------------------4�¾u?}cw U×’@--------------------------------------------------5¡ƒvƒ------------------------------------------------------------6e’UÓw----------------------------------------------------------7c’ }ªMÊ Ö?“------------------------------------------------8cÑ^ ›¨ÒÑÉ---------------------------------------------------9¾Å[p“ õdi qhh ›¨ÒÑÉ-------------------------------10¾¬H ›p`xƒ“ ›Övup------------------------------------11¾UÓw ”êQ““ ÅI”’ƒ------------------------------------12Ö?“T ¾u?ƒ ›Ÿvu= ›ÁÁ´---------------------------------13}vÓ aÅ”ƒe lØØ`------------------------------------14¾ÓM ”êQ“ ›Övup---------------------------------------15¾Ö?“ ƒUI`ƒ“ ¢S<’>Ÿ?i”------------------------------16

206 ¾ƒ™‡” ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï‹) ›M}ÖS<U/›M}Ñu\U;

›?‹.›Ã.y=/›?.É.e“ K?KA‹ ÁvL²` ui � ‹ “ � +.y= SŸLŸM“ Sq×Ö`-----------------------------1¨v SŸLŸM“ Sq×Ö`------------------------------------2›e†Ÿ<›Ã ¾SËS]Á `Ç -----------------------------3� �¾ “„‹“ Q铃 Ö?“ --------------------------------------4�¾u?}cw U×’@--------------------------------------------------5¡ƒvƒ------------------------------------------------------------

78

6e’UÓw----------------------------------------------------------7c’ }ªMÊ Ö?“------------------------------------------------8cÑ^ ›¨ÒÑÉ---------------------------------------------------9¾Å[p“ õdi qhh ›¨ÒÑÉ-------------------------------10¾¬H ›p`xƒ“ ›Övup------------------------------------11¾UÓw ”êQ““ ÅI”’ƒ------------------------------------12Ö?“T ¾u?ƒ ›Ÿvu= ›ÁÁ´---------------------------------13}vÓ aÅ”ƒe lØØ`------------------------------------14¾ÓM ”êQ“ ›Övup---------------------------------------15¾Ö?“ ƒUI`ƒ“ ¢S<’>Ÿ?i”------------------------------16

207 ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï‹) ¾›M}ÖS<uƒ/¾›M}Ñu\uƒª“ U¡”Áƒ U”É” ’¬;

ØpS<” }Ñ’²w’¬U--------------------------------------1�¾Ö?“ ›?¡e}”i” W^}™‹ ›Le}T\”U-------------2¾Ñ”²w/¾›=¢•T> ‹Ó`---------------------------------------3uK?L Ñ<ÇÃ/Y^ eKU”Á´----------------------------------4uÖ?“ Ÿ?L¬ u×U \p eKJ’------------------------------5uÖ?“ Ÿ?L¬ u×U Kw²< c¯ƒ ceKU”Öwp----------6¾Ö?“ ›?¡e}”i” W^}™‹ ìvà Ø\ eLMJ’------------------------------------------------7¾Iw[}cu< ›SKŸŸƒ Ø\ eLMJ’-----------------------8Ÿ²=I uòƒ u›ÒÖS<˜ ’Ña‹ U¡”Áƒ------------------9K?L(ÃÑKê)-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------98

Section: Enabling factors (Characteristics of the service) for Utilization of HEP services by the CommunitylØ` ØÁo ¢É ´KM301 �`e ¨ÃU ¾`e u?}cw ¾Ö?“

›ÑMÓKAƒ uT>ÂeðMÒ‹G< ¾ƒ—¬” ¾Ö?“ É`σ ƒS` �L‹G<;

Ö?“ Ÿ?L----------------------------------------------------------1Ö?“ ×u=Á-------------------------------------------------------2JeúM---------------------------------------------------------3�¾ÓM ¾Ö?“ É`σ--------------------------------------------4¾vIM I¡U“ cÜ--------------------------------------------5K?L(ÃÑKê)-----------------------------------------------------98

…302

302 ¾Ö?“ ›?¡e}”i” W^}™‹ `e-”/¾`e” u?ƒ Ôw˜}¬ Á¬nK<”;

›----------------------------------------------------------------1¾KU---------------------------------------------------------------2

303 ¾Ö?“ ›?¡e}”i” W^}™‹ `e-”/¾`e” u?ƒ uU” ÁIM Ñ>²? ÃÔu—K<;

uXU’ƒ Ÿ›”É Ñ>²? uLÃ------------------------------------1uXU’ƒ ›”É Ñ>²?---------------------------------------------2uG<Kƒ XU’ƒ ›”É Ñ>²?------------------------------------3u¨` ›”É Ñ>²?-------------------------------------------------4ueÉeƒ XU’ƒ ›”É Ñ>²?-----------------------------------5K?L(ÃÑKê)-----------------------------------------------------98

304 ¾Ö?“ ›?¡e}”i” W^}™‹ Ÿ`e u?ƒ c=SÖ< U” ÁÅ`ÒK<;

eKÖ?“ ›?¡e}”i” ýaÓ^U (ûŸ?Ï‹)    Áe}U^K<--------------------------------------------------1eKÖ?“ ›?¡e}”i” ýaÓ^U (ûŸ?Ï‹) ÁdÁK<--------------------------------------------------------2K?L(ÃÑKê)-------------------------------------------------------------

79

------------------------------------------------------------------------------------------------------------------------------------98

305 ¾Ö?“ ›?¡e}”i” W^}™‹ Ÿ`e u?ƒ ŸSÖ<&U” Áe}U^K<<; U” ÁdÁK<;

›?‹.›Ã.y=/›?.É.e“ K?KA‹ ÁvL²` ui �‹ “ � +.y= SŸLŸM“ Sq×Ö`-----------------------------1¨v SŸLŸM“ Sq×Ö`------------------------------------2›e†Ÿ<›Ã ¾SËS]Á `Ç -----------------------------3� �¾“„‹“ Q铃 Ö?“ --------------------------------------4�¾u?}cw U×’@--------------------------------------------------5¡ƒvƒ------------------------------------------------------------6e’UÓw----------------------------------------------------------7c’ }ªMÊ Ö?“------------------------------------------------8cÑ^ ›¨ÒÑÉ---------------------------------------------------9¾Å[p“ õdi qhh ›¨ÒÑÉ-------------------------------10¾¬H ›p`xƒ“ ›Övup------------------------------------11¾UÓw ”êQ““ ÅI”’ƒ------------------------------------12Ö?“T ¾u?ƒ ›Ÿvu= ›ÁÁ´---------------------------------13}vÓ aÅ”ƒe lØØ`------------------------------------14¾ÓM ”êQ“ ›Övup---------------------------------------15K?L(ÃÑKê)-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------98

306 Ö?“ Ÿ?L H>Ŭ/Ôw˜}¬ Á¨nK<; ›----------------------------------------------------------------1¾KU---------------------------------------------------------------2

307 ¾Ö?“ ›ÑMÓKAƒ/I¡U“ KTÓ–ƒ Ö?“ Ÿ?L U” ÁIM Ñ>²? ÃH@ÇK<;

uXU’ƒ Ÿ›”É Ñ>²? uLÃ------------------------------------1uXU’ƒ ›”É Ñ>²?---------------------------------------------2uG<Kƒ XU’ƒ ›”É Ñ>²?------------------------------------3u¨` ›”É Ñ>²?-------------------------------------------------4ueÉeƒ XU’ƒ ›”É Ñ>²?-----------------------------------5K?L(ÃÑKê)-----------------------------------------------------98

308 uU” ÃÑ<›³K<; uSŸ=“------------------------------------------------------------1uupKA/uð[e Ë`v---------------------------------------------2uÓ`-------------------------------------------------------------3 K?�L(ÃÑKê)-----------------------------------------------------98

309 Å`f SMe U” ÁIM `kƒ ÃÑ<›³K<; ________ Ÿ=.T@ƒ`---------------------------------------------1›L¨<k¨<U----------------------------------------------------98

310 uÖ?“ Ÿ?L¬ uÖ?“ ›?¡e}”i” W^}™‹ ¾T>cØ U” ›Ã’ƒ ¾Ö?“ ›ÑMÓKAƒ ¾Ñ—K<;

¡ƒvƒ------------------------------------------------------------1¾u?}cw U×’@ ›ÑMÓKAƒ-----------------------------------2¾pÉS ¨K=É ›ÑMÓKAƒ------------------------------------3¾¨K=É ›ÑMÓKAƒ---------------------------------------------4¾ÉI [¨K=É ›ÑMÓKAƒ-------------------------------------5KU`S^“ I¡U“---------------------------------------------6 K?L(ÃÓKì<)---------------------------------------------------------------------------------------------------------------------------98

311 uÖ?“ Ÿ?L¬ ¾T>cÖ¬ ¾Ö?“ ›ÑMÓKAƒ Ø^ƒ um ’¬ wK¬ ÁevK<”;

›----------------------------------------------------------------1¾KU---------------------------------------------------------------2

312 KØÁo lØ` 311 SMc< #¾KU$ ŸJ’ ‹Ó\ U”É” ’¬; ÅÒÓS¬ ÃÖ¾l::

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

313 ŸÖ?“ Ÿ?L¬ KT>ÁÑ–<ƒ ¾Ö?“ ›ÑMÓKAƒ ¡õÁ ðîS¬ Á¬nK<”;

›----------------------------------------------------------------1¾KU---------------------------------------------------------------2

314 ŸÖ?“ Ÿ?L¬ KT>ÁÑ–<ƒ ¾Ö?“ ›ÑMÓKAƒ eKðîS<ƒ ¡õÁ U” ÃLK<;

u×U ¬É ’¬-------------------------------------------------1¬É ’¬---------------------------------------------------------2¬ÉU [ŸiU ›ÃÅKU--------------------------------------3`Ÿi ’¬---------------------------------------------------------4 u×U `Ÿi ’¬------------------------------------------------5

Section Four: Need Factors (Characteristics of disorder) for Utilization of HEP by the CommunitylØ` ØÁo ¢É ´KM

80

401 ¾Ö?“ Ÿ?L¬” ¨Ã”U ¾Ö?“ ›?¡e}”i” W^}™‹ ¾T>Ôu–< KU” ›Ã’ƒ ¾Ö?“ ›ÑMÓKAƒ ’¬;

¾Q铃 ISU----------------------------1¾u?}cw U×’@-----------------------------2`Ó´“--------------------------------------3�¨K=É ›ÑMÓKAƒ--------------------------4ÉI[ ¨K=É ›ÑMÓKAƒ------------------5¾u?}cw ISU-----------------------------6K¡ƒvƒ--------------------------------------7K?L(ÃÓKì<)--------------------------------98

402 �`e ¨ÃU ¾`e u?}cw uUƒSS<uƒ Ñ>²� ? QSS< U” Å[Í c=Å`e ’¬ Ö?“ Ÿ?L ¾T>Ôu–<ƒ;

ISS< ¨Ç=Á¬ ”ÅËS[-------------1�ŸM}gK”------------------------------------2¾SS¬ c¬ SwLƒ/� SÖ׃ c=ÁqU--------------------3K?L(ÃÓKì<)--------------------------------98

10. N. ¾Ö?“ ›?¡e}”i” øaÓ^U uIw[}cu< ²”É uu?}ew U×’@& u“„‹“ uQ铃 Ö?“ Là �ÁS׬” K¬Ø ¾T>Çee SÖÃp&

›ÖnLÃ S[Í

¾u?ƒ ›v¬^ YU-------------------------------------------------------------------------------------------¾u?ƒ lØ`?--------------------------------------------------- kuK?------------------------------------------¨[Ç----------------------------- µ”-------------------------- ¡MM------------------------------------------

¡õM ›”É: ¾}ÖÁm¬ S[Í

eUU’ƒÖ?“ ÃeØM˜! eT@ ----------------------------------- ÃvKM:: u “ ›ጎንደር ዩኒቨርሲቲ Ç=e ¢”+’”}M ¾Ö?“ ›Övup ›=”e+~ƒ የድህረ ምረቃ (ú.›?.Ç=) ተማሪና u “ ›ጎንደር ዩኒቨርሲቲ Ç=e ¢”+’”}M ¾Ö?“ ›Övup ›=”e+~ƒ uU°^w ÔÍU µ” በአማራ ብሔራዊ ክልላዊ መንግስት ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ U” ”ÅT>SeM KT¨p� uT>"H@Ũ< Ø“ƒ Là }d �ò ’˜::

u›=ƒÄåÁ ôÅ^K© Ç=V¡^c=© K?ùwK=¡ S”Óeƒ ¾}}Ñu[¬” ¾Ö?“ ›?¡e}”g” ýaÓ^U ¾Iw[}cu<” ¾Ö?“ ›?¡e}”i” ýaÓ^U(ûŸ?Ï) }ÖnT>’ƒ ¾U“Ö“ c=J” Ÿ`e ¾T>Ñ–¬ S[Í S”Óeƒ ¾}hK ¾Ö?“ ›ÑMÓKAƒ ”Ç=ÁpÉ“ ”Ç=}Ñw` Ã[ÇM:: � �

¾`e u?ƒ K²?I c=vM u°ÉM ¾}S[Ö c=J” K²=I Ø“ƒ Ã[Ç” ²”É 30 eŸ 40 Åmn ÑÅT ¾T>¨eÉ ØÁo� ‹” M”ÖÃkƒ ”ðMÒK”:: ¾T>cÖ<” SMe uUeÖ=` ¾T>Öup c=J” ŸU`U\ }dò� � ‹ ¬ß KT”—¬U c¬ ¾cÖ<”” S[Í ›dMð” ›”cØU:: uØ“~ Là ¾ÓÉ Sd}õ ¾KwƒU:: ’Ñ` Ó” ¾`e ›e}Á¾ƒ ¨ÃU SMe ÖnT>

81

eKJ’ uØ“~ Là Ãd}óK< wK” }eó “Å`ÒK”::� u²=I Ø“ƒ Là Sd}õ u`e S<K< ðnŘ’ƒ Là ¾}Sc[} c=J” ›”É ØÁo ¨ÃU G<K<”U ØÁo‹” ›KSSKe ËLK<:: U” ›Mvƒ }ÚT] S[Í ŸðKÑ< Ÿ²=I uòƒ ucÖ”ƒ Ÿ`É/¨[kƒ Là ¾}Ökc<ƒ/¾}²[²\ƒ c‹ T’ÒÑ` ËLK<::

›G<” eK Ø“~ T“†¨<”U ’Ñ` K=ÖÃl˜ ÃðMÒK<; ›G<” SÖÃl” SËS` ‹LKG<”;�

SËS]Á c¯ƒ ----------------- SÚ[h c¯ƒ -------------------- k” --------------------------------------SMe cܨ< (ª) }eTU}ªM -----------------1 SMe cܨ< (ª) ›M}eTS<U ----------------2¾S[Í cwdu=¨< eU ------------------------------------------ò`T ------------------ k” ----------------------¾}q××]¨< (ª) eU -----------------------------------------ò`T ------------------ k” ----------------------

Socio-Economic and Demographic Characteristics (for Women Aged 15-49)

lØ` ØÁo ¢É ´KM101 °ÉT@ e”ƒ ’¬; ¯Sƒ-----------------------------------------------------

›L¨<k¨<U--------------------------------------------98SSKe ›MðMÑ<U --------------------------------99

102 ¾SÚKh MÏ” c=¨KÆ °ÉT@ e”ƒ ’u`; ¯Sƒ-----------------------------------------------------›L¨<k¨<U--------------------------------------------98SSKe ›MðMÑ<U --------------------------------99

103 ¾Òw‰ G<’@ � U”É” ’¬; ÁKÑv(‹)------------------------------------------------1 ÁÑv(‹)--------------------------------------------------2}KÁÃ}¬ ¾T>•\----------------------------------3 vLD (T>e~) ¾V}uƒ--------------------------------4¾ð (‹)------------------------------------------------�K?L(ÃÑKî)----------------------------------------------6

104 ¾ƒUI`ƒ Å[Í U”É” ’¬; ÁM}T[(‹)-------------------------------------------1 T”uw“ Síõ w‰----------------------------------2 Ÿ1—-6— ¡õM-----------------------------------------3 Ÿ7—-8— ¡õM-----------------------------------------4 Ÿ9—-12— ¡õM--

82

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105 K›Kñƒ 12 ¨^ƒ ª’— e^ U”É” ’¨<; Y^›Ø-------------------------------------------------1 Ö<[}—--------------------------------------------------2 }T]----------------------------------------------------3 ›ŸM Ñ<Ç}—-------------------------------------------4 ¾u?ƒ Su?ƒ------------------------------------------�’ÒÈ-----------------------------------------------------6 ¾k” W^}—-------------------------------------------7 ¾S”Óeƒ }k×]------------------------------------8¾ÓM É`σ }k×]--------------------------------9 ¾ S.Á.É }k×]-----------------------------------10 ¾^c< É`σ c^}— ÁK<ƒ----------------------11 ¾^c< É`σ c^}— ¾K?K<ƒ--------------------12 u^c< }k×] Ñu_ /›d ›eÒ]------------------13 K?L(ÃÑKî)--------------------------------------------14

106 ¾u?}cw ›ÖnLà ¨`G© ¾Ñu= SÖ” e”ƒ ’¨<;

w`---------------------------------------------------------›L¨<k¨<U-------------------------------------------98SSKe ›MðMÑ<U -------------------------------99

107 uu?}cw ¨<eØ ¾T>Ñ–< ¾c‹ w³ƒ e”ƒ ’¬;

lØ`-----------------------------------------------------SSKe ›MðMÑ<U -------------------------------99

108 °U’ƒ U”É” ’¬; ¾›=ƒÄåÁ *`„Ê¡e }ªQÊ---------------------1eMU“------------------------------------------------�

-2 Ÿ„K=¡---------------------------------------------------3ýa}e ”ƒ-------------------------------------------4�K?L(ÃÑKî)----------------------------------------------5

109 wN?` U”É” ’¬; ›T^----------------------------------------------------1›Ñ¬-----------------------------------------------------2ƒÓ_-----------------------------------------------------3*aV----------------------------------------------------4 K?L(ÃÑKî)----------------------------------------------5

110 u²=I u?ƒ e”ƒ ¡õKA‹ KS˜ ÃJ“K<;� ¡õM----------------------------------------------------111 Ÿu?}cw SHM c¯ƒ& XáM& _ÉÄ&

eM¡/VvÃM ÁK¬ ›K; › ¾KU c¯ƒ 1 2 XáM 1 2 _ÉÄ 1 2

83

eM¡/VvÃM 1 2¾u?}cw U×’@ (Ÿ15-49 ¾°ÉT@ ¡MM LK< c?„‹)

¡õM: e’ }ªMÊ

lØ` ØÁo ¢É ´KM101 ›G<” uQà ²S” eK¨KÆ›†¬ MЋ SÖ¾p

ðMÒKG<:: �MÏ ¨MŬ Á¬nK<;

›-------------------------------------------------1¾KU------------------------------------------------2

106

102 Ÿ¨KÆ›†¬ ¨”É ¨ÃU c?ƒ MЋ ›G<” Ÿ`e Ò` ›w[¬ ¾T>•\ MЋ ›Kƒ;

›-------------------------------------------------1¾KU------------------------------------------------2

104

103 e”ƒ ¨”É MЋ Ÿ`e Ò` ›w[¬ Õ^K<; e”ƒ c?ƒ MЋ Ÿ`e Ò` ›w[¬ Õ^K<;U”U ŸK?K #00$ ÃS´Óu<::

u?ƒ ¨eØ ÁK< ¨”É MЋ----------- _____u?ƒ ¨eØ ÁK< c?ƒ MЋ------------- _____

104 Ÿ¨KÆ›†¬ ¨”É ¨ÃU c?ƒ MЋ uÃQ¨ƒ ÁK< ’Ñ`Ó” ›G<” Ÿ`e Ò` ›w[¬ ¾TÕ\ MЋ ›Kƒ;

›-------------------------------------------------1¾KU------------------------------------------------2

106

105 uQèƒ ÁK< ›G<” Ÿ`e Ò` ›w[¬ ¾TÕ\ e”ƒ ¨”É MЋ ›Kƒ; uQèƒ ÁK< ›G<” Ÿ`e Ò` ›w[¬ ¾TÕ\ e”ƒ c?ƒ MЋ ›Kƒ;U”U ŸK?K #00$ ÃS´Óu<::

K?L x ÁK< ¨”É MЋ--------------� _____K?L x � ÁK< c?ƒ MЋ---------------- _____

106 uQèƒ}¨MÊ uL Qè~ ÁKð� /¾V} ¨”É ¨ÃU c?ƒ MË‹ ¨MŬ Á¬nK<”; ¾KU ŸJ’&S”—¬U c=¨KÉ ÁKkc ¨ÃU ¾Qèƒ UM¡ƒ Ád¾ ’Ñ` Ó” uQèƒ ÁKq¾ Qé” uTKƒ ÖÃp::

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108

107 e”ƒ ¨”É MЋ S<}¬u M� <; e”ƒ c?ƒ MЋ S<}¬u M� <; U”U ŸK?K #00$ ÃS´Óu<::

uQèƒ ¾K?K</¾V~ ¨”É MЋ----- ____uQèƒ ¾K?K</¾V~ c?ƒ MЋ------- ____

108 103”& 105” “ 107” ›ÖnK¬ ÉU\” �ÁeÑu<::U”U ŸK?K #00$ ÃS´Óu<::

ÖpLL ¾}¨KÆ MЋ w³ƒ------------ ____

109 108” Á[ÒÓÖ<:: ƒ¡¡M SJ”” KT[ÒÑØ&uQèƒ ²S” u›ÖnLà _____ MË‹ ¨MŪM:: ƒ¡¡M ’¬”;›------------------- __ __ ¾KU----›G<” ”Å›eðLÑ>’~ Ÿ101� � eŸ 108 ÁK¬” Áe}Ÿ¡K<::

110 108” Á[ÒÓÖ<:: ›”É ¨Ã”U Ÿ²=Á uLà ¨K=É/MЋ- __ __›M¨KÆU/¨K=É ¾KU--------------------------

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111. ›G<” ¾¨KÆ›†¬” MЋ eU ”Ç=G<U SËS]Á Ÿ¨Kƃ MÏ ËUa MЋ uQÃ� ƒ S•` ›KS•^†¬” SS´Ñw ðMÒKG<:: ¾G<K<”U MЋ eU 212 Kà ÃS´Óu<:: S”ƒÁ MЋ ŸK< u}K¾/ K?L SeS`/� rows ÃS´Óu<:: Ÿ12 MЋ uLà ¨MŬ ŸJ’ ŸG<K}—¬ SeS`/ rows ËUa }ÚT] SÖÃp/ questionnaire ÃÖkS<::112 KSËS]Á“ K}Ÿ×à MÏ U” eU cÖ<›†¬; ¾SÚ[h MÏ--------------------------------------

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113 Qé’<(œ) (YU) ¨”É ¨Ãe c?ƒ ’¬/“ƒ;¾SÚ[h MÏ--------------------------------------

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84

ŸSÚ[h 2— MÏ--------------------------------- 2¨”É------------------------------------------------1c?ƒ--------------------------------------------------2¨”É------------------------------------------------1c?ƒ--------------------------------------------------2

114 Qé’<(œ) uU” ¨`“ ¯S} UI[ƒ }¨KÅ; MÅ~(œ) S† ”ÅJ’ ÖÃp&�¾SÚ[h MÏ---------------------------------

ŸSÚ[h 1— MÏ----------------------------

ŸSÚ[h 2— MÏ---------------------------

¨`--------------------------------------------------1¯.U-------------------------------------------------2¨`--------------------------------------------------1¯.U-------------------------------------------------2¨`--------------------------------------------------1¯.U-------------------------------------------------2

115 Qé’<(œ) uQèƒ ›K(‹)”;¾SÚ[h MÏ---------------------------------

ŸSÚ[h 1— MÏ----------------------------

ŸSÚ[h 2— MÏ---------------------------

›--------------------------------------------------1¾KU-------------------------------------------------2›--------------------------------------------------1¾KU-------------------------------------------------2›--------------------------------------------------1¾KU-------------------------------------------------2

116 ›G<” `Ñ<´ ’� ƒ”; ›--------------------------------------------------1¾KU-------------------------------------------------2� `ÓÖ— ›ÃÅKG<U-----------------------------8

¡õM G<Kƒ: ¾¨K=É lØØ`/SŸLŸM (Contraception)201 ›G<” eK u?}cw U×’@ TƒU vM“ T>eƒ � `Ó´“”

KT²Ó¾ƒ ¨ÃU KSŸLŸM eKT>ÖkT›¬ ¾}KÁ¿ ¾¨K=É SŸLŸÁ ²È‹ S¨Á¾ƒ ðMÒKG<:: �eK¨K=É SŸLŸÁ ²È‹ cU}¬ Á¬nK<”;

202. ¾¨K=É SŸLŸÁ ²È‹” }ÖpS¬ Á¬nK<”;

01 ¾c?ƒ ²Lm ¾¨K=É SŸLŸÁ ²È/Female Sterilization: c?„‹ K?L }ÚT] MЋ ”Çè� MÆ/ � ”ÇÕ^†¬ ¾kÊ ØÑ“ TÉ[Ó

ËLK<”;

›------1¾KU----2

K?L }ÚT] MЋ ”ÇèMÆ/ ”ÇÕ`� � ¾kÊ ØÑ“ ›É`ѪM”;›-------------------------------------------1¾KU---------------------------------------

85

--202 ¾¨”É ²Lm ¾¨K=É SŸLŸÁ ²È/Male

Sterilization. ¨”Ê‹ K?L }ÚT] MЋ ”Çè� MÆ/ � ”ÇÕ^†¬ ¾kÊ ØÑ“ TÉ[Ó

ËLK<”;

›------1¾KU----2

K?L }ÚT] MЋ ”ÇèMÆ/ ”ÇÕ`� � ¾kÊ ØÑ“ ÁÅ[Ñ vM/ Ñ<›Å— ›Kƒ;›-------------------------------------------1¾KU-----------------------------------------2

03 u›õ ¾T>ªØ ¾¨K=É SŸLŸÁ ¡’>”/Pill: c?„‹ ”ÇÁ[Ó²< ¾¨K=É SŸLŸÁ ¡’>” �u¾k’< SªØ ËLK<”;.

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

04 uTIì” ¬eØ ¾T>kSؾ¨K=É SŸLŸÁ ²È/IUD: c?„‹ uŸ=U ¨Ã� ”U u’`e uSI쓆¬ ¬eØ ¾¨K=É SŸLŸÁ ²È K<ý/loop TekSØ Ã‹LK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

05 ¾¨K=É SŸLŸÁ S`ô/Injectables: c?„‹ K›”É ¨Ã”U Ÿ²=Á uLà ¨^ƒ `Ó� ´“” ¾T>ŸLŸML†¬ ¾¨K=É SŸLŸÁ S`ô uÖ?“ vKVÁ‹ K=c׆¬ ËLK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

06 u¡”É Là ¾T>ku` ¾¨K=É SŸLŸÁ ²È/Implants: : c?„‹ K›”É ¨Ã”U Ÿ²=Á uLà ¯S ƒ� `Ó� ´“” ¾T>ŸLŸML†¬ ¾¨K=É SŸLŸÁ ƒ“”i aÉe/small rods uŸ=U ¨Ã� ”U u’`e uL׬ Ÿ”dž¬ Kku`L†¬ ËLK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

07 ¾¨”É ¢”ÊU/Condom: ¨”Ê‹ ¾Ów[eÒ Ó”–<’ƒ ŸTÉ[Ò†¬ uòƒ ¾¨”É ¢”ÊU/ rubber sheath uwK� †¬ Là TØKp ËLK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

08 ¾c?ƒ ¢”ÊU/Female Condom: c?„‹ ¾Ów[eÒ Ó”–<’ƒ ŸTÉ[Ò†¬ uòƒ ¾c?ƒ ¢”ÊU/ sheath uwM †¬ ¬eØ � SeÑvƒ

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

09 Ö<ƒ uTØvƒ `Ó´“” ¾SŸLŸM ²È/ �Lactation Amenorrhea Method (LAM): c?„‹ M͆¬” uTØvƒ `É´“” SŸLŸM ËLK<;�

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

10 ¾k” SqÖÖ]Á ²È/Rhythm Method: : c?„‹ KÓw[eÒ Ó”–<’ƒ wl uT>J’<uƒ � Á”Ç”Æ ¨` K=Á[Ó²< uT>‹K<uƒ ¾¨\ k“ƒ Ów[eÒ Ó”–<’ƒ vKSðìU � `Ó´“” SŸLŸM ËLK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

11 ¾¨”É ¾²` õ_ Ÿc?~ wMƒ �”ÇÃÑv ¾Sq×Ö` ²È/Withdrawal: ¨”Ê‹ ¾Ów[eÒ Ó”–<’ƒ c=ðîS< ¾²` õ_Á†¬ ”ÇÃðe“ �¾eT@ � †¬ [Ÿ Ýõ dÃÅ`c< w †¬” � � �T¬×ƒ ËLK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

12 ¾É”Ñ}— `Ó´“ SŸLŸÁ ²È/� Emergency Contraception. : c?„‹ ÁKSŸLŸÁ ²È ¾Ów[eÒ Ó”–<’ƒ ŸÅ[Ñ<& � `Ñ´“” KSŸLŸM Ów[eÒ Ó”–<’ƒ uðìS< uZYƒ k“ƒ ¬eØ ¾}K¾ ¾É”Ñ}— Ñ>²? ¾¨K=É SŸLŸÁ ¡’>” S¬cÉ Ã‹LK<;

›------1¾KU----2

›-------------------------------------------1¾KU-----------------------------------------2

13 `Ó´“” KSŸLŸM c?„‹ ¨Ã”U ¨”Ê‹ �cKT>ÖkS<›†¬ K?KA‹ SŸLŸÁ S”ÑÊ‹ ¨Ã”U ²È‹ cU}¬ Á¬nK<”;

›--------1ÃÓKè¾KU------2ÃÓKè

›-------------------------------------------1¾KU-----------------------------------------2›-------------------------------------------1¾KU-----------------------------------------2

203 202” Á[ÒÓÖ<::U”U: › }ÖpS¬ ›Á¬lU---------------¨Å 304 ÃH>Æ

86

u=Á”e ›”É ²È: › }ÖpS¬ Á¬nK<-------------------- --------------------------------------------206

lØ` ØÁo ¢É ´KM204 ”ÇÁ[Ó²< � KT²Ó¾ƒ ¨ÃU KSŸLŸM T“†¬”U

’Ñ` }ÖpS¬ Á¬nK<”; uT”—¬U S”ÑÉ ¾VŸ\ƒ ²È ’u`”;

›---------------------------------------------1¾KU--------------------------------------------2

…211

205 U” }ÖpS¬ ¨Ã”U ›É`Ѭ Á¬nK<; 202“ 203” (ŸeðKÑU 201”) Áe}Ÿ¡K<::

206 202(01)” Á[ÒÓÖ<:: c?ƒÄª kÊ ØÑ“ ›LÅ[Ñ<U-------------1 c?ƒÄª kÊ ØÑ“ ›É`ѪM-------------2 ....20

9207 116” Á[ÒÓÖ<:: ’õcÖ<` ( `ÓÖ—) ›ÃÅK<U-----------1�

’õcÖ<` “†¬------------------------------2 …211208 u›G<’< Ñ>²? ”ÇÁ[Ó²< � KT²Ó¾ƒ ¨ÃU

KSŸLŸM ¾T>ÖkS<ƒ ¨Ã”U ¾T>ÁÅ`Ñ<ƒ ’Ñ` ›K;

›---------------------------------------------1¾KU--------------------------------------------2

…211

209 ›G<” ¾ƒ™‹” ¾SŸLŸÁ ²È ¾}ÖkS< ’¬;�G<K<”U ¾}Ökc<ƒ” Á¡wu::Ÿ›”É ¾SŸLŸÁ ²È Ÿ´`´\ ¬eØ uw³ƒ KT>ÖkS<ƒ ²È ´KM ¾T>¬” SS]Á ß}K<::

¾c?ƒ ²Lm ¾¨K=É SŸLŸÁ ²È-------G¾¨”É ²Lm ¾¨K=É SŸLŸÁ ²È-----K u›õ ¾T>ªØ ¾¨K=É SŸLŸÁ ¡’>”--NuTIì” ¬eØ ¾T>kSؾ¨K=É SŸLŸÁ ²È--------------------------S ¾¨K=É SŸLŸÁ S`ô------------------W u¡”É Là ¾T>ku` ¾¨K=É SŸLŸÁ ²È---------------------------[¾¨”É ¢”ÊU-------------------------------c ¾c?ƒ ¢”ÊU---------------------------------g Ö<ƒ uTØvƒ `Ó´“” � ¾SŸLŸM ²È-------------------------k¾k” SqÖÖ]Á ²È----------------------u ¾¨”É ¾²` õ_ Ÿc?~ wMƒ ”ÇÃÑv ¾Sq×Ö` ²È----------}�¾É”Ñ}— `Ó´“ SŸLŸÁ ²È--------†�K?L (ÃÑKê)-------------------------------------------------------------------------------------›

…301

…301

210 ›G<” ¾T>ÖkS<ƒ” ¾SŸLŸÁ ²È KSÚ[h Ñ>²? Ÿ¾ƒ ›Ñ–<ƒ;

ØÁo lØ` 209 Là Ÿ›”É ¾SŸLŸÁ ²ÈuLà ›¡wu¬ ŸJ’& eK SŸLŸÁ ²È¬ ÃÖÃl::

¾S”Óeƒ ¨Ã”U ¾ÓM c?¡}` SJ’< SK¾ƒ ŸM}‰K&&¾x ¬” YU ¾éñ& � ------------------------------------------------------- ¾x YU�

¾SŸLŸÁ ²È¬ TUŸ”(kÊ ØÑ“) ŸJ’& ¾ó`Tc=& ¾Se¡ W^}—& ¾c<p& ¾²SÉ/ Ñ<›Å— ¢É ›Á¡u<&&

¾S”Óeƒ c?¡}`¾S”Óeƒ Jeú M-----------------------21�¾S”Óeƒ Ö?“ ×u=Á--------------------22¾S”Óeƒ Ö?“ Ÿ?L-----------------------23}”kdni ¡K=’>¡--------------------------24¾Se¡ W^}—-----------------------------25K?L ¾S”Óeƒ c?¡}` (ÃÑKê)-----------------------------------------------------------26¾ÓM ¾Ö?“ c?¡}`¾ÓM Jeú M/¡K=’>¡--------------------�21ó`Tc=---------------------------------------22¾ÓM NŸ=U---------------------------------23

…301

87

}”kdni ¡K=’>¡--------------------------24¾Se¡ W^}—-----------------------------25K?L ¾ÓM Ö?“ c?¡}` (ÃÑKê)-----------------------------------------------------------26K?L U”ßc<p--------------------------------------------31u?}¡`e+Á”--------------------------------32²SÉ/Ñ<›Å—--------------------------------33K?L (ÃÑKê)------------------------------------------------------------------------------------96

211 ¾¨K=É Sq×Ö]Á ²È ¾T>јuƒ” u �Á¬nK<;

›---------------------------------------------1¾KU-------------------------------------------2

…301

¾ƒ ’¬;

K?L x ;�

Á”ǔƔ U”ß uSÖ¾p }Ñu=¬” ÔÉ �Á¡wu<::

¾S”Óeƒ ¨Ã”U ¾ÓM c?¡}` SJ’< SK¾ƒ ŸM}‰K&&¾x ¬” YU ¾éñ& � ------------------------------------------------------- ¾x YU�

¾S”Óeƒ c?¡}`¾S”Óeƒ Jeú M------------------------G�¾S”Óeƒ Ö?“ ×u=Á---------------------K¾S”Óeƒ Ö?“ Ÿ?L-----------------------N}”kdni ¡K=’>¡--------------------------S¾Se¡ W^}—-----------------------------WK?L ¾S”Óeƒ c?¡}` (ÃÑKê)------------------------------------------------------------[¾ÓM ¾Ö?“ c?¡}`¾ÓM Jeú M/¡K=’>¡--------------------�ó`Tc=---------------------------------------g¾ÓM NŸ=U---------------------------------k}”kdni ¡K=’>¡---------------------------u¾Se¡ W^}—-----------------------------}K?L ¾ÓM Ö?“ c?¡}` (ÃÑKê)-----------------------------------------------------------†K?L U”ßc<p---------------------------------------------’u?}¡`e+Á”---------------------------------–²SÉ/Ñ<›Å—---------------------------------®K?L (ÃÑKê)-------------------------------------------------------------------------------------›

88

¡õM ZYƒ: Òw‰“ Ów[eÒ Ó”–<’ƒ (Marriage and Sexual Activity)lØ` ØÁo ¢É ´KM301 u›G<’< c¯ƒ ›Ów}ªM” ¨Ãe ”Å›Ñ� v c¬

Ÿ¨”É Ò` ›w[¬ Õ^K<;›& ›G<” Ów‰KG<-----------------------1›& Ÿ¨”É Ò` ›w_ ¾•`G< �       ’¬-------------------------------------2¾KU&ŸT”U Ò` ›ÃÅKG<U------------3

…304

302 ›Ów¬ ¨Ã”U ”Å›Ñ� v c¬ Ÿ¨”É Ò` ›w[¬ ’<[¬ Á¬nK<”<;

›& ›Ów‰G<-------------------------------1›& Ÿ¨”É Ò` ›w_ ’<_ ›¬nKG<-----------------------------2¾KU&›LÑvG<U------------------------------3

…304

303 ›G<” ¾Òw‰ G<’@ � U”É” ’¬; ÁÑv‹; vK<œ ¾V}vƒ; ¾ð ‹; ŸvK<œ }Kà � �

ÁÑv‹------------------------------------------1 vK<œ ¾V}vƒ-------------------------------2 ¾ð ‹-----------------------------------------3 �ŸvK<œ }Kà ¾Uƒ•`-------------------�

304 K?KA‹ c‹ eKS•^†¬ Á[ÒÓÖ<:: ŸSkÖM uòƒ ¾SLg<›” ¾ÓM Ñ<Çà KSÖup ›eðLÑ>¬” Ø`ƒ ÁÉ`Ñ<::

305 ¾u?}cw ¾’<a Ñ<ÒÄ‹” ¾uKÖ KS[ǃ ›G<” eKÓw[eÒ Ó”–<’ƒ ›”Ç”É ØÁo‹ SÖ¾p ðMÒK� G<::

KSËS]Á ¾Ów[eÒ Ó”–<’ƒ c=ðêS< °ÉT@ e”ƒ ’u`;

Ów[eÒ Ó”–<’ƒ ðêT@ ›L¬pU----00 °ÉT@------------------------------------ __ __

…401

306 KSÚ[h Ñ>²? ¾Ów[eÒ Ó”–<’ƒ ¾ðìS<ƒ SŠ ’u`; Ÿ12 ¨^ƒ u‹ ŸJ’:� SMc< uk“ƒ& ucdU” ƒ“ �u¨^ƒ SS´Ñw ›uƒ:: 12 ¨^ƒ (1 ¯Sƒ) �“ Ÿ²=Á uLà ŸJ’: SMc< u¯Sƒ SS´Ñw ›uƒ::

__ __ k” uòƒ__ __ XU”ƒ uòƒ__ __ ¨` uòƒ__ __ ¯Sƒ uòƒ

Section Four: Fertility PreferenceslØ` ØÁo ¢É ´KM401

104” Á[ÒÓÖ<::vM ¨Ã”U T>eƒ ”Ç=S¡’< ›M}Å[ÑU (›MSŸ’<U)---------------¨Å 402 ÃH>Æ�vM ¨Ã”U T>eƒ � ”Ç=S¡’< }Å`ѪM (S¡’ªM)-------------------------------------- …409

402

116” Á[ÒÓÖ<::’õcÖ<`/ `ÓÖ— ›ÃÅK<U� ______›G<” eK¨Åòƒ pÉ� ›”Ç”É ØÁo‹ Õ\—M:: K?L MÏ ”Ç=•`� ÃðMÒK<”; ¨Ãe K?L MÎ ”ÇÕ`� ÃðMÒK<”;

’õcÖ<` “†¬ ______›G<” eK¨Åòƒ pÉ� ›”Ç”É ØÁo‹ Õ\—M:: ›G<” Ÿ›[Ѳ<ƒ/ŸT>¨Mƃ MÏ uL K?L MÏ �”Ç=•`� ÃðMÒK<”; ¨Ãe K?L MÎ ”ÇÕ`�

K?L MÏ ”Ç•[˜ °ðMÒKG<------------1�K?L MÏ ”Ç•[˜ ›MðMÓU-----------2�T`Ñ´ ›M‹MU wLK‹------------------3›M¨c”G<U/›L¬pU: “ ’õcÖ<`-----------------------------4� “ ’õcÖ<`/ `ÓÖ— ÁMJ’‹� � -----5

…404…409

…405…404

403

116” Á[ÒÓÖ<::’õcÖ<`/ `ÓÖ— ›ÃÅK<U� ______Ÿ›G<” uL � K?L MÏ ŸS¬KÉ uòƒ e”ƒ Ñ>²? SÖup/Sq¾ƒ ÃðMÒK<;’õcÖ<` “†¬ ______

__ __ ¨`--------------------------------------1__ __ ¯Sƒ-----------------------------------2›G<”-----------------------------------------993

…409

89

›G<” Ÿ›[Ѳ<ƒ/ŸT>¨Mƃ MÏ uL � K?L MÏ ŸS¬KÉ uòƒ e”ƒ Ñ>²? SÖup/Sq¾ƒ ÃðMÒK<;

T`Ñ´ ›M‹MU wLK‹---------------994ŸÒw‰ uL--------------------------------�995K?L (ÃÑKê)-----------------------------------------------------------------------------------996›L¬pU-----------------------------------998

404

203” Á[ÒÓÖ<:: ¾¨K=É SŸLŸÁ ²È ÃÖkTK<”;

›M}Ö¾lU---------------¨Å 405 ÃH>ƾKU& ›G<” ›ÃÖkS<U------------¨Å 405 ÃH>Æ›& ›G<” ÃÖkTK<---------------------- …409

405

¨Åòƒ uT”—¬U Ñ>²? � `Ó´“” KT²Ó¾ƒ ¨ÃU KSŸLŸM ¾¨K=É SŸLŸÁ ²È � ÖkTKG< wK¬ ÁevK<;

›---------------------------------------------1¾KU--------------------------------------------2›L¬pU--------------------------------------8

…407…407

406

¾ƒ™‹” ¾¨K=É SŸLŸÁ ²È SÖkU” ÃS`×K<;

¾c?ƒ ²Lm ¾¨K=É SŸLŸÁ ²È-------01¾¨”É ²Lm ¾¨K=É SŸLŸÁ ²È-----02 u›õ ¾T>ªØ ¾¨K=É SŸLŸÁ ¡’>”--03uTIì” ¬eØ ¾T>kSؾ¨K=É SŸLŸÁ ²È--------------------------04 ¾¨K=É SŸLŸÁ S`ô------------------05 u¡”É Là ¾T>ku` ¾¨K=É SŸLŸÁ ²È--------------------------06¾¨”É ¢”ÊU------------------------------07 ¾c?ƒ ¢”ÊU--------------------------------08 Ö<ƒ uTØvƒ `Ó´“” � ¾SŸLŸM ²È------------------------09¾k” SqÖÖ]Á ²È---------------------10 ¾¨”É ¾²` õ_ Ÿc?~ wMƒ ”ÇÃÑv ¾Sq×Ö` ²È----------11�¾É”Ñ}— `Ó´“ SŸLŸÁ ²È-------12�K?L (ÃÑKê)------------------------------------------------------------------------------------96� `ÓÖ— ›ÃÅKG<U-----------------------98

…409…409…409…409…409…409…409…409…409…409…409…409…409

407

¨Åòƒ uT”—¬U Ñ>²? ¾¨K=É SŸLŸŸÁ ²È ¾TÃÖkS<ƒ ª“ U¡”Áƒ U”É” ’¬ wK¬ ÁevK<;

eK›LÑvG<-----------------------------------11Fertility related reasons: ¾Ów[ eÒ Ó”–<’ƒ eKTLÅ`Ó-----21 ›`ÝKG</eK›[ØG<---------------------22 Subfecund/infecund…………...…23 w²< MÏ S¬KÉ eKUðMÓ--------24

90

Opposition to use ^c? eKUn¨S¬----------------------31 vKu?} eKT>n¨S¬------------------32 K?KA‹? eKT>n¨S<--------------------33 NÃT•ƒ eKTÃðpÉ----------------34¾°¬kƒ ‹Ó` ¾SŸLŸ? ²È ›L¬pU------------41 ¾T>јuƒ” x ›L¬pU--------42�Method related reasons: uÖ?“ Là ÁK¬ eÒƒ-----------------51 ¾Ô’”Äi ‹Óa‹ õ^‰----------------52 up`w eKK?K----------------------------53    ªÒ¬ ¬É eKJ’----------------------54 K›ÖnkU U‡ eLKJ’---------------55 Interferes with body`s normal process ………………………….56K?L (ÃÑKê)------------------------------------------------------------------------------------96� `ÓÖ— ›ÃÅKG<U-----------------------98

…409

408

¾›Ñu< u=J” •a& ¾¨K=É Sq×Ö]Á ²È ÃÖkS< ’u`;

›---------------------------------------------1¾KU--------------------------------------------2›L¬pU--------------------------------------8

409

103 “ 105 Á[ÒÓÖ<::�uIèƒ ÁK< Q铃 w³ƒ __________uòƒ MÏ dÕ[ƒ(dèMÆ) uIè} ²S” K=•`ƒ uƒ¡¡M ¾T>ðMÑ<ƒ” ¾MÏ w³ƒ u=¨e’< e”ƒ ÃK< ’u`;

uIèƒ ¾K?K< Q铃 w³ƒ __________uIè} ²S” K=•`ƒ uƒ¡¡ ¾T>ðMÑ<ƒ” ¾MÏ w³ƒ u=¨e’< e”ƒ ÃK< ’u`;ulØ` ’>’Ó`� ƒ ÅÒÓS¬ ÃÖÃl::

U”U-----------------------------------------00lØ`--------------------------------------------K?L(ÃÑKî)-----------------------------------96

U”U-----------------------------------------00lØ`--------------------------------------------K?L(ÃÑKî)-----------------------------------96

Ú`e

Ú`e

Ú`e

Ú`e

410

ŸMË‹ S”ŸM e”„‹ ¨”É e”„‹ c?ƒ ”Ç=G’< �ÃðMÒK<; ¨ÃU Ke”„‡e Kë ÓÉ ¾K� ƒU;

¨”É c?ƒ ŸG<Kƒ ›”Ælƒ` --- --- ---K?L(ÃÑKî)-----------------------------------96

91

¾“„‹ Ö?“ (°ÉT@Á†¬ Ÿ15 eŸ 49 ¯Sƒ KJ’<) � �

¡õM ZYƒ: ¾pÉS ¨K=É“ ¾¨K=É ›ÑMÓKAƒlØ` ØÁo ¾SÚ[h ¨K=É

YU------------------------

ŸSÚ[h 1—¬ ¨K=ÉYU---------------------

ŸSÚ[h 2—¬ ¨K=ÉYU------------------------

101 114 ›[ÒÓØu1997 ¯.U ›”É“ Ÿ²=Á uLà ¨K=É ______----------------¨Å 102 ÃH>Æ&u1997 ¯.U ¨K=É ¾KU ----------------------------------------------------------------- -----------------------------

201102 114 ›[ÒÓØ: u1997 ¯.U “ Ÿ²=Á u� �L ¾}¨KÆ Q铃 YU ŸdØ’< ¬eØ éõ/›eÑv:: ŸSÚ[h¬ ¨K=É ËU[¬

eKG<K<U ¨K=É ØÁo‹” ÖÃp:: ›G<” u›Kóƒ ›Ueƒ ¯S ƒ� ¬eØ eK}¨KÆ Q铃 ›”Ç”É ØÁo‹ MÖÃp ðMÒKG<� (eK Á’Ç”Æ Q铃 u}“ÖM “¨^K”� � )::.

103 ŸØÁo 212 (Ÿ]ýaÇ¡i” ¡õM

¾SÚ[h ¨K=ÉYU------------------------

ŸSÚ[h 1—¬ ¨K=ÉYU---------------------

ŸSÚ[h 2—¬ ¨K=ÉYU------------------------

104 KSÚ[h ¨K=É w‰u²=I `Ó´“� Ñ>²? KpÉS ¨K=É ¾Ôu–<ƒ ¾Ö?“ vKVÁ ›K;

› ŸJ’ T””; K?L c¬;T”’ †¬” uSÖ¾p �G<K<”U ¾}Ökc<ƒ” ÃS´Óu<&

¾Ö?“ vKVÁGŸ=U-----------------------G’`e/›ªKÏ ’`e---------K[ǃ ›ªÏ ’`e---------NK?L c¬¾vQM ›ªLÏ-----------S ¾Iw[. Ö?“ W^}—----W K?L(ÃÑKê)-------------------------------------------------›T”U ›L¾G<U----------¾

105 K²=I `Ó´“� ¾pÉS ¨K=É ›ÑM¡KAƒ ¾ƒ ›Ñ–<;K?L x ;�

Á”ǔƔ U”ß uSÖ¾p� }Ñu=¬” ÔÉ Á¡wu<::

¾S”Óeƒ ¨Ã”U ¾ÓM c?¡}` SJ’< SK¾ƒ ŸM}‰K&&¾x ¬” YU �¾éñ& ----------------------------- ¾x YU�

u?ƒ--------------------------G¾S”Óeƒ É`σ¾S”Ó. Jeú M--------K�¾S”Ó. Ö?“ ×u=Á-----N¾S”Ó.Ö?“ Ÿ?L---------SK?L ¾S”Óeƒ c?¡}` (ÃÑKê)----------------------------------------------------W¾ÓM ¾Ö?“ É`σ¾ÓM Jeú./¡M’>¡-------[K?L ¾ÓM ¾Ö?“ c?¡}` (ÃÑKê)-----------------------------------------------------cK?L(ÃÑKê)-------------------

92

------------------------------›

106 K²=I `Ó´“� ¾pÉS ¨K=É ›ÑM¡KAƒ KSËS]Á Ñ>²? c=ÁÑ–< ¾e”ƒ ¨` `Ñ<´ ’u\� ;

¨`--------------------------›L¬pU------------------98

107 u²=I `Ó´“� e”ƒ ¾pÉS ¨K=É ›ÑM¡KAƒ ›Ñ–<;

w³ƒ--------------------------›L¬pU------------------98

lØ` ØÁo ¾SÚ[h ¨K=ÉYU------------------------

ŸSÚ[h 1—¬ ¨K=ÉYU---------------------

ŸSÚ[h 2—¬ ¨K=ÉYU------------------------

108 u²=I [Ó´“� ¾pÉS ¨K=É ¡ƒƒM c=ÁÅ`Ñ< u=Á”e ›”É Ñ>²?: }S¾ÅU Óòƒ}K¡}ªM”&¾i”ƒ “S<“ cÖªM”& ¾ÅU “S<“ cÖªM”&

› ¾KU ¡wŃ 1 2 ¾ÅU Óðƒ 1 2 I”ƒ “S<“ 1 2 ¾ÅU “S<“ 1 2

109 upÉS ¨K=É ¡ƒƒK Ñ>²? ¾ `Ó´“ ‹Ó` �UM¡„‹ }’Óaƒ ’u`”&

›--------------------------1¾KU-------------------------2›L¬pU-------------------8

110 ¾ `Ó´“‹Ó` UM¡„‹� Ÿ ¿� ¾ƒ SH@É ”ÇKu� -ƒ }’Óaƒ ’u`”&

›--------------------------1¾KU-------------------------2›L¬pU-------------------8

111 Qé’<(œ) (YU) c=¨MÆ U” ¾Ö?“ vKVÁ `Ç � �›Å[ÓM&K?L ŸJ’< T”’ †¬” �uSÖ¾p G<K<”U ¾}Ökc<ƒ” ÃS´Óu<&SKg<œ T”U ›K[ǘU ŸKK< u©KÆuƒ Ñ>²? ›ªm c¬ S•` ›KS•\” ÃÖÃl&

¾Ö?“ vKVÁGŸ=U-----------------------G’`e/›ªKÏ ’`e---------K[ǃ ›ªÏ ’`e---------NK?L c¬¾vQM ›ªLÏ-----------S ²SÉ/Ñ<œÅ—-------------W K?L(ÃÑKê)------------------------------------------------›T”U ›M[ǘU---------¾

¾Ö?“ vKVÁGŸ=U--------------------G’`e/›ªKÏ ’`e------K[ǃ ›ªÏ ’`e-----NK?L c¬¾vQM ›ªLÏ-------S ²SÉ/Ñ<œÅ—---------W K?L(ÃÑKê)------------------------------------------›T”U ›M[ǘU-----¾

¾Ö?“ vKVÁGŸ=U----------------------G’`e/›ªKÏ ’`e--------K[ǃ ›ªÏ ’`e--------NK?L c¬¾vQM ›ªLÏ---------S ²SÉ/Ñ<œÅ—-----------W K?L(ÃÑKê)----------------------------------------------›T”U ›M[ǘU--------¾

112 Qé’<(œ) (YU) ¾ƒ ¨Kƃ:

K?L x ;�

¾S”Óeƒ ¨Ã”U ¾ÓM c?¡}` SJ’< SK¾ƒ ŸM}‰K&&¾x ¬” YU �¾éñ& ----------------------------- ¾x YU�

u?ƒ-----------------------11--------- ¨Å 314 ÃH>ƾS”Óeƒ É`σ¾S”Ó. Jeú M------21�¾S”Ó. Ö?“ ×u=Á---22¾S”Ó.Ö?“ Ÿ?L--------23K?L ¾S”Óeƒ c?¡}` (ÃÑKê)---------------------------------------------------26¾ÓM ¾Ö?“ É`σ¾ÓM Jeú./¡M’>¡-----31

u?ƒ---------------------11-------- ¨Å 314 ÃH>ƾS”Óeƒ É`σ¾S”Ó. Jeú M---21�¾S”Ó. Ö?“ ×u=Á-22¾S”Ó.Ö?“ Ÿ?L-----23K?L ¾S”Óeƒ c?¡}` (ÃÑKê)---------------------------------------------26¾ÓM ¾Ö?“ É`σ

u?ƒ-----------------------11--------- ¨Å 314 ÃH>ƾS”Óeƒ É`σ¾S”Ó. Jeú M------21�¾S”Ó. Ö?“ ×u=Á---22¾S”Ó.Ö?“ Ÿ?L--------23K?L ¾S”Óeƒ c?¡}` (ÃÑKê)-------------------------------------------------26¾ÓM ¾Ö?“ É`σ

93

K?L ¾ÓM ¾Ö?“ c?¡}` (ÃÑKê)---------------------------------------------------36K?L(ÃÑKê)-----------------------------------------------96

¾ÓM Jeú./¡M’>¡--31K?L ¾ÓM ¾Ö?“ c?¡}` (ÃÑKê)----------------------------------36K?L(ÃÑKê)-----------------------------------------96

¾ÓM Jeú./¡M’>¡-----31K?L ¾ÓM ¾Ö?“ c?¡}` (ÃÑKê)-------------------------------------------------36K?L(ÃÑKê)---------------------------------------------96

113 Qé’<(œ) (YU) ¾}¨KŬ ukÊ ØÑ“ (CS) ’¬”&

›----------------------1¾KU--------------------2

›----------------------1¾KU--------------------2

›----------------------1¾KU--------------------2

114 u¨KÆ uG<Kƒ ¨^ƒ ¬eØ ”Ų=I ¯Ã’ƒ zà V” � �

›? }kwKªM”&¾zà V” ›? ”¡wM � �Ád¿›†¬&

›----------------------1¾KU--------------------2›L¬pU---------------8

¾Q铃 Ö?“: K“„‹“ K}”ŸvŸu=� ‹ (°ÉT@Á†¬ Ÿ›Ueƒ ¯Sƒ u‹ KJ’< Q铃)�

¡õM ›”É: ¾Qé’<(œ) S[ÍlØ` ØÁo ¢É ´KM101 ŸQé’<(œ) (YU) Ò` Áƒ” Ó”–<’ƒ u}SKŸ}

›”Ç”É ØÁo‹” MÖÃp ðMÒKG<� & ŸQé’<(œ) (YU) Ò` Áƒ” Ó”–<’ƒ U”É” ’¬ ¨ÃU `°e KQé’<(œ) (YU)U”É” ’ƒ&

¨LÏ “ƒ-----------------------------------� -----1¨LÏ ›vƒ-----------------------------------------2¾ ”Ë^ “ƒ-----------------------------------� � --¾ ”Ë^ ›vƒ-----------------------------� --------c?ƒ ›Áƒ------------------------------------------5¨”É ›Áƒ----------------------------------------6›dÇÑ> u?}cw--------------------------------------7Iƒ/¨”ÉU------------------------------� --------8

K?L ²SÉ-------------------------------------------9›”³SÉU---------------------------------------10

102 Qé’<(œ) (YU) ¾}¨KŬ SŠ ’¬& k”-----------------------------------------------------k’<” ›L¬pU----------------------------------98k”----------------------------------------------------¨\” ›L¬pU---------------------------------98¯Sƒ------------------------------------------------¯S~” ›L¬pU---------------------------9998

103 ¾Qé’<(œ) (YU) °ÉT@ e”ƒ ’¬&Ÿ›eðKÑ ØÁo lØ` 102 “/¨Ã”U 103 �›c}ÁÃ}¬ Áe}Ÿ¡K<&

S<K< °ÉT@------------------------------------

¡õM G<Kƒ: ¾“ƒ Ö<ƒ ›SÒÑw�201 Qé’<(œ) (YU) ¾ “ƒ Ö<ƒ Öw„ Á¬nM&� ›--------------------------------------------------

1 …203

94

¾KU------------------------------------------------2

202 Qé’<(œ) (YU) ›G<”U ¾ “ƒ Ö<ƒ � ›--------------------------------------------------1¾KU------------------------------------------------2

203 Qé’<(œ) (YU) ƒ“”ƒ“ ¨Ã”U ƒ“”ƒ T � uÖ<Ù ¾Ö׬ ’Ñ` ›K”&

›--------------------------------------------------1¾KU------------------------------------------------2›L¬pU-------------------------------------------8

204 Qé’<(œ) (YU) ƒ“”ƒ“ ¨Ã”U ƒ“”ƒ T � ¾uL¬ ¨Ã”U ¾Ö׬ ¬H& u?u= ö[S<L ¨Ã”U K?L k}ƒ&ßTm/fÇ/hÃ/¾\´ ¬H& T”—¬U UÓw ›K”&

› ¾KU ›L¬pU¬H 1 2 8¨}ƒ 1 2 8ßTm/fÇ/hà 1 2 8 T”—¬U UÓw 1 2 8

¡õM ZYƒ: ¾Q铃 Ö?“lØ` ØÁo ¢É ´KM301 ¾Qé’<(œ) (YU) ¡ƒvƒ ¾}éðuƒ Ÿ`É ›Kƒ::

› ŸJ’& u¡� T¾ƒ ‹LKG<”::�›& Ã~›M----------------------1�›&›M ¾U----------------------2�Ÿ`É ¾KU--------------------------3

?…305

302 G. k’<” ŸŸ`Æ ÃÑMwÖ<::K. Ÿ`Æ ¡ƒv~ ScÖ~” Ÿd¾“ k’< ŸM}S²Ñu uk” ƒÃ¿ 66” Ãéñ::N. ŸG<Kƒ Ñ>²? uLà zà T>” ›? Ÿ}cÖ&� ¾p`w Ñ>²? “ 2— ¾p`w Ñ>²? k“ƒ ÃS´Óu<::�

k” ¨` ¯Sƒu=c=Í=

                                                                                              

þK=Ä 0 (c=¨KÉ ¾T>cØ)

                                                                                              

þK=Ä 1                                                                                               

þK=Ä 2                                                                                               

þK=Ä 3                                                                                               

Ç=ú+ 1

                                                                                              

Ç=ú+ 2

                                                                                              

Ç=ú+ 3

                                                                                              

T>´Me                                                                                               

zÃT>” ›?�                                                (¾p`w Ñ>²?)                                                

zÃT>” ›?�                                                (2— ¾p`w Ñ>²?)                                                

95

303 302” ›[ÒÓØG<K<U Ÿu=.ˆ.Í= eŸ T>� ´Me ÁK<ƒ ¡ƒv„‹›M}S²Ñu<U---------¨Å 304 ò=ÆG<K<U Ÿu=.ˆ.Í= eŸ T>� ´Me ÁK<ƒ ¡ƒv„‹ }S´ÓuªM------------------------------ ...307

304 wN?^© ¾¡ƒvƒ ²S‰ k” ÚUa Qé’<(œ) (YU) ¾¨cŬ/¾¨cÅ‹¬ u²=I Ÿ`É Là ÁM}é𠡃vƒ ›K ¨Ã:: SLg<(œ) u=.ˆ.Í=& þK=Ä 0-3& Ç=.ú.+. 1-3 & “/¨Ã”U T>´Me ŸÖkc< �w‰ #›”$ ÃS´Óu<:: › ŸJ’&KT>SŸ}¬ ¾¡ƒuƒ ›Ã’ƒ uk” ƒÃ¿ #66$ Ãéñ::

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

...307

...307

...307

305 wN?^© ¾¡ƒvƒ ²S‰ k” ÚUa Qé’<(œ) (YU) ui ”Çò¬/ ”ÇÃ� � � ³ƒ KSŸLŸM ¡ƒvƒ ¨eÊ/¨eÇ Á¬nM/ � ¬nK‹ ¨Ã::

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

…?..307

306

306G

306K

306N

306S

206W

306[

306c

v¡� Qé’<(œ) (YU) ¾T>Ÿ}K<ƒ” ¡ƒv„‹ ¨eÊ/¨eÇ ”ÅJ’ ÔÑ\˜:: Ÿd”v ui � �¾T>ŸLŸM& u¡’É ¨Ã”U uƒ¡h ¾T>cØ“ Övd ¾T>ðØ` ¾u=.c=.Í= ¡ƒvƒ

u›õ ¾T>cØ ¾þK=Ä ¡ƒvƒ Öw �

Qé’<(œ) (YU) Ÿ}¨KÅ uG<Kƒ XU” ƒ ¬eØ �¨Ã”U uL ¾þK=Ä ¡ƒvƒ ›Ó˜~›M/›Ó˜K‹ ¨Ã::� �

¾þK=Ä ¡ƒvƒ e”ƒ Ñ>²? }cØ~›M::

u ó ¨Ã”U uÇK? ¾T>¨Ò“ ›”Ç”É Ñ>²? �Ÿþ.K=.Ä Öw Ò` ¾T>cØ ¾Ç=.ú.+ ¡ƒvƒ�

¾Ç=.ú.}. ¡ƒvƒ e”ƒ Ñ>²? }cØ~›M::

Qé’<(œ)”(YU) ui ”Çò¬/ ”Çóƒ ŸŸ<õ˜ � � �ui KSŸLŸM Qé’< 9 ¨^ƒ ¨Ã”U Ÿ²=Á uLà �c=J’¬/c=J“ƒ u¡”É Là ¾T>¨Ò ¾T>´Me ¡ƒvƒ

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8uSËS]Á G<Kƒ XU” ƒ---------1�uL----------------------------------------2�

w³ƒ----------------------------------------

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

w³ƒ----------------------------------------

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

…?306W

…?306c

307 302” ›[ÒÓØ&¾p`w Ñ>²? zà T>” ›? ¾}S²Ñu� up`w Ñ>²? K}cÖ zà T>” ›? k” ›M}çðU�up`w Ñ>²? K}cÖ zà � T>” ›? k” }îñ›M -------------------------- ¨Å 308 ÃH>Æ

---------------------------------------------- ..310308 Qé’<(œ) (YU) zà T>” ›? }kwKA/ }kwL �

¨Ã:: ”¡wK<” ›dÃ::�›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

…?...310

309 Qé’<(œ) (YU) vKñƒ eÉeƒ ¨^ƒ zà T>” �›? }kwK<›M/}kwLK‹ ¨Ã::

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

310 Qé’<(œ) (YU) vKñƒ G<Kƒ XU” ƒ }pTØ �’u[¬/’u^ƒ ¨Ã::

›-----------------------------------------1¾KU---------------------------------------2›L¬pU----------------------------------8

…?..316

311 ›G<” Qé’<(œ) (YU) }pTØ uÁ²¬/ uÁ³ƒ Ñ>²? ¾UƒÖ׬ U” ÁIM ”ÅT>cÖ¬/ ”ÅT>c׃ KT¨p ðMÒKG<:: � � �

Ÿ}KSŬ Á’c& Ÿ<M ¾J’&Ÿ}KSŬ �¾T>uMØ }cØ„ M� /}cØ~› M� ¨Ã:: Ÿ’c&

u×U Á’c--------------------------------1 uSÖ’< Á’c-----------------------------2 }SddÃ----------------------------------3 ¾uKÖ--------------------------------------4¾T>Ö׬ ›M}cÖ¬U

96

Ÿ}KSŬ u×U Á’c ¨Ãe uSÖ’< Á’c /M}c׃U------------------------------5›L¬pU----------------------------------8

312 Qé’<(œ) (YU) }pTØ uÁ²¬/uÁ³ƒ Ñ>²? Ÿ}KSŬ Á’c& Ÿ<M ¾J’&Ÿ}KSŬ �¾T>uMØ ”Ç=uL/ ”ɃuL }cØ„ M� � � /}cØ~› M� ¨Ãe U”U ¾T>uL ›M}cÖ¬U:: Ÿ’c (ÔƒÑ<ƒ)& Ÿ}KSŬ u×U Á’c ¨Ãe uSÖ’< Á’c }cØ„ M � /}cØ~› M� ¨Ã::

u×U Á’c--------------------------------1 uSÖ’< Á’c-----------------------------2 }SddÃ----------------------------------3 ¾uKÖ--------------------------------------4UÓw ›lS<M/›lTK‹--------------5 UÓw ›M}cÖ¬U/M}c׃U---------------------------------------------------6›L¬pU----------------------------------8

313 K}pTÖ< U¡` ¨Ã”U I¡U“ ŸT“†¬U x � (U”ß) ðMѬ ’u` ¨Ã::

›-----------------------------------------1¾KU---------------------------------------2 ..315

314 U¡` ¨Ã”U I¡U“ Ÿ¾ƒ õKÑ</›Ñ–<::

K?L x �

Á”ǔƔ U”ß uSÖ¾p }Ñu=¬” ÔÉ �Á¡wu<::

¾S”Óeƒ ¨Ã”U ¾ÓM c?¡}` SJ’< SK¾ƒ ŸM}‰K&&¾x ¬” YU ¾éñ& � ------------------------------------------------------- ¾x YU�

¾S”Óeƒ c?¡}`¾S”Óeƒ Jeú M------------------G�¾S”Óeƒ Ö?“ ×u=Á----------------K¾S”Óeƒ Ö?“ Ÿ?L-------------------N}”kdni ¡K=’>¡---------------------S¾Se¡ W^}—------------------------WK?L ¾S”Óeƒ c?¡}` (ÃÑKê)---------------------------------------------------[¾ÓM c?¡}`¾ÓM Jeú M/¡K=’>¡----------------c�ó`Tc=-----------------------------------g¾ÓM NŸ=U-----------------------------k}”kdni ¡K=’>¡-----------------------u¾Se¡ W^}—-------------------------}K?L ¾ÓM Ö?“ c?¡}` (ÃÑKê)----------------------------------------------------†K?L U”ßc<p-----------------------------------------’vIL© NŸ=U----------------------------–K?L (ÃÑKê)---------------------------------------------------------------------------------²

315 Qé’<(œ) }pTØ ŸÁ²¬/ŸÁ³ƒ ËUa ŸT>Ÿ}K<ƒ ¬eØ ”Ç=Ö×/ ”ɃÖ× }cØ„ M/}cØ~› M � � � �G. ŸM¿ ûŸ?ƒ ¾}c^ ðdi (¾›Ÿvu= YU ¨Ã’U *.›`.›?e ûŸ?ƒ)K. kÉV ¾ gÑ *.›`.›?e ðdi�N. uS”Óeƒ ¾}ðkÅ uu?ƒ ¬eØ }²ÒË    ðdi

› ¾KU ›L¬pUŸ*.›`.›?e ûŸ?ƒ ¾}c^ ðdi 1 2 8*.›`.›?e ðdi 1 2 8uu?ƒ ¬eØ }²ÒË    ðdi 1 2 8

316 KSÚ[h Ñ>²? (YU) c=çÇÇ& cÑ^¬” KTe¨ÑÉ U” }Å[Ñ::

Qé’< i”ƒ u?ƒ }ÖpS<›M------01cÑ^¬ i”ƒ u?ƒ }ÖK<›M-------02cÑ^¬ ¨Å õdi Te¨ÑÍ }ÖK<›M-------------------------------03cÑ^¬ Ÿqhh Ò` }ÖK<›M------04cÑ^¬ }kw\›M--------------------05cÑ^¬ T@Ç Là }ƒ~›M---------06K?L (ÃÑKê)--------------------------------------

97

-----------------------------------996

10. S. ¾u<É” ¬Ãà SÖÃp SU]Á

SÓu=Á&Ö?“ ÃeØM˜! eT@ ------------------------------- ÃvLM:: ÃI” ¾u<É” ¬Ãà ’@ S^ªKG<::� � ------------------------------- ¬ÃÃ~” u‚ý ÃkÇM& êOõU èeÇM:: (Á”Ç”Æ/ÇD }dò ^c<(dD)”� � � ueU ”Ç=Áe}ª¬p/”Ée}ª¬p ›É`Ó/Ñ>)::� � �

¾u<É” ¬Ãà }dò� ‹ SS]Á&

K²=I ¾ú.›?‹.Ç= e^ K=[Æ”/K=ÁÓ²<” eK}eTS< “SeÓ“K”:: Ñ>²?� ”“ ¬kƒ¨” ¾T� "ðM ðnÅ—’ƒ” “Å”nK”:: ¾S×’¬ ŸÔ”Å` ¿’>y`c=+/ ›Ç=e ¢’+’@”M ¾Ö?“ ›Övup ›=”e+~ƒ� � c=J”&¾Ö?“ ›?¡e‚”i” ýaÓ^U ƒÓu^ (¾Ö?“ ›?¡e‚”i” øaÓ^U uIw[}cu< ²”É u“„‹“ uQ铃� Ö?“&u¡ƒvƒ “ uu?}ew U×’@ LÃ) uU°^w ÔÍU µ”& u›T^ wN?^© ¡ML© S”Óeƒ&›=ƒÄåÁ� ÁS׬” K¬Ø uT>Çee Ø“ƒ Là ¾c^” ”Ñ—K”::� �

`e� u²=I `e ²<]Á ¬kƒ ÁK� � ƒ c=J”& ¾T>cÖ<” S[Í ¾Ö?“ ›?¡e‚”i” ýaÓ^U K`e“ KK?KA‹ ¾T>cÖ¬” ›ÑMÓKAƒ KTÔMuƒ/KThhM Ã[Ç“M::

Ÿ²=I ¾T>’Ó\” ’Ñ` uS<K< T>eØ^© ’¬:: ¾`e” MUÉ KSeTƒ õLÔƒ ›K”:: ¾`e eU uT”—¬U ]þ`ƒ ›Ã"}ƒU:: eK nKSÖÃl ¨Ã”U eKýaË¡~ ØÁo "Kƒ ueM¡ lØ` 00251 918 056668 ¨Ã”U 00251 920 252761 SŨM ËLK<& ¨ÃU ŸýaË¡~ ª“ }S^T] Ÿ›„ S´Ñu< ÃÁM Ò` S’ÒÑ`� ËLK<::

Ÿ’@ ÃMp `e u`d‹G< ”Ƀ’ÒÑ\/”Ƀ¨Á¿ ðMÒKG<:: ¬ÃÃ~” ’@ uØÁo ËU^KG<::’Ñ` Ó”� � � � � � � Ÿ²=Á u%EL ŸS¨ÁÁ `°c< Ÿ¨×” ¨Å SeS^‹”/S¨ÁÁ `°c< ”É”SKe ¨Ã”U uU”ðMѬ ’Ñ` Ó”� dƒÇec<ƒ/dƒ¨Á¿uƒ Kk[ ’Ñ` Gdw KTU׃ ×Mn ÑvKG<::�

K?KA‹ vK<ƒ Là LKSeTTƒ ¨Ã”U ¾}K¾ ›e}Á¾ƒ KSeÖƒ ËLK<:: ¾uKÖ ¾}KÁ¿ Hdx‹ ucT” lØ`& Se^ƒ ¾T>Ñv” ¾uKÖ S[Í Ã•[“M:: uÉÒT@ ¾`e” MUÉ KSeTƒ õLÔƒ ›K”& ”ȃ� Áe¬c<M;� �

¬Ã~~” ¨ÅTÖ“kl c¯ƒ e”Å`e ”ɬlƒ ›Å`ÒG<:: S“ðe � � "Kuƒ uke H>Ŭ u}‰K� ƒ õØ’ƒ }SMc¬ ÃUÖ<::

ŸSËS^‹” uòƒ T“†¬U ØÁo ›Kƒ”;

98

¾u<É” ¬Ãà SU]Á ØÁo‹&

10. ¾Ö?“ ›?¡e‚”i” ýaÓ^U K`e U”É” ’¬; (ýaÓ^S<” ”ȃ Á¿M; ýaÓ^S< u`e� � S”Å`/›Ÿvu= ²”É U” ÃUeLM;)

11. ŸÖ?“ ›?¡e‚”i” ýaÓ^U ƒÓu^ uòƒ u“”} ›Ÿvu= ª“ ª“ ¾Ö?“ ‹Óa‹ U”É” ’u\; �(’²=I ¾Ö?“ ‹Óa‹ ”Ç=•\ ÁÅ[Ñ<ƒ ª“ ª“ U¡”Á„‹ U”É” ’u\;)� �

12. u›G<’< c¯ƒ (ŸÖ?“ ›?¡e‚”i” ýaÓ^U ƒÓu^ u%EL) u“”} ›Ÿvu= ª“ ª“ ¾Ö?“ �‹Óa‹ U”É” “†¬; (’²=I ¾Ö?“ ‹Óa‹ ”Ç=•\ ÁÅ[Ñ<ƒ ª“ ª“ U¡”Á„‹ U”É” “†¬;)� �

13.Ö?“” u}SKŸ} u“”} ›Ÿvu= U” K¬Ø ›K; (u“„‹“ I퓃 Ö?“ LÃ; u¡ƒvƒ LÃ; uu?}cw � �U×’@ LÃ;)

14.›”É u?}cw }S[k ¾T>vK¬ SŠ ’¬;

15.u}S[l“ vM}S[l u?„‹/u?}cx‹ SŸŸM M¿’„‹ ›K<”; (u“„‹“ I퓃 Ö?“ LÃ; u¡ƒvƒ LÃ; �uu?}cw U×’@ LÃ;)

16.¾}S[l u?}cx‹ LM}S[lƒ u?}cx‹ VÈM G<’¬ K[ÏU Ñ>²? ¾kq¿ ’¬”; (²Lm’ƒ)�

17.¾}S[l u?}cx‹ LM}S[lƒ u?}cx‹ VÈM ŸMJ’<& u`e ›e}Á¾ƒ U¡”Á„‡ U”É” “†¬;

18.eK Ö?“ ›?¡e‚”i” ýaÓ^U ÖkT@ �‹ ¾uK} K=’Ó\˜ ËLK<; eK ýaÓ^S< ¾}dd} Ó”³u? u›Ÿvu=Á‹G< ›K”;

99

10. W. ¾nK SÖÃp SU]Á

Ñ>²?” ¨eŬ ’@” eK›Ñ–<˜ LScÓ”� ƒ ðMÑcMÑcKG<:: eT@� -------------------------- ÃvLM:: nK SÖÃl” ’@ ÖÃk¨KG<:: --------------------------- � � � nK SÖÃl” u‚ý ÃkÇM& êOõU èeÇM::

¾nK SÖ?p }dò SS]Á&�

K²=I ¾ú.›?‹.Ç= e^ K=[Æ”/K=ÁÓ²<” eK}eTS< “SeÓ“K”:: Ñ>²?� ”“ ¬kƒ¨” ¾T� "ðM ðnÅ—’ƒ” “Å”nK”:: ¾S×’¬ ŸÔ”Å` ¿’>y`c=+/ ›Ç=e ¢’+’@”M ¾Ö?“ ›Övup ›=”e+~ƒ� � c=J”&¾Ö?“ ›?¡e‚”i” ýaÓ^U ƒÓu^ (¾Ö?“ ›?¡e‚”i” ýaÓ^U uIw[}cu< ²”É u“„‹“ uQ铃� Ö?“&u¡ƒvƒ “ uu?}ew U×’@ LÃ) uU°^w ÔÍU µ”& u›T^ wN?^© ¡ML© S”Óeƒ&›=ƒÄåÁ� ÁS׬” K¬Ø uT>Çee Ø“ƒ Là ¾c^” ”Ñ—K”::� �

eK Ö?“ ›?¡e‚”i” ýaÓ^U (Ö?“ ›?¡e‚”i” ýaÓ^U ÁS׬” K¬Ø) ÁK¨ƒ” MUÉ ”Ç=ÁŸõK<˜� Ÿ`e Ò` S’ÒÑ` ðMÒKG<::� u}KÃU ’Å ›”Æ ¾ú.›?‹.Ç= e^ ¯LT& ýaÓ^S< uIw[}cu< ²”É� u“„‹“ uQ铃 Ö?“&u¡ƒvƒ “ uu?}ew U×’@ Là ÁS׬” K¬Ø uTØ“ƒ Là e”J” K¨Åòƒ ue^ LÃ� � K=¬M ¾T>‹M ƒUI`ƒ SÁ´ ”ðMÒK”:: �

nK SÖÃl Ÿ›”É c¯ƒ Á’c Ñ>²? èeÇM:: ¾`ce ›e}Á¾ƒ ”ÇÁSMÖ˜ eKUðMÓ nK SÖÃl” u� ‚ý kǪKG<:: U”U ”Ÿ êOõ ¾U¨eÉ wJ”U uõØ’ƒ `e� � � ¾T>’Ó\˜” uS<K< LMêõ ‹LKG<:: � ¾`e ›e}Á¾ƒ ”ÇÁSMÖ” nK SÖÃl � u‚ý eKT>kÇ ÉUê” Ÿõ ›É`Ѭ S“Ñ`” `ÓÖ’— ÃG<’<:: �

G<K<U ¾T>’Ó\” ’Ñ` uS<K< T>eØ^© ’¬:: ÃIU TKƒ ¾`e nK UMMe SMf‹ uU`U\ u<É” ›vLƒ w‰ ¾T>¨l c=J” u]þ`‹” ¾U“Ÿƒ}¬ T”—¬U `e� � � ¾T>cÖ<” S[Í ¾`e” T”’ƒ ’ÅTÃÑMê� “[ÒÓØM� K”:: eK nK SÖÃl ¨Ã”U eK ýaË¡~ ØÁo � "Kƒ ueM¡ lØ` 00251 918 056668 ¨Ã”U 00251 920 252761 SŨM ËLK<& ¨ÃU ŸýaË¡~ ª“ }S^T] Ÿ›„ S´Ñu< ÃÁM Ò` S’ÒÑ`� ËLK<::

Áe¬c<! eKTÃðMÑ<ƒ T”—¬”U ’Ñ` S“Ñ` ÓÈ ¾Ku� � ƒU& uT”—¬U Ñ>²? nK SÖÃl” Ts[Ø Ã‹LK<::

eKÑKêG<M ’Ñ` T”—¬U ’Ñ` ØÁo ›Kƒ;

u²=I nK SÖÃp KSd}õ ðnÅ— ’ƒ”;

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

100

}ÖÁm Ue¡` k”

¾nK SÖÃp SU]Á: K¡MM& Kµ”“ K¨[Ç Ö?“ vKYMו‹ “ KÖ?“ ›?¡e}”i” W^}™‹�

¾ÖÁm ¢É: --------------------------------------------------------------------------------------------------------------

¾ØÁo SLi ¢É: ------------------------------------------------------------------------------------------------------

¡MM: ------------------------ µ”: --------------------- ¨[Ç: -------------------- kuK?: ------------------------

¾ØÁo SLi eU“ Lò’ƒ: �------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

¾ÖÁm ›e}Á¾ƒ: ------------------------------------------------------------------------------------------------------

k”: ----------------------------------------------- c¯ƒ& Ÿ ------------------------- eŸ -------------------------�

¾nK SÖÃl SU]Á ØÁo‹&

1. ¾Ö?“ ›?¡e‚”i” ýaÓ^U uU” Å[Í LÃ ÃÑ—M; (¾Ö?“ ›?¡e‚”i” ýaÓ^U ió”“ ›ÖnkU)

101

2. �`e uT>c\Sƒ ›Ÿvu= ¾Ö?“ ›?¡e‚”i” ýaÓ^U uIw[}cu< ²”É ÁS׬ K¬Ø ŸK& U” ¯Ã’ƒ K¬Ø ”ÇS× ÃcT� M;� (¾Iw[}cu< ¾Ö?“ ›?¡e‚”i” ýaÓ^U ›ÑMÓKAƒ ¬kƒ� SÚS`; ¾Iw[}cu< ¾Ö?“ G<’@ ShhM;� )

3. ¾}S[l u?}cx‹ ŸM}S[lƒ u?}cx‹ Ò` c=’éç\ M¿’~” ”ȃ Á¿M; (›”É u?}cw }S[k� � ¾T>vK¬ SŠ ’¬; }S^m u?}cw KSvM Seð`~ U”É” ’¬; ŸÑ>²? u%EL ¾}S[l u?}cx‹ Å[͆¬” ÃÖwnK<”;)

4. ¾Ö?“ ›?¡e‚”i” ýaÓ^U u“„‹“ uI铃 Ö?“ Là ÁS׬ K¬Ø U”É” ’¬; (“„‹ ¾pÉS ¨K=É� � ›ÑMÓKAƒ ÁÑ—K<”; “„‹ K¨K=É ›ÑK=ÓKAƒ ¾Ö?“ É`Ï„‹” ÃÔu—K<”; “„‹� � ¾ÉI[ ¨K=É ›ÑMÓKAƒ ÁÑ—K<”; I铃 6 ¨` eŸ=VL†¬ ¾“ƒ Ö<ƒ w‰ ÃÖvK<”; I铃� � zÃT>” ›? Ãc׆ªM”;)�

5. ¾Ö?“ ›?¡e‚”i” ýaÓ^U u¡ƒvƒ Là ÁS׬ K¬Ø U”É” ’¬; (¾¡ƒvƒ ió” U” ÃSeLM; I铃 G<K<”U ¾¡ƒvƒ ¯Ã’„‹ ß}vK<”;)

6. ¾Ö?“ ›?¡e‚”i” ýaÓ^U uu?}cw U×’@ Là ÁS׬ K¬Ø U”É” ’¬; (Iw[}cu< ¾u?}cw U×’@ ›ÑMÓKAƒ ›²¬ƒa ÃÖkTM”; ¾¨”Ê‹/¾vKA‹ eKu?}cw U×’@ ›ÑMÓKAƒ ›SKŸŸƒ U”É” ’¬;) ¾ƒ™‡” ¾u?}cw UÖ’@ ²È‹ Iw[}cu< ›²¬}a ÃÖkTM;)

7. u}S[l u?}cx‹“ vM}S[lƒ u?}cx‹ SŸŸM M¿’~” ›K”; (¾Ö?“ ›?¡e‚”i” ýaÓ^U ÁS׬ K¬Ø u“„‹“ I퓃 Ö?“ LÃ; u¡ƒvƒ LÃ; uu?}cw U×’@ LÃ;)�

8. ŸLà ŸÖke“†¬ K¬Ù‹ u}ÚT] ¾Ö?“ ›?¡e‚”i” ýaÓ^U ›UØ…M wK¬ ¾T>Áeu<ƒ Ÿõ}— K¬Ø U”É” ’¬; (uHÃÏ”“ ¾›Ÿvu= ”êI“& ›?‹.›Ã.y=/›?Ée& ¨²})

9. ¾Ö?“ ›?¡e‚”i” ýaÓ^U ƒÓu^ u}SKŸ} ÁÒÖS< ‹Óa‹ Ÿ’u\& ‹Óa‹ U”É” ’u\; ›G<”e U”É” “†¬; (ª“ ÉÒõ ›Ø[ƒ; S<Á© ÉÒõ Ø[ƒ; ¾W^}— „KA „KA SKkp; ¾Iw[}cu<� � ›SKŸŸƒ;)

10.’²=I” Sc“¡KA‹ ”ȃ }¨×D†¬;� �

11.¾ƒ™‡ ¾Ö?“ ›?¡e‚”i” ýaÓ^U ûŸ?Ћ ’Ç=kØK< ¨Ã”U ”Ç=Ö“Ÿ\ ÃS¡^K<; (v¡� � � K²=I SMe Tw^]Á ÃeÖ<&)

12.¾ƒ™‡ ¾Ö?“ ›?¡e‚”i” ýaÓ^U ûŸ?Ћ Ss[Ø ›Kv†¬; (v¡� K²=I SMe Tw^]Á ÃeÖ<&)

13.¾Ö?“ ›?¡e‚”i” ýaÓ^U uT>ÁS׬ K¬Ø Là }ê°• K=ÁS<Ö< ¾T>‹K< ’Ña‹ U”É” “†¬ wK¬ ÁevK<; (uÖ?“ Ÿ?L¬ ¾T>cÖ< ¾I¡U“ ›ÑMÓKAƒ Ø^ƒ ›ddu=’ƒ ›ÑMÓK~” ŸSÖkU ßK¡LM”; ªÒ“ ¾Ñ<µ `kƒ ¾›ÑMÓKA~” ›ÖnkU ¬c<” K=ÁÅ`Ó Ã‹LM”; ¾°¬kƒ T’e (SŠ ¾Ö?“ Ÿ?L¬” SÔw–ƒ ”ÇKw”) ›ÑMÓK~” ŸSÖkU ßK¡LM”;)�

14.u`e ›SKŸŸƒ ¨Åòƒ ¾Ö?“ ›?¡e‚”i” ýaÓ^U ›ÑMÓKAƒ KThhM Ö?T¬ S”ÑÉ U”É” ’¬� wK¬ ÁevK<; (Iw[}cu<” Td}õ; K?KA‹ ¾u?}cw ¬d’@ cß‹”;

¾Ö?“ ›?¡e‚”i” ýaÓ^U ÁS׬” K¬Ø ¾T>Çcc< G<K<’U ØÁo‰‹” eKSKc<M” “ScÓ“K”::� U”›Mvƒ — d“’d¬ ¾k[ Ndw K=•`� ƒ ËLM&¾Ö?“ ›?¡e‚”i” ýaÓ^U” u}SKŸ} K?L }ÚS] ¾`e-” MUÉ K=’Ó\” ÃðMÒK<”;

Ñ>²?” ¨eŬ eL“Ñ\” u×U “ScÓ“K”::�

102

Information Sheet and Consent Form for Implementation of Health Extension program in

West Gojjam Zone, Amhara National Regional State, Ethiopia

Name of the Principal Investigator: Mezgebu Yitayal Mengistu

Name of the organization: University of Gondar/Addis Continental Institute of Public

Health

Name of the Sponsor: University of Gondar and Addis Continental Institute of public Health

Information Sheet and Consent Form prepared for participants from Kebeles of West

Gojjam Zone Amhara National Regional State, Ethiopia that studies Implementation of

Health Extension program

Introduction

103

UNIVERSITY OF GONDARAND

ADDIS CONTINENTAL INSTITUTE OF PUBLIC HEALTH

This information sheet and consent form is prepared by the investigator whose main aim is to

study Implementation of Health Extension program in West Gojjam Zone, Amhara

National Regional State, Ethiopia. The investigator is PhD student from University of

Gondar /Addis Continental Institute of Public Health..

Purpose: The purpose of this research is to assess the implementation of health extension

program in relation to motivation of health extension workers (HEWs), utilization of health

extension program (HEP) services by the community and outcome of HEP on the community in

terms of family planning, immunization and Maternal and child health in West Gojjam, Amhara

national Regional State, Ethiopia.

Health service extension program is an innovative approach which is encompassed under the

Health Sector Development Program to meet the millennium Development Goals (MDGs).

While the program is innovative and is supposed to bring better health status of population

especially in peripheral areas, studies done concerning program are rare.

Therefore the findings of this study will contribute a substantial share in maximizing utilization

of health service, improving healthy practice, and enhancing motivation of HEWs and overall

reduction of morbidity and mortality.

Procedure: In order to assess the Implementation of Health Extension Program in West

Gojjam Zone, Amhara National Regional State, Ethiopia, we invite you to take part in our

project. If you are willing to participate in our project, you need to understand and sign the

consent form. Then, you will be asked to give your response by the data collectors. For this

questionnaire based study, participants are health extension workers and all mothers (women

aged 15-49) during the study period. All the responses given by the participants and the results

obtained will be kept anonymous and confidential using coding system where by no one will

have access to your responses.

Risk and/or Discomfort: By participating in this research project you may feel that it has some

discomfort specially on wasting your time (about 30-40 minutes) but this may not be too much

as you are going to health institutions for you and your family health care and comparing its

104

potential benefits it contributes to the overall improvement of the health status of the community.

There is no risk in participating in this research project.

Benefits: If you participate in this research project, you may not get direct benefit but your

participation is likely to help us in assessing the motivation of health extension workers,

utilization of health extension program and outcome of the health extension program and in

identifying factors affecting these issues in West Gojjam Zone, Amhara National Regional State,

Ethiopia.

Finally it will give an insight whether policy change is required or not based on the findings of

the study for improving the health status of the community.

Incentives: You will not be provided any incentives to take part in this project.

Confidentiality and Anonymity: The information that we will collect from this research project

will be kept confidential. Information about you that will be collected from the study will be

stored in a file, which will not have your name on it, but a code number assigned to it. Which

number belongs to which name will be kept under lock and key, and it will not be revealed to

anyone except the principal investigator.

Right to Refuse or Withdraw: You have the full right to refuse from participating in this

research (you can choose not to respond some or all of the questions) if you do not wish to

participate; and this will not affect your health services you get at from any health facilities. You

have also the full right to withdraw from this study at any time you wish to, without losing any of

your rights as a resident of this site.

Persons to contact: If you have any question you can contact any of the following individuals

and you may ask at any time you want.

1. Mezgebu Yitayal Mengistu: University of Gondar/Addis Continental Institute of Public

Health

Tel: +251 581 116221/ +251 920 252761 OR +251 918 056668

E-mail: mezgebuy@yahoo.com OR mezgebuy@gmail.com

105

2. Professor Yemane Berhane: Addis Continental Institute of Public Health,

Tel: +251 114 168207/ + 251 911219785

E-mail: yemaneberhane@ethionet.et OR yemane_b@hotmail.com

3. Professor Yigzaw Kebede: School of Public Health Sciences, College of Medicine and

Health University of Gondar

Tel: +251 581 116221/ +251 918 722268

E-mail: gkyigzaw@yahoo.com

የምርምር/ጥናት/ ማብራሪያና የስምምነት መግለጫ ቅጽ

የምርምር ፕሮጀክቱ ርዕስ: uU°^w ÔÍU µ” በአማራ ብሔራዊ ክልላዊ መንግስት ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ U” ”ÅT>SeM KT¨p ¾T>É`Ó Ø“ƒ�

የዋና ተመራማሪ ስም: S´Ñu< ÃÁM S”Ó� e~ የድርጅቱ ስም:   ጎንደር ዩኒቨርሲቲ“ ›Ç=e ¢”+’”}M ¾Ö?’“ ›Övup ›=”e+~ƒ የስፖንሰሩ ድርጅት ስም: ጎንደር ዩኒቨርሲቲ“ ›Ç=e ¢”+’”M ¾Ö?“ ›Övup ›=”e+~ƒ�

ይህ ማብራሪያና የስምምነት መግለጫ ቅጽ የተዘጋጀው u “ ›ጎንደር ዩኒቨርሲቲ Ç=e ¢”+’”}M ¾Ö?“ ›Övup ›=”e+~ƒ የድህረ ምረቃ (ú.›?‹.Ç=) ተማሪና u “ ›ጎንደር ዩኒቨርሲቲ Ç=e ¢”+’”}M ¾Ö?“ ›Övup ›=”e+~ƒ አማካሪ

አማካኝነት ነው፡፡

መግቢያ

የዚህ የምርምር ማብራሪያና የስምምነት ቅጽ ዓላማ አሁን እርሰዎ እንዲሳተፉበት የምንጠይቀዎተን የምርምር ጥናት ምንነት ማብራራት

ነው፡፡ በዚህ የምርምር ፕሮጀክት ለመሳተፍ ከመወሰንዎ በፊት ይህንን የማብራሪያ ቅጽ በጥንቃቄ በማንበብ ጥያቄዎች ካሉዎት

ይጠይቁ፡፡ በተጨማሪም በጥናቱ መሳተፍ ከጀመሩ በኃላ በማንኛውም ጊዜ ጥያቄዎች ካሉዎት መጠየቅ ይችላሉ፡፡

የምርምር ፕሮጀክቱ ዓላማ

›=ƒÄåÁ M¡ � °”ÅT”—¬U ÇÑ> GÑ` uÖ?“¬ J’ uKA‹ TIu^© ›=¢•T>Á© ²`ö‹ ¨ÅL ¾k[‹ GÑ` eƒJ”� � S”ÓeƒU ÃI”” G<’@ ŸÓUƒ ¬eØ uTeÑvƒ u}KÃU ¾Iw[}cu<” ¾Ö?“ G<’@ KThhM� � ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ Là ›¬LM::

106

’Ñ` Ó” ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ u}KÃU ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ: ¾Iw[}cu< ¾Ö?“ ›?¡e}”i” øaÓ^U }ÖnT>’ƒ “ ¾Ö?“ ›?¡e}”i” øaÓ^U� uIw[}cu< ²”É ÁS׬ K¬Ø uU” G<’@ Là ”ÇK ¾T>Ádà ؓƒ Uw³U ›M}”H@ÅU::� � �

በመሆኑም የዚህ ጥናት ዓላማ የዚህ ምርምር ፕሮጀክት ዋና ዓላማ uU°^w ÔÍU µ” በአማራ ብሔራዊ ክልላዊ መንግስት ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ U” ”ÅT>SeM KT¨p ¾T>É`Ó c=J” u}KÃU� ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ: ¾Iw[}cu< ¾Ö?“ ›?¡e}”i” øaÓ^U }ÖnT>’ƒ “ ¾Ö?“ ›?¡e}”i” øaÓ^U� uIw[}cu< ²”É ÁS׬ K¬Ø KSÇce ¾T>Å[Ó Ø“ƒ ፡፡ ከጥናቱ የሚገኘው መረጃም ለጤና አገልግሎት ዕቅድ

ባለሙያዎችና ለጤና ሥራ አመራሮች ከፍተኛ ጠቀሜታ ይኖረዋል ተብሎ ይገመታል፡፡

የአስራር ሂደት

uU°^w ÔÍU µ” በአማራ ብሔራዊ ክልላዊ መንግስት ¾Ö?“ ›?¡e}”g” ýaÓ^U ƒÓu^ U” ”ÅT>SeM KT¨p� uT>É`Ó Ø“ƒ (TKƒU ¾Ö?“ ›?¡e}”i” W^}™‹ }’di’ƒ: ¾Iw[}cu< ¾Ö?“ ›?¡e}”i” øaÓ^U }ÖnT>’ƒ “ ¾Ö?“ ›?¡e}”i” ýaÓ^U� uIw[}cu< ²”É ÁS׬ K¬Ø) እርሰዎ እንዲሳተፉ

ጋብዘንዎታል፡፡ በዚህ ጥናት ውስጥ ለመሳተፍ ከተስማሙ ስምምነቱን በደንብ መረዳትና እንዲሁም መፈረም ይገባዎታል፡፡ ከዚያ

በመቀጠል በጥናቱ መረጃ ሰብሳቢዎች ለሚጠየቁት ጥያቄ እንዲመልሱ ፈቃደኝነትዎ ይጠየቃል፡፡

በዚህ ጥናት የሚሳተፉት ¾Ö?“ ›?¡e}”i” W^}™‹“ K?KA‹ Ø“~ ¾T>SKŸ †¬ ¾Ö?“ vKVÁ� ‹“ Lò� ‹ “ °“„‹� ¨Ã”U ¾u?}cw Lò� ‹ ሲሆኑ የሚሠጡት መልስም ሆነ የሚገኘው ውጤት በምስጢር ይጠበቃል፡፡

ሊከሰቱ የሚችሉ ስጋቶችና ምቾት መጓደሎች

በዚህ ጥናት መሳተፍዎ ምናልባት ጊዜዎን ሊሻማብዎ ይችል ይሆናል፡፡ ነገር ግን ዘወትር ወደ Ö?“ ›ÑMÓKAƒ cÜ É`Ï„‹ ከመመላለስዎና የጥናቱ ውጤት ወደፊት KQ퓃 uIèƒ ¾S•` Ñ<Çà ከሚሠጠው ጥቅም አንጻር ይህን ያህል አይደለም፡፡

በዚህ ጥናት በመሳተፍዎ ምንም ዓይነት ስጋት (ችግር) አያጋጥምዎትም፡፡

ጥቅሞች

በዚህ ጥናት በመሳተፍዎ የተለየ ጥቅም አያገኙም፡፡ ነገር ግን የእርሰዎ በጥናቱ መሳተፍ uÑÖ]~ ›=ƒÄåÁ TIu^© ›=¢•T>Á©“ ›=¢KAÍ=”L© Ñ<ÇÄ‹ ŸQ퓃 uIèƒ ¾S•` ÁKS•` G<’@} Ò` ÁK¬” Ó”–<’ƒ ለማወቅ የሚረዳ

ሲሆን ¾Q퓃 Vƒ Kuk’e þK=c=‹” KSp[î“ eƒ^}Í=‹” KS}Óu` Ã[ÇM::

ማካካሻ

በዚህ ጥናት በመሳተፍዎ ምንም ዓይነት ማካካሻ አይሠጥዎትም፡፡ ነገር ግን በጥናቱ በመሳተፍዎ ምስጋናችን ከፍተኛ ነው፡፡

ምስጢር ስለመጠበቅ

107

ከዚህ ጥናት የሚገኝ መረጃ በሙሉ በምስጢራዊነት ይጠበቃል፡፡. ለዚህ ጥናት የሚሠበሰበው እርሰዎ የሚመለከት መረጃ በማህደር

የሚቀመጥ ሲሆን ማህደሩም በስመዎ ሳይሆን በተለየ ኮድ ሲቀመጥ ኮዱ ከዋናው ተመራማሪ ውጭ ለማንም አይገለጽም፡፡

በጥናቱ ያለመሳተፍ ወይም ራስን የማግለል መብት

በጥናቱ ላለመሳተፍ ከፈለጉ በዚህ ጥናት ያለመሳተፍ ወይም ከአንድ በላይ ወይም ሁሉንም ጥያቄዎች አለመመለስ ይችላሉ፡፡ በዚህ

ጥናት ባለመሳተፍዎ ወይም በከፊልም ሆነ በሙሉ ጥያቄዎችን ባለመመለስዎ ”Å’ª]’ƒ� ¾T>ÁÖ<ƒ አገልግሎት አይኖርም፡፡

የሚገናኟቸው ሠዎች

ይህ ጥናት የጥናቱ ተሳታፊዎች ከጉዳት መጠበቃቸውን በሚያረጋግጠው ጎንደር ዩኒቨርሲቲ በሚገኘው ኮሚቴ ታይቶ ድጋፍ አግኝቷል፡፡

በጥናቱ ዙሪያ ማንኛውም ጥያቄ ካለዎት ከሚከተሉት ውስጥ ማንኛውንም ሠው በሚፈለጉት ጊዜ ማነጋገር ይችላሉ፡፡

1. S´Ñu< à � ÁM S”Óe~: Ô”Å` ¿’>y`c=+ ስልክ ቁጥር +251 58 111 6221/ +251 920 252761 ¨ÃU +251 918 056668

2. ýaôc` ¾T’ w`G’@: ›Ç=e ¢”+’” M ¾Ö?“ ›Övup ›=”e+~ƒ� ስልክ ቁጥር +251 114 168207/ + 251 911219785

3. ýaôc` ÃÓ³¬ ŸuÅ: Ô”Å` ¿’>y`c=+ eM¡ lØ` +251 581 116221/ +251 918 722268

ይህንን ቅጽ አንብበውት ከሆነና አሁንም ሆነ በሌላ ጊዜ ጥያቄ የመጠየቅ እድል ተሠጥተዎ ከሆነ ወይም ይህ ቅጽ ተነቦና

ተብራርቶለዎት ከሆና ለመሳተፍ ከተስማሙ እባክዎ ስመዎንና ፊርማዎን ከዚህ በታች ያስቀምጡ፡፡

የተሳታፊ ስም _________________________________ ቀን ________________ ሁለተኛ ተሳታፊ ስም ____________________________ ቀን ________________

የስምምነት ተቀባይ ፊርማ ________________________ ቀን _______________

ተሳታፊው ማንበብና መጻፍ የማይችል ከሆነ

የምስክር ፊርማ _____________________________________ ቀን _______________

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CURRICULUM VITAEName: Mezgebu Yitayal Mengistu

Sex: Male Place of Birth: Addet, West Gojjam, Ethiopia Date of Birth: 10/07/19751. Language AbilityLanguage Speak Read WriteAmharic English

2. Educational BackgroundCollege/University

Field of Study Period Attended Award CGPA

Addis AbabaUniversity

MPH- HealthManagement

2004-2006 Master of Public Health

3.52

Jimma University Environmental Health Science

1998-2001 Bachelor of Science 3.39

University of Gondar*

Sanitary Science 1992-1994 Diploma 3.47

* University of Gondar was formerly known as Gondar College of Medical Sciences and it was under Addis Ababa University

3. Trainings (Short Seminars) Modular training on EPI, ORT, ART and Vitamin A- organized and given by Gedeo

Zone Health Department at Dilla, Ethiopia from 20/04/1996-01/05/1996 Training on Health Management- organized and given by Gedeo Zone Health

Department at Dilla, Ethiopia from 13-18/05/1996 Training on Health Management Information System- organized and conducted by

South Nations Nationalities and People` s Region Health Bureau in collaboration with Gedeo Health Department and ESHE/JSI at Dilla, Ethiopia from 03-06/07/2002

Training on Advances in Health Communication and Advocacy- organized and conducted by Health Education Center, Federal Ministry of Health of Ethiopia in collaboration with Johns Hopkins University Center for Communication Programs and United Nations Population Fund at Nazareth, Ethiopia from 10-26/02/2003

Ethiopian Public Health Training Initiative (EPHTI) Curriculum Development and Staff Strengthening; Fifth Teaching-Learning Workshop- organized and conducted by EPHTI, Carter Center-Ethiopia at Nazareth, Ethiopia from 04-14/07/2003

Training on Essential Nutrition Actions- organized and conducted by the Carter Center/EPHTI in collaboration with the LINKAGES Project at Dilla College of Teacher Education and Health Sciences from 16-19/01/2004

Training on Lactation Management- organized and conducted by the LINKAGES Project in Ethiopia in collaboration with the Carter Center/EPHTI, at Debub University from 26-27/07/2004

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4. Work Experiences 09/02/2008 to date: Lecturer and Head at Department of Health Management and Health

Economics, School of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia

Responsibilities: teaching health management, health economics and public health courses for under graduate and graduate students and participating in extracurricular activities of the university.

11/09/2007-08/02/2008: Dean and Instructor at Abay Health College, Debre Markos, Ethiopia

Responsibilities: planning, implementing and evaluating curricular activities of the          college and teaching health science students.

11/09/2006-10/09/2007: Academic Vice Dean and Instructor at Abay Health College, Debre Markos, Ethiopia

Responsibilities: planning, implementing and evaluating curricular activities of the college and teaching health science students.

2002-2004: Instructor and Department Head for Environmental Health department, Faculty of Public Health, Health Sciences College, Hawassa UniversityResponsibilities: teaching environmental health and health sciences students; planning, implementing and evaluating environmental health department activities; and receiving assignments from the Head of the Public Health Faculty

2001-2002: District Environmental Health Expert at Yirgacheffe District Health office, Gedeo Zone Health, Department, South Nations Nationalities and People` s Region Health Bureau, EthiopiaResponsibilities- planning, implementing and evaluating environmental health activities of the district: carrying out supervision of food and drinking establishments, and health care facilities of the district; and receiving assignments from the Head of the District Health Office

1994-1998: District Sanitarian at Bulle and Yirgacheffe District Health offices, Gedeo Zone Health, Department, South Nations Nationalities and People` s Region Health Bureau, EthiopiaWorking for each districts for two yearsResponsibilities- planning, implementing and evaluating environmental health activities of the districts: carrying out supervision of food and drinking establishments, and health care facilities of the districts; and receiving assignments from the Head of the District Health Office

5. Researches

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Economic Burden of Tuberculosis to Patients and Their Families: a Cross-sectional Study at Addet Health Center, Yilmana Densa District, Amhara National Regional State, 2007(unpublished)

Economic Burden of Tuberculosis to Patients and Their Families: a Cross-sectional Study at Felege Hiwot Referral Hospital, Bahir Dar , Amhara National Regional State, 2006(unpublished)

Review of literature on environmental and health to help the environmental economics policy forum to identify possible research ideas for future contracted by Environmental Economics Policy Forum for Ethiopia, 2004

6. Publications Yitayal M. and W/Cherkos A. (2004): Food Hygiene for Environmental Health Students,

carter center/USAID, Ethiopia

7. Hobbies and Other Skills Browsing internet and communicating with peoples and organizations; watching TV

especially soccer match and athletics championship; and working ability of Microsoft word, Microsoft power point and Microsoft excel

8. Current Address Mezgebu Yitayal P.O. Box 628, School of Public Health College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia Tel: 0920 252761 OR 0918 056668 (mobile), +251 111 558386(Home): E-mail: mezgebuy@yahoo.com OR mezgebuy@gmail.com

9. ReferencesI. Dr. Mesfin Addisse, Community Health Department, Faculty of Medicine, Addis Ababa

UniversityTel: + 251 911 406790; E-mail: shewit91@yahoo.com

II. Dr Abraham Aseffa, Armauer Hansen Research Institute (AHRI)Tel: + 251 911 247525; E-mail: aseffaa@yahoo.com

III. Dr. Belaynew Wassie, School of Public Health, University of GondarTel: + 251 911 385423/+251 918 778268; E-mail: bewassie@yahoo.com

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