1
Confidential
REPUBLIC OF INDONESIA
SSN99.RT
CENTRAL INSTITUTION OF STATISTIC
1999 SOCIAL SAFETY NET SURVEY
HOUSEHOLD SOCIO-ECONOMIC AND HOUSEHOLD MEMBERS LISTING
I. LOCATION IDENTIFICATION
01
02
03
04
05
06
07
08
09
10
11
Province
District/Municipality *)
Sub-district
Village/Village Unit*)
Are
Enumerator Area Number
Segment Group Number
Segment Number
Sample Code Number
Serial Number of sample household
Village classification
01
02
03
Name of the head of household
Number of Household members
Number of household members aged 529 years old and in school
1. Urban
2. Rural
1. Least developed
village
2. Developed
village
II. HOUSEHOLD CHARACTERISTIC
04
05
Number of household members aged 5 –
29 years old and no longer in school
Number of woman aged 15-49 years old,
married, and currently using
contraceptive method
III. ENUMERATION PARTICULARS
01
02
03
04
Name and NIP of enumerator
Enumerator occupation:
1. Province
3. Sub-district
staff
staff
2. District
4. Hired worker
staff
Date of enumeration
Signature of Enumerator
05
06
07
08
Name and NIP of Supervisor
Supervisor occupation:
1. Province
3. Sub-district
staff
staff
2. District
4. Hired worker
staff
Date of supervision
Signature of Supervisor
2
3
IV. HOUSEHOLD MEMBERS EDUCATION AND HEALTH CHARACTERISTICS
Taken from List of VSEN99.K Block IV
A (column 1,2,4 and 5)
H.H
Name of
Gend- Age
members Household er
(Year)
Serial
member
M=1
number
F = 2
1
01
02
03
04
05
06
07
08
09
10
2
3
4
Household members aged 5 – 29 years old
School
Attendance
Not yet/none
1 ! [K. 12)
In school 2
! [K. 6]
No longer in
school 3
! [K. 11]
5
Level of
Education
(code)
6
Did you get
scholarship
which
started year
98/99 ?
Source of
scholarship
(code)
The monthly
amount of
scholarship
(in thousand
rupiah)
How do you
get the
scholarship?
(code)
! [K.12]
If K.5=3,
the reason
no longer
in school
(code)
8
9
10
11
Yes 1
No
2
[K. 12]
7
Codes for column 6:
[Level of education]
Codes for Column 8:
[Source of Scholarship]
Codes for Column 10:
(Scholarship funding)
1. Primary School/MI
2. Junior High School/MTs
3. High School/it’s level
4. Academy/University
1. Government JPS (= Social Safety Net)
2. Government Non-JPS
3. GN-OTA (Foster Parents National Movement)
4. Private
5. Others (foster parents, individual, etc)
1. Directly given at Postal Office
2. Giving power of attorney to the school teacher/
school committee
3. Directly from the school
4. BNI Bank
5. Others
4
5
Did you
have any
health
complaints
during
the last
three
months?
Did you
go for
treatment?
Yes,
Out
patient 1
Yes, In
patient 2
Yes 1
No
2
! K.20]
No
0
! [K18]
12
13
IV. HOUSEHOLD MEMBERS EDUCATION AND HEALTH CHARACTERISTICS (continued)
Women Aged 15 – 49 years old and married which also
For All of Household members
current user of contraceptive
For Out Patient/In Patient, the last treatment
If K.13=1
or 2, the
place of
treatment
(code)
If K.14 =5
or 6 !
[K.18]
14
If
K.14=1
to 4,
did you
use the
Health
Cards?
Yes 1
No 2
!
[K18]
15
ExpenDid
you get diture
charged
(in thou
Yes 1 sand
No 2 rupiah)
!
[K20]
16
17
If the treatment
place is Private
hospital/BUMN/Ot
hers, or not using a
Health Cards
facility
(K.14=5 or 6 or
K.15=2)
Source Cost out
of
patient/
expendi In patient
ture
18
19
When
did you
start
using
the last
method
?
Was the
last
method
that you
used
your
own
choice?
Who
advised
you?
(code)
(code)
20
Yes 1
![K.23]
No 2
21
22
Source
to
obtain
the
method
(code)
If
K.23=1
to 4,
did you
use the
Health
Cards?
If
K.23=5
or 6 !
[K.31]
23
Yes 1
No 2
!
[K31]
24
Codes for Column 11:
[Reason no longer in school]
Codes for Column 14, 23, and 27:
[Place of treatment/ In Patient/ FP/Pregnancy examination]
Codes for column 18, 31, and 37:
[Source of Expenditure)
01. Age
02. Expensive
03. Married
04. Take care of household
05. Enough of education
06. The school too far
07. Unintelligent/not capable
08. Helping family /working
09. Parents lost their job
10. Parents income is not enough
11. Others
1. Government Hospital
2. Puskesmas/Pustu (Integrated Health Center/Supporting Puskesmas)
3. Polindes (Village Maternity Clinic)
4. Posyandu (Integrated Service Post)
5. Private hospital /BUMN (State Owned Corporation)
6. Others
1. Household
2. Health Insurance
4. Certificate of Poverty
8. Others
Did
you get
charged
?
Yes 1
!
[K30]
No 2
!
[K33]
25
Codes for Column 20:
[Use of contraceptive/the last method used]
1. After August 31, 1998
2. Before September 1, 1998
6
7
Asked to household members who are Source and FP cost/
pregnant women
pregnancy examination
Did you
receive
pregnan
cy
examina
tions
Place of
pregnan
cy
examina
tion
(code)
Yes 1 If
![K.33] K.27=5
No 2 or 6
[K.31]
26
27
If
K.27=1
to 4, did
you use
Health
Card for
pregnan
cy
examination?
Yes 1
No
2
![K.31]
Did you
get
charged
28
29
Codes for column 22:
[Person who give an advised,
the way/ contraceptive)
1. Doctor
2. Health workers/Midwife
3. Family Planning workers
4. Village officer
5. Husband
6. Relatives
7. Others
Yes 1
No 2
!
[K33]
If K25
or
K29=1,
the cost
of last
examina
tion
If the examination
place is Private
hospital/BUMN/Ot
hers, or not using a
Health Card
facility
(K.27=5 or 6/ K24
or K.28=2)
(in
The cost
Source
thousand of
of last
rupiah)
expendi examinati
ture
on (in
thousand
rupiah)
30
31
32
Woman giving birth after August 31, 1998
Place of
delivery
(code)
If
K.33=4
to 8 !
[K.37]
33
Codes for Column 33:
[Place of delivery]
1. Government hospital
2. Puskemas/Pustu
3. Polindes (Village Maternity Clinic)
4. Private hospital
5. Maternity hospital/Maternity house
6. Private Midwife Practice
7. Traditional Health Attendant
8. Others
Did you
use
Health
Card
facility?
Did you
get
charged
?
Yes 1
Yes 1 No 2
No 2 !
! [K37] [K.39]
34
If
K.35=1,
amount
of
expendi
ture?
Pregnant woman/post-natal
women and children < 3 years
Source
of
delivery
(In
thousand cost
(code)
rupiah)
35
36
After
August
31, ’98
did you
receive
Cost of
Suppledelivery mentary
(in
Food
thousand Program
rupiah)
(PMT)
If K.33=4 to 8/ if
not using Health
Card facility
[K.34=2)
37
38
Yes 1
No
2
(other hh
member)
39
Kind of
food
received
(code)
Where did
you get the
Supplemen
tary Food
Program?
(code)
40
41
Codes for Column 40:
[Kind of Supplementary
Food Program ]
Codes for Column 41:
[Supplier of Supplementary Food
Program]
1. Food
2. Vitamin
3. Food & Vitamin
1. Puskesmas
2. Polindes
4. Posyandu
8. Others
8
9
V. SOCIO ECONOMIC CONDITIONS OF HOUSEHOLD
(To be asked to Household Head/ Wife/ Husband of Household Head)
A. HEALTH
1.a. DId the household get information about Health Card?
Yes
1
No
2 → go to [ Q. 2.a ]
b. From whom?
[Please fill in code 1 if Yes, code 0 if Not]
1. Village head/Village official
2. Puskesmas/Midwife in the village/”PLKB” ( Family Planning Field Workers)
3. Mass Media (TV, Radio, Newspaper)
4. Neighbor/relative
5. Others (elaborate …………………..)
c. What do you know about Health Card?
[Please fill in code 1 if Yes, code 0 if Not]
The answer do not read it in front of respondent
1.Free treatment for poor people at the Puskesmas/Pustu/Polindes/ Midwife in the
village
2.Free pregnancy examination for poor people at the Puskesmas/Pustu/Polindes/
Midwife in the village
3. Free childbirth for poor people at the Puskesmas/Pustu/Polindes/ Midwife in
the village
4. Giving supplementary food for pregnancy woman and “batita” (children under
three years)
2. a. Does the household having a Health Card?
Yes
1
No 2 → [R.4]
b. How did it obtain the card?
1. Given by village officer/health officer
2. Requested to village officer/health officer
c. Did you get it after August 31, 1998?
Yes
1
No 2
3.a. Did you use Health Card for treatment after August 31, 1998?
Yes, always
1 → [R4]
Yes, sometimes
2
Never
3
b. If Q.3.a = 2 or 3, why?
[Please fill in code 1, if ‘yes’, code 0 if ‘no’]
1. Place of treatment too far
2. Expensive transportation
3. No daily service
4. The service is not good enough
5. Have to pay
6. Seldom/ never get sick
7. Afraid to go to Medical Service
8. Others
c. If Q.3.b coded 1 more than one, the main is (please fill in as appropriated with
code Q.3.b)
B. EDUCATION
[ To be asked if there is a household member aged 5-29 years old]
4. If Block IV Column 5 there was a household member’s coded 2, did the
household have problem in paying education in year 1998/1999?
Yes
-1
No
-2 → [Q.6]
5. How to solve the problem:
[Please fill in code 1 if ‘yes’, code 0 if ‘no’]
a. Postpone the tuition fee
b. Borrowed
c. Ask for aid/scholarship
d. Sold items/pawned
e. Try to have extra income
f. Requested Certificate of Poverty from village head
g. Others
6. If Block IV Column 5 there was a household member’s coded 1 or 3, did you
really want to pay him/her to go to school?
1. Yes, if get the funding/aid
2. Yes, if the domestic economy getting better
3. Yes, because other reason
4. No
C. ECONOMY
7. Was there any ‘labour intensive program’ in the last year
Yes
-1
No
-2
Don’t know
-3
8. a. Was there any household member who joined the Labour-Intensive Program in
the last 6 months:
Yes
-1
No
-2 → [Q.14]
b. If there was, number of household members participating:
Male:…………..persons
Female: …………… persons
9. Number of man-days participated in Labour Intensive Programs in the last 6
months:
Sept
Oct
Nov
Dec
Jan
Feb
Total
…. …… …… ……. …. …… ……………..
10. The activity of Labour Intensive Programs joined:
[Please fill in code 1 if ‘yes’, code 0 if ‘no’]
a. Repairing river bank
b. Cleaning gutter
c. Re-constructing roads
d. Cultivating unused land
e. Others (elaborate……………….)
11. Average wage received per person per day: Rp. …………..
12. Were there any wages received in form of commodities?
Yes
1
No
2 → [Q.15]
10
11
13. Kind of commodities received:
1. 9 staple commodities → [Q.15]
2. Non 9 staple commodities→ [Q.15]
14. If Q.8.a=2, main reason did not join Labour Intensive Program:
1. Small payment
4. Not selected
2. The location too far
5. No need
3. Overload work
6. Don’t know
15. Does this household receive subsidies program aid/clothing distribution/food / 9 staple
commodities in the last 6 months?
1. Yes, free
2. Yes, cheap purchase
3. Yes, both (free and cheap purchase)
4. No → [Q.17]
16. If Q.15 coded 1 to 3;
a. How many times did you receive this aid during the past 6 months? ………times
b. Donors:
1. government
4. Self-supporting
2. private/individual
0. Don’t know
c. If you received the aid from “Self-supporting” , thourhg which activity was this done?
[please fill in code 1 if ‘yes’, code 0 if ‘no’]
1. Free/selling cheap 9 staple commodities 3. “lumbung desa”/villgae rice barn
2. Collecting rice
4. Others
17. Were there any self-supporting Community activities in this village (during the last 6
months). [Please fill in code 1 if ‘yes’, code 2 if ‘no’, or code 0 for don’t know]
a. Free/sold cheap 9 staple commodities
b. Giving scholarship
c. Distributed second-hand clothes
d. Cultivated unused land
e. Labour IntensiveProgram activity
f. Skill training
g. Others
18. Possession of valuable goods at time of enumeration and purchase/sale of valuable goods
during the last 6 months
[Please fill in 1 if ‘yes’, code 0 if ‘no’]
Possessed
Purchased Sold/Pawned
a. Sewing machine
a
b. Radio/tape recorder
b
c. TV
c
d. Refrigerator
d
e. Jewelry/gold/gems stone
e
f. Satellite dish
f
g. Bicycle/ boat
g
h. Motor cycle/ motor boat
h
i. Car/ motor ship
I
j. Land
j
k. House/yard
k
D. WELFARE STATUS
19. Does each member of the household (in general) pray, according to their own religion?
Yes
1
No
2
20. Do all the members of the household in general eat (essential food) 2 times a day or more?
Yes
1
No
2
21. Do all household members have different clothes for home, work/ school and traveling?
Yes
1
No
2
22. Is the floor of the house made of non-soil/earth?
Yes
1
No
2
23. If the children are sick and or Eligible Couples want to use contraceptive, do they go to the
facility/health workers and get the medicine/modern method?
Yes
1
No
2
E. PERCEPTION
24. Opinion about procedures to determine families/households who have the right to receive
health and education aid:
[Please fill in code 1 if ‘yes’, code 2 if ‘no’, or code 0 for don’t know]
a. The statement is very clear
b. Need to have door to door registration for families/households who will
receive aid.
c. To determine/select families/households who will receive the aid, there should
be a discussion in advance
d. The family/household who will receive the aid should be announced first
25. Opinion of respondent about recipient of health card/ 9 staple commodities/ scholarship/
Labour Intensive Program:
[Please fill in respondent opinion as well as for each kind of aid]
a. Health Card
c. Scholarship
b. 9 staple commodities
d. Labour Intensive Program
Codes for respondent’s opinion:
1. All, appropriate
2. Majority, appropriate
3. Minority, appropriate t
4. Not appropriate
5. Don’t know
26. If there are other parties who want to give aid (capital, sembako, etc), who will be a key
person (honest person) to handle aid distribution?
1. Head of village/village official
2. School teacher/principal
3. Religious leader
4. ‘Puskesmas’ doctor
5. Midwife in the village
6. Others (elaborate………..)
12