Jimma University College of business and economics CBE AND PARTNERSHIP MANAGEMENT UNIT Community Based Training Programme (CBTP) DATA COLLECTION INSTRUMENT FOR PROBLEM IDENTIFICATION Year: I, CBTP Phase: I Region: _________________________ Zone ____________ Woreda ________________ Kebele _____________________ Part I: - Questionnaire at Household Level 1. Family Details 1.1 Number of Family Members (including relatives, servant maids and any other person living in the house). 1.1.1 Male ____________ 1.1.2 Female ____________ 1.1.3 Total _____________ 1.2 Head of the Family 1.2.1 Wife ____________ Husband ____________ Others, Specify ________________________ 1.2.2 Age ____________ 1.2.3 Occupational Status ______________________________ 1.2.4 Educational Status ______________________________ 1.2.5 Marital Status: Married __________ Unmarried ___________ Divorced __________ Widowed ___________ 1.3 Age Group of Family Members in Number 1.3.1. 0 – 6: Male ___________ Female ____________ 1.3.2. 7 – 14: Male ___________ Female ____________ 1.3.3. 15 – 64: Male ___________ Female ____________ 1.3.4. 65 & above: Male ___________ Female ____________ 1.4 Educational Levels of Family Members (Excluding Pre-School Children) 1.4.1. Illiterate: Male ___________ Female ____________ 1.4.2. Literate: 1.4.2.1. Only Read and Write: Male ________ Female ________ 1.4.2.2. Elementary (1 – 6) Grade: Male ________ Female ________ 1.4.2.3. Junior High (7 – 8) Grade: Male ________ Female ________ 1.4.2.4. High School (9 – 10) Grade: Male ________ Female ________ 1.4.2.5. Preparatory Class: Male ________ Female ________ 1.4.2.5. Technical & Vocational Level: Male ________ Female ________ 1.4.2.6. College/ University: Male ________ Female ________ 1.5 Culture 1.5.1 Language (Write 1 for the first language and 2 for the Second language etc.) Afan Oromo____Amharic____Keffai____Yem____Dawaro_____Gurage_____Other_______ 1.5.2 Ethnic Category: ___________________________ 1.5.3 Religion: Muslim _________ Christian _________ Other, Specify ___________________________ Page 1 of 4 2. 3. 4. 5. Source of Income 2.1 How many of the family members have permanent employment in organizations? ______ Male ______________ Female _________________ 2.2 How many of the family members have temporary employment options from time to time? _______ Male ______________ Female _________________ 2.3 How many of the family members earn a pension? ___________________ 2.4 Regular salary/wage per month/annual earnings adjusted for month from employment 2.4.1 1 – 50 Male ___________ Female ____________ 2.4.2 51 – 150 Male ___________ Female ____________ 2.4.3 151 – 300 Male ___________ Female ____________ 2.4.4 301 – 450 Male ___________ Female ____________ 2.4.5 451 – 600 Male ___________ Female ____________ 2.4.6 601 – 1000 Male ___________ Female ____________ 2.4.7 > 1000 Male ___________ Female ____________ 2.4.8 Total Income for the Household _________________ 2.5 How many of the household members are involved in trade activities? 2.5.1 Retailing: Male ___________ Female ____________ Capital: ________________ 2.5.2 Wholesale: Male ___________ Female ____________ Capital: ________________ 2.5.3 Both: Male ___________ Female ____________ Capital: ________________ 2.5.4 Total income/month from trade for the household ____________________ 2.6 How many of the household members are involved in production activity? 2.6.1 Service (Service for example includes barber shop, tele–center, hotel, & cafeteria): Male ______________ Female _________________ What type of service? ____________________________________________________________ 2.6.2 Agriculture: Farming: ________ Animal Husbandry: ________ Mixed Farming: ________ 2.6.3 Cottage Industry: _______________ 2.6.4 Medium Scale Industry: ________ 2.6.5 Large Scale Industry: ___________ 2.7 How do you market your products? To: 2.7.1 Consumers (direct) _______ 2.7.2 Wholesalers _______________ 2.7.3 Retailers ___________________ 2.7.4 Others _____________________ Is your income sufficient (just for subsistence) to support your family? Yes No How many of your family members do not have any job at all? Male _______________ Female _______________ Do you have a habit of saving money? Yes No Page 2 of 4 6. 7. 8. 9. 10. 11. If ‘YES’ for Q#5, what facilities do you use for saving? Formal: Banks______ Insurance ______ Microfinance (MFI) ______ Other, Specify ___________________ Informal: Idir ______ Iqub ____________ Other, Specify __________________________ Do you have any intention to invest outside of the area you are active now? Yes No If ‘YES’ for Q#7, in what area of investment? Please, specify the particular type as well. Agriculture…………………………… Particularly in: ______________________________________ Service ………………………………… Particularly in: ______________________________________ Trade (Retailing or wholesale) Particularly in: ______________________________________ Industry……………………………….. Particularly in: ______________________________________ Others …………………………………. Particularly in: ______________________________________ Do you have problems associated with investment? Yes No 9.1 In what areas do you encounter problems? a. Lack of Resources: Finance …………………………………………………………….. Labor (State whether skilled, semi-skilled, unskilled) ________________________ Energy (power interruption)…………………………….. Materials…………………………………………………………… Government Regulations…………………………………… Personal Problems …………………………………………… b. Environmental & Natural Problems (e.g. plants and animal disease, unfavorable whether condition) _________________________________________________________________________________________________ ________________________________________________________________________________________________ c. Others: Please, specify: _____________________________________________________________________ ___________________________________________________________________________________ 9.2 What do you recommend to solve these problems, if any? (Mention as much as possible.) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Do you have problems related to saving? Yes No If ‘YES’, please, mention some of them. ________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Are there investment opportunities in your area? Yes No If ‘YES’, what are the promising sectors for the investment? Rank them. 1st ____________________________ 3rd _________________________________ 2nd ____________________________ 4th _________________________________ Page 3 of 4 12. 13. 14. 15. 16. 17. 18. Do you have proper know how on how to start new businesses (small scale, large-scale)? Yes No 12.1. If ‘NO’, in what areas do you lack the skills, or what are the common problems you confront? 1. _____________________________________ 4. _____________________________________ 2. _____________________________________ 5. _____________________________________ 3. _____________________________________ 6. _____________________________________ 12.2. How do you think the know-how can be improved? Recommend some. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ What are the major problems associated with the start up and running of business entities in your area? Mention as many points as possible in order of their severity. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ What do you generally suggest to alleviate these problems? Cite the possible options. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Are there sources of credit in your kebele? Yes No If ‘YES’, what are they? Formal: Banks_____ Saving & Credit Associations/MFIs _____ NGOs _____ Other, Specify ___________ Informal: Idir ________ Iqub ______________ Other, Specify __________________________ What basic problems are associated with formal credit? ____________________________________________ ____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ Are there any post–sanction visits made by the banks (i. e. visits made by the bank officials to check whether the money is used for the intended purposes)? Yes No Mention all the parties or stakeholders that you think can take part in alleviating the problems you have cited above. 1. ____________________________________________ 5. ____________________________________________ 2. ____________________________________________ 6. ____________________________________________ 3. ____________________________________________ 7. ____________________________________________ 4. ____________________________________________ 8. ____________________________________________ _______________________ ________________________________________________________________________________ _________________________________________________________________________________ Page 4 of 4
