Version 11 – 16/05/14
WSUP HOUSEHOLD SURVEY QUESTIONNAIRE
This questionnaire is designed for survey of WASH services in urban areas. This is a print version, but the questionnaire will typically be delivered using a smartphone
platform (e.g. DoForms). The questionnaire is associated with a Survey Analysis Workbook for automated data analysis.
It is essential that you read WSUP’s guidance on (1) how to design your survey and (2) how to use this questionnaire. Contact erl@wsup.com.
1.00
1.01
1.02
1.03
1.04
1.05
2.00
2.01
2.02
2.03
2.04
2.05
2.06
2.07
2.08
2.09
3.00
3.01
3.02
3.03
3.04
3.05
3.06
3.07
3.08
3.09
Identifier information (interview date, location, respondent)
Interviewer
Survey date (dd/mm/yy)
Survey district
Additional house identifiers
Respondent’s gender
Basic sociodemographic information
No. of women ≥18 and ≤60
No. of girls >3 and <18
No. of infant girls ≤3
No. of elderly women >60
No. of men ≥18 and ≤60
No. of boys >3 and <18
No. of infant boys ≤3
No. of elderly men >60
Total no. of people in household [should equal sum of 2.01-2.08]
Water
Main source of drinking water? [Select one]
1 - Mobile vendors (tanker-trucks, carts, bottled water, water sachets), or unprotected well or spring
2 - Waterpoint/kiosk/standpipe supplied by network or borehole
3 - Shared network connection (into shared plot/compound)
4 - Household network connection (into house or own plot)
5 - Other
DK
INTERVIEWER ASSESSMENT: Is main source of drinking water a WSUP-supported facility? [Y] or [N] or [DK] or [NA]
Typical length of time per day that water is available? (hours)
Typical length of time for a single trip to collect water? (minutes including queuing)
Typical amount of water used per day? (litres per household per day)
Do you consider amount of water supplied to be sufficient to meet your household’s requirements each day? [Y] or [N]
Typical amount of money spent on water per week? (local currency per household per week)
If you made an initial investment in the water facility, how much was it? (e.g. connection fees, piping; but not including within-house plumbing or fittings such as
sinks or shower units) (local currency per household) [if nothing, write “0”]
How happy are you with your main water source in terms of…
very happy
happy
unhappy
very unhappy
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Version 11 – 16/05/14
3.10
4.00
4.01
4.02
4.03
4.04a
4.04b
4.05a
4.05b
4.06a
4.06b
4.07
4.08
3.09a - price?
3.09b - water quality (taste, colour, etc.)?
3.09c - water pressure?
3.09d - distance from home and queuing time?
3.09e - availability (continuity of supply, opening hours, etc.)?
INTERVIEWER ASSESSMENT: Does the respondent know the right person to talk to if there is a problem with the water supply? [Y] or [N] or [DK] or [NA]
Sanitation
Usage arrangement for household’s sanitation facility? [Select one]
1 - Household toilet (single household)
2 - Communal/shared toilet (used by defined group of households, NOT pay-per-use)
3 - Public toilet (can be used by anyone, free or pay-per-use)
4 - Other including open defecation
DK
NA
How many people share use of the communal/shared toilet?
Technology type of household’s main toilet facility? [Select one]
1 - Open defecation or plastic bag
2 - Unimproved pit latrine (no slab, or non-cleanable slab)
3 - Pit latrine with cleanable slab
4 - Flush to open cesspit or open drain
5 - Flush to septic tank or pit
6 - Flush to sewer
7 - Portable toilet with emptying service
8 – Other
DK
NA
INTERVIEWER ASSESSMENT: How many women and girls (over 3 years old) are there in this household?
If 4.04a > 0: INTERVIEWER ASSESSMENT: How many of these women and girls actually use the sanitation facility?
INTERVIEWER ASSESSMENT: How many infants (aged 3 or under) are there in this household?
If 4.05a > 0: INTERVIEWER ASSESSMENT: How many of these infants use the sanitation facility, or have their faeces disposed of to toilet?
INTERVIEWER ASSESSMENT: How many people with disabilities are there in this household? [people who have any sort of condition that makes it difficult for
them to move around, including pregnant women, people who can’t hear or see well, people confined to bed, older people with mobility problems, and people
with HIV/Aids]
If 4.06a > 0: INTERVIEWER ASSESSMENT: How many of these people with disabilities actually use the sanitation facility?
INTERVIEWER ASSESSMENT: Based on questions 4.04-4.06: which, if any, of the following categories exist in this household but do not regularly use the sanitation facility?
1 - Women and girls
2 – Infants
3 - People with disabilities (not including people with HIV/AIDS)
4 - People with HIV/Aids
5- none of them (all have access)
Approximate distance from home to sanitation facility? (metres)
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Version 11 – 16/05/14
4.09
4.10
4.11
4.12
4.13
4.14
5.00
5.01
5.02
5.03
5.04
6.00
6.01
6.02
6.03
6.04
6.05
6.06
Typical time for a single trip to the sanitation facility? (minutes including queuing)
Typical amount of money spent on the main sanitation facility per month? (local currency per household per month)
If you made an initial investment in the sanitation facility, how much was it? (local currency per household)
How happy are you with the sanitation facility in terms of…
very happy
happy
4.12a Price?
4.12b – cleanliness (for all except for single HH toilet)? For single for single HH toilet, observe or ASK: are you happy with
quality in terms of keeping it clean (i.e. is it easy enough to keep it clean)?
4.12c - distance from home?
4.12d - access for everyone in household, 24h a day?
4.12e - status of handwashing facilities?
4.12f - container for disposal of menstrual hygiene material?
4.12g – comfortable to use during menstruation?
INTERVIEWER ASSESSMENT: Does the respondent know the right person to talk to if there is a problem with the sanitation facility? [Y], [N], [NA]
INTERVIEWER ASSESSMENT: Is main sanitation facility a WSUP-supported facility? [Y] or [N]
Hygiene behaviour (handwashing and water storage)
When should you wash your hands?
Does the respondent indicate before meal, after meals, and after defecation? [Y] or [N] or [NA]
What is the main reason you should wash your hands?
Does the respondent indficate an understanding of the link between poor handwashing and disease? [Y] or [N] or [NA]
Can you show me where you wash your hands?
Can the respondent show you a handwashing location with clean water and soap readily available? [Y] or [N] or [NA]
Can you show me where you store your drinking water?
Is water stored in a clean container with lid, with no obvious contamination or contamination risk? ([Y] or[ N]; if water not stored in house: [NA])
Pit emptying
INTERVIEWER ASSESSMENT: Does the respondent use a non-sewered sanitation facility (household, shared/communal or public) that requires sludge removal?
[Y] or [N] or [NA] or [DK]
[If 6.01 = [N], END OF INTERVIEW]
INTERVIEWER ASSESSMENT: Does the respondent have more or less direct control of pit-emptying? [Y] or [N] or [DK] or [NA]
If 6.02 = [N], END OF INTERVIEW
Does the pit/tank currently need emptying? [Y] or [N] or [DK] or [NA]
Does the pit/tank overflow during the rainy season? [Y] or [N] or [DK] or [NA]
Has the pit or tank ever been emptied while you have been living here? [Y] or [N] or [NA] or [DK]
[If 6.05 = [N] or [DK] or [NA], go to 6.12]
Who emptied the pit/tank the last time it was emptied? [Select one]
1 - Members of household or informal manual emptier
2 - Formal small business using manual or automated tool (e.g. pump)
3 - Formal larger business (vacuum tanker etc.)
4 - Other
DK
NA
unhappy
very unhappy
3
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6.07
6.08
6.09
6.10
6.11
6.12
6.13
6.14
6.15
6.16
6.17
Who paid for emptying of the pit/tank the last time it was emptied? [Select one]
1 - Only my household
2 - All households that share this toilet
3 - Landlord
4 - Free service (provided by e.g. municipality or an NGO)
5 - Other
DK
NA
How much did the last emptying cost? (total cost, local currency) [Y] or [N] or [DK] or [NA]
INTERVIEWER ASSESSMENT: Ask “How much sludge was removed?” Estimate the number of cubic metres or containers. [Y] or [N] or [DK] or [NA]
How satisfied were you with the service overall? [Select one]
1 - very happy
2 – happy
3 - unhappy
4 - very unhappy
NA
INTERVIEWER ASSESSMENT: Where was sludge disposed of the last time?
1 - Disposed of inappropriately (e.g. buried locally, or dumped to local wasteland, or open drain, or unauthorised water body)
2 - Disposed of appropriately (e.g. to transfer station, sewer, or authorised disposal location or treatment facility)
DK
NA
Do you or the landlord plan to empty the pit in the future? [Y] or [N] or [DK] or [NA]
[If 6.12 = [N], END OF INTERVIEW]
When do you expect the pit will be emptied (how many months from now)? [Y] or [N] or [NA]
Who will pay for emptying of the pit/tank next time? [Select one]
1 - Only my household
2 - All households that share this toilet
3 – Landlord
4 – Other
DK
NA
How much do you expect the next emptying will cost? (total cost, local currency) [If the respondent doesn’t know, write [DK]; if no answer/ not applicable write
[NA}]
Have you or other users started to save money to pay for the next pit emptying? [Y] or [N] or [DK] or [NA]
Who will empty your pit? [select one]
1 - Members of household or informal manual emptier
2 - Formal small business using manual or automated tool (e.g. pump)
3 - Formal larger business (vacuum tanker etc.)
4 - Other
DK
4
Version 11 – 16/05/14
6.18
7.00
7.01
7.02
7.03
7.04
7.05
7.06
7.07
7.08
7.09
7.10
NA
INTERVIEWER ASSESSMENT: Is there strong indication of intention to use a WSUP-supported pit-emptying service over approximately the next year? [Y] or [N], or
[DK] or [NA]
Landry Facility
Usage arrangement for household’s laundry facility [Select one]
12345 - Other
DK
INTERVIEWER ASSESSMENT: Is main source of drinking water a WSUP-supported facility? [Y] or [N] or [DK] or [NA]
Typical length of time per day that water is available? (hours)
Typical length of time for a single trip to collect water? (minutes including queuing)
Typical amount of water used per day? (litres per household per day)
Do you consider amount of water supplied to be sufficient to meet your household’s requirements each day? [Y] or [N]
Typical amount of money spent on water per week? (local currency per household per week)
If you made an initial investment in the water facility, how much was it? (e.g. connection fees, piping; but not including within-house plumbing or fittings such as
sinks or shower units) (local currency per household) [if nothing, write “0”]
How happy are you with your main water source in terms of…
very happy
happy
3.09a - price?
3.09b - water quality (taste, colour, etc.)?
3.09c - water pressure?
3.09d - distance from home and queuing time?
3.09e - availability (continuity of supply, opening hours, etc.)?
INTERVIEWER ASSESSMENT: Does the respondent know the right person to talk to if there is a problem with the water supply? [Y] or [N] or [DK] or [NA]
unhappy
very unhappy
5