E-VERIFICATION BASELINE MARKET SURVEY: April 2014
MARKET LOCATION QUESTIONNAIRE
DASHBOARD
Name
ML01
Market Hub
ML02
Market Location
ML03
Market Location District
109
SECTION C: RETIAL SHOP INTERVIEW
ENUMERATOR: Interview all shops starting with the largest shop (by ag-input sales) and work down. Ask to interview the store owner or manager. Seek the respondent’s consent by reading the informed consent
paragraph.
C01. Name of Retail shop ____________________________________________
C02. Has this shop sold any of these agricultural inputs: maize seed, herbicide, pesticide, fertilizer in the past 12 months? ________ YES…1 NO…2. If ‘NO’, end survey.
1- Respondent Details
ENUMERATOR: Ask these questions of the individual you encounter in the shop. If this person is not the primary decision maker (owner/manager) please write down this person’s information, as well as the name
and contact information of the primary decision maker. Then, contact the primary decision maker and attempt to set a time to interview that person to fill out the remainder of the questionnaire.
Question
Code
Response
C03. What is your name?
C04. What is your position in this shop?
SHOP POSITION CODE
if C04 is not 1 or 2 then skip to
C07. If C04 is 2, skip to C08.
C05. What is the owner/manager’s
name?
C06. What is the phone number of the
owner/manager?
C07. What is your phone number?
BUILDING SHOP POSITION
MATERIAL CODE
CODE
Wood...........................1
Owner...................1
Mud.............................2
Manager.................2
Aluminum....................3
Spouse of owner....3
Bricks..........................4
Worker...................4
Cement.......................5
Other......................5
Other (please specify) 6
2- Shop Details
ENUMERATOR: Ask these questions of the most knowledgeable person on these topics. Usually that is the manager or the owner.
Question
Code
C08. Position of respondent
SHOP POSITION
CODE
C09. In what year did you become the
manager?
C10. How many employees work in this
shop including yourself?
C11. Is this shop officially registered to
sell agricultural inputs?
(year)
Other..........................7
Response
Yes…1
No…..2
110
3Question
Code
C13. Does this shop have electricity?
Yes…1
No…..2 >> C15
C14. How many power outages did
this shop experience in a typical month
over the last 12 months?
C15. What is the primary building
material of this shop?
C16. What is the total selling area of
this shop (in square meters)?
4-
Structure of shop
Response
BUILDING MATERIAL CODE
Products and Sales
C17. In what year did this shop first
start selling agricultural inputs?
C18. Have you ever carried products
with a scratch-off label so that the
customer can check product quality?
C19. In what year did you carry
products with a scratch-off label?
C20. Do you currently carry any
products with a scratch-off label?
C21. Are your sales of agricultural
inputs
Yes…1
No…..2 >> C21.
Permanent-year
round……………………..……..1
Temporary (some months, not
consistent)…..…2
Seasonal (some months, consistent
annually)...3
C22. What share of this shop’s total
sales are made up of sales of
agricultural inputs?
111
5- Decision-Maker Details.
ENUMERATOR: Ask these questions of the individual who is the primary decision maker (possibly owner/manager) of this shop, in terms of deciding what products to stock and how to manage the store.
Question
Code
C23. What is your name?
C24. What is your position in this
shop?
C25. In what year did you become the
manager?
C26. What is your phone number?
POSITION CODE
C27. Enumerator: Were you able to
interview the decision maker for the
shop?
C28. Can you read or write in any
language?
Yes…1
No…..2
C27. What is your level of education?
EDUCATION CODE
Yes…1
No…..2
Response
MARITAL STATUS EDUCATION CODE
CODE
Never attended school..........1
Married........................1
Less than primary school......2
Divorced/Separated....2
Primary school......................3
Widowed.....................3
O levels.................................4
Never married.............4
A levels.................................5
Any univerisy .......................6
Universtiy degree..................7
C28. What is your age (in years)?
C29. What is your gender
Female ….1
Male ……..2
C30. What is your marital status?
MARITAL STATUS CODE
C31. How many members are there in
your household?
Yes…1
No…..2
Enumerator: For this survey, a
household is defined as a group of
people who live and eat together, share
resources and form a common
decision-making unit.
112
6-
Banking and Credit
Enumerator: Ask these questions of the most knowledgeable person on these topics. Usually that is the manager or the owner.
INVENTORY CODE
Question
Code
Computer based inventory software.......1
C32. Position of the respondent
POSITION CODE
Paper lists and counts...................................2
C33. Does this shop currently have any
outstanding loans?
C34. Does this shop purchase products
on credit?
C35. Does this shop have a bank
account?
C36. Is the bank account the same as
that of the owner’s?
C37. How do you keep track of your
inventory?
C44. Does the shop own this building?
Yes…1
No…..2
Yes…1
No…..2
Yes…1
No…..2 >> C37.
Yes…1
No…..2
INVENTORY CODE
By sight (no record).......................................3
C45. Does the shop own this land?
Response
Do not keep track..........................................4
Other ............................................................97
Yes…1
No…..2
Yes…1
No…..2
113
MONTH CODE
7-
Jan………….…..1
Feb……………..2
March……….….3
April…………….4
May……………..5
June…………….6
Products
C46. Position of Respondent…………….. POSITION CODE _____
Products
Did this shop stock this
product anytime in
second season 2013?
Yes...1
No…2
Did this shop
stock this
product anytime
in first season
2014?
Yes...1
How many
different
brands/varieties
have you carried
anytime in first
season 2014?
What
proportion of
your sales of
fertilizer is this
product?
C49.
C50.
2nd season 2013
What month
did sales start
for [Product]?
No…2
C47.
1
Maize seed
2
Glyphosate
herbicide
3
Insecticide
4
NPK fertilizer
5
Urea fertilizer
C48.
C51a.
What was the
peak month of
sales for
[Product]?
C51b.
July…………….7
Aug…………….8
Sept……………9
Oct……………10
Nov…………...11
Dec…………...12
SHOP POSITION
CODE
Owner....................1
Manager.................2
Spouse of owner....3
Product details
Worker...................4
1st season 2014
2nd season 2014
Other......................5
What month
did sales start
for [Product]?
C51c.
What was the What month will
peak month of sales start for
sales for
[Product]?
[Product]?
C51d.
C51e.
UNIT CODE
Kg...................1
Gram..............2
Litre................3
Pound.............4
What will be the
peak month of
sales for
[Product]?
C51f.
114
8- Product Varieties - MAIZE
List all the
varieties of
[Product] you
have in stock or
have sold in the
past year for this
product.
C52a – m
1
Other
(enable if
C48a = 997)
C52b - m
Do you know if
this variety is an
Open Pollenated
Variety
(OPV)/local
variety, or if it is a
hybrid / improved
variety?
Do you sell this
variety by weight
from opened bulk
containers in this
shop?
OPV……….1
Hybrid…….2
Don’t know 3
Yes…1
No…..2
C53 – m
C54 – m
What was the market
share of [product] for
this variety?
Container size(s)
What container size(s)
What is the
did you have in stock for price for
this variety in the past
each size?
year? (list all sizes for
each variety that are
Please use
sold in a sealed
the current
package or container)
or most
recent price
UNIT
Quantity
(UGX)
CODE
(Percent)
C55 – m
C56a – m
C56b – m
C56c – m
Source(s)
How many
units did you
sell of this
size for this
variety in 1st
season 2014?
C56d – m
Name of source(s)
where you
purchased this
product for this
season (list all
sources for this
variety):
C57a – m
What kind of source
is this?
What is the
location of this
source?
Retail shop……1
Distributor……..2
Another farmer..3
Wholesaler..…..4
Other…………..5
(name of
town/city)
C57b – m
C57c – m
1
2
3
2
1
2
3
3
1
2
3
4
1
2
3
5
1
2
3
115
8- Product Brands - HERBICIDE
List all the
varieties/brands
of [Product] you
have in stock or
have sold in the
past year for this
product.
Other
(enable if
C48a = 997)
Do you sell this
product by weight
from opened bulk
containers in this
shop?
Yes…1
No…..2
C52a – h
1
C52b – h
C54 – h
What was the market
share of [product] for
this brand?
Container size(s)
What container size(s)
What is the
did you have in stock for price for
this variety in the past
each size?
year? (list all sizes for
each brand that are sold Please use
in a sealed package or
the current
container)
or most
recent price
UNIT
Quantity
(UGX)
CODE
(Percent)
C55 – h
C56a – h
C56b – h
C56c – h
Source(s)
How many
units did you
sell of this
size for this
/brand in 1st
season 2014?
C56d – h
Name of source(s)
where you
purchased this
product for this
season (list all
sources for this
brand):
C57a – h
What kind of source
is this?
What is the
location of this
source?
Retail shop……1
Distributor……..2
Another farmer..3
Wholesaler..…..4
Other…………..5
(name of
town/city)
C57b – h
C57c – h
1
2
3
2
1
2
3
3
1
2
3
4
1
2
3
5
1
2
116
3
8- Product Brands – FERTILIZER
List all the
brands of
[Product] you
have in stock or
have sold in the
past year for this
product.
Other
(enable if
C48a = 997)
Do you sell this
product by weight
from opened bulk
containers in this
shop?
Yes…1
No…..2
C52a
1
C52b
C54
What was the market
share of [product] for
this brand?
Container size(s)
What container size(s)
What is the
did you have in stock for price for
this variety in the past
each size?
year? (list all sizes for
each /brand that are
Please use
sold in a sealed
the current
package or container)
or most
recent price
UNIT
Quantity
(UGX)
CODE
(Percent)
C55
C56a
C56b
C56c
Source(s)
How many
units did you
sell of this
size for this
brand in 1st
season 2014?
C56d
Name of source(s)
where you
purchased this
product for this
season (list all
sources for this
brand):
C57a
What kind of source
is this?
What is the
location of this
source?
Retail shop……1
Distributor……..2
Another farmer..3
Wholesaler..…..4
Other…………..5
(name of
town/city)
C57b
C57c
1
2
3
2
1
2
3
3
1
2
3
4
1
2
3
5
1
117
2
3
9- Farmer/Market Perceptions
Question
C58. Position of Respondent
C59. What do you think are the three greatest problems faced by farmers in
adopting agricultural inputs such as hybrid maize seeds, herbicides, and
fertilizers?
C60. Do you provide advice to farmers about which products to purchase?
C61. Do you provide advice to farmers about what brands of products to
purchase?
C62. How do you decide which products to recommend? (Do not read
responses. Check all that apply).
Code
POSITION CODE
PROBLEM CODE
Response
a.
b.
c.
First ______________
Second ____________
Third_______________
Yes…1
No…..2
Yes…1
No…..2
A. Products that are effective
B. Products that are affordable to that customer
C. Products that are new
D. Products that are overstocked
E. Other (please specify)
_______________________
C63a. Which hybrid maize seed variety do you recommend most often?
C63b. Other
C64a. Which brand of glyphosate herbicide do you recommend most often?
C64b. Other
C65a. Which brand of fertilizer do you recommend most often?
C65b. Other
C66. How do you decide which products to stock? (Do not read responses.
Check all that apply)
MAIZE VARIETIE CODE
C67. How do you decide who to purchase your products from? (Do not read
responses. Check all that apply)
A.
B.
C.
D.
GLYPHOSATE BRAND CODE
FERTILIZER BRAND CODE
A. Products that customers ask for
B. Products we stocked last year
C. Products that sold well last year
D. Try to stock new products
E. Price
F. Profitability
G. Other (please specify)
____________________________
Best price
Convenience of acquiring products
Established relationship/trust
Other (please specify)
118
____________________________
C68. How knowledgeable do you think farmers are about agricultural inputs
and practices?
Not at all knowledgeable……..1
Not too knowledgeable…........2
Somewhat knowledgeable…3
Knowledgeable………………4
Very knowledgeable………...5
C69. Do you give farmers advice on how to properly use agricultural inputs?
Yes…1
No…..2
119
Appendix
MAIZE VARIETIE CODES
GLYPHOSATE BRAND CODES
FERTILIZER BRAND CODES
DH04
1
Longe 6H
19
Agro-sate 360 SL
1
Sweep W.S
19
Agroleaf/Agrloblen
1
DH06
2
Longe 7H
20
Coopersate 36%SL
2
Touchdown
20
Algifol TM
2
DK8031
3
Longe 8H
21
Glycel 41% SL
3
Touchdown 48%SL
21
Bio Zinc
3
FH500S
4
Longe 9H
22
Glyphosate
4
Twiga Glyphosate
22
Bio-Forge
4
FH6150
5
MM3
23
Glyphotox
5
Weed End
23
Bio-Potash
5
H10H
6
PAN 67
24
Glyweed
6
Weed Up
24
Biophos
6
H614
7
PAN67
25
Green Fire
7
Weed-Up 48% SL
25
Megacal
7
H614
8
Ssalongo
26
Helosate (Twigasate)
8
WeedFire
26
New Suryamin
8
H628
9
UH 5053
27
Kalach Extra 70 SG
9
Weedall
27
Sett Enhanced
9
H629
10
UH 6063
28
Kalachi 360 SL
10
Weedmaster 50%SL
28
Sugar Mover
10
H6H
11
UH5051
29
LB-Glyphosate
11
Willosate 36%
29
Vegimax
11
H7H
12
UH5052
30
Liphosate
12
Other
997
Other
997
KH500-43A
13
UH6303
31
Mamba
13
KH600-15A
14
YARA 41
32
Pin-Up 48% SL
14
Longe 10H
15
YARA 42
33
Round UP 36% SL
15
Longe 11H
16
YARA41
34
Round Up Turbo
16
Longe 4
17
YARA42
35
Roundfam
17
Longe 5
18
Other
997
Super Weeder
18
120
AGRICULTURAL INPUTS STUDY COMMUNITY LISTING EXERCISE: May 2014
DASHBOARD:
Household Identification
ComID. Computer Number
Name
A01. Market hub
A02. Market location code
A03a. District
A03b. Subcounty
A04. LC1
EnumID. Enumerator
A05. Household Number
Prefilled
Prefilled
Prefilled
Prefilled
Prefilled
Prefilled
Prefilled
Code
SECTION A: COVER
Question
A06a. Enter the correct name of the LC1 if it is incorrect in the
list above
A06b. Enter the correct name of the subcounty if it is incorrect
or missing in the list above
A07a. GPS – Latitude (N/S)
A07a_1. GPS – Latitude degrees
A07a_2. GPS – Latitude minutes (mm.mmm’)
A07b_1. GPS – Longitude (E) degrees
Name
Code
1=N, 2=S
B11 Code
77- Never attended
A07b_2. GPS – Longitude (E) minutes (mm.mmm’)
A07c. Accuracy (meters)
88- less than P1
A07d. Elevation (meters)
A07e. Were you able to interview this household??
A07f. Why not?
A08. What is the name of household head (Surname, First
name)?
A09. What is the common household name in the village?
A10. Name of the Primary Respondent (Surname, First name)
(Try to interview the household member who is the primary decision
maker on agricultural activities for the household)
1..Yes>>A08 2..No
Codes
>>End of Survey if A07e=2
A07f Codes
1- P1
2- P2
1. Household refused interview
3- P3
4- P4
2. Household not available 5- P5
6- P6
3. Other
7- P7
8- Technical school
9- S1/Junior 1
10- S2/Junior 2
11- S3
12- S4
13- S5
14- S6
15- Tertiary after O-level
16- Tertiary after A-level
17- Some university or college
18- University degree or higher
121
Informed Consent
We are conducting a short survey to learn about the activities of households in this community regarding farming and other activities. I would like to ask you
some questions about your household. Your participation in this short interview is completely voluntary. Do you agree to take part in this survey?
Yes…1
No…..2
A15. Consent given
A16a. Date/time stamp
SECTION B: HOUSEHOLD INFORMATION
First, I would like to ask you some information about your household. For this survey, a household is defined as a group of people who live and eat together, share resources and form a common
decision-making unit. A household member is anyone who met these criteria more than half of the time during the past 3 months. The household head is the individual who plays a leading role in
household decision-making, particularly household economic activity and expenditures.
B01. How many people currently live in this household?
B03. Of the current household members, how many are less than 3 years old?
B04. What is the respondent’s relationship to the household head?
B05. Who is the person in this household who mainly makes decisions about agriculture, including purchasing inputs?
(name)
B06. Relationship of [B05 Name] to the household head?
Household head
Decision maker (B05)
[disable if B06 =1]
B07. Sex
B08.
1=M
2=F
Age
B09.
Marital
status
B10. Can
[Name] read
and write in
any
language?
1=Yes
2=No>>B10B
B10A.
What is
[Name]’s
primary
written
language
? >>B11
(Codes)
B10B.
What is
[Name]’s
primary
spoken
language
?
(Codes)
B11.
Education
level
(Highest
grade
completed)
B12. During the last
12 months, what
was [NAME]’s main
economic activity
12345678910111213141516-
(Codes)
B04 & B06Code
household head
spouse
son/daughter
son/daughter-in-law
grandson/granddaughter
parent
brother/sister
nephew/niece
nephew/niece of wife
cousin of head
brother/sister-in-law
parent-in-law
cousin of wife
other relative
shambaboy/maid
other, no relation
B09 Code
12345-
12345678-
B12 Code
Own agriculture (incl. crop
production and animal
husbandry)
Agricultural employment
(someone else’s land)
Non-agricultural employment
Non-agricultural selfemployment
School
Housework
None
Other
single
married (monogamous)
married (polygamous)
divorced or separated
widowed
122
SECTION C1: FARMING AND INPUT USE
Enumerator: These questions should be asked of the person who makes the decisions regarding agriculture and agricultural input purchases (person named in B05) if possible.
C01
Question
Response option
During the past two cropping seasons (Season 1 2014 and Season 2 2013), did any member of
your household cultivate any crops for household consumption or sale?
Why did your household not cultivate any crops in the past two cropping seasons? >>NEXT
SECTION
Yes….1 >> C03
No…...2
No access to land................1
Other economic activities.....2
Bad weather.........................3
Illness in family.....................4
Other economic shock.........5
Season 1, 2014….............. 1
Season 2, 2013…………… 2
C02
C03
C04
C05
C06
When was the last season that your household cultivated any crops?
What is the total land area that your household cultivated during [the last season that your
household cultivated any crops (C03)]?
During the past two cropping seasons, did your household cultivate any maize?
Response
C06 Code
(acres)
Yes
No
1
2
What are the three most important crops that your household cultivated in [the last season that
your household cultivated any crops (C03)], in terms of total area cultivated?
(List crops in order of most area cultivated, second most area cultivated, third most area
cultivated. If less than 3 crops are cultivated, select “None”)
a)
b)
c)
________________
________________
________________
SECTION C2: PRODUCTS
PRODUCT
Did your
household
purchase any
[PRODUCT] in
the past two
cropping
seasons (Season
1 2014 or
Season 2 2013)?
Yes...1 >> C10a
No…2
Don’t know...9
C08
1
Maize seed
2
Glyphosate
herbicide
3
Inorganic fertilizer
If no, why not?
Was the maize
seed that you
Too expensive.............................1 purchased
Not available in nearby markets..2 conventional/local,
Don’t trust the quality..................3 hybrid or some of
Don’t need to use this product....4 each type?
Don’t know how to use................5
No money...................................6 (check all that
Believe that product will harm soil apply)
fertility..........................................7
Other...........................................8
Conventional....1
Hybrid...............2
Don’t know........9
C09
C10
What type of
inroganic
fertilizer did your
household
purchase?
(check all that
apply)
NPK....1
Urea....2
DAP....3
Other...4
C11
Where was this product
most frequently
purchased for use in the
past two cropping
seasons (Season 1 2014
and Season 2 2013)?
Retail shop……..1
Distributor……....2
Another farmer....3
Informal ag inputs
dealer……………4
Wholesaler..…….5
Other…………….6
C12
1- Millet
2- Maize
3- Sorghum
4- Cassava
5- Sweet potatoes
6- Irish Potatoes
7- Beans
8- Rice
9- Onions
10- Tomatoes
11- Cowpeas
12- Field peas
13- Pigeon peas
14- Cotton
15- Eggplant
16- Cabbage
17- Carrots
18- Simsim
19- Chilies
20- Cashewnuts
21- Groundnut
What is the location of this source? Were you usually
satisfied with the
This village……………………………1
quality of the
Another village in this district………..2 [PRODUCT] you
The market location trading center…3 purchased from
The nearest trading center…………..4
this source?
The district trading center……………5
Another district center……………..…6
Kampala……………………………….7
Other………………………….………..8
Yes...1 >> NEXT
PRODUCT
No…2
22- Sugarcane
23- Tobacco
24- Pumpkin
25- Malakwang
26- Ginger
27- Cooking bananas
28- Dessert bananas
29- Brewing bananas
30- Coffee
31- Vanilla
32- Yams
33- Cowpea leaves
34- Greengram
35- Sunflower
36- Soyabenas
91- Other 1
92- Other 2
93- Other 3
94 –None 1
95- None 2
If no, why not?
Did not germinate……1 (Maize only)
Yield lower than
expected………………2
Quality not what was
expected……….……...3
Too expensive………..4
Vulnerable to pests......5 (Maize only)
Vulnerable to drought…6 (Maize only)
Other……………………7
C13
C14
C15
123
SECTION D: PHONE USE
Enumerator: These questions should be asked of the person who mainly makes decisions about agriculture, including agricultural input purchases (person named in B05) if possible.
D01
Question
Does [Name in B05] have his/her own mobile phone?
D02a
Does [Name in B05] have access to any other working mobile phone?
D02b
Does [Name in B05] have access to a working mobile phone?
D03
How many working mobile phone does [Name in B05] own or have access to?
Response options
Yes…1
No…2 >>D02b
Yes…1 >>D03
No…2
Yes…1
No…2 >>D04
Number
D04
Does anyone else in this household have access to any other working mobile
phones?
Yes…1
No…2
Response
Now I would like to ask you some questions about phones that [Name in B05] owns or has access to.
(disable if D01 = 2 and D02b==2)).
ID
PHONE
NUMBER
D05. Please list the
phone numbers that
he/she uses most
frequently, in order of
frequency of use (up to
3)
Enumerator: Enter
999999999 if the
respondent cannot
recall the phone
number or does not
know it.
(0)
1
2
D05a. If the respondent
refused to provide the
phone number, list the
reason.
Privacy………………..1
Does not want
unsolicited calls/SMS..2
Phone owner not in this
household………........3
Phone not working…..4
Cannot find phone
number……………….5
D06. Phone number verification
Enumerator (test call or own number
test): Please validate the phone
number by flashing the phone or
verifying the number on the phone
directly using the codes at the bottom
of the table. Document the verification
used
Flash: heard the phone ring or saw
the missed call………1
Verified number on the phone by
entering * or # code…..2
Phone not currently working…3
Saw the phone, but unable to
verify…4
Phone was not present….5
Network not available….6
Other….7
D07. Who owns this
phone?
[Name in B05]………1
Another member in
this household….…..2
A neighbor……….....3
A family member in
the village………...…4
A friend in the
village……………….5
Another person
outside the village…6
D08. How often does
he/she use this
number?
Every day…………1
At least 4
times/week……….2
At least 1 time/week
but less than 4
times/week……….3
At least 1
time/month……….4
Less than 1 time per
month……………..5
Never-----------------6
D09a.
Does
he/she ever
use this
number to
send SMS
messages?
Yes…1
No…2
Don’t
know…9
D09b.
Does
he/she ever
use this
number to
receive
SMS
messages?
Yes…1
No…2
Don’t
know…9
D11. Would
he/she be
willing to
receive
promotional
messages on
this phone line
for new
agricultural
products
available in
nearby shops?
Yes…1
No…2
Primary phone
number
Secondary
phone number
Phone number verification code:
Use *135* 8# for MTN
Use *120# for Airtel/Warid
Use #999# for UTL
Use *100*9# for Orange
124
SECTION E: END
Question
A13. Team leader
A14. Language of interview
A16b. Date/time stamp
Response
A14 Code
1- Luganda
2- Lusoga
3- Lugisu
4- Swahili
5- Runyakitara
6- Lugwere
7- Ateso
8- Rukonjo
9- English
10- Other
125
E-Verification Community Listing Exercise: May-June 2014
Worksheet for village pair validation
TL name: ________________________________
MH name: ________________________________
ML name: _______________________________
PAIR: Village1 name: ____________________
Village2 name: ___________________________
Are these two villages at least 3 km apart from one another?
Is there any other reason that one of these two villages could not be included in the
study such as a disaster like disease outbreak or natural disaster?
Yes
No >> go to next pair
Yes >> go to next pair
No
Ask a village leader the following questions in each village. Use the response codes below to provide a
categorical response. Subtract the response code of village 2 from the response code of village 2.
Validation questions
Response codes
1
Number of households
2
Percent of households growing
maize
3
Distance to ML
Less than 50….…1
50 – 100 ………..2
100 – 200 ………3
200 – 400 ………4
More than 400….5
0 – 30 percent ….1
31 – 60 percent…2
61 – 80 percent…3
81 – 90 percent…4
91 – 100 percent..5
Less than 1 km…..1
1 – 3 km…………2
3 – 5 km…………3
More than 5 km…4
Village 1
Village 2
Difference between villages
Absolute
value of the
results
(Village 1) – (Village 2) =
(Village 1) – (Village 2) =
(Village 1) – (Village 2) =
Determine if any of the following conditions apply to the pair based on the results column in the table above:
Is the result of line 1 equal to or greater than 4?
Yes >> go to next pair
No >>
Is the result of line 2 equal to or greater than 4?
Yes >> go to next pair
No >>
Is the result of line 3 equal to or greater than 3?
Yes >> go to next pair
No >>
The result of any two lines (any two out of 1, 2, or 3)
are each greater than or equal to 2?
Yes >> go to next pair
No >>
Did you successfully confirm that PAIR 1 is a good
match?
Yes >> start CLE
No >> start a new worksheet with the next pair
126
IFPRI UGANDA AGRICULTURAL INPUTS STUDY
BASELINE SURVEY HOUSEHOLD QUESTIONNAIRE
JULY – AUGUST 2014
SECTION A1: DASHBOARD
Sample Identification
Name
A01. Market hub
A02. Market location code
A03. District
A04. Subcounty
A05. LC1
enumID. Name/code of enumerator
A06. Household Number
Prefilled
Prefilled
Prefilled
Prefilled
Prefilled
TRACKING SAMPLING (A13)
If a sampled household cannot be
interviewed, enter HHID above, list reason
1234567-
Prefilled
SECTION A2: HOUSEHOLD IDENTIFICATION AND LOCATION
Question
Response
A07. Enter the correct name of the LC1 if it is incorrect in A05
A08. Enter the correct name of the subcounty if it is incorrect or missing in A04.
A12. Was the sampled household able to be interviewed?
A13. Why was it not possible to interview the household
A14. Language of conducting the interview
A15. What is the religion of the household head?
A16. Name/code of team leader
A17. Date of first interview. This must be filled in for the program to work properly!
A18. Date of second interview
A19. Reason for second interview
Household moved outside sample area
Refused interview
Household dissolved and not available
Found but not available for interview
Household known, but in another LC1
Household does not exist, wrong in CLE
Other
Question
A11a. GPS – Latitude (N/S)
A11a_1. GPS – Latitude degrees
A11a_2. GPS – Latitude minutes
A11b_1. GPS – Longitude (E) degrees
A11b_2. GPS – Longitude (E) minutes
A11c. Accuracy (meters)
A11d. Elevation (meters)
A09. What is the name of household head (Surname, First name)?
Enumerator: Enter the correct name of the household head if it is incorrect in the label.
A10. What is the common household name in the village?
Enumerator: Enter the correct common household name if it is incorrect in the label.
SECTION A3: INTERVIEW DETAILS
Question
111213141567-
Response Code
Yes…1>>A14 No…2
(Language Code)
1-Catholic, 2-Anglican, 3-Muslim, 4-Other Christian, 5-Other
(get time)
1 – Problem with Surveybe program, 2 – Respondent not available, 3 –
Interview not completed on first visit, 4 – Call back interview to resolve
missing or inconsistent data.
127
Language Code (A14)
Luganda
8Rukonjo
Lusoga
9English
Lugisu
10- Alur
Swahili
11- Runyarwanda
Runyakitara
12- Other
Lugwere
Ateso
Response
Code
N=1, S=2
Response
Response
INFORMED CONSENT FORM: ENGLISH
Before beginning the survey with each household, the enumerator must introduce the survey to the household head and/or spouse and obtain their consent to participate. Please make
it clear to them that their participation in the survey is voluntary. The introduction to the survey should be read directly from the questionnaire. The following is a guide for the
introduction and consent form. This is not a literal translation of the local language versions presented in the questionnaire.
Informed Consent Form
We are a research team evaluating a project that is just beginning in Central, Western, and Eastern Uganda. We are conducting a survey to learn about the economic condition and
well-being of families in Uganda, and especially about agriculture. We conducted a census survey in May and June 2014 where we interviewed your household. As part of the same
study, we are visiting some of the same households again. We would like to invite your household to participate in this new survey round. If you agree to participate, members of our
team will interview your household on three separate occasions. During these interviews we will ask about your farming practices, sources of income, food consumption, the health and
diet of your children, and other topics related to your household’s general living situation. The total amount of time we request for your household’s participation for this interview is
about 1.5-2 hours.
The first interview would take place today. There is no risk associated with your household’s participation in this study. This study will benefit the people of Uganda by helping to
identify good practices in agriculture.
Your participation in this project is completely voluntary. You may decide not to participate at any time – now or even during the study. If there are any questions that you don’t feel
comfortable answering, then you don’t have to answer. You will not be penalized in any way if you decide not to participate, or to stop participating. You and your household
members are allowed to ask questions at any time about the study. You can do so before you agree to participate, or at any time during your participation. The information you
provide will not be given to anyone in your community or to anyone else not involved with research related to this study. Your names will be kept separate from the data collected so
that only general information about everyone in the project can be studied and reported. If you agree to participate in this study, we can provide you with a copy of this letter if you
would like. We can also provide you with names and contact information of the people involved in running the study in case you have questions in the future.
Please ask the respondent if they consent to participate in the study: (check one)
Your participation in this survey is voluntary. Have you understood the information I gave you and do you agree that you and members of your household will
participate in the interviews and other activities I have just described?
YES
NO
If the household gives consent to all of the data collection please check YES. If the household does not give consent to all of the data collection, check NO, stop the interview and
inform your team leader. Team leaders will discuss the reason for this refusal and decide whether a partial data collection, for some instruments, is possible for this household.
Date and time stamp
128
CONTENTS
SECTION
A1
A2
A3
Consent
B
C
D1
D2
E
F1
F1A
G1
G1A
F2
G2
G3
Q
H
S
I
J
K
L
M1
M2
M3b
N
O
Q1a
R
Q2
TOPIC
PAGE
Household Identification
Household GPS Location
Interview Details
Consent
Household Composition
Land Area and Tenure
Crop Choice: First Season 2014
Crop Choice: Second Season 2013
Maize Plot Area, First Season 2014
Agricultural Production: Major Crops on all plots, First season 2014
Agricultural Production: Maize production on selected representative plot, First Season 2014
Agricultural Inputs: On all Plots, First Season 2014
Agricultural Inputs: On selected representative plot, First Season 2014
Agricultural Production: Major Crops on all plots, Second Season 2013
Agricultural Inputs: On all Plots, Second Season 2013
Agricultural Inputs: Perceptions of quality and counterfeiting
Preferences and Beliefs– Qualitative
Community Participation and Other Activities
Social Networks: Advice Network
Current Assets, by gender
Non-agricultural employment
Credit
Farming Knowledge and Sources of Information
Food Consumption and Expenditures
Food Away from Home and Consumption Habits
Food Consumption of Children Age 6-35 months
Non-food Consumption and Expenditures
Shocks
Preferences and Beliefs - Qualitative: Secondary agricultural decision maker
Land Area Measurement Maize Plots
Preferences and Beliefs – Quantitative
129
1
1
1
2
5
8
9
10
11
12
13
14
15
16
17
18
20
23
25
27
29
30
31
34
38
39
40
41
42
43
44
CODES AND INSTRUCTIONS FOR SECTIONS B1, B2 and B3
CODE 1 (B03, B22, B23, B24)
12345678910111213141599-
household head
spouse
son/daughter
son/daughter-in-law
grandson/granddaughter
parent
brother/sister
nephew/niece
nephew/niece of wife
cousin of head
brother/sister-in-law
parent-in-law
cousin of wife
other relative
shambaboy/maid
other, no relation
CODE 2 (B16, B28)
CODE 3 (B19, B30)
1- single
2- married (monogamous marriage)
3- married (polygamous marriage)
4- divorced or separated
5- widowed
77881819202122232425262728293031323334353698-
CODE 4 (B23, B25)
1- Own agriculture (incl. farming on fields operated
by household, livestock, piggery, etc)
2- Agricultural employment (someone else’s land)
3- Non-agricultural employment
4- Non-agricultural self-employment
4567-
School
Housework
Other
None
Never attended
<P1
P1
P2
P3
P4
P5
P6
P7
Technical school
S1/Junior 1
S2/Junior 2
S3
S4
S5
S6
Tertiary after O-level
Tertiary after A-level
Some university
University degree or higher
Technical or trade school
Don’t know
Ages in months as of July 2014, calculated from
month and year of birth
Months
January-01
February-02
2011
2012
30
29
2013
18
17
2014
6
5
16
15
14
13
12
11
4
3
2
1
0
10
9
8
7
March-03
April-04
May-05
June-06
July-07
August-08
36
35
28
27
26
25
24
23
September-09
October-10
November-11
December-12
34
33
32
31
22
21
20
19
161718192067-
Language Code (B28)
Luganda
8Rukonjo
Lusoga
9English
Lugisu
10- Alur
Swahili
11- Runyarwanda
Runyakitara
12- Other
Lugwere
Ateso
DEFINITION OF A HOUSEHOLD: For this survey, a household is defined as a group of people who live and eat together, share resources and form a common decision-making unit.
DEFINITION OF HOUSEHOLD MEMBERS: For this survey, a household member is an individual who belongs to the household as defined above who has lived with the household for
at least six of the last twelve months. The individual should spend the majority of their time living/sleeping with the household. Also, new entrants into the household who are likely
permanent new members but who entered less than 6 months ago are also included as household members, including newborn children, adopted children, and newly married spouses
of members.
130
B1. HOUSEHOLD COMPOSITION AND CHARACTERISTICS
Respondent ID Code:
First, we would like to ask you about each member of your household. (First list the household head, then the spouse, their children and then other
household members.)
I
D
Name
Sex
C
O
D
E
Relationship to
household head
Age
(in completed
years)
Marital
Status
If less than
30 years old:
(B04>13)
Is [NAME]
currently in
school?
Can [NAME]
read and
write in any
language?
What is the
highest
grade that
[NAME]
completed
in school?
During the last 6 months (since January 2014)…
(B04>14)
…did [NAME]
work in
agriculture on
land operated by
this house-hold?
…did [NAME]
work at a job
that paid a
salary or
wages?
… did [NAME]
work at nonagricultural selfemployment?
1- Yes
2- No
B07
CODE 3
1- Yes
2- No
B09
1- Yes
2- No
B10
1- Yes
2- No
B11
(B04<30)
B01
1- M
2- F
B02
CODE 1
B03
CODE 2
B04
B05
1- Yes
2- No
B06
B08
…what
activity did
[NAME]
spend the
most time
in?
CODE 4
B12
Agricultural decision makers in the household
Question
B25. Who is the person in this household who mainly makes decisions about agriculture, including purchasing inputs?
Response codes
(dropdown form HH roster of household members 14 and older)
B26. Enumerator: Is [Name of B25] the same person as [prefill decision maker from CLE]
1- Yes, >>28
2- No
1- The person listed in the CLE was not correct
2- The main decision maker has changed since June
3- Other
(language code)
1- Yes
2- No >> B31
(dropdown form HH roster of household members 14 and older)
B27. This is a different person than your household identified as the main agricultural decision maker when we visited
your household in June. What is the reason for this different response?
B28. What is the primary spoken language of [Name of B24]?
B29. Do any other household members help make decisions about agriculture, including purchasing inputs?
B30. Who are the other people in the household who make decisions about agriculture in this household? (List up to
two other members, in order of their influence in these decisions.)
B31. Is [Primary agricultural decision maker – B25] available to participate in part of this interview?
B32. Is [NAME of secondary agricultural decision maker – B30a] available to participate in part of this interview?
131
1212-
Yes
No
Yes
No
Response
a.
b.
B2. HOUSEHOLD MEMBERS AGE 0-3 YEARS
Respondent ID Code:
Now, we would like to ask you a few questions about each member of your household under 4 years old.
PREFILLED FROM PREVIOUS PAGE
ID
Name
Sex
Relationship to
CODE
household head
B01
1- M
2- F
B02
B03
Age
B04
What is [NAME’S]
birthdate?
DD
B16
MM
B17
YY
B18
Enter sources of [NAME’S]
birthdate
CODE B19
B19
Ages 0-3 years only
This means that
What is
[NAME] is
[NAME’S]
[calculated
correct age
months] month’s
in months?
old. Is that
correct?
1- Yes
2- No
B20
(if B20 = 1,
enter
calculated
months. If
B20 = 2
B21
Who is the
biological
mother of
[NAME]
Who is the
biological
father of
[NAME]
Who is the
primary
caretaker of
[NAME]
ENTER ID
CODE
(dropdown)
77- deceased
88- not a
resident
B22
ENTER ID
CODE
(dropdown)
77- deceased
88- not a
resident
B23
ENTER ID
CODE
(dropdown)
B24
CODE B19
1234567-
Birth certificate
Child health card /immunization card
Stamped book
Other written record
Event calendar
Mother’s recall
Other HH member’s recall
Page | 132
CODES FOR SECTION C
CODE 1 (C07)
12345678-
FROM HOUSEHOLD HEAD’S RELATIVES
FROM SPOUSE’S RELATIVES
GIVEN BY FRIENDS
GIVEN BY AUTHORITIES
WALKED IN
PURCHASED
BORROWED/RENTED
OTHER
CODE 2 (C08)
12345-
CUSTOMARY
MAILO LAND
LEASE HOLD
FREE HOLD
OTHER
CODE 3 (C09)
1- NONE
2- LAND TITLE
3- CERTIFICATE OF OCCUPANCY
4- SALES AGREEMENT
5- OTHER
999- N/A
CODE 4 (C10)
1- YES, UNRESTRICTED
2- YES, WITH APPROVAL
3- NO
999- N/A
Page | 133
C. LAND AREA AND TENURE
Now we want to ask you questions about the agricultural land that your household had access to during the last 2 farming seasons.
C01
During the last 2 farming seasons (First Season 2014 and Second Season 2013), how
many land parcels did your household have access to (owned, rented, borrowed)?
DEFINITION OF A PARCEL: For this survey, a parcel is a continuous
piece of land under one ownership status.
Enumerator:
Create parcel
name to use to
refer to this
parcel (e.g. “hill
parcel”)
Parcel ID
ENUMERATOR: Start with the largest parcel, proceeding to the smallest.
What is the area
of this parcel?
How far is this parcel
from your home?
UNIT CODE
1- acre
2- sq. meter
3- hectare
4- square feet
DIST CODE
1- meters
2- km
3- miles
PARCEL NAME
AREA
UNIT
C02
C04
C04u
DISTANCE DISTANCE
CODE
C05
C05u
Did your
household
have
access to
this parcel
in January
2014?
12-
Yes
No
C06
How did
your
household
obtain
this
parcel?
Under what
land tenure
system does
your
household
operate this
parcel?
What
means
does your
household
have of
securing
this parcel?
Does
your
household
have the
right to
sell this
parcel?
CODE 1
CODE 2
CODE 3
CODE 4
C07
C08
C09
C10
Does this
parcel
have
access to
channel
irrigation?
12-
Yes
No
What is the soil
quality of this
parcel?
12345-
Very good
Good
Fair
Poor
Very poor
If you were to buy
this parcel, how
much would you
pay? (exclude the
area containing a
home and other
structures)
USH
C11
C12
C13
1
2
3
4
5
6
7
8
9
Page | 134
D1. CROP CHOICE – First Season 2014
Now we want to ask you questions about parcels that your household had under own production in the first season 2014 (January 2014 — July 2014).
D00a. What was the most recent season during which your household cultivated any
crops?
D01a. Did your household cultivate any maize in first season 2014?
12312-
First season 2014
Second season 2013
Before second season 2013
Yes
No >>Parcel roster
Note:
IfD00==1, all production modules should be
answered for 1st season 2014 and 2nd season 2013.
If D00==2, skip D1, F1A, F2A, second set of
questions in sections G1 and G2. If D00==3, skip
to section I.
D01b. On how many parcels did your household cultivate any maize in first season 2014?
a. During first season
2014, was this parcel
under own production?
Parcel ID
FIRST
SEASON
2014
PARCEL
NAME
12-
Yes
No
b,c. What was the area
cultivated on this parcel?
1- Acre
2- Sq. Mete
3- Hectare
4- Sq. feet
Y/N
AREA
UNIT
D03a
D03b
D03c
Did your
household
grow any
maize on
[PARCEL
NAME] in
first
season
2014?
12-
Yes
No
D04
a. During first season 2014, what crops were under cultivation on this parcel?
b. For each crop, what area was under production?
Record maize area first if maize was cultivated on this parcel, then record up to 4 other crops cultivated on this
parcel. If no maize was cultivated on this parcel, record the five most important crops in terms of area cultivated.
See CROP CODES. [Use the same area unit as unit in D03c.]
AREA
1- Acre
2- Sq. Mete
3- Hectare
4- Sq. feet
Did you
use
herbicid
e on
this
parcel
during
first
season
2014?
Did you
use
fertilize
r on
this
parcel
during
first
season
2014?
Enumerator: For each question,
record up to two household
member IDs. Ask that they list first
the person who played the leading
role,and put that person in the first
column.
During the first season of 2014
…who in the
household
decided what to
grow on this
parcel?
…who in the
household
spent the most
time working on
this parcel?
ID Code ID Code
ID
Code
ID
Code
D13a
D13b
CROP
AREA
CROP
AREA
CROP
AREA
CROP
AREA
CROP
AREA
1- Yes
2- No
1- Yes
2- No
D05a_1
D05b_1
D05a_2
D05b_2
D05a_3
D05b_3
D05a_4
D05b_4
D05a_5
D05b_5
D10
D11
D12a
D12b
1
2
3
CROP CODES
1- MILLET
3- SORGHUM
4- CASSAVA
6- IRISH POTATOES
7- BEANS
8- RICE
9- ONIONS
10- TOMATOES
11- COWPEAS
12- FIELD PEAS
13- PIGEON PEAS
14- COTTON
15- EGGPLANT
16- CABBAGE
17- CARROTS
18- SIMSIM
19- CHILIES
20- CASHEWNUTS
21- GROUNDNUT
22- SUGAR CANE
23- TOBACCO
24- PUMPKIN
25- MALAKWANG
26- GINGER
27- COOKING BANANAS
28- DESSERT BANANAS
29- BREWING BANANAS
30- COFFEE
31- VANILLA
32- YAMS
33- COWPEA LEAVES
34- GREENGRAM
35- SUNFLOWER
36- SOYA BEANS
51- MAIZE (HYBRID)
52- MAIZE (CONVENTIONAL)
53- MAIZE (TYPE NOT KNOWN)
54- WHITE FLESH SWEET POTATO
55- ORANGE FLESH SWEET POTATO
56- YELLOW FLESH SWEET POTATO
91- OTHER
Page | 135
D2. CROP CHOICE – Second Season 2013
Now we want to ask you questions about parcels that your household had under own production in second season 2013 (Aug 2013 — Dec 2013).
D00b. Did your household cultivate any crops in second season 2013?
Yes…1
No….2
Yes…1
No….2
D14a. Did your household cultivate any maize in second season 2013?
D14b. On how many parcels did your household grow any maize in first season 2014?
a. During second season
2013, was this parcel
under own production?
(prefilled
from C02)
12-
Parcel ID
SECOND
SEASON
2013
PARCEL
NAME
Yes
No
b,c. What was the area
cultivated on this parcel?
1- Acre
2- Sq. Mete
3- Hectare
4- Sq. feet
Y/N
AREA
UNIT
D15a
D15b
D15c
Did your
household
grow any
maize on
[PARCEL
NAME] in
second
season
2013?
34-
Yes
No
D16
a. During second season 2013, what crops were under cultivation on this parcel?
b. For each crop, what area was under production?
Record maize area first if maize was cultivated on this parcel, then record up to 4 other crops cultivated on
this parcel. If no maize was cultivated on this parcel, record the five most important crops in terms of area
cultivated.
See CROP CODES. [Use the same area unit as unit in D03c.]
AREA
1- Acre
2- Sq. Mete
3- Hectare
4- Sq. feet
CROP
AREA
CROP
AREA
CROP
AREA
CROP
AREA
CROP
AREA
D17a_1
D17b_1
D17a_2
D17b_2
D17a_3
D17b_3
D17a_4
D17b_4
D17a_5
D17b_5
Did you use
herbicide
on this
parcel
during
second
season
2013?
Did you
use
fertilizer
on this
parcel
during
second
season
2013?
12-
12-
Yes
No
D22
Yes
No
D23
Enumerator: For each question,
record up to two household member
IDs. Ask that they list first the person
who played the leading role,and put
that person in the first column.
During the second season of 2013
…who in the
household decided
what to grow on
this parcel?
…who in the
household
spent the most
time working on
this parcel?
ID Code
ID Code
ID
Code
ID
Code
D24a
D24b
D25a
D25b
1
2
3
CROP CODES
1- MILLET
3- SORGHUM
4- CASSAVA
6- IRISH POTATOES
7- BEANS
8- RICE
9- ONIONS
10- TOMATOES
11- COWPEAS
12- FIELD PEAS
13- PIGEON PEAS
14- COTTON
15- EGGPLANT
16- CABBAGE
17- CARROTS
18- SIMSIM
19- CHILIES
20- CASHEWNUTS
21- GROUNDNUT
22- SUGAR CANE
23- TOBACCO
24- PUMPKIN
25- MALAKWANG
26- GINGER
27- COOKING BANANAS
28- DESSERT BANANAS
29- BREWING BANANAS
30- COFFEE
31- VANILLA
32- YAMS
33- COWPEA LEAVES
34- GREENGRAM
35- SUNFLOWER
36- SOYA BEANS
51- MAIZE (HYBRID)
52- MAIZE (CONVENTIONAL)
53- MAIZE (TYPE NOT KNOWN)
54- WHITE FLESH SWEET POTATO
55- ORANGE FLESH SWEET POTATO
56- YELLOW FLESH SWEET POTATO
91- OTHER
Page | 136
E. MAIZE PLOT AREA RECALL – First Season 2014
Enumerator: Ask the respondent to report the area of each PLOT on which maize was cultivated in these parcels. At the end of the survey you will record the area of one of these plots using a
GPS unit.
PARCEL ID
(prefilled
from parcels
with
D01a=1)
PLOT NAME
(PlotID
generated by
program)
Enumerator:
Create plot
name to use
to refer to
this plot (e.g.
“large maize
plot”)
E02
Please tell us the area of each
of your PLOTS on which any
maize was cultivated in first
season 2014 on [PARCEL
NAME].
(AREA AS RECALLED BY
THE FARMER)
UNIT CODE:
acre.........1
meter sq.....2
hectare......3
square feet..4
AREA
E04a
UNIT
E04b
MAIZE plots only
Is the plot
intercropped with
other crops
or types
(hybrid/conv
entional) of
maize?
What are the three most
important other crops grown on
this plot in terms of area
cultivated (not including any
types of maize)?
Crop 1
Crop 2
Crop 3
Area planted (report area in same unit as used in E04c). What area was planted under
[CROP] on this plot in first season 2014?
Hybrid maize
Conventional
maize
Maize
(Don’t
know type)
AREA
E06a
AREA
E06b
AREA
E06c
Crop 1
Crop 2
Crop 3
Has your
household
harvested any
maize yet from
this plot that was
planted in first
season 2014?
Yes...1
No....2
Yes...1
No....2
>>E07
E05a
E05b
E05c
E05d
AREA
E06d
AREA
E06e
AREA
E06f
E07
CROP CODES
1- MILLET
3- SORGHUM
4- CASSAVA
6- IRISH POTATOES
7- BEANS
8- RICE
9- ONIONS
10- TOMATOES
11- COWPEAS
12- FIELD PEAS
13- PIGEON PEAS
14- COTTON
15- EGGPLANT
16- CABBAGE
17- CARROTS
18- SIMSIM
19- CHILIES
20- CASHEWNUTS
21- GROUNDNUT
22- SUGAR CANE
23- TOBACCO
24- PUMPKIN
25- MALAKWANG
26- GINGER
27- COOKING BANANAS
F1. AGRICULTURAL PRODUCTION: MAJOR CROPS ON ALL PLOTS – First Season 2014
28- DESSERT BANANAS
29- BREWING BANANAS
30- COFFEE
31- VANILLA
32- YAMS
33- COWPEA LEAVES
34- GREENGRAM
35- SUNFLOWER
36- SOYA BEANS
51- MAIZE (HYBRID)
52- MAIZE (CONVENTIONAL)
53- MAIZE (TYPE NOT KNOWN)
54- WHITE FLESH SWEET POTATO
55- ORANGE FLESH SWEET POTATO
56- YELLOW FLESH SWEET POTATO
91- OTHER
Respondent ID:
Page | 137
Enumerator: Collect data on up to 6 crops, ranked by area, grown during first season 2014. (Use crop choice information from Section E to identify the 6 main crops. Include maize even if maize
was not one of the main 6 crops based on area.)
Please tell me about the main (6) crops including maize your household grew over first season 2014 (January – July 2014).
FIRST
SEASON
2014
Crop
Code
Was this a
partial
harvest?
If yes, what
proportion is
still in the field?
(Enumerator: Record the total
from all plots for each state of
harvest for each crop)
(January—
July 2014)
CROP
How much of [CROP] did your
household harvest?
F01
Qty.
Unit
State
If not yet
harvested.
...888
>>next
crop
UNIT
CODE
1 Fresh
2 Dried
3Threshed
F02q
F02u
F02s
Did you
sell any of
the
[CROP]?
How much of [CROP] did
your household sell?
(Record the total from all
plots)
Yes…1
No…2
>>F05
1 More than
half
2 Half
3 Less than half
Yes…1
No…2 (>>
next crop)
Qty.
F03
F04
F05
F06q
What was the total
value of the [CROP]
that your household
sold?
Units
State
UNIT
CODE
1 Fresh
2 Dried
3Threshed
USH
F06u
F06s
F07
CROP CODES
1- MILLET
3- SORGHUM
4- CASSAVA
6- IRISH POTATOES
7- BEANS
8- RICE
9- ONIONS
10- TOMATOES
11- COWPEAS
12- FIELD PEAS
13- PIGEON PEAS
14- COTTON
15- EGGPLANT
16- CABBAGE
17- CARROTS
18- SIMSIM
19- CHILIES
20- CASHEWNUTS
21- GROUNDNUT
22- SUGAR CANE
23- TOBACCO
24- PUMPKIN
25- MALAKWANG
26- GINGER
27- COOKING BANANAS
28- DESSERT BANANAS
29- BREWING BANANAS
30- COFFEE
31- VANILLA
32- YAMS
33- COWPEA LEAVES
34- GREENGRAM
35- SUNFLOWER
F1A. AGRICULTURAL PRODUCTION: PRODUCTION ON SELECTED REPRESENTITIVE MAIZE PLOT – First Season 2014
UNIT CODES
12111213141516171819202122232425262728515253-
KG
NUMBER
100 KG SACKS
50 KG SACKS
25 KG SACKS
20 L TIN
5 L TIN
20 L CAN
10 L CAN
5 L CAN
3 L CAN
1 L CAN
20L BASKET/BASIN
10L BASKET/BASIN
BIG BUNCH (12 CLUSTERS)
MED BUNCH (8 CLUSTERS)
SMALL BUNCH (5 CLUSTER)
2L JUG/MUG
1L JUG/MUG
½L JUG/MUG
BIG BUNDLE
MED BUNDLE
SMALL BUNDLE
36- SOYA BEANS
51- MAIZE (HYBRID)
52- MAIZE (CONVENTIONAL)
53- MAIZE (TYPE NOT KNOWN)
54- WHITE FLESH SWEET POTATO
55- ORANGE FLESH SWEET POTATO
56- YELLOW FLESH SWEET POTATO
91- OTHER
Respondent ID:
Page | 138
Now we want to specifically ask you about production and sales on [REPRESENTITIVE PLOT] on which you grew maize in First Season 2014.
CROP
In which month did
you first plant
[CROP] on [PLOT
NAME] in first
season 2014?
F01
51
52
53
Hybrid maize
Conventional maize
Maize (type unknown)
Other crop (crop code)
Other crop (crop code)
CROP
F8
Did you sell [CROP] harvest
from [PLOT NAME] in first
season 2014?
Did you harvest any
[CROP] from [PLOT
NAME] in first season
2014?
12-
Yes
No>>next crop
F9
F13
Hybrid maize
51
Conventional maize
52
Maize (type unknown)
53
Was this a
If yes, what proportion
partial harvest? is still in the field?
1(for each state of harvest for each crop) 2Quantity
F10q
Units
State
UNIT
CODE
12-
F10u
How much [CROP] did your households
sell in TOTAL from [PLOT NAME]
Yes
1No >> F13 23-
Yes
No >>next crop
F14q
3F10s
F11
F12
FILL OUT ONE COLUMN ONLY
Who did you sell to?
123456-
Units
State
Price per unit
UNIT
CODE
1- Fresh
2- Dried
3- Threshed
F14s
Total value
received for
quantity sold
F15a
F15b
F14u
More than half
Half
Less than half
Fresh
Dried
Threshed
(for each state of harvest for each crop)
Quant
12-
How much [CROP] did you harvest
from [PLOT NAME] in total this
season?
Neighbor/family
Informal/Bicycle trader
Market trader
Retail shop
Farmer group
Other
UNIT CODES
12111213141516171819202122232425262728515253-
KG
NUMBER
100 KG SACKS
50 KG SACKS
25 KG SACKS
20 L TIN
5 L TIN
20 L CAN
10 L CAN
5 L CAN
3 L CAN
1 L CAN
20L BASKET/BASIN
10L BASKET/BASIN
BIG BUNCH (12 CLUSTERS)
MED BUNCH (8 CLUSTERS)
SMALL BUNCH (5 CLUSTER)
2L JUG/MUG
1L JUG/MUG
½L JUG/MUG
BIG BUNDLE
MED BUNDLE
SMALL BUNDLE
F17
Other crop (crop code)
Other crop (crop code)
Page | 139
G1. AGRICULTURAL INPUTS ON ALL PLOTS – First Season 2014
We would like to collect information on the inputs your household used on all plots. We are interested in all inputs used on your household’s plots.
Enumerator: Use a separate line for each variety/brand of each input.
INPUTS FOR ALL PLOTS
DURING FIRST SEASON 2014...
(up to 3 varieties/brands for maize seed, herbicide, fertilizer)
Is this brand a …how much
Input ...did you use …what was the
glyphosate
[INPUT] did you
Code any [INPUT] variety/ brand of
on your plots? [INPUT]?
(non-selective) use?
herbicide?
1- Yes
(Enumerator:
2- No
enter labor
>> Next input
1- Yes
98 - DK
quantity as a
2- No
total of all labor
9- D/K
time for all
workers.)
Qty
G01
G02
Conventional/local seeds
101
Hybrid seeds
102
Hired Labor
103
(pre-filled
F1A52)
(pre-filled
F1A51)
Exchange labor or festive labor
104
Inorganic fertilizer
105
Organic fertilizer
106
Herbicides
107
Pesticides
108
Plowing (animals or mechanized)
109
Irrigation
110
Other
111
G03
G03a
G04q
...did you …what
purchase quantity of
[INPUT]? [INPUT] that
you used was
purchased?
1- Yes (same unit at
2- No G04t)
>> G08
...how much
did you pay
in total for
[INPUT]
applied to
maize plots?
USH
Where was What is the
[INPUT]
location of
most
this source?
frequently
purchased?
CODE 1
CODE 2
G08
G09
Unit
G04u
G05
G06
G07
CODE 1
123456-
Retail shop
Distributor
Another farmer
Informal ag inputs dealer
Wholesaler
Other
UNIT CODES
Labor units:
1- Hours
2- Days
3- Weeks
4- Months
Units for 101, 102, 105-108
1- KG
2- NUMBER
11- 100 KG SACKS
12- 50 KG SACKS
13- 25 KG SACKS
14- 20 L TIN
15- 5 L TIN
16- 20 L CAN
17- 10 L CAN
18- 5 L CAN
19- 3 L CAN
20- 1 L CAN
21- 20L BASKET/BASIN
22- 10L BASKET/BASIN
23- BIG BUNCH (12 CLUSTERS)
24- MED BUNCH (8 CLUSTERS)
25- SMALL BUNCH (5 CLUSTER)
26- 2L JUG/MUG
27- 1L JUG/MUG
28- ½L JUG/MUG
51- BIG BUNDLE
52- MED BUNDLE
53- SMALL BUNDLE
CODE 2 (G09)
12345678-
From this village
From a nearby village
From [ML of village]
From a different trading center
within [MH of village]
From the [MH of village] town
From outside [ MH of village]
From Kampala
From Kenya
Page | 140
G1A. AGRICULTURAL INPUTS ON SELECTED REPRESENTITIVE PLOT – First Season 2014
Now we want to specifically ask you about input use on [REPRESENTITIVE PLOT] in First Season 2014.
Enumerator: Use a separate line for each variety/brand of each input.
DURING FIRST SEASON 2014...
(up to 3 varieties/brands for maize seed, herbicide, fertilizer)
INPUTS FOR
[REPRESENTITIVE PLOT]
Input ...did you use any [INPUT] …what was the
on your plots?
variety/ brand of
Code
[INPUT]?
1- Yes
2- No
>> Next input
98 - DK
Is this brand a
…how much
glyphosate (non- [INPUT] did you
selective)
use?
herbicide?
(Enumerator:
enter labor
1- Yes
quantity as a total
2- No
of all labor time
9- D/K
for all workers.)
Qty
Conventional seeds
Hybrid seeds
Hired Labor
Exchange labor or festive labor
Inorganic fertilizer
Organic fertilizer
Herbicides
Pesticides
Plowing (animals or
mechanized)
Irrigation
Other
G01
101
G10
G11
G11a
G12q
...did you …what
purchase quantity of
[INPUT]? [INPUT] that
you used was
purchased?
1- Yes (same unit at
2- No G04t)
>> G08
...how much
did you pay
in total for
[INPUT]
applied to
maize plots?
Where was What is the
[INPUT]
location of
most
this source?
frequently
purchased?
USH
CODE 1
CODE 2
G16
G17
Unit
G12u
G13
G14
G15
102
103
104
105
106
107
108
109
110
111
CODE 1
123456-
Retail shop
Distributor
Another farmer
Informal ag inputs dealer
Wholesaler
Other
UNIT CODES
Labor units:
1- Hours
2- Days
3- Weeks
4- Months
Units for 101, 102, 105-108
1- KG
2- NUMBER
11- 100 KG SACKS
12- 50 KG SACKS
13- 25 KG SACKS
14- 20 L TIN
15- 5 L TIN
16- 20 L CAN
17- 10 L CAN
18- 5 L CAN
19- 3 L CAN
20- 1 L CAN
21- 20L BASKET/BASIN
22- 10L BASKET/BASIN
23- BIG BUNCH (12 CLUSTERS)
24- MED BUNCH (8 CLUSTERS)
25- SMALL BUNCH (5 CLUSTER)
26- 2L JUG/MUG
27- 1L JUG/MUG
28- ½L JUG/MUG
51- BIG BUNDLE
52- MED BUNDLE
53- SMALL BUNDLE
CODE 2 (G09)
12345678-
From this village
From a nearby village
From [ML of village]
From a different trading center
within [MH of village]
From [MH of village] town
From outside [ MH of village]
From Kampala
From Kenya
Page | 141
F2. AGRICULTURAL PRODUCTION: MAJOR CROPS ON ALL PLOTS – Second Season 2013
Respondent ID:
Enumerator: Collect data on up to 6 crops, ranked by area, grown during first season 2014. (Use crop choice information from Section E to identify the 6 main crops. Include maize even if maize
was not one of the main 6 crops based on area.)
Please tell me about the main (6) crops including maize your household grew over second season 2013 (August – Decembers 2013).
SECOND
SEASON 2013
Crop
Code
How much of [CROP] did your
household harvest?
If yes, what
proportion is still in
the field?
Did you sell
any of the
[CROP]?
(Enumerator: Record the total from
all plots for each state of harvest for
each crop)
(August –
December
2013)
Quant
.
CROP
Was this
a partial
harvest?
F18
F19q
Unit
State
UNIT
CODE
1- Fresh
2- Dried
3- Threshed
F19s
F19u
How much of [CROP] did your
household sell?
(Record the total from all plots)
1- Yes
2- No
>>F22
123-
F20
F21
More than half
Half
Less than half
1- Yes
2- No
>> next crop
Qty.
F22
F23q
Units
State
UNIT
CODE
1- Fresh
2- Dried
3- Threshed
F23s
F23u
CROP CODES
1- MILLET
3- SORGHUM
4- CASSAVA
6- IRISH POTATOES
7- BEANS
8- RICE
9- ONIONS
10- TOMATOES
11- COWPEAS
12- FIELD PEAS
13- PIGEON PEAS
14- COTTON
15- EGGPLANT
16- CABBAGE
17- CARROTS
18- SIMSIM
19- CHILIES
20- CASHEWNUTS
21- GROUNDNUT
22- SUGAR CANE
23- TOBACCO
24- PUMPKIN
25- MALAKWANG
26- GINGER
27- COOKING BANANAS
28- DESSERT BANANAS
29- BREWING BANANAS
30- COFFEE
31- VANILLA
32- YAMS
33- COWPEA LEAVES
34- GREENGRAM
35- SUNFLOWER
What was
the total
value of
the
[CROP]
that your
household
sold?
USH
F24
UNIT CODES
12111213141516171819202122232425262728515253-
KG
NUMBER
100 KG SACKS
50 KG SACKS
25 KG SACKS
20 L TIN
5 L TIN
20 L CAN
10 L CAN
5 L CAN
3 L CAN
1 L CAN
20L BASKET/BASIN
10L BASKET/BASIN
BIG BUNCH (12 CLUSTERS)
MED BUNCH (8 CLUSTERS)
SMALL BUNCH (5 CLUSTER)
2L JUG/MUG
1L JUG/MUG
½L JUG/MUG
BIG BUNDLE
MED BUNDLE
SMALL BUNDLE
36- SOYA BEANS
51- MAIZE (HYBRID)
52- MAIZE (CONVENTIONAL)
53- MAIZE (TYPE NOT KNOWN)
54- WHITE FLESH SWEET POTATO
55- ORANGE FLESH SWEET POTATO
56- YELLOW FLESH SWEET POTATO
91- OTHER
Page | 142
G2. AGRICULTURAL INPUTS ON ALL PLOTS – Second Season 2013
We would like to collect information on the inputs your household used on all plots. We are interested in all inputs used on your household’s plots.
Enumerator: Use a separate line for each variety/brand of each input.
DURING SECOND SEASON 2013...
(up to 3 varieties/brands for maize seed, herbicide, fertilizer)
INPUTS FOR ALL PLOTS
Input ...did you use any …what was
Code [INPUT] on your the variety/
plots?
brand of
[INPUT]?
1- Yes
2- No
>> Next input
98 - DK
Is this brand a …how much
glyphosate
[INPUT] did
(non-selective) you use?
herbicide?
(Enumerator:
enter labor
quantity as a
total of all
1- Yes
labor time for
2- No
all workers.)
9- D/K
Qty
G01
Conventional seeds
101
Hybrid seeds
102
Hired Labor
103
G18
G19
G19a
...did you
purchase
[INPUT]?
…what
quantity of
[INPUT] that
you used was
purchased?
(same unit at
G04t)
1- Yes
2- No
>> G08
...how much
did you pay in
total for
[INPUT]
applied to
maize plots?
USH
Where was
[INPUT] most
frequently
purchased?
What is the
location of this
source?
CODE 2
CODE 1
Unit
G20q G20u
G21
G22
G23
G24
G25
Exchange labor or festive labor 104
Inorganic fertilizer
105
Organic fertilizer
106
Herbicides
107
Pesticides
108
Plowing (animals or
mechanized)
Irrigation
109
Other
111
110
CODE 1
123456-
Retail shop
Distributor
Another farmer
Informal ag inputs dealer
Wholesaler
Other
UNIT CODES
Labor units:
1- Hours
2- Days
3- Weeks
4- Months
Units for 101, 102, 105-108
1- KG
2- NUMBER
11- 100 KG SACKS
12- 50 KG SACKS
13- 25 KG SACKS
14- 20 L TIN
15- 5 L TIN
16- 20 L CAN
17- 10 L CAN
18- 5 L CAN
19- 3 L CAN
20- 1 L CAN
21- 20L BASKET/BASIN
22- 10L BASKET/BASIN
23- BIG BUNCH (12 CLUSTERS)
24- MED BUNCH (8 CLUSTERS)
25- SMALL BUNCH (5 CLUSTER)
26- 2L JUG/MUG
27- 1L JUG/MUG
28- ½L JUG/MUG
51- BIG BUNDLE
52- MED BUNDLE
53- SMALL BUNDLE
CODE 2
12345678-
From this village
From a nearby village
From [ML of village]
From a different trading
center within [MH of village]
From the [MH of village] town
From outside [ MH of village]
From Kampala
From Kenya
Page | 143
G3. AGRICULTURAL INPUTS: PERCEPTIONS ON QUALITY AND COUNTERFEITING
Respondent ID:
[CONFIDENTIAL AND REMOVED]
Page | 144
Q1. PREFERENCES AND BELIEFS
Respondent ID:
[CONFIDENTIAL AND REMOVED]
Page | 145
H. PARTICIPATION IN FARMER GROUPS AND OTHER ACTIVITES
H00
Is any household member a member of a farmer group?
What are the names of all farmer
groups in which any member of your
household is a member?
Enumerator: Write the name of each
farmer group in the order they are
given.
Which household
members are the most
active participants in this
farmer group?
List ID Codes for up to two
household members in the
order given.
12Is any
member of
your
household
currently a
leader in this
farmer
group?
12FARMER GROUP NAME
ID CODE 1
ID CODE 2
H01
H02a
H02b
H03
Yes
No >> H07
Which household
member is currently a
leader in this farmer
group?
(list up to 2 members)
How many farmer
group meetings or
activities have
members of your
household
attended in the
past 3 months?
What is the main
activity of this farmer
group?
CODE 1
CODE 1
1-
Yes
No
>>H05
MEMBER
ID 1
H04a
MEMBER
ID 2
H04b
NUMBER
H05
H06
Promoting production of a
commercial crop
2- Promoting production of a
non-commercial crop
3- Obtaining information from
extensionists
4- Sharing farming advice
5- Sharing marketing advice
6- Sharing labor
7- Social activities
8- Other farm activities
9- Other non-farm activities
10- Other (specify)
Page | 146
Positions Held in the Community
H07
Does any member of your household hold a position in the
community either in leadership, government or as business
leader?
12-
Yes
No >> H09
Which household members hold a position the community?
What role does [NAME] hold in the community?
Enumerator: Write the ID CODE and NAME of each household member
that holds a position in the community.
12345678910H09
(Allowed up to six names.)
ID CODE
NAME H08
LC Chairperson
Other LC leadership position
NGO extension worker
Government extension worker
Health worker
School head or teacher
Business leader
Religious leader
Other political leader
Other
Page | 147
S. SOCIAL NETWORKS: ADVICE NETWORK
Respondent ID:
[CONFIDENTIAL AND REMOVED]
Page | 148
I. CURRENT ASSETS
Respondent ID:
Enumerator: The primary respondent for this section is the household member most knowledgeable about the assets the household owns. Other household members can assist in the recall.
Record the ID CODE of the respondent and indicate if the spouse of the respondent is present during the interview.
I00
Is the spouse present?
1.
2.
3.
Yes
No
Respondent has no spouse
We now want to learn about the assets you and your household members own and the equipment you have for agricultural production.
ASSET
CODE
CONVERSION FACTORS
1 HECTARE = 2.47 ACRES
1 METRE SQ = 0.000245 ACRE
ASSET
I01
001
002
003
004
005
006
008
009
010
011
012
013
014
101
102
How many
[ASSET] does
your household
own?
IF 0
>> NEXT ASSET
What is the current value
of the total quantity of
[ASSET] your household
owns? (That is, if you
bought them now in the
current condition, how
much would you have to
pay ….?)
QUANTITY
I02
USH
I03
What percentage of the total value of [ASSET]...
...jointly belongs to the
household head and
his/her spouse(s)?
...belongs only to the
household head?
...belongs only to a
spouse of the
household head?
12345I04
12345I05
12345I06
All(>>Next asset)
More than half
Half
Less than half
None
All
More than half
Half
Less than half
None
All
More than half
Half
Less than half
None
HOUSEHOLD ASSETS
House (where members of your household cook, eat or sleep)
Other buildings (such as, free standing latrines, bathing areas, storage facilities, etc)
Furniture (tables, beds, chairs, cupboards/sideboards, stools, etc)
Furnishings (such as carpets, mats, mattresses, nets, curtains, etc.)
Household appliances (such as kettle, clothes press, stove, lamps, etc.)
Radio (cassette player, mp3 player, small radios, etc)
Other electronic equipment and accessories (such as TV, etc.)
Car battery
Bicycle
Other transport equipment (specify)
Jewelry, watches and wall clocks
Household supplies (such as saucepans, basins, plates, cups, etc.)
Other household assets (specify)
LAND (in Acres)
Agricultural land parcels owned in acres
Enterprise land parcels owned in acres
Page | 149
How many [ASSET]s does
your household own?
ASSET
CODE
CONVERSION FACTORS
1 HECTARE = 2.47 ACRES
1 METRE SQ = 0.000245 ACRE
ASSET
I01
IF 0
>> NEXT ASSET
What is the current value
of the total quantity of
[ASSET] your household
owns? (That is, If you
bought them now, how
much would you have to
pay ….?)
What percentage of the total value of [ASSET]...
...jointly belongs to the
household head and his/her
spouse(s)?
...belongs only to the
household head?
...belongs only to a
spouse of the
household head?
12345-
12345-
QUANTITY
USH
12345-
I02
I03
I04
All(>>Next asset)
More than half
Half
Less than half
None
I05
All
More than half
Half
Less than half
None
All
More than half
Half
Less than half
None
I06
LIVESTOCK/POULTRY
201
Cows (including female calves)
202
Bulls (including male calves)
203
Oxen
204
Pigs
205
Goats
206
Sheep
207
Donkeys
208
Chickens/pigeons/doves/guinea fowl
209
Other livestock/poultry (specify)
210
Structures for livestock raising
301
302
ENTERPRISE ASSETS
Tools (such as, hoes, shovels, hammers, slashers, spears, pangas,
etc.)
Machinery/equipment (such as, ox plough, grinding mill, generator,
knapsack sprayers, etc.)
303
Buildings for the enterprise
304
Transport equipment for the enterprise
305
401
Other enterprise assets
Cash savings
Page | 150
J. EMPLOYMENT OFF OWN FARM
Respondent ID:
Enumerator: please ask these questions for household members aged 12 years or older
I would now like to ask you about your employment activities of your own farm for the past 6 months.
ID
Did [NAME] do any paid work or
unpaid work off your own farm in
the past 6 months?
Yes……..1
No……...2 >> Next member
J01
During the past 6
months, what was
[NAME’s] MAIN
occupation?
What kind of
industry is this
work connected
with?
OCCUPATION
CODE
INDUSTRY
CODE
J02
J03
How many months
in the past 6
months did [NAME]
work in this
occupation?
In a typical
month, how
many days did
[NAME] work in
this occupation
For this occupation
was [NAME] paid
wages/salary or selfemployed?
123-
J04
J05
J06
Wages
Self-employed
No pay
Does [NAME]
stay at home
while working
in this
occupation?
12-
Yes
No
J07
1
2
3
4
5
6
7
OCCUPATION CODES
INDUSTRY CODES
12345678-
1234567891011-
Farmer (own farm)
Livestock/animal husbandry
Fisherman
Self-employment in household or business enterprise
Casual farm labour (not own farm)
Casual non-farm labour
Salaried (professional, government, NGO)
Other
Farming and forestry
Husbandry (livestock)
Fishing
Manufacturing and handicrafts
Trade
Construction
Repair of vehicles and other machines
Transport
Public services and administration
Mining and quarry
Other
Page | 151
K. CREDIT
K01
K02
K02a
K03
K04
K05
K06
K07
Respondent ID:
Question
Have you or any household member borrowed any funds or obtained goods or
services on credit in the last 12 months?
During the last 12 months did any household member try to borrow funds or obtain
goods or services on credit from any person or institution and was refused?
What is the main reason that the loan/credit application was denied?
During the last 12 months did any household member want to borrow but did not
apply for it?
Why did they not apply to borrow?
If more borrowing had been available to any household member during the last 12
months at usual terms for your household would they have taken it?
Why would they have not taken more borrowing?
What is the total amount of borrowing your household still owes, including any
borrowing that occurred more than 12 months ago but that your household still has
to pay back?
Response options
1- Yes
2- No
1- Yes
2- No
1- No collateral
2- Not enough income
3- Withstanding debt
4- Already has too many loans
5- Reason for loan not a sound investment
6- Other
1- Yes
2- No
1- Believed would be refused because have defaulted in past
2- Believed would be refused for other reasons
3- Too expensive (high interest rate or high cost of obtaining loan)
4- Inadequate collateral
5- Do not like to be in debt
6- Do not know any lenders
7- Believed would not be able to pay it back
8- Believed lender did not have any funds
9- Corruption/polotics/bureaucracy
10- Did not want to register
11- Other
1- Yes
2- No
1- Not needed
2- Do not think can repay
3- Do not want to owe more
4- Too expensive
5- Harassment by lender
6- Other
Response
USH
Page | 152
L. PRIMARY AGRICULTURAL DECISION-MAKER FARMING KNOWLEDGE AND SOURCES OF INFORMATION
Respondent ID:
Enumerator: ask these questions of the individual in the household who is the primary decision maker regarding agriculture [Name B25]. If the primary decision maker is not available ask the
secondary decision maker[Name B30a].
Now I want to ask you a few more questions about farming.
L01
Question
What are some ways to improve soil fertility?
Enumerator: do not prompt, check all that apply
L02
When planting maize, where should fertilizer be placed?
L03
Maize seed should be planted deeper in moist soil than in dry soil
L04
How deep in inches should maize seeds be planted in moist soil?
L05
When is maize most vulnerable to weeds?
L06
What are some good methods of weed control?
Enumerator: do not prompt, check all that apply
L07
For which kind of chemical fertilizer do you need to add soil between the seed and the fertilizer?
Response codes
1- Planting seeds earlier
7- Using machines
2- Use of chemical fertilizers
8- Using rest periods (fallow)
3- Application of farm yard manure
9- Avoiding rest periods
4- Planting on hills
10- Crop rotation
5- Preparing and applying composts 99- Don’t know
6- Mulching
1- On the surface
2- Above the seed but below some soil
3- Below the seed
99- Don’t know
1- True
2- False
1- Less than 1 inch
2- 1-2 inches
3- More than 2
99- Don’t know
1- First three weeks
2- First five weeks
3- First ten weeks
4- Not sensitive
99- Don’t know
1- Crop rotation
8- Ploughing (animal traction or
2- Proper spacing
mechanized)
3- Irrigation
9- Using high quality seed
4- Timely planting
10- Using herbicide
5- Hand pulling
11- Hand hoeing
6- Soil fertility improvement
12- Mulching
7- Using fertilizer
99- Don’t know
1- For DAP fertilizer only
2- For UREA fertilizer only
3- For NPK fertilizer only
4- Not required for any kind of fertilizer
99- Don’t know
Response
Please answer a few questions about your use of a radio.
Page | 153
Question
Does anyone in your household own a working radio at home or
on their phone?
Does anyone in your household have access to a radio from
other sources?
Code
1- Yes
2- No
1- Yes
2- No
L10
Where do you usually listen to the radio (check all that apply)
L11
Last month, how many times did you listen to the radio?
123451234599-
L13
Name your three favorite radio stations
L14
Usually, at what time of day do you listen to the radio? (check all
that apply)
L15
What are your preferred types of radio programs? (check all that
apply)
L08
L09
Answer
At home
While working
While traveling
At a neighbor’s home
Other
Every day
3-4 times per week
1-2 times per week
Irregularly
Did not listen to the radio last month. (>>L16)
Don’t know
a.
b.
c.
1234123456789-
Morning
Afternoon
Evening
No specific time of day
News
Drama
Music
Documentaries
Phone-ins
Sports
Agriculture
Religious program
Others
Page | 154
I would like to ask you a few questions about your mobile phone.
L16
L17
L18
L19
Question
When our team visited your household a few weeks ago, we were told
that you [do/do not] have your own mobile phone. Is that still true?
When our team visited you earlier, we were told that you [do/do not]
have a second mobile phone. Is that still true?
When our team visited you earlier, we were told that you [do/do not]
have access to another working mobile phone. Is that still true?
Please confirm, how many mobile phones do you have access to?
Phone number
Is the
phone
number
correct?
If the respondent
refused to provide the
phone number, list
the reason.
123412L20
Primary (prefilled
from CLE)
Secondary (prefilled
from CLE)
Enter new number(s)
(if any)
L21
Yes>>
L26
No
5L22
If not,
enter
correct
phone
number
Privacy
Does not want
unsolicited
calls/SMS
Phone owner
not in this
household
Phone not
working or
lost/stolen
Cannot find
phone number
Reason for incorrect
phone number:
1-
234L23
Response codes
1- Has own mobile phone
2- Does not have own mobile phone >> L18
1- Has a second mobile phone
2- Does not have a second mobile phone
1- Has access
2- Does not have access>> next section
L24
Was never a
phone number of
anyone in this
household
Number
recorded
incorrectly
Number no
longer in use
New phone
number
This is the:
Phone number verification
Enumerator: Please validate the
primary and secondary phone
numbers by flashing the phone
or verifying the number on the
phone directly using the codes
at the bottom of the table.
Document the verification used
12-
123L25
Primary
number
Secondary
number
Other
number
34567L26
Flash: heard the phone
ring or saw the missed call
Verified number on the
phone by entering * or #
code
Phone not currently
working
Saw the phone, but unable
to verify
Phone was not present
Network not available
Other
Response
Who owns this phone?
How often do you use
this number?
12123456L27
[Name in B25]
Another member in
this household
A neighbour
A family member in
the village
A friend in the
village
Another person
outside the village
3-
456L28
Every day
At least 4
times/week
At least 1
time/week but
less than 4
times/week
At least 1
time/month
Less than 1 time
per month
Never
Would yoube
willing to
receive
promotional
messages on
this phone line
for new
agricultural
products
available in
nearby shops?
(there will not
be any charge
to receiving
messages)
12-
Yes
No
L29
Page | 155
M1. FOOD CONSUMPTION AND EXPENDITURES (RECALL: LAST 7 DAYS)
Respondent ID:
Enumerator: Ask the person most knowledgeable about food purchases and preparation in the last 7 days. The reference period is the last 7 days
(the same day of the week as today) through yesterday.
Now I want to ask you about food consumption by your household since [REFERENCE DATE].
Food code
Have any members of your household
purchased, received without purchasing, or
consumed [FOOD ITEM] in the last 7 days,
excluding [FOOD ITEM] consumed outside
the home?
Have members of
your household
purchased
[FOOD ITEM] in
the last 7 days?
Purchased
How much
How much
[FOOD ITEM] did did your
your household
household
purchase in the
pay in total
last 7 days?
for [FOOD
ITEM] in the
last 7 days?
(same unit
as M04u)
COMPLETE M02 FOR EACH FOOD
ITEM FIRST, THEN ASK M03-M09
FOR EACH ITEM
Food Item
M01
1
Matooke
2a
2b
Orange flesh sweet potatoes
White or yellow flesh sweet
potatoes
4
Irish Potatoes
5
Cassava (Fresh)
6
Cassava (Dry/Flour)
7
Rice
8
Maize (grains)
9
Maize (cobs)
10
Maize (flour)
11
Bread/Pancakes
12
Millet
13
Sorghum
What quantity
of the [FOOD
ITEM]
purchased did
your
household
consume in
the last 7
days?
From Own Stocks
How much [FOOD ITEM] did your
household consume from its own stocks
in the last 7 days? By "stocks" I mean
food that your household had obtained
more than 7 days ago from your own
farm production or from previous
purchases or transfers. Include
previous purchases or transfers.
Obtained Without Purchase
How much [FOOD ITEM] did your
What quantity of
household obtain without purchase
the [FOOD
from other sources in the last 7 days?
ITEM] obtained
What I mean by other sources is from:
from other
household production, household
sources did the
business, in-kind pay, barter, or as
household
gifts in the last 7 days.
consume in the
IF ZERO >>NEXT ITEM
last 7 days?
(same unit as
M08u)
YES.1
NO..2
YES..1
NO...2>>M07
QTY
UNIT
CODE
USH
QTY
QTY
UNIT
CODE
QTY
UNIT
CODE
QTY
M02
M03
M04
M04u
M05
M06
M07
M07u
M08
M08u
M09
Page | 156
Food code
Have any members of your household
purchased, received without purchasing, or
consumed [FOOD ITEM] in the last 7 days,
excluding [FOOD ITEM] consumed outside
the home?
Have members of
your household
purchased
[FOOD ITEM] in
the last 7 days?
Purchased
How much
How much
[FOOD ITEM] did did your
your household
household
purchase in the
pay in total
last 7 days?
for [FOOD
ITEM] in the
last 7 days?
(same unit
as M04u)
COMPLETE M02 FOR EACH FOOD
ITEM FIRST, THEN ASK M03-M09
FOR EACH ITEM
Food Item
M01
15
Sim sim
16
Beef
17
Pork
18
Goat Meat
19
Other Meat
20
Chicken
21
Fresh Fish
22
Dry/Smoked Fish
23
Eggs
24
Fresh Milk
25
Sour milk
26
Corn soy blend/Nyuka
28
Cooking oil
29
Ghee
30
Margarine, Butter, etc.
31
Passion Fruits
32
Sweet Bananas
33
Mangoes
34
Oranges
35
Guava
36
Pumpkin
What quantity
of the [FOOD
ITEM]
purchased did
your
household
consume in
the last 7
days?
From Own Stocks
How much [FOOD ITEM] did your
household consume from its own stocks
in the last 7 days? By "stocks" I mean
food that your household had obtained
more than 7 days ago from your own
farm production or from previous
purchases or transfers. Include
previous purchases or transfers.
Obtained Without Purchase
How much [FOOD ITEM] did your
What quantity of
household obtain without purchase
the [FOOD
from other sources in the last 7 days?
ITEM] obtained
What I mean by other sources is from:
from other
household production, household
sources did the
business, in-kind pay, barter, or as
household
gifts in the last 7 days.
consume in the
IF ZERO >>NEXT ITEM
last 7 days?
(same unit as
M08u)
YES.1
NO..2
YES..1
NO...2>>M07
QTY
UNIT
CODE
USH
QTY
QTY
UNIT
CODE
QTY
UNIT
CODE
QTY
M02
M03
M04
M04u
M05
M06
M07
M07u
M08
M08u
M09
Page | 157
Food code
Have any members of your household
purchased, received without purchasing, or
consumed [FOOD ITEM] in the last 7 days,
excluding [FOOD ITEM] consumed outside
the home?
Have members of
your household
purchased
[FOOD ITEM] in
the last 7 days?
Purchased
How much
How much
[FOOD ITEM] did did your
your household
household
purchase in the
pay in total
last 7 days?
for [FOOD
ITEM] in the
last 7 days?
(same unit
as M04u)
COMPLETE M02 FOR EACH FOOD
ITEM FIRST, THEN ASK M03-M09
FOR EACH ITEM
Food Item
M01
37
Pineapple
38
Paw paw (papaya)
39
Watermelon
40
Avocado
41
Jackfruit
42
Black fruit(Mpafu/ Jambula)
45
Onions
46
Tomatoes
47
48
Cabbages
Dodo/Abuga (amaranthus
leaves)
49
Cow pea leaves (ebbo, gobbe)
51
Carrots
52
Tamarind
53
Eggplants
54
Other Vegetables
55
Beans (fresh)
56
Beans (dry)
57
Peas
58
Groundnuts (unshelled)
59
Groundnuts (shelled)
60
Groundnuts (pounded)
What quantity
of the [FOOD
ITEM]
purchased did
your
household
consume in
the last 7
days?
From Own Stocks
How much [FOOD ITEM] did your
household consume from its own stocks
in the last 7 days? By "stocks" I mean
food that your household had obtained
more than 7 days ago from your own
farm production or from previous
purchases or transfers. Include
previous purchases or transfers.
Obtained Without Purchase
How much [FOOD ITEM] did your
What quantity of
household obtain without purchase
the [FOOD
from other sources in the last 7 days?
ITEM] obtained
What I mean by other sources is from:
from other
household production, household
sources did the
business, in-kind pay, barter, or as
household
gifts in the last 7 days.
consume in the
IF ZERO >>NEXT ITEM
last 7 days?
(same unit as
M08u)
YES.1
NO..2
YES..1
NO...2>>M07
QTY
UNIT
CODE
USH
QTY
QTY
UNIT
CODE
QTY
UNIT
CODE
QTY
M02
M03
M04
M04u
M05
M06
M07
M07u
M08
M08u
M09
Page | 158
Food code
Have any members of your household
purchased, received without purchasing, or
consumed [FOOD ITEM] in the last 7 days,
excluding [FOOD ITEM] consumed outside
the home?
Have members of
your household
purchased
[FOOD ITEM] in
the last 7 days?
Purchased
How much
How much
[FOOD ITEM] did did your
your household
household
purchase in the
pay in total
last 7 days?
for [FOOD
ITEM] in the
last 7 days?
(same unit
as M04u)
COMPLETE M02 FOR EACH FOOD
ITEM FIRST, THEN ASK M03-M09
FOR EACH ITEM
Food Item
M01
61
Sugar
62
Sugarcane
63
Coffee (powder/packet)
64
Tea Leaves (powder/packets)
65
Salt
66
Soda
67
Beer
68
Other Alcoholic Drinks
69
Other Drinks
70
Other foods
What quantity
of the [FOOD
ITEM]
purchased did
your
household
consume in
the last 7
days?
From Own Stocks
How much [FOOD ITEM] did your
household consume from its own stocks
in the last 7 days? By "stocks" I mean
food that your household had obtained
more than 7 days ago from your own
farm production or from previous
purchases or transfers. Include
previous purchases or transfers.
Obtained Without Purchase
How much [FOOD ITEM] did your
What quantity of
household obtain without purchase
the [FOOD
from other sources in the last 7 days?
ITEM] obtained
What I mean by other sources is from:
from other
household production, household
sources did the
business, in-kind pay, barter, or as
household
gifts in the last 7 days.
consume in the
IF ZERO >>NEXT ITEM
last 7 days?
(same unit as
M08u)
YES.1
NO..2
YES..1
NO...2>>M07
QTY
UNIT
CODE
USH
QTY
QTY
UNIT
CODE
QTY
UNIT
CODE
QTY
M02
M03
M04
M04u
M05
M06
M07
M07u
M08
M08u
M09
Page | 159
M2. FOOD AWAY FROM HOME AND CONSUMPTION HABITS
Now that we have an idea of consumption at home, we want to learn about habits away from home and more about some specific foods.
M10
Has anyone in the household purchased any prepared foods, or paid to eat food outside the household in the past 7 days?
M11
M12
M13
List the ID code of each person who has eaten any food outside the home in the past 7 days
List the number of days out of 7 that each person ate outside the home (not including school meals)
What was the total value of all meals taken outside the home by all household members in the past 7 days (except for
meals taken by children at school)? (UGX)
What was the total value of meals taken by children at school per week? (UGX)
On average in the past 7 days, how many meals did adult members of your household eat per day at home?
On average in the past 7 days, how many meals did child members (age less than 14) of your household eat per day at home?
M14
M15
M16
Yes…1 No…2 (>>M18)
List ID codes and number of days in the boxes below
a.
b.
c.
d.
e.
a.
b.
c.
d.
e.
Number
Number
Number of people
M17
M18
M19
M20
M21
M22
M23
M24
M25a
M25b
f.
f.
Total number of meals
How many adults who are not living with your household shared at least one meal with your household in the past 7 days? How many
meals did they share in total?
How many children who are not living with your household shared at least one meal with your household in the past 7 days? How many
meals did they share in total?
Question
How many months in the last 12 months did you have problems satisfying the food needs of the household?
Thinking back over the last 12 months, in which months was the shortage of food most acute for your household?
(Check all that apply)
Code
Number of months. (0>>Sec. M3a)
During that month, compared to your usual diet, did you cut back quantity of food consumed by adult males (14 years and
older)?
During that month, compared to your usual diet, did you cut back quantities served per meal to adult females (14 years and
older)?
During that month, compared to your usual diet, did you cut back quantities served per meal to boys (less than 14 years)?
During that month, compared to your usual diet, did you cut back quantities served per meal to girls (less than 14 years)?
During that month, did you or members of your household go to sleep at night hungry because there was not enough food?
How often did this happen during that month?
Yes…1 No…2
Response
July 2013
Aug. 2013
Sept. 2013
Oct. 2013
Nov. 2013
Dec. 2013
Jan. 2014
Feb. 2014
March 2014
April 2014
May 2014
June 2014
Yes…1 No…2
Yes…1 No…2
Yes…1 No…2
Yes…1 No…2
1 = 1-2 times
2 =3-10 times
3 = more than 10 times
Page | 160
M3b. FOOD CONSUMPTION OF CHILDREN AGES –6-35 MONTHS (continued)
Respondent ID:
Enumerator: Ask this section to a household member who is the mother or caretaker of a child age 6-35 months old in the household (from Section B2). Ask this question for all children age 6-35 months (less
than 3 years old), including the child just discussed in the previous table. Enter the Respondent ID above and enter the ID Codes and Names of the children in the table.
Ask, “Please describe everything that [NAME] ate yesterday during the day or night, whether at home or away from home.” Ask what the child first ate after waking up in the morning. Then ask when was
the next time the child ate anything and what was eaten. Continue this line of questioning for each eating occasion, including at mid-day, evening, at night and in between. If a food in any of the groups below is
mentioned, enter a 1 for that group. Once a food in that group is named, there is no need to enter anything else for that group. If the respondent mentions mixed dishes, like a porridge, sauce or stew, ask “What
ingredients were in that dish?” If mother cannot recall enter “998”.
ID CODE (pre filled)
Child name
(prefilled)
Starches (like
sorghum,
matooke,
cassava, maize,
white sweet
potato, irish
potato, porridge
or rice)?
Leafy dark green
vegetables (like
skumawiki,
pumpkin leaf or
cow pea leaf)?
Dairy
products like
milk,
yoghurt or
cheese?
Organ
meat? (liver,
kidney,
heart)
Other meat
(beef, pork,
lamb, goat,
chicken,
duck)?
Eggs
Orange colored
fruits or
vegetables
(like orange
sweet potato,
pumpkin,
mango,
carrots)?
Other
vegetables
(like
cabbage, or
cucumber)?
Other fruit
(like
banana,
pineapple,
avocado or
tomato)?
Groundnuts,
simsim,
sunflower
seeds,
peas or
other
seeds,
beans?
Vegetable
oil,
margarine,
or butter?
1. Yes
2. No
9. D/K
M32
1. Yes
2. No
9. D/K
M33
1. Yes
2. No
9. D/K
M34
1. Yes
2. No
9. D/K
M35
1. Yes
2. No
9. D/K
M36
1. Yes
2. No
9. D/K
M37
1. Yes
2. No
9. D/K
M38
1. Yes
2. No
9. D/K
M39
1. Yes
2. No
9. D/K
M40
1. Yes
2. No
9. D/K
M41
1. Yes
2. No
9. D/K
M42
How many
times did
[NAME] eat
solid, semisolid, or soft
foods other
than liquids
yesterday
during the day
or night?
(TIMES)
M43
Page | 161
N. NON-FOOD CONSUMPTION AND EXPENDITURES (RECALL PERIOD: PAST 30 DAYS)
Ask these questions to the household member most knowledgeable about household expenditures on goods other than food
I would now like to ask you some questions about a list of non-food items that your household may have purchased or received by other means for household consumption in the last 30 days.
Received by other means should include gifts, aid, in-kind wages, gathering, collecting and other transfers. (Please exclude from your answers any item purchased or received for processing or
resale in a household/individual business.)
Respondent ID: (dropdown from B2)
ITEM
CODE
ITEM DESCRIPTION
Have members of
your household
purchased any [ITEM]
in the last 30 days?
How much did the
household pay in
TOTAL for [ITEM]?
Have members of your
household received
[ITEM] by other means
in the last 30 days?
(Don’t Know…998)
(Don’t Know…998)
(Don’t Know…998)
(USH)
1.
2.
N03
N04
1.
2.
N01
1
Adult Clothing or Fabric for Making Clothing
2
Child’s Clothing or Fabric for Making Clothing
3
Footwear and Repairs of Footwear
4
Soap or Detergent
5
Hair or Beauty Products
6
Toothbrush or other dental products
7
Hygiene items such as napkins, toilet paper
8
Batteries
9
Cigarettes and other tobacco
10
Fuel sources such as Kerosene, Firewood, Charcoal,
Matches
Furniture items and furnishings such as: mats,
curtains, blankets, bedding, mattresses
Household appliances such as, iron, kettle, charcoal
and kerosene stoves, radio
11
12
N02
Yes
No (>>N04)
Yes
No (>>Next item)
If you would have
purchased this amount of
[ITEM], how much would
you have had to pay for
it?
(Don’t Know…998)
(USH)
N05
Page | 162
O. SHOCKS (Recall period: In the past 2 years)
Respondent ID code:
Enumerator: Please ask O04 after administering O01-O03. There should be only one shock which gets an “X” in O04.
Households sometimes experience unexpected events that hurt them economically and affect their normal livelihood. We want to ask you a series of questions about the
negative unexpected events you may have faced over the past two years (i.e. past 24 months) part of 2012, 2013, and part of 2014
Negative Shocks (unexpected events)
Enumerator: Ask about all shocks.
Shock
Code
Did the household
experience [SHOCK] in the
past 24 months?
What year (2012, 2013,
2014) was this shock
the worst?
Of the shocks that
occurred, which one was
the worst for your family?
12-
(Write the year of the
worst shock)
Put an “X” in the
appropriate row
Yes
No >> next shock
[SHOCK]
O01
Major loss of crops due to drought
101
Major loss of crops due to too much rain, flood
102
Major loss of crops due to other reason (pests, disease)
103
Cannot sell crops produced for the market
104
Major decline in the price of crops the household usually sells
105
Major increase in the price of food the household eats
106
Major increase in fuel prices
107
Loss of livestock due to drought/death/theft
201
Loss of productive assets (due to theft, fire, erosion, storms, etc.)
202
Death of household member
301
Death of extended family member
302
Loss of income due to illness or injury of household member
303
Loss of a regular job of a household member
401
Disputes with community members over land, assets, or income opportunity
402
Access to government program was stopped
501
Withdrawal of NGO assistance
502
O02
O03
O04
Page | 163
Q1a. PREFERENCES AND BELIEFS – Secondary decision maker
Respondent ID:
[CONFIDENTIAL AND REMOVED]
Page | 164
R. LAND AREA MEASUREMENT: MAIZE PLOTS
Use the GPS device to measure the area of the representative maize plots [NAME of plot selected for F1a and G1a].
Now, with your permission, I would like to measure the area of some of one of your plots using a GPS device. The GPS device measures the perimeter of the plot as you walk around it and then
calculates the area in square meters. (After measuring the plots, write down the area of the plot that you measured and give it to the respondent.)
R00
P
A
R
C
E
L
I
D
E02
May I measure one of your fields?
P
L
O
T
I
D
E03
1.
2.
Area planted under each type of maize.
Yes
No >> End interview
Are you able to measure this
plot?
(Prefilled from section E)
Hybrid maize
seeds
E06a
Conventional
maize seeds
E06b
Don’t know type
of seeds
E06c
1234-
YES
NO
PLOT INACCESSIBLE
RESPONDENT
REFUSED TO GO TO
THAT PLOT
R01
Enter GPS coordinates of corner of plot nearest to the homestead
GPS Measurement of
Plot Area
AREA
UNIT
R02a
R02b
Latitude
(D M)
R03a
Longitude
(D M)
R03b
Accuracy
(meters)
R03c
Elevation
(meters)
R03d
Page | 165
Q2. PREFERENCES AND BELIEFS – QUANTITATIVE
Respondent ID:
[CONFIDENTIAL AND REMOVED]
Page | 166
IFPRI AGRICULTURAL INPUTS STUDY COMMUNITY QUESTIONNAIRE:
JULY-AUGUST 2014
DASHBOARD:
Household Identification
A01
Market hub
Prefilled
A02
Market location code
Prefilled
A03
Community
Prefilled
SECTION A: COVER
Question
A04
Please re-enter the name of the LC1 if it is
incorrect or missing:
A05
Please re-enter the name of the subcounty if it
is incorrect or missing:
Code
Enumerator: Enter the GPS coordinates for
one of the following locations, indicate the
location (A06_0a), and describe it (A06_0b)
A06_0a
Location of GPS reading
A06_0b
Description of GPS location
A06a
GPS – Latitude (N/S)
A06_1
GPS – Latitude degrees (dd)
A06_2
GPS – Latitude minutes (mm.mmm)
A06b_1
GPS – Longitude (E) degrees (dd)
A06b_2
GPS – Longitude (E) minutes (mm.mmm)
A06c
Accuracy (meters)
A06d
Elevation (meters)
1 - center of main village market
2- home of LC1 chairperson or other
leader
3- Central LC1 meeting place
4- Church (give name)
5- School (give name)
6- Major crossroads (name streets)
9- Other location
1=N, 2=S
167
Response
Enumerator: Ask these questions to the LC1 chairperson. If the chairperson is not available to be interviewed, ask
these questions to another knowledgeable community leader. Start by asking the respondent for consent to conduct
the interview.
Informed Consent
We are a research team studying agricultural input use by farmers in some areas of Uganda. We would like to invite you to
participate in a survey that is part of the study. This study will benefit the people of Uganda by identifying methods for improving
the quality of inputs available to farmers.
If you agree to participate, we will ask you some questions about this community. The interview should last approximately 20
minutes. There is no risk associated with your participation. Your participation is completely voluntary. If you do not feel
comfortable answering a question, then you do not have to answer it. You will not be penalized in any way if you decide not to
participate, or if you stop participating. You will not be rewarded for participation, either. You may ask questions at any time
about the study. The information you provide will not be given to anyone in your community or to anyone else not involved with
research related to this study. If you agree to participate in this study, we can provide you with a copy of this consent letter if
you would like. We can also provide you with names and contact information of the people involved in running the study.
Have you understood the information I gave you and do you agree to participate in the interview I have just described?
Yes…1
No…..2
A07. Consent given
A08. Date/time stamp
Respondent details
Question
Code
Response
A09. Name of informant (Surname, First name)
A10. [NAME in A09]’s position
A11. How long has [Name in A09] held this position
1- LC1 chairman
2- Other village official
3- Traditional leader
4- Religious leader
5- Other (specify)
YEARS
(enter 0 if less than 1 year)
168
SECTION B: LC1 DEMOGRAHICS, LAND AND INFRASTRUCTURE
B01
B02
B03
B04
B05
B06
Question
Response code
How many households are currently in this
LC1?
In the last 12 months [Since June 2013], how
many households moved into this LC1?
In the last 12 months [Since June 2014], how
many households moved out of this LC1?
What is the total land area of this village?
Number
What share (percent) of total land area is used
for crop production?
What is the most common land tenure system
in this LC1?
B07
What is the main source of drinking water for
LC1 residents during the […] season?
B07a
How many bore holes are there in the
LC1/zone?
Number
Number
1- Acres
2- Square kilometers
(Number from 0-100)
12345-
1- Bore hole
2- Water tank or truck
3- Protected well
4- Rain water
5- River, stream, or pond
6- Tap or piped water
7- Unprotected well
8- Other
(Number)
1- Yes
2- No
B08
1- YES
2- NO
(Number from 0-100)
B09
B10
B11
B12
What is the name of the nearest trading center
with shops to buy farm inputs such as seed,
fertilizer and agricultural chemicals?
How far is it to [B11]?
B13
What is the main form of travel to [B11]?
123-
Locally-maintained (feeder road)
Community-maintained (rural access road)
Federally-maintained (Ministry of Works, all
weather road)
4- Cart path
5- Foot path
NAME
Kilometers
123-
Area
Unit
A. Dry
B. Rainy
CUSTOMARY
MAILO LAND
LEASE HOLD
FREE HOLD
OTHER
B07b Is there a river, stream, pond, or
other natural body of water inside the
LC1/zone or within 1 mile?
Does this LC1 have any access to electricity
from the national electric grid?
What share (percentage) of households have
electricity?
What type of road provides the main access to
this LC1?
Response
Walking/on foot
Bicycle
Bus or taxi
169
B14
How long does it take to reach [B11] by [B13]?
4- Boda boda/motorcycle
5- Privately owned car or truck
6- Other
Minutes
B14a
B14b
Enumerator: Is B11 the Market Location in the
sample for this community?
How far it is to [Market Location NAME]?
1- Yes >> B15
2- No
Kilometers
B14c
What is the main form of travel to [B14b]?
B14d
B15
How long does it take to reach [B14b] by
[B14c]?
How far is it to [Hub NAME]?
7- Walking/on foot
8- Bicycle
9- Bus or taxi
10- Boda boda/motorcycle
11- Privately owned car or truck
Other
Minutes
B16
What is the main form of travel to [Hub NAME]
B17
How long does it take to reach [Hub NAME] by
[B16]
Does this LC1 have a primary school?
B18
B19
How far is it to the nearest primary school in
another LC1?
B20
For each of the following health facilities, what
is the distance to the nearest facility from the
LC1?
Kilometers
1- Walking/on foot
2- Bicycle
3- Bus or taxi
4- Boda boda/motorcycle
5- Privately owned car or truck
6- Other
Minutes
1- Yes>>B20
2- No
Kilometers
HEALTH FACILITY LOCATION (IN MILES),
ENTER 0 IF INSIDE THE LC1
Drug shop
Private or Government Health Center
Hospital
Clinic
170
SECTION C: FARMING ACTIVITIES
C01
C02
C03
C04
C05
C06
Question
Response code
What share (percent) of households in this community
are farming households (cultivate any crops)
What share (percent) of households grew any maize
for sale or home consumption in the past 2 cropping
seasons (Season 2 2013 and Season 1 2014)?
How many active farmer groups are there in this
community?
What share (percent) of farmers belong to a farmer
group?
Are there any agriculture extension services available
in this community?
Who provides the extension services?
(Number from 0-100)
C07
How frequently do extension officers offer trainings in
this community?
C08
Are extension officers available for farmers to contact
about questions on crop choices and input use?
171
(Number from 0-100)
Number
Number from 0-100
1212312345612-
YES
NO >> SECTION D
NAADS
NGO
Other
Weekly
Monthly
Quarterly
Bi-annually
Annually
Less than 1 time per year
YES
NO
Response
SECTION D: SHOCKS
What major negative events have happened to this LC1 in the past 2 years [since June 2012] in
order of severity?
List up to 3 negative events
Date of the event
MM
YYYY
(99=N/A)
D01a
__ __ __
__ __
__
D01b
__ __ __
__ __
__
D01c
__ __ __
__ __
__
What major positive events have happened to this LC1 in the past 2 years [since June 2012]?
List up to 3 positive events
Date of the event
MM
YYYY
(99=N/A)
__ __ __
__ __
__
__ __ __
__ __
__
__ __ __
__ __
__
D02a
D02b
D02c
Enumerator: Thank the respondent!
172
What share of
households in the
LC1 were affected?
(Number from 0-100)