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SENDONG MULTI CLUSTER and INITIAL RAPID ASSESSMENT

Key Informant Interview Form

Sendong. Philippines Multi Cluster Initial and Rapid Assessment (MIRA)– Key Informant Interviews Page 1 of 8

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GI GENERAL INFORMATION

GI1 Team No.

GI2 Name of Team Leader

GI3 Date of Interview (DDMMYYYY)

GI4 Interviewer 1 Name

GI5 Interviewer 1Telephone

GI6 Interviewer 1 Gender

GI7 Interviewer 1 Organization

GI8 Interviewer 2 Name

GI9 Interviewer 2 Telephone

GI10 Interviewer 2 Gender

GI11 Interviewer 2 Organization

GI12 Province

GI13 Municipality/City

GI14 Barangay/Sitio/Purok

GI15 P-Code (for office use only)

GI16 Key Informant Profession/Role

GI17 Key Informant Gender

1. Male O

2. Female O

GI18 Key Informant Contact Number

SP SITE POPULATION

SP1 Total # of Households?

SP2 Total Population Male Female

1. Less than 5 years

2. 5 to less than 12 years

3. 12 to less than 18 years

4. 18 to 60 years

5. Above 60 years

Total

SP3 Total # of female headed households (including widows)?

VP VULNERABLE POPULATION

Boys Girls

VP1 How many children under 1 year of age are here?

VP2 How many children under 1 year do not have their mother with them?

VP3 Have you seen or heard of children less than 18 years old at

this site who are vulnerable (e.g. orphans, without usual care givers, who are disabled?) Select One Only

1. Yes O

2. No (Jump to VP 5) O

3. DK (Jump to VP 5) O

VP4 If yes, estimate how many?

Male

Female

VP5 Estimated number of vulnerable

adults (18+) Male Female

With Physical and mental disabilities

VP6 Estimated number of

unaccompanied elderly people (60 and above)

Male Female

VP7 Estimated number of indigenous peoples?

Male Female

VP8 How many of these indigenous

peoples have special needs?

VP9 Was there population displacement prior to Sendong? Select

One Only

4. Yes O

5. No (Jump to BI1) BI O 6. DK (Jump to BI1 O

VP10 If yes, what was the cause? (Select all that apply)

1 Natural Disaster O

2 Armed Conflict O

VP10X Others, specify

BI BASIC INFORMATION

BI1 Is there an accessible functioning market in the area? Select One Only

1. Yes O

2. No (Jump to BI5) O 98. Don’t know (Jump to BI5) O 0. NA/NR O BI2 What are the reasons why people can no longer access the

market? Select All that Apply

1. No money to buy food O

2. Prices of goods have increased O 3. No goods in the market O 4. Market was destroyed/physically inaccessible O

98. Don’t know O

0. NA/NR O BI2X Other (please specify)

BI3 Which of the following food items are present in the market(s)? (Select all that apply)

A Rice

B Milk

C Vegetables

D Fruits

E Cooking Oil

F Cooking Fuel




G Cassava

Z. Don’t Know

X Other

BI3X Specify Other

BI4 Which of the following NON- food items are present in the market(s)? (Select all that apply)

H Blankets

I Bed Mats

J Kitchen Sets

K Plastic Sheets

L Jerry Cans/Water Containers

M Soap

N Clothes

O Sanitary Cloth

98. Don’t Know

0. NA/NR

X Other

BI4X Specify Other

BI5 Which of the following are available in this community? (Select all that apply)

Services Now

A. Electricity

B. Water Schemes

C. Drainage

D. Schools

E. Religious building

F. Drinking water

G. Pathways

H. Access road

I. Access to Health facility

J. Confidential Gender Based Violence response services

K. Gas supply

98. Don’t Know

0. NA/NR

BI6 Is there a problem in the community because people do not have enough, or good enough, clothing, shoes, bedding or

blankets? Select One Only

1. Yes O

2. No O

98. Don’t know O 0. NA/NR O

BI7 Do you know of relief and rehabilitation organizations working in the area right now? Select One Only

1. O

2. No (Jump (Jump to BI11)to BI14) O

BI8 If “Yes” then what areas do the organizations work in now?

(Select all that apply)

A. Cash grant B. Cash for work C. Food distribution D. Cash/ Food Voucher

E. NFI distribution F. Agricultural inputs

G. Shelter

H. Nutrition

I. Women’s Development

J. WASH

K. Education

L. Welfare

M. Psycho-social support

N. Health

O. Protection

X Others

98. Don’t know

0. NA/NR

BI8X Specify Other

BI9 What are the names of the most active organizations working here now?

1st

2d

3rd

BI10 Do you know of CBOs working in the area right now? Select One Only

1. Yes O

2. No Jump to Jump (Jump to WS1)to BI17) O 98. Don’t Know Jump to WS1)to O 0. NA/NR Jump to WS1)to O

BI12 If yes, list the names of the 2 most active CBO’s.

1.

2.

WS Water Supply

WS1 Is there a serious problem in your community because people do not have enough water that is safe for drinking or cooking? Select One Only

1. Yes O 2. No ( O

98. Don’t know O

0. NA/NR O

WS2 What are the main sources of water in your community?




Rank

Drinking water

source

1=Open well 2 = Borehole/ hand pump

3=Stream/river 4=Storage/collection container

5=Piped water sys 6=Piped water supply 7=Bowser/Tanker

98=Don’t know 0=NA/Blank

Sufficiency

1=Sufficient 2=Not

sufficient 0=NA/Blank

Physical status

WS3. Are

water sources safe/ protected?

1= Yes 2= No

98=Don’t Know 0=NA/Blank

1st

2nd

3rd

WS4 Does water from the main water source appear clean? Select One Only

1. Yes (Skip to WS5) O

2. No O

98. Don’t know O

0. NA/NR O

WS5 Do affected families have water containers with lid available at HH that are used for water storage?

Select One Only

A Yes O

B No O

98. Don’t know O

0. NA/NR O

WS6 Is water treated at household level? Select One Only

1. Yes O

2. No (S p to WS7) O

98. Don’t know O

0. NA/NR O

WS7 If yes, indicate which of the following methods are used to treat water? (Select all that apply)

A Chemical disinfection

B Boiling

C Filtering

D Solar

E Decanting

X Other

WS7X Specify Other

WS8 Is approximately 15 litres/day of water available per person

each day? Select One Only

3. Yes O

4. No (S to WS7) O

98. Don’t know O

0. NA/NR O

WS9 How long do people have to walk to collect the water from the source? Select One Only

1. No walk / available within household O

2. Less than15 minutes O

3. Up to 30 minutes O

4. 60 minutes O

5. More than 60 minutes O

98. Don’t know O

0. NA/NR O

WS10 Who usually collects water? (Select one only)

A. Adult Men (above 18 years old) O B. Adult Women (above 18 years old) O

C. Child boy (above 1 year and below 18 years) O

D. Child girl (above 1 year and below 18 yaers) O 98. Don’t Know O

0. NA/NR O

WS11 Have cases of acute watery diarrhea increased in the last 2 weeks? Select One Only

1. Yes O

2. No (S kip to WS7) O

98. Don’t know O 0. NA/NR O

SA SANITATION

SA1 Do people in the community have easy and safe access to

clean toilets? Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

SA2 Problems of access to

toilets for defecation and bathing purposes by

1=Severe problems

2=Moderate problems 3=No significant problem

Toilets Bathing

1. Men

2. Women

3. Elderly Persons

4. Persons with disabilities

5. Children

SA3 How long do you have to walk from

dwelling place to use toilets?

1=No walk

2=up to 15 minutes 3=up to 30 minutes 4=up to 60 minutes

5=More than 60 minutes

1. Men (prior to the crisis)

2. Women (prior to the crisis)

3. Men (After the crisis)

4. Women (After the crisis)




SA4 Do most toilets have locks? Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

HA HYGIENE AWARENESS & PRACTICES

HA1 Availability of soap Select One Only

1. Easily available O

2. Not easily available O

3. Not available at all O

HA2 How are you washing your hands after defecation? Select One Only

1. With water O

2. With soap and water O

3. With ash O

4. Not washing at all O

HA3 Availability of appropriate female sanitary protection materials? Select One Only

1. Easily available O

2. Not easily available O

3. Not available at all O

4. Could not ask question O

HA4 Proportion of household possessing soap?

1=<25% 2=25-50% 3=51-75% 4=>76%

1. Prior to the crisis

2. After the crisis

FS FOOD SECURITY

FS1 Is there a problem in your community with food; for example: because there is no food or not good enough food?

Select One Only

1. Yes O

2. No Jump (Jump to FS3)to O

98. DK O

0. NR/NA O

FS2 What are the main concerns related to food in your community? (Rank up to four)

Rank

Concerns 1= Not enough food 2= Not good enough food

3= No cooking facilities 4= No utensils 5= No cooking fuels

6= Loss of agricultural land 7= Loss of agricultural assets (tools, storage, seeds, etc.)

8 = No physical access to markets/ no markets 9 = No money/resources to purchase food

98=Don’t know 0=NA/Blank

1st

2nd

3rd

4th

FS3 Do people still have food stocks in their households? Select One Only

1. Yes O

2. No(Jump to FS5 O

98. DK(Jump to FS5 O

0. NA/NR(Jump to FS5 O

FS4 For how long are these food stocks estimated to last? Select One Only

1. Less than 1 week O

2. One week O

3. Two weeks O

4. One month O

98. DK O

0. NA/NR O

FS5 Are there significant changes in the total amount of food that people are eating since Sendong, on average?

Select One Only

1. Amount consumed has increased O

2. Amount consumed has remained the same O

3. Amount consumed has decreased O

98. Don’t know O

0. NA/NR O

FS6 What are the main sources of food in your community? (Rank up to three)

Rank

1= Own production (Jump to FS8 2 = Purchase from local market (Jump to FS8

3 = Humanitarian assistance 4 = Other (specify) (Jump to FS8 98=Don’t know (Jump to FS8

0 = N/A

1st

2nd

3rd

FS7 IF you have received food or cash assistance, have you received any of the following in the past 24 hours? (Select all that apply)

A. Rice) O

B. Noodles O

C. Beans O

D. Oil O

E. HEB O

F. Plumpy doz O

G. Cash O

H. Other food item O

98. Don’t know O

0. NA/NR O

FS8 What are the prices per kilogram of the staple foods in the

area before and after the disaster?




Staple Food

Pricing before disaster Pricing after disaster

Rice

Corn

Camote (sweet potato)

Cassava

Gabi

Meat (chicken, fish, etc.)

FS9 Are female headed households, pregnant women, lactating mothers, children, persons with disability and the elderly prioritized for food distribution? Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

NU NUTRITION

NU1 Is there information on infants that are exclusively breastfed? Select One Only

1. Yes O

2. No (Jump to NU3 O

98. DK (Jump to NU34 O

0. NA/NR (Jump to NU3 O

NU2 If yes, please specify percentage:

NU3 Have infant milk products (e.g. milk formulas) and/or baby bottles/teats been distributed since the disaster?

Select One Only

1. Yes O

2. No Jump to NU5 O

98. DK Jump to NU5 O

0. NA/NR Jump to NU5 O

NU4 If yes, please specify by whom?

NU5 What percentage of infants in the area are formula fed/formula dependent? Select One Only 1 = None

2 = Less than 10 3 = 10 – 25% 4 = More than 25%

10= Don’t know 0=NA/Blank

Before disaster

After disaster

NU6 Has the community/health staff identified any problems in feeding children less than 2 years of age since the emergency/disaster started? Select One Only

1. Yes O

2. No Jump to NU8 O

98. DK Jump to NU8 O

0. NA/NR Jump to NU8 O

NU7 If yes, what problems?

A. Loss of apetite B. Taste fatigue due to non-variation in food supply/non-

appropriate supply of complementary food

C. Presence of sickness (diarrhea, fever, coughs, etc). D. Underfeeding E. Vomiting F. Dehydration G. Don’t know X Other (specify) NU4X Specify other

NU8 Have any of the children here been reached by the following during the last 3 weeks? (Select all that apply)

A. Multivitamins (sprinkles) or tablets

B. Screening for malnutrition C. Assessment of infant and young child

feeding practices

D. Vitamin A supplementation

E. Counseling on breastfeeding or complementary feeding

F. Other nutrition programs

G. Don’t know

H. . NA/NR

SH H

PR PROTECTION

PELTER

PR1 Do you consider safety and security a concern in your community? Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

PR2 What are the major protection concerns (select all that apply): (Select all that apply)

A. Lack of adequate physical protection by national authority B. Breakdown of law and order (i.e. looting, criminality) C. Presence of unlawful group(s) on arms D. Absence of civilian character (presence of armed personnel) E. Extortion/Illegal taxation E. Violence(s) between members of displaced community and/or host community

G. Threat from host community H. Presence or risk of Sex and Gender Based Violence I. Incidents of child abuse and exploitation J. Presence or risk of human trafficking K. Missing persons L. Forced return or relocation M. Split families (family members separated from other family members)

N. Lack of adequate communication between family members and/or to emergency response (i.e., ambulance, fire brigade)




O. Loss of legal document(s) P. Persons with special needs (i.e., disabilities, elderly, single-headed household, single women)

Q. No arrangements for the remains of the deceased PR2X Specify other

SHELTER.

SH SHELTER

SH1 Is there a problem in your community because people do

not have an adequate place to live in? Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

SH2 What is the estimated percentage houses …..?

Unaffected

Partially damaged but habitable

Severely damaged and uninhabitable (but can be rehabilitated)

Totally destroyed

SH3 For those with houses affected, what are the main types of

shelter options being used? (Rank top 3)

Rank

1=Evacuation centre 2=Living with host family within the community

3=Living with host family in a different community

(oustside of the Barangay) 4=Improvised shelter on households own land

5=Living in repaired / partially damaged house 6=Renting a house or apartment 7=Temporary or semi permanent shelter other than tents

8 = Living in tents 9= Other (Please specify:______________________) 10= Don’t know

0=NA/Blank

1st

2nd

3rd

SH4 What are the concerns with meeting shelter needs in your

community?Rank Top 4

Rank

1= No evacuation centers available 2= No temporary or semi permanent shelters 3= Existing shelters are over crowded 4= People are being forced to live in highly affected /

damaged houses 5= Lack of skills to repair / build shelters 6= Lack of materials to repair partially damaged houses

7= Lack of materials to build temporary shelter 8= Limited community capacity to house affected people 9= Affected households lack financial resources (renting,

rebuilding, etc) 10= Property rights 11= Other (Specify:_______________)

0 = NA/Blank

1st

2nd

3rd

4th

LA LIVELIHOOD / AGRICULTURE

LA1 Is there a problem in your community because people do not have enough income, money or resources to live? Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

LA2 What are traditionally the

main sources of

income for people in the community?

( Rank main sources)

Main sources of income 1 = Farming

2 = Fishing

3 = Livestock

4 =Wage Labor

5 = Trade

6 = Cottage Industry

7 = Tourism

8 = Remittance

99 = Other

98 = Don’t Know

0 = NA/NR

LA3 How How were they affected by

Sendong?

1 = Not affected

2 = Slightly affected

3 = Highly affected

98 = Don’t know

0 = NA/NR

Source of income Affect

1st source

2nd source

3rd source

LA2X If other, specify income source

LA4 What ate the

immediate

needs for

livelihoods

recovery?

(Rank from 1-3,

1 being most

important)

1. Land reclamation

2. Inputs for land preparation (tools, cash,

machinery)

3. Inputs for crops planting (agri inputs)

4. Livestock

5. Vaccination and medication for surviving animals

6. Fishing inputs

7. Irrigation system recovery

8. Building materials

9. Shelter for livestock

10. Debris Removal

11. Other

0. None/NA

1st Immediate need

2nd Immediate need

3rd Immediate need

HE HEALTH

HE1 Is there a problem in your community because people are not able to get adequate healthcare?

Select One Only

1. Yes O

2. No O

98. DK O

0. NA/NR O

HE2 What are the main health concerns in this

community right

now?

Main diseases 1=Fever 2=skin disease

3=tuberculoses (TB) 4=Diarrhea 5=Difficulty in Breathing/Respiratory

6=Difficulty in sleeping/nightmares

7=Diabetes 8=Heart Disease

9=High Blood Pressure 10=jaundice /Hepatitis




96=Other

1st

2nd

3rd

4th

5th

HE2X Specify other

HE3 How many Health Facilities can you access from your community? (Select all that apply)

A. Hospital

B. Maternal and child health services

C. Barangay Health Center

D. Mobile health clinic/unit

E. EC Health Center

F. Mobile Health Clinic/Unit

G. Temporary Health Facility

X. Other

HE1X Specify Other

HE4 How long on average take to get to the nearest health facility? Select One Only Before Now

A. With in 1 hour by foot O O

B. 1 -2 hour by car O O

C. More than 2 by car O O

D. Don’t know O O

E. NA O O

HE5 Is transport available for referrals? Select One Only

1. Yes, no cost O

2. Yes, User pays O

3. No O

4. Do not know O

5. NA O

HE6 Was the Health facility close to your community damaged recently? Select One Only

1. Fully Damaged (irreparable) O 2. Damaged (Repairable) O 3. Less Damage (Repairable with less

resources) O

4. No Damage O

5. NA O HE7 Has been the following vaccination campaign in your

community for….? (Select all that apply)

1-6 months 6-12

Months More than 12

months

A. Polio B. Measles C. Routine Child

Immunization(under 5 y)

HE8 Which healthcare professionals are available at the delivery points? (Select all that apply)

F. Male medical officers (male doctors)

G. Female medical officers (lady doctors)

H. Male medical technicians/dispensers

I. Female medical technicians/dispensers

J. LHV/Midwife

K. LHW

L. Traditional birth attendants

M. Don’t know

X. Other

HE8X Specify other

MC MASS COMMUNICATION

MC1 Which of the following is your most

trusted source of information? Rank 1-4 (1being the least trusted and 4 most trusted)

Rank = 1 – 4 NA=0

1. Newspaper

2. Radio 3. Television

4. SMS

5. Internet

MC2 What time do you listen/read/watch your most trusted source of information? (Select all that apply)

A. 7-10am

B. 3-5pm

C. 5-7pm

D. 7-10pm

CR1 Which community infrastructure assets is the highest priority

for you to be repaired?

(Rank top 3)

1=Multipurpose Hall 2=Comm/religious school

3=Village bridges 4=water mills/springs/reservoirs

5=Churches 6=irrigation / drains channels

7=Mosques 8=Village market 9=Provincial Roads

10=Orphanages, youth centers, sport ground 11=Municipal Roads

12=Barangay Road 13=Access roads/link roads 14= Police Station

15=Farm to Market Roads 16=Irrigation Systems 17=DK

18=Other 96=NA/None

1st

2nd

3rd

CR1X Specify other

ED EDUCATION

ED1 IS there a problem in your community because children are not in school or are not getting a good enough

education? Select One Only

1. Yes O

2. No O 98. Don’t know O

0. NA/NR O




ED2 How many

education institutions were/are operating? N

um

ber

Nam

es

Part

ially

Dam

aged

Fu

lly

Dam

aged

1. Elementary School

2. High school

3. College/University

4. Non-Formal

5. Other

ED3 Are children going to school at the moment? (Select One Only)

Boys Girls

1. Yes O O

2. No (Jump to ED5 O O

99. Don’t Know(Jump to ED5 O O

0. NA/NR(Jump to ED5 O O ED4 How many children are presently going to

school?

Boys Girls

ED5 What are the reasons for children not going to schools? (Select all that apply)

A. Male Teachers not available

B. Female Teachers not available

C. Schools damaged in flood

D. Schools overcrowded

E. School occupied by IDP’s

F. Lack of WASH Facilities

G. Not accessible

X. Other

ED5X Specify Other

ED6 Other buildings / facilities available to be used as learning

spaces for children? (Select One Only)

1. Available O

2. Not Available O

3. Don’t Know O

ED7 Are schools being used as evacuation

centers? (Select One Only)

Teaching Learning

1. Yes O O

2. No Jump to ED9 O O

3. Don’t Know O O

ED8 If Yes, please specify which school

ED9 What kind of support for education is

most essential right now in this community?

(Rank top 3)

1= Repairing damaged school buildings for facilities

2 = Establishing temporary spaces 3 = Ensuring safety of school aged children and teachers

4 = Providing school materials 5 = Providing teaching and learning resrouces 6 = Providing psychosocial support to teachers

and students 7 = School feeding 8 = Recruiting teaching staff 9 = Providing incentives to teachers

98 = Don’t’ know 0 = NA/NR

1st

2nd

3rd

ED8X Specify other

ED10 How many education

institutions were/are operating? N

um

ber

Nam

es

Part

ially

Dam

aged

Fu

lly

Dam

aged

6. Elementary School

7. High school

8. College/University

9. Non-Formal

10. Other

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SENDONG MULTI CLUSTER and INITIAL RAPID ASSESSMENT · sendong multi cluster and initial rapid assessment ... sendong multi cluster and initial rapid assessment ... m soap n clothes