EGC Ghana HH 041607

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EGC Ghana HH 041607 Powered By Docstoc
					3/29/07:
1. I've added another mental health module based on the CES-D Depression Scale. Should we delete the old one?
2. In Section 6B - Land info 3, we need codes for traditional positions.
3. We've added modules including social participation, digist span assessment, and pattern recognition at the end of the surve
   Can you determine where to put them in the survey and adjust the contents accordingly?
4. On the social partipication questionnaire (at the end of the survey), is it okay to ask people who they voted for?
uld we delete the old one?

n recognition at the end of the survey, which should be completed separately for each child / member of the household.

ple who they voted for?
f the household.
SECTIONS INCLUDED:                                   6    Agriculture
1   Roster                                                A     Livestock and Assets
                                                          B     Land Information
2   Education                                             C     Output and Stored Crops
    A General Education                                   D     Inputs
    B Educational Career                                  E     Land Transactions
    C Literary and Apprenticeship
                                                     7    Information
3   Health                                                A     Agricultural Information
    A Health in last two weeks                            B     Other Information
    B Preventative (Immunizations)
    C Postnatal Care/ Child Health and Development   8    Household Enterprise
    D Fertility / Other Women's Health                    A    HH Enterprise Information
    E Contraception and AIDS                              B    Labor
    F Insurance                                           C    Expenditures
    G Mental Health                                       D    Inventory, Sales, Purchases
    H Activities of Daily Living and Misc. Health         E    Other Revenue
    I   Anthropometry
                                                     9    Relatives
4   Labor / Time use                                      A      Parents, Children, and Siblings
    A Activity Status and Main Occupation                 B      Absent Spouses
    B Activity Status and Secondary Occupation
    C Underemployment                                10   Misc. Income and Expenses
    D Unemployment                                        A      Transfers out
    E Time Use                                            B      Transfers in

5   Migration                                        11   Credit, Assets, and Savings
    A Migration                                           A      Borrowing
    B Temporary Migration                                 B      Assets
    C Migration History                                   C      Saving
                                                          D      Lending
Section 1 -- MEMBERS OF THE HOUSEHOLD
Fill in this whole sheet with data from GLSS5; fill out for new household members
                                                                                                                          If 12 years or older,                                                                     In what region/country was
                                               What is [name's]                           How old is                                                                                                                      [name] born?
                                                                                                                                                                                                   What is [name's]




                                                                                                                                           (if more than one spouse, the first one)
                                          relationship with head of                                                                                                                                                         1=Western
                                                                      What is [name's]     [name]?
             Sex (Male = 1; Female = 2)


                                                                                                         What is [name's]                                                                               religious
                                                  household?                                                                                                                                                                 2=Central




                                                                                                                                               If spouse is in HH, spouse's ID
                                                                        date of birth?    (years and   current marital status?                                                        At what       denomination?
                                                   1= Head                                                                       Does                                                                                      3=Gt. Accra
                                                                                           months if        1=married,                                                                age did         1=Catholic
                                          2=Spouse (wife/husband)                                                              [name's]                                                                                       4=Volta
                                                                                                                                                                                                      2=Anglican
 Member ID




                                                                                                        2=consensual union,                                                           [name]
                                           3=Child (son/daughter)     (if not available    under 5,                             spouse                                                                                       5=Eastern
                                                                                                            3=separated                                                                             3=Presbyterian
                                                4=Grandchild                code        otherwise only                          live in                                               first get                             6=Ashanti
                                                                                                               (>> 9)                                                                                4=Methodist
                                           5=Parent/parent-in-law                                                               house-                                                married                            7=Brong Ahafo
                                           6=Son/daughter-in-law
                                                                          DD = 99           years)          4=divorced                                                                             5=Pentecostalist
                                                                                                                                                                                                                            8=Northern
                                                                                                                                 hold?                                                or start
                                                                          MM = 99                              (>> 9)                                                                                6=Spiritualist
                                               7=Other relative                                                                Yes = 1                                                                                    9=Upper East
                                              8=Adopted/foster/        Year = 9999) (if less than 12        5=widowed                                                                  living     7=Other Christian
                                                                                                                                                                                                                         10=Upper West
                                                                                                                                No = 2
                                                                                                               (>> 9)                                                                  with a          8=Muslim
                                                   stepchild                            years >> 10)                            (>> 9)                                                                                 96=Other ECOWAS
                                                                                                          6=never married                                                                            9=Traditional
                                                 9=Househelp                                                                                                                          partner?     10=No religion
                                                                                                                                                                                                                       97=Africa other than
                                                                                                                (>> 10)
                                               10=Non-relative                                                                                                                                                               ECOWAS
                                                                      DD    MM    Year    Years       Months                                                                                                            98=Outside Africa
   1                2                                 3                       4                   5                6                7                      8                              9              10                     11
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Section 1, PAGE 2 -- MEMBERS OF THE HOUSEHOLD (continued)
Fill in this whole sheet with data from GLSS5; fill out for new household members
                                                                                                                                                                                                             Ethnic group codes
                                                                                                                       What kind of work has
                                                                                                                                                                                                                  1=Asante
                                                                                             What was [name's]        [name's] father done for                                         What was [name's]        2=Akwapim
              What is [name's]
                                                                                          father's highest education      most of his life?                                             mother's highest           3=Fanti
                 nationality?
                                                                                              level completed?        1=Professional/technical                                           education level            4=Ga
             1= Ghanaian (birth)                                                                                                                                                           completed?
                                                                                                    1=None           2=Administrative/manageri                                                                   5=Dangme
                2=Ghanaian                                                                                                                                                                   1=None
                                                                                                  2=Primary                       al                                                                              6=Krobo
                (naturalized)      To what ethnic group   Does [name's]                                                                            Does [name's]                           2=Primary               7=Ewe
                                                                                                3=Middle/JSS                 3=Clerical




                                                                                                                                                                        ID of Mother
                                                                           ID of Father
                3=Burkinabe        does [name] belong?    father live in                                                                        mother live in house-                    3=Middle/JSS
 Member ID




                                                                                                4=Voc/Comm                     4=Sales                                                                             8=Guan




                                                                             (>> 18)




                                                                                                                                                                          (>> 22)
                  4=Malian                                 house-hold?                                                                                 hold?                             4=Voc/Comm               9=Nzema
                                                                                                  5='O' level                5=Service
                 5=Nigerian                                  Yes = 1                                                                                  Yes = 1                              5='O' level           10=Hausa
                                                                                                    6=SSS                  6=Agric./Ani-                                                      6=SSS
                  6=Ivorian                                  No = 2                                                                                   No = 2                                                    11=Dagomba
                                                                                                  7='A' level        Husb./Forest/Fishing/Hunti                                            7='A' level
                 7=Togolese                                  (>> 16)                                                                                  (>> 20)                                                  12=Mamprusi
                                                                                             8=Training college                   ng                                                   8=Training college        13=Gonja
                 8=Liberian
                                                                                                 9=Tech/prof             7=Production &                                                   9=Tech/prof         14=Grussi/ Frafra
             9=Other ECOWAS
                                                                                                 10=Tertiary                related works                                                 10=Tertiary            15=Dagati
              10=Other African                                                                                                                                                            11=Koranic
                                                                                                 11=Koranic              8=Workers NEC                                                                           16=Kusasi
             11=Other (specify)                                                                                                                                                         12=Don't know
                                    Ethnicity      Code                                        12=Don't know              9=Homemaker                                                                       17=Kassena-Nankani
                                                                                                                        10=Other (specify)                                                                      18=Kankoma
                                                                                                                                                                                                                19=Nanumba
                     12                     13                  14            15                     16                         17                       18                19                 20                 20=Builsa
         1                                                                                                                                                                                                   21=Other (specify)

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Section 1, PAGE 3 -- MEMBERS OF THE HOUSEHOLD (concluded)
Fill in columns 21-24 from GLSS5; fill out columns 21-23 for new HH members and columns 25-30 for HH members listed during GLSS5
For columns 27-30, either fill out column 27 (if the respondent moved to a city in Ghana listed in column 27) OR columns 27 and 28 (if the respondent
       moved to a city in Ghana not listed in column 29) OR column 30 (if the respondent left Ghana)
                                                                                    For what reason
                                                                                                                         Where did [name] move?
             What kind of work has [name's]                     While                Still a
                                                  For how                                      did [name] move                              In Ghana                      Outside of Ghana
             mother done for most of her life?                 absent,            household
                                                    many                                             away?
                1=Professional/technical                        is/was            member?                                                                    REGION:
                                                   months                                       1=job transfer     1 = other household in
              2=Administrative/managerial                     [name] a Classified                                                                            2=Western
                                                 has [name]                                        2=seeking             this village
                        3=Clerical                           member of   as HH      1=Yes                                                                    3=Central
                                                 been away                                       employment             2 = Kumasi
                          4=Sales                              another  member      (>>28)                                                                  4=Gt. Accra
 Member ID




                                                  from this                                       3=spouse's            3 = Sunyani
                        5=Service                           household?   during     2=No,                                                                     5=Volta
                                                 household                                       employment           4 = Cape Coast
                                                                                                                                                             6=Eastern
                      6=Agric./Ani-                          (including GLSS5?      moved                              5 = Koforidua
                                                       ?                                          4=marriage                                 give name of    7=Ashanti     give name of
              Husb./Forest/Fishing/Hunting                     single-               away                                 6 = Accra
                                                                                                5=other family                                    city        8=Brong         country
                     7=Production &                            person    1=Yes      (>>26)                               7 = Tamale
                                                     (if 6                                           reason                                                    Ahafo
                       related works                        household?)  2=No       3=No,                             8 = Bolgatanga
                                                 months or                                       6=education                                                9=Northern
                    8=Workers NEC                                                  deceased                            9 = Koforidua
                                                     less,                                        7=political/                                               10=Upper
                                                                                                                           10 = Wa
                      9=Homemaker                              1=Yes               (>> next                                                                     East
                                                   >> 24)                                           religious      11 = Sekondi-Takordi
                   10=Other (specify)                           2=No                person)                                                                  11=Upper
                                                                                               8=other (specify)           12 = Ho
                                                                                                                                                               West
                            21                      22          23         24         25              26                    27                    28            29               30
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Section 2 (Education), Part 1 -- GENERAL EDUCATION
Fill in this whole sheet with data from GLSS5; fill out whole sheet for new household members                                                GRADE LEVEL
                      1              2            3              4           5             6            7             8     QUALIFI-         CODES
                     Has      What was the What was the Did (NAME)           Is     Is the school                           CATION
                                                                                                     What is How much time does              None = 0
                 (NAME) highest grade         highest     attend school / (NAME)      (NAME)           the                  CODES
                                                                                                             (NAME) spend going              Pre-school = 01
                 ID of person interviewed



                                                                                                                            None = 01        P1 = 11
                    ever       successfully educational college at any still in       attending      current to and from school
                                                                                                                                             P2 = 12
                  attended     completed? qualification time during the school?       Public or
                                                                                                     grade?        daily?   MSLC = 02
 Member ID




                                                              past 12                  Private?                             BECE = 03        P3 = 13
                  school?                    attained?                                                                                       P4 = 14
                                                              months?                                                       Voc/Comm =
                                (see grade                                 Yes = 1                    (see IF IN A BOARDING 04               P5 = 15
                                                                                     Public = 1                                              P6 = 16
                  Yes = 1         codes)        (see          Yes = 1      No = 2       Private      grade       SCHOOL     Teacher Tra.     JSS1 = 17
                No = 2 (>>                  qualification No = 2 (>>       (>>12) religious = 2      codes)       CODE      A = 05           JSS2 = 18
                  Part 2C)                     codes)         Part 2B)              Private non-                HRS … 00    Teacher Post     JSS3 = 19
                                                                                     religious = 3             MINS … 00    Sec = 06         M1 = 20
                                                                                                                            GCE O Level      M2 = 21
                                                                                                              HRS     MINS  = 07             M3 = 22
                                                                                                                            SSCE = 08        M4 = 23
             1                                                                                                                               SSS1 = 24
                                                                                                                            GCE A Level      SSS2 = 25
             2
                                                                                                                            = 09             SSS3 = 26
             3                                                                                                              Tech/Prof.       S1 = 27
             4                                                                                                              Cert = 10        S2 = 28
                                                                                                                            Tech/Prof Dip    S3 = 29
             5                                                                                                              = 11             S4 = 30
             6                                                                                                              HND = 12         S5 = 31
                                                                                                                            Bachelor = 13    L6 = 32
             7                                                                                                                               U6 = 33
                                                                                                                            Masters = 14
             8                                                                                                                               Voc/Technical/C
                                                                                                                            Doctorate = 15   omputer/Comm/
             9                                                                                                              Other = 16       Agric = 41
                                                                                                                            (specify)        Teacher Train =
      10
                                                                                                                                             42
      11                                                                                                                                     Nursing = 43
                                                                                                                                             Polytechnic = 51
      12                                                                                                                                     University = 52
      13                                                                                                                                     Other tertiary =
                                                                                                                                             53
      14                                                                                                                                     Other = 61
      15                                                                                                                                     (specify)

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Section 2, Part 1 -- GENERAL EDUCATION (continued)
Fill in this whole sheet with data from GLSS5; fill out whole sheet for new household members 12 years of age and older
                  9        10          11           12      13         14       15       16       17       18        19                                           20            21             22             23
                                               How      How     How many                                                                                                 Who paid for          Did          What was
                                                                                I want to ask you about the educational expenses for (NAME) during the past 12 months.
                 ID OF PERSON INTERVIEWED



                                               many    many      hours and                                                                                                most of the       (NAME)        the amount
                                             hours ofhours of    minutes of                                    How much was spent on….                                   educational         have a           of the
                                             class did
                                                     class did homework did                                      (AMOUNT IN CEDIS)                                        expenses?       scholarship /   scholarship
                                             (NAME)  (NAME) (NAME) do                                                                                                                        bursary        / bursary
                                                                             School Contri- Uniforms Books                Trans-    Food, Expenses In-kind         (IF
 Member ID




                                                     miss last
                                            attend last          last week?                                                                                               Father = 1       during the     received for
                                                                            fees and butions and sports         and     portation board, on extra expenses? CANNOT
                                               week?   week?                                                                                                              Mother = 2         past 12       the past 12
                                                                              regis- to parent/ clothes?      school      to and    and/or classes?             BREAK
                                             (exclude(exclude                                                                                                          Both parents = 3     months?         months?
                                                                             tration teacher                 supplies?     from    lodging                      DOWN)
                                               extra   extra                                                                                                              Other HH
                                                                              fees?      assoc-                          school?      at
                                              classes)classes)                                                                                                           member = 4          Yes = 1
                                                                                         iation                                    school?
                                                                                                                                                                       Other relative = 5 No = 2 (next
                                                                                        (PTA)?
                                            vacation vacation                                                                                                          Non-relative = 6      person)
                                            code 99 code 99                                                                                                                Self = 7
                                                                                                                                                                          Other = 8
                                             hours     hours   HRS MINS                                                                                                                                   AMOUNT

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Section 2, Part 1 -- GENERAL EDUCATION (continued)                                                                                                  GRADE LEVEL
NEW -- fill out this sheet for all household members currently enrolled in school                                                                   CODES
                                                                                                                                                    None = 0
                  24                    25                 26         27                      28                              29                    Pre-school = 01
                  Is      Name of school and code (if What is Does NAME          What is the name of NAME's      What is the name of NAME's         P1 = 11
                                                                   have one
              (NAME) on village roster, otherwise         the                  teacher? (if NAME has the same     ENGLISH LANGUAGE                  P2 = 12
             ID OF PERSON INTERVIEWED



                                                                  teacher for
              currently     code NV if not on roster)   current most or all of          teacher all day)                   teacher?                 P3 = 13
                                                                                                                                                    P4 = 14
             in school?                                 grade? the school
                                                                                                                                                    P5 = 15
                                                                            day?                                (or code NV if the teacher is not   P6 = 16
 Member ID




                                         Yes = 1                (see                                                  on the village roster)        JSS1 = 17
                                                                           1 = Yes                                                                  JSS2 = 18
                                         No = 2                grade       2 = No,
                                        (>> page               codes)                                                                               JSS3 = 19
                                                                          NAME has                                                                  M1 = 20
                                          15)                              different                                                                M2 = 21
                                                                         teachers for                                                               M3 = 22
                                                                        math, science,                                                              M4 = 23
                                                                        language, etc.                                                              SSS1 = 24
                                                                                                                                                    SSS2 = 25
                                                                                                                                                    SSS3 = 26
                                                                                                                                                    S1 = 27
                                                   name   ID                             name           ID              name               ID       S2 = 28
      1                                                                                                                                             S3 = 29
      2                                                                                                                                             S4 = 30
                                                                                                                                                    S5 = 31
      3                                                                                                                                             L6 = 32
      4                                                                                                                                             U6 = 33
      5                                                                                                                                             Voc/Technical/Co
                                                                                                                                                    mputer/Comm/Ag
      6                                                                                                                                             ric = 41
      7                                                                                                                                             Teacher Train =
                                                                                                                                                    42
      8
                                                                                                                                                    Nursing = 43
      9                                                                                                                                             Polytechnic = 51
     10                                                                                                                                             University = 52
                                                                                                                                                    Other tertiary =
     11
                                                                                                                                                    53
     12                                                                                                                                             Other = 61
     13                                                                                                                                             (specify)
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                                                                       2 part 1 _ general educ 4 NEW
            Section 2, part 1 -- GENERAL EDUCATION (concluded)
            NEW -- fill out this sheet for students currently in school
                            30                     31           32                       33                      34            35                36               37
             What is the name of NAME's           How          Does         How does (NAME) obtain the          Does      What kinds of     How many         What mode of
              MATHEMATICS teacher?                many      (NAME)                   textbooks?              (NAME) meals or snacks           times a     transportation does
                                                days has  have all the                                      participate does (NAME)         week does   (NAME) use to go to
                                                           textbooks 1 = provided by school, can take home                                                      school?
             (or code NV if the teacher is        your                                                          in a   receive at school?    (NAME)
                                                           needed for   2 = provided by school, cannot take                                            (if boarding, how does
               not on the village roster)        school                                                       feeding                         receive
                                                             school?                    home                                                             (NAME) get there?)
Member ID




                                                  been                  3 = newly purchased from the school
                                                                                                            program at    1 = breakfast     this food?         1 = walk
                                                open for 1 = yes, has     4 = newly purchased from private    school?       2 = snack                         2 = bicycle
                                                 the last       all                    market                               3 = lunch                           3 = car
                                               30 days?      2 = has                   5 = gift                1 =yes 4 = other (specify)                       4 = bus
                                                           some, but     6 = passed down from older sibling    2 = no                                          5 = train
                                                              not all            7 = purchased used                    (separate multiple                      6 = boat
                                                          3 =has none            8 = other (specify)                     responses with                       7 = animal
                                                                                                                            commas)                       8 = other (specify)


                    name               ID
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                                                                                     Page 11
Section 2, part b – Educational Career
Fill in this whole sheet with data from GLSS5; fill out whole sheet for new household members
              1               2                    3                    4                 5          6              7                 8                9
 ID          Has     How many course- What was the highest Was the technical / Has (NAME)          How      What was the What was the highest      Was the
          (NAME) years did (NAME) certificate (NAME)               computer /      ever attended   many     last institution    qualification       tertiary
             ever         complete?          obtained?         vocational school     a tertiary  years did    attended?      (NAME) achieved?     institution
          attended                                             (NAME) attended educational (NAME)             Advanced/                            Public or
                                              None = 1
          technical       None = 1                             public or private?   institution   attend?     Specialist         None = 1          Private?
                                            NACVET = 2
            and/or      3 months = 2          IMIS = 3
                                                                                       (e. g..             teacher training    Certificate = 2
         vocational     6 months = 3         NVTI = 4              Public = 1       University,                    =1           Diploma = 3       Public = 1
           school?       1 Year = 4       City & Guild = 5     Private religious = polytechnic,            Polytechnic = 2       HND = 4            Private
                         2 Years = 5       Certificate = 6              2               etc)?               University = 3     Bachelor = 5      religious = 2
           Yes = 1       3 Years = 6        Diploma = 7           Private non-       Yes = 1                  Other = 4         Masters = 6      Private non-
           No = 2 4 Years and above = Other = 8 (specify)         religious = 3     No = 2 (>>                 (specify)       Doctorate = 7     religious = 3
            (>>5)             7                                                       part 2c)                               Other = 8 (specify)
                                                                                                 YEARS
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Section 2, part b -- EDUCATION CAREER (concluded)
NEW -- fill out whole sheet for all current household members ages twelve and older
              11           12          13         14                           15
 ID Has (NAME) How many                Has       How        If (NAME) ever attended a secondary
     ever repeated times has (NAME)              many      institution, what was (NAME)'s major
            / did      (NAME) ever / did times has       field(s) of study? (list one or more codes)
                                                                          1 = science
     (NAME) ever repeated / (NAME) (NAME)
                                                                        2 = humanities
         repeat a          did      ever skip skipped /
                                                                       3 = social science
          grade?       (NAME) a grade?            did                   4 = engineering
                        repeat a               (NAME)                    5 = medicine
          1 = yes        grade?      1 = yes    skip a                      6 = law
          2 = no                     2 = no     grade?                   7 = education
                                                                       8 = other (specify)

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Section 2, part c -- LITERARY AND APPRENTICESHIP
Fill out for all household members 5 years and older
          1           2          3          4                                  5             6          7               8               9            10              11             12          13           14            15
                    Can  In what Ghanaian       Can         In what            What          Can         Has     If not attending/   For how Is (NAME)           How long What is the main       Did      How much Has (NAME)
                 (NAME)      language can     (NAME)      Ghanaian       languages does (NAME) (NAME)             attended, why?       many        or has                                     (NAME)          did     ever attended
                                                                                                                                                                  (is) the  trade (NAME) is
                   read a  (NAME) read a       write a  language can         (NAME)       do written    ever     Low quality = 1 months has (NAME)                                            pay a fee    (NAME)      other short
                  phrace/phrase/ sentence?    sentence (NAME) write           speak         calc-    attended a Not available = 2    (NAME) ever been an        apprentice-     learning?      for this   pay for the    training
                sentence in
                          (SHOW FLASH            in       a phrase/       comfortably? ulations? literacy        Do not need = 3        been    apprentice?        ship?                      training?    training?     courses
 Household ID




                 English?       CARD)         English?    sentence?       (list all - see             course?     Too costly = 4    attending /                                (REFER TO                               lasting not
                           State the one in             State the one       language        (USE                Takes much time = attended a        Yes,                        SECTOR         Yes, in                 more than 6
                 (SHOW which (NAME) is         Yes = 1     in which       codes below ) FLASH           Yes =            5            literacy currently = 1                                  kind = 1                  months?
                 FLASH     most proficient     No = 2    (NAME) is                        CARDS) 1(>>9)           Not useful = 6      course?   Yes, in past
                                                                                                                                                                            TRADE/SKILLS       Yes, in
                 CARD)      (see language              most proficient                                 No = 2       Too far = 7                     =2                        GLSS CODE       cash = 2                  Yes = 1
                             codes below)              (see language                       Yes = 1               Spouse does not                No = 3 (if no                    BOOK)        Both = 3                   No = 2
                 1 = Yes                                codes below)                       No = 2                     want = 8                    >> 15)                                       No = 4                   (>>Next
                  2 = No                                                                                        Other = 9 (specify)                                                            (>>14)                   member)

                                                                                                                      >>10
                                                                                                                                    MONTHS                                    MAIN
                                                                                                                                                                YRS   MTHS   TRADE CODE
  1
  2
  3
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  5
  6
  7
  8
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 12
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LANGUAGE CODES: Ghanaian codes : None = 1; Twi/Fanti = 2; Ewe = 3; Ga-Dangme = 4; Dagbani = 5; Frafra/Grusi = 6; Nzema = 7; Wali/Dagari = 8; Other = 9 (specify)
Other language codes : French = 10; German = 11; Spanish = 12; Portuguese = 13; Chinese = 14; Japanese = 15
TRAINING CODES: Clerical = 1; Prof/Managerial = 2; Computer = 3; Marketing = 4; Teaching = 5; Leadership = 6; Medicine = 7; Accountancy = 8; Trade/Skill = 9; Other = 10 (specify)
Section 3 (Health), part a -- HEALTH IN LAST TWO WEEKS
Most of these questions were in GLSS5, however ask again to all HH members to capture current health
            1                2                3                   4               5          6           7           8                 9                       10               11                           12                        13
ID During the last     What was the         Was      Was (NAME) given any For how During the For how During the              Was the health facility    What time of On the most recent visit   What was the main reason for the   Where did the
     2 weeks has illness that (NAME) (NAME) of the following to drink: many                last 2     many    last 2 weeks          open?                   day did      whom did (NAME)               most recent visit?         consultation take
       (NAME)            suffered?       given the                              days    weeks, did    days? has (NAME)                                 [NAME] arrive         consult?                     Illness … 1                   place?
    suffered from                          same       1 = Oral Rehydration during the (NAME)                    consulted           1 = yes             at the facility?   Doctor … 01                    Injury … 2
                                                                                                                                                                            Dentist … 02                Follow-up … 3
     either illness   Fever…1 (>>5)      amount to          salt (ORS)         last 2 have to stop             any health           2 = no                                                                                          Hospital … 1
                                                                                                                                                                            Nurse … 03                  Check-up… 4
       or injury?      Diarrhea with      drink as       2 = Rice water        weeks     the usual   (1 - 14)    facility?                                               Medical Asst … 04            Prenatal care … 5
                                                                                                                                                                                                                                     Clinic … 2
                      blood…2 (>>5)      before the          3 = Soup            has     activities  DAYS                                                                  Midwife … 05               Postnatal care … 6          MCH Clinic … 3
      Neither ...1        Watery          watery     4 = Home-made sugar/ (NAME) because of                      Yes ...1                                                 Pharmacist … 06              Vaccination … 7           Maternity Home … 4
         (>>6)          Diarrhea…3      diarrhea, or    saltwater solution    suffered      this                 No … 2                                                 Drug/Chemical Seller         Other … 8 (specify)           Pharmacy … 5
     Illness …. 2    Cold / Cough…4       more, or      5 = Milk or infant   from this condition?                 (>>22)                                                        … 07                                           Chemical store … 6
     Injury …. 3           (>>5)           less?              formula        condition                                                                                   Trad. Healer … 08                                      Consultant's Home
         (>>3)       Guinea Worm…5                     6 = Coconut water          ?      Yes … 1                                                                         Trained TBA … 09                                               …7
      Both …. 4            (>>5)         1 = same           7 = Water                  No … 2 (>>                                                                       Untrained TBA … 10                                     Patient's Home … 8
                                                                                                                                                                          Spiritualist … 11
                    Bilharzia…6 (>>5) 2 = more               8 = herbs        (1 - 14)       8)                                                                                                                                Community epicenter
                                                                                                                                                                             Other … 12
                      Other…7 (>>5)       3 = less     9 = Other (specify)     DAYS                                                                                                                                                     …9
                                                                                                                                                                                                                               Other (specify) … 10



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                                                              3 part a_health in past 2 weeks
Section 3, Part a -- HEALTH IN LAST TWO WEEKS continued
Most of these questions were in GLSS5, however ask again to all HH members to capture current health
                 14                        15             16                  17                18               19              20                21
What was the name of the facility? Is this a public How much did       What mode of       How much did How much time How long did you How much TOTAL
                                       or private   (NAME) pay transport did (NAME) (NAME) pay did it take to travel have to wait at the time (waiting and
 (enter name and code if in village     facility?      for this      use to travel to the to travel there to and from the  health facility      receiving
                                                                       health facility?
    or code NV if not in village)                   consultation?                         and to return?      facility?     before being     treatment) did
                                                                        1 = walking
                                     Public … 1                                                                           attended to by a (NAME) spend at
                                                                         2 = bicycle
                                     Private … 2       CEDIS          3 = motorcycle
                                                                                              CEDIS       TRAVEL TIME      health officer? the health facility?
                                     Private non-                          4 = car
                                    religious … 3                      5 = bus/public                                     WAITING TIME CONSULTATION
                                                                          transport                                                               TIME
                                                                    6 = other (specify)

         NAME              CODE                                                                        HRS      MINS      HRS      MINS       HRS      MINS




                                                                            Page 16
Section 3, part a -- HEALTH IN LAST TWO WEEKS concluded
Most of these questions were in GLSS5, however ask again to all HH members to capture current health
                 22                    23                24           25            26             27              28           29                      30
 ID     During the last two How many nights How much did           During the  How much      Total medical      Were the  For the past Who pays for the greatest portion of
        weeks was (NAME) did (NAME) stay (NAME) or will last 2 weeks did (NAME) expenses over                  medicine/   12 months        the health expenses incl.
       admitted to a hospital in hospital/health (NAME) pay for did (NAME)         pay       the past two 2     medical was (NAME)      consultations and hospital stays (if
         or health center on                                                                                                                           any)?
                              center during the     staying in a    buy any   altogether for     weeks          supplies  hospitalized
              account of
                               last two weeks? hospital / health medicine or      these                        available/    for any
           illness/injury?                                                                                                                  Household member … ID
             (INCLUDE
                                                 center during the  medical   medicine and (IF CANNOT          obtainable    injury?           Other relative … 80
          TRADITIONAL               ( 1- 14)      last two weeks?  supplies?     medical         GIVE         in the same                       Government … 81
             HEALING                                                            supplies? BREAKDOWN)             place?     Yes … 1              Employer … 82
             CENTERS)              NIGHTS            AMOUNT         Yes … 1   (AMOUNT)                                      No … 2     Household member's employer … 83
               Yes… 1                                               No … 2                                                                      Health insurance … 84
         No … 2 (>>25)                                                                                                                          Other … 85 (specify)


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Section 3, part b – PREVENTATIVE HEALTH – IMMUNIZATIONS
Fill in data taken during GLSS5; ask questions of ALL household members who were not asked these questions during GLSS5
            1                                                              2                                                      3              4             5
 ID        Has                                  Has (NAME) ever received the following vaccines?                           Did you have to     How        Why was
        (NAME)                                   1 = yes; 2 = no; 3 = don't know; 4 = not applicable                        pay any fee for    much     (NAME) not
        ever been               COPY FROM IMMUNIZATION BOOK / (WEIGH -IN) CARD IF AVAILABLE                                      these          was     immunized?
                                                                                                                           immunizations?              Too young .. 1
      immunized?                                                                                                                               paid?
                                                                                                                                                         Don't know
                                             IF ALL ANSWERS EQUAL 3 AND/OR 4>>> PART 3C
                                                                                                                             Yes .. 1                 (NAME) had to
        Yes … 1                                                                                                            No … 2 (Next
                                                                                                                                              (CEDIS)        …2
         No … 2                                                Type of immunization                                           person)                 Health center too
      (if no >> 5)                                                                                                                               >>        far … 3
                                                                                                                                               NEXT      Shortage of
                                                                                                                                               PERSO     supply … 4
                                                                                 FIVE IN              VITAMIN     YELLOW                                 Other … 5
                  BCG                  POLIO                         DPT           ONE   MEASLES         'A'       FEVER                                  (specify)
                           0      1     2    3       Booster    1     2      3
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Section 3 part c – Child Health / Postnatal care
fill in entire sheet from GLSS5; ask entire sheet to new household members under 5 years old
                     1               2              3              4            5          6             7                8         9           10              11
 ID             Did you or    How many Did you have to How much            Does (or At what age     At what age       At what  At what age      Does   Who usually looks
              someone else      times did        pay for        do you      did) the     was       did (NAME)         age was did (NAME) (NAME)          after (NAME)
             take [name] to    [name] go      consultations? usually pay    mother    (NAME)         receive any     (NAME)    receive any participate     during the
      ID of person interviewed




                                                 1 = yes                                           liquid (except               food other                  daytime?
             a health center     there for                      for one   breastfeed? weaned?                           first                    in a
                                              2 = no (>> 5)                                         water) other                   than                    1 = mother
                for a post-  consultations                   consulation? (NAME)                                       given                 community
                                                                                                        than                 breastmilk for              2 = adult male
               natal care in in the past 12                                           REPORT       breastmilk for      water? the first time? feeding   3 = adult female
                the past 12      months?                       (CEDIS)      1 = yes       IN       the first time?             REPORT IN program?        4 = male child
                  months                                                     2 = no   MONTHS        REPORT IN        87 = not MONTHS                    5 = female child
                  1 = yes                                                    (>> 9)   87 = still     MONTHS            yet     87 = not yet    1 = yes     6 = creche
              2 = no (>> 5)                                                            breast-      87 = not yet                               2 = no  7 = other (specify)
                                                                                       feeding


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Section 3, part c – Child Health / Development
NEW -- complete for all children in household ages 9 and younger
                       1                  2                 3                         4                5              6
 ID         Does (NAME) attend         In the How many children's/ picture How many other         In the past   In the past
           any organized learning last 7       books are there in the house.    books (adult      week, how     week, how
              or early childhood       days, (answer once for entire house)         books,       many times many times
       ID of Person Interviewed




           education programme,         how                                  schoolbooks, etc.) was (NAME) was (NAME)
             such as a private or      many                                    are there in the left in care of left alone?
            government facility, hours did                                    house? (answer another child
           including kindergarten (NAME)                                       once for entire      (that is,
             or community child       attend?                                       house)         someone
                     care?                                                                         under 10
                                                                                                 years old)?
                   Yes … 1
                   No … 2

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Section 3, part c – Fertility and Prenatal care
fill in columns 1 - 12 from GLSS5; complete questions 1 - 12 for women ages 12-49 who are new to HH and questions 13 - 14 for HH members present during GLSS5
           1            2           3         4          5            6      7              8              9           10        11       12       13       14
 ID    Have you     Have you      How       How     I would like How        How     I would like to     Did you   How many Are you During the Are you During the
       ever been    ever given   many       many to make sure many          many    make sure you      have any     of those  pregnant  past 12 pregnant  past 12
       pregnant?     birth to agirls have boys have you have        girls boys are have total number pregnancy    pregnancies   now?    months    now?    months
                      child?
                               you given you given given birth to are still still   of …. Children which did did not end               have you          have you
                                                                                                                    in a live
       Yes … 1                  birth to? birth to?     …          alive? alive?         alive?      not end in a             Yes … 1    been   Yes … 1    been
                   IF NO,                                                                                            birth?
       No … 2     PROBE:
                                                                                                      live birth?              (>>16) pregnant? (>>16) pregnant?
       (>> Part   Even one                 BOYS       TOTAL       GIRLS BOYS            TOTAL                     NON-LIVE    No … 2            No … 2
         3E)      who lived      GIRLS               NUMBER                         NUMBER OF          Yes … 1     BIRTHS              Yes … 1           Yes … 1
                 only a few                             OF                           CHILDREN           No … 2                         No … 2            No … 2
                hours or less?                      CHILDREN                            ALIVE           (>>11)                          (>>Part           (>>Part
                                                    (Q.3 + Q.4)                       (Q.6 + Q.7)                                         3E)               3E)

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Section 3, part d – Fertility and Prenatal Care
fill in entire sheet from GLSS5; complete entire sheet for women ages 12-49 who are new to household and
       ask questions 15 - 17 to any HH members who were pregnant during GLSS5
if any members of the household who were present during GLSS5 have become pregnant or given birth since the survey (regardless of whether they were
       pregnant / had recently given birth when GLSS5 was administered), ask the questions on this page to them about the new birth and fill in their answers
       on one of the extra columns at the bottom of the page -- make sure to record HH ID in the first column
              15           16          17           18           19              20                         21                 22            23              24
ID      How did this    Is that   Are you now During this How old From where did you                 From whom did you        How       How much Why didn't you go for
                                                                         receive that care?           receive that care?                               prenatal care?
      pregnancy end? child still breastfeeding? pregnancy was your                                                            many      did you pay
                                                                                                        Doctor … 01
                         alive?                   did you   pregnancy                                    Nurse … 02        times did    for the first
                                                                           Prenatal clinic                                                            Can't afford … 1
       Live birth … 1               Yes … 1     receive any when you                                 Medical Asst … 03       you go       prenatal
                                                                           (private ) … 1                                                              No health care
       Still birth … 2 Yes … 1      No … 2       pre-natal      first                                  Midwife … 04          there?    consultation?
                                                                      Prenatal clinic (public)        Pharmacist … 05                                   available … 2
        ( 7+ months)   No … 2                      care?     received           …2                                                                   Health care too far …
                                                                                                    Chemical Seller … 06
           (>>18)       (>>18)                               prenatal      Hospital … 3               Trad Healer … 07
                                                                                                                                        >> Part 3E             3
      Mis-carriage …                              Yes ... 1    care?   Maternity Home … 4            Trained TBA … 08                                 Not necessary … 4
          3 (>>18)                                No … 2              Home of practitioner …        Untrained TBA … 09                  AMOUNT       Other … 5 (specify)
         Other … 4                                (>>24)     WEEKS                5                   Spiritualist … 10
                                                                       Community epicenter          Other … 11 (specify)
      (specify) (>>18)
                                                                                     …6
                                                                              Other … 7 (specify)

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Section 3, part d – Fertility / Women's Health
NEW -- complete for all women in household ages 12 to 49
                25              27            28        29          30            31            32              33
 ID         How many      After your last    How    For how How old were Do you still How old were            If still
           years/ months    child, how       many     many      you at your     have       you when you   menstruating,
            have passed   many months       months months did      first     menstruation?    stopped     have you gone
          since second to passed before     passed     you     menstruation?               menstruating? more than three
             last child?   you resumed      before breastfeed?                 Yes … 1                   months without
                              sexual         your              Not yet …87     No … 2                    menstruating one
                          relationships?    period                                                       or more times in
                                             came                                                         the past year?
                           Not yet …87      back?                                                            1 = yes
          years months                                                                                        2 = no

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Section 3, part e -- Contraceptive use and HIV/AIDS awareness
fill in entire sheet from GLSS5; complete entire sheet for new household members ages 12 and older
           1                        2                        3                   4                     5                6                 7         CODES FOR QUESTION 5
ID     Are you or     What main method are you using?    IF Q.2 = 01 If Q.2 = 01 TO 09, ASK:     Why are you Do you think you Which main Not married … 11
                                 Pill … 01                                                                         will use a                       Fertility-related reasons
      your partner                                      TO 09, ASK:                              not using any                    contraceptive
                            Male condom … 02                            Where did you get the                    contraceptive                   Infrequent sex / no sex … 22
       using any           Female condom … 03                                                    contraceptive                     would you Menopausal/Hysterectomy … 23
                                                                             method?                           method to delay or
       method to                IUD … 04                How much                                   method?                        prefer to use? Wants as many children as
                                                                                                                avoid pregnancy in
       prevent or             Injection … 05            did you pay                                                                                 possible … 26
                             Female sterl … 06                      Prenatal clinic (private) …                     the future?                        Opposition to use
         delay                                            for that                1              See codes at                        See codes at
                              Male sterl … 07                                                                                                       Respondent opposed … 31
      pregnancy?              Implants … 08
                                                         during the Prenatal clinic (public) … 2    right       Yes, Delay/Avoid        right
                                                                                                                                                    Husband opposed … 32
                             Foam/Jelly … 09            last month?        Hospital … 3                          Pregnancy … 1                      Religious prohibition ... 34
       Yes … 1                  LAM … 10                                Maternity home … 4                      Yes Other reason                       Lack of knowledge
       No … 2                Abstinence … 11             AMOUNT       Home of practitioner … 5                         …2                           Knows no method ... 41
                               Rhythm … 12                             Pharmacy/Chemist/Drug                         No … 3                         Knows no source ... 42
        (>>5)
                             Withdrawal … 13                                  store .. 6                        Don't know … 4                         Method-related reasons
                           Other … 14 (specify)                                                                                                     Health concerns ... 51
                                                                      Community epicenter … 7                         (>>8)
                            IF Q=10 - 14 >> 8)                                                                                                      Fear of side effects ... 52
                                                                         Other … 8 (specify)
                                                                                                                                                    Lack of access / too far ... 53
                                                                                                                                                    Costs too much ... 54
                                                                                                                                                    Inconvenient to use ... 55
                                                                                                                                                    Interferes with body's normal
  1                                                                                                                                                 processes ... 56
  2                                                                                                                                                 Other (specify) ... 96
                                                                                                                                                    Don't know ... 98
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  6                                                                                                                                                 CODES FOR QUESTION 7
                                                                                                                                                    Pill … 01
  7
                                                                                                                                                    Male condom … 02
  8                                                                                                                                                 Female condom … 03
  9                                                                                                                                                 IUD … 04
                                                                                                                                                    Injectibles … 05
 10
                                                                                                                                                    Female sterilization … 06
 11                                                                                                                                                 Male sterilization … 07
 12                                                                                                                                                 Implants … 08
                                                                                                                                                    Foam/Jelly … 09
 13
                                                                                                                                                    Lactational Amen. Method …
 14                                                                                                                                                 10
 15                                                                                                                                                 Periodic abstinence … 11
                                                                                                                                                    Withdrawal … 12
 16
                                                                                                                                                    Diaphragm ... 13
 17                                                                                                                                                 Other (specifiy) ... 96
 18                                                                                                                                                 UNSURE ... 98
Section 3, part e -- Contraceptive use and HIV/AIDS awareness (concluded)
fill in columns 8 throuh 13 from GLSS5; ask questions 14 and 15 to HH members present during GLSS5 complete entire sheet for new household members ages 12 and older
                8                        9                         10            11             12                   13               13           14
  ID Now I would           What can people do to prevent    Is it possible Can the virus If yes, by what What would you do to       Do you    If yes, how CODES FOR QUESTION
         like to talk to             HIV/AIDS              for a healthy- that causes        means?       prevent yourself from      know        many     9
           you about                                           looking        AIDS be                    being infected with the anyone that    people? Abstain from sex … 01
        something else.       (UP TO 3 MAIN WAYS)             person to     transmitted      During      virus that causes AIDS? currently                Use condom … 02
         Have you ever                                         have the from a mother pregnancy … 1                               has died of             Limit sex to one
          heard of an            see codes at right         AIDS virus?       to child?  During delivery Abstain from sex … 1 AIDS in the                 partner/stay faithful to one
         illness called                                                                        …2        Be faithful to partner … past year?              partner … 03
          HIV/AIDS?                                           Yes … 1         Yes … 1        During                  2              1 = yes               Limit number of sexual
                                                               No … 2          No … 2     breastfeeding     Have safe sex … 3       2 = no                partners … 04
            Yes … 1                                          Don't know        (>>13)          …3           Use a condom … 4                              Avoid sex with prostitutes
          No … 2 (>>                                              …8       Don't Know                      Other … 5 (specify)                            … 05
         Next Person)       1st         2nd         3rd                    … 3 (>>13)                                                                     Avoid sex with persons
                                                                                                                                                          who have many partners …
     1
                                                                                                                                                          06
     2                                                                                                                                                    Avoid sex with
     3                                                                                                                                                    homosexuals ... 07
                                                                                                                                                          Avoid sex with persons
     4
                                                                                                                                                          who inject drugs
     5                                                                                                                                                    intravenously ... 08
     6                                                                                                                                                    Avoid blood transfusions
                                                                                                                                                          ... 09
     7                                                                                                                                                    Avoid injections ... 10
     8                                                                                                                                                    Avoid sharing razors/blads
     9                                                                                                                                                    ... 11
                                                                                                                                                          Avoid kissing ... 12
   10                                                                                                                                                     Avoid mosquito bites ... 13
   11                                                                                                                                                     Seek protection from
                                                                                                                                                          traditional practioner ... 14
   12
                                                                                                                                                          Other (specify) ... 96
   13                                                                                                                                                     Don't know ... 98
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Section 3, part f -- Insurance -- individual specific questions
fill in columns from 1 through 9 from GLSS5; complete entire sheet for new household members and questions 10 and 11 for everyone
             1               2             3                4                     5            6           7                   8                               9         10        11
 ID Has (NAME) If (NAME) has never Is (NAME)        If (NAME) is no         If (NAME) is  What are the    Does    Has (NAME) paid premium or                    Has       Is       Does
         ever been   been registered, why?     still      longer a member,     registered or covered, expected       (NAME) expected to pay for the current (NAME) (NAME) (NAME)
       registered or Premium is too high registered              why?           what type of scheme benefits of     pay all/part       insurance year?      benefitted covered     have
      covered with a         …1            or covered? Premium is too high …    is he/she registered this scheme?      of the                                from the under the informal
           health        Does not have                             1                    with?                       premium?                                 scheme? national     health
         insurance       confidence in         Yes,           Do not have             (CHECK          Only OPD                                                          health  insurance
          scheme?       operators of the    registered       confidence in        MEMBERSHIP         services … 1     All … 1                                Yes …1 insurance coverage
                         scheme … 2        … 1 (>>5) purveyors of scheme               CARD)           Only in-      Part … 2                                No … 2 scheme?        (e. g.
      Yes registered   Covered by other        Yes,              …2             District mutual … 1     patient     Exempted                                           1 = Yes through a
        … 1 (>>3)        avenues … 3       covered …      Covered by other      Private mutual … 2 services … 2         …3                                             2 = No     susu)?
       Yes covered No knowledge of any        (>>5)        alternatives … 3    Private company … 3 Both … 3            (>>9)                                                     1 = Yes
        … 2 (>>3)        scheme … 4          No … 3        Was not getting      Other … 4 (specify)                  N/A … 4       a PAID      b EXPECTED                         2 = No
          No … 3      Other … 5 (specify)                    benefits … 4                                              (>>9)     (AMOUNT)         TO PAY
                       NEXT PERSON                      Other … 5 (specify)                                                                     (AMOUNT)
                                                         (NEXT PERSON)

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Section 3, part g – Mental Health
NEW -- fill out for all household members ages 10 and older
GSS: we are interested in assessing mental health status but acknowledge that two pages might be too much -- suggestions for which questions are most important / which can be cut?
           1             2            3           4                       5              6              7               8             9             10               11                    12
ID Have you        How long did Have you How long did                 Have you How long did the Have you felt How long did        Have you     How long did       Have you            How long did
      experienced the insomnia experienced the fatigue               been short-      short-       sadness for   this period of exper-ienced the period of     experienced a           the period of
           any         last?     fatigue or     last?               tempered or temperedness and    extended     sadness last?   any fear or fear and anxiety period of feeling           feeling
                                                                                                                                anxiety in the     last?         hopeless or            hopeless or
      insomnia in               exhaustion                              hyper-    hypersensitivy periods of time
                                                                                                                                    past 4                    worthless in the        worthless last?
        the past 4  (Answer in   the past 4  (Answer in             sensitive in       last?      during the 4     (Answer in
                                                                                                                                   weeks?       (Answer in     past 4 weeks?
         weeks?    either weeks   weeks?    either weeks              the past 4                     weeks?       either weeks                 either weeks                            (Answer in
                   OR days, not             OR days, not               weeks? (Answer in either                  OR days, not     1 = often    OR days, not       1 = often           either weeks
        1 = often      both)     1 = often      both)                            weeks OR days,     1 = often         both)          2=            both)       2 = sometimes          OR days, not
           2=                        2=                               1 = often     not both)    2 = sometimes                   sometimes                        3 = never               both)
       sometimes                sometimes                                2=                         3 = never                     3 = never
        3 = never                3 = never                           sometimes
                                                                      3 = never


                   WKS DAYS                        WKS DAYS                        WKS       DAYS                         WKS DAYS                        WKS     DAYS                WKS DAYS

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Section 3, part g -- MENTAL HEALTH CONCLUDED
NEW -- fill out for all household members ages 10 and older
GSS: we are interested in assessing mental health status but acknowledge that two pages might be too much -- suggestions for which questions are most important / which can be cut?
ID        13                14            15             16                 17               18                19
      In the past 4    How long did In the last 4    In the last 4     In the last 4      In the past    Where have you
      weeks, have                   weeks, how
                      the feeling that               weeks, how      weeks, was there       30 days,     sought help for
           you          everything   many days        many days        a time when         have you      problems with
     experienced a                 did problems
                       was an effort                       did        health-related     sought help    emotional health,
      period when           last?  with feelings/      problems      problems caused           for    alcohol, or drug use?
      you felt like                  emotions,            with       difficulties with     problems
       everything      (Answer in    alcohol, or        feelings/     concentration,          with       1 = health care
     was an effort?   either weeks    drug use         emotions,         memory,          emotional       professional
                      OR days, not cause you to       alcohol, or     understanding,         health,  2 = religious group /
       1 = often          both)    be unable to         drug use        or thinking      alcohol, or religious counselor
          2=                          carry out     cause you to          clearly?         drug use?    3 = non-religious
      sometimes                    your normal        stay in bed                                             group
       3 = never                        daily           for more                            1 = Yes   4 = family members
                                     activities?    than half the                            2 = No    5 = other (specify)
                                                          day?                             3 = Can't




                      WKS DAYS           DAYS          DAYS               WKS              DAYS               WKS

 1
 2
 3
 4
 5
 6
 7
 8
 9
10
11
12
13
14
15
16
17
18
Section 3, part g -- MENTAL HEALTH (ALTERNATIVE MODULE)
NEW -- fill out for all household members ages 10 and older

In the past week, how many days have you:
                  Been         Had      Felt     Felt that Fel hopeful     Felt       Had      Felt happy?     Felt    Could not
                bothered     trouble depressed? everything about the     fearful?   restless                 Lonely?      get
               by things     keeping             you did     future                  sleep?                            "going"?
              that usually your mind              was an
    ID            don't     on what               effort?
                 bother     you were
                  you?       doing?

                  1          2           3            4         5           6          7           8           9          10
          1
          2
          3
          4
          5
          6
          7
          8
          9
         10
         11
         12
         13
         14
         15
         16
         17
         18
Section 3, part h --ACTIVITIES OF DAILY LIVING
NEW -- fill out for all household members ages 10 and older
ID                 1            2              3           4                                       5             6             7             8             9            10              11              12            13            14            15            16
       ID of Person Being Interviewed



              If (NAME) How long If (NAME) How long                                            If (NAME) How long If (NAME) How long If (NAME) How long If (NAME) had How long If (NAME) How long If (NAME) How long
            had to carry a     has      had to sweep      has                                 had to walk        has      had to draw        has       had to bend,       has      to stand up from     has      had to bathe       has       had to feed       has
            heavy load for (NAME)        the floor or  (NAME)                                    for 5 km     (NAME) water from a (NAME)                 kneel, or     (NAME) a seated position (NAME) his/herself (NAME) his/herself (NAME)
               20 meters                yard without                                          without any                 well without                stoop without                   on the floor               without any                 without any
                               had                        had                                                    had                         had                          had                           had                         had                        had
             without any                  any help,                                            help, could                  any help,                    any help,                    without any                 help, could                 help, could
                           difficulty /               difficulty /                                           difficulty /                difficulty /                 difficulty /                  difficulty /                difficulty /                difficulty/
             help , could               could he/she                                          he/she do it?               could he/she                 could he/she                   help, could                he/she do it?               he/she do it?
             he/she do it?
                              been          do it?       been                                   1 = easily      been          do it?        been           do it?        been        he/she do it?     been                        been                        been
               1 = easily   unable to     1 = easily   unable to                                 2 = with     unable to    1 = easily     unable to                    unable to                     unable to     1 = easily    unable to     1 = easily   unable to
                2 = with     do this?      2 = with     do this?                                difficulty     do this?     2 = with       do this?     1 = easily      do this?       1 = easily     do this?      2 = with      do this?      2 = with     do this?
                                          difficulty                 difficulty               3 = not at all                difficulty                   2 = with                       2 = with                   difficulty                  difficulty
                                        3 = not at all             3 = not at all                                         3 = not at all                 difficulty                    difficulty                3 = not at all              3 = not at all
                                                                                                                                                       3 = not at all                3 = not at all

                                                         YRS MOS                    YRS MOS                YRS MOS                     YRS MOS                     YRS MOS                         YRS MOS                     YRS MOS                     YRS MOS
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
 19
 20
 21
Section 3, part h – Miscellaneous Health
NEW -- fill out for all household members ages 10 and older
 ID In general, how         Have you         In the past 3     Have you ever    At what    Do you still How long In one day     In the past Would you     If so, when?      Will you     Are you so   How many
      would you rate ever had any months, have you had the habit of age did smoke, or have ago did you how many                 12 months, like to quit                   actually quit  addicted to  days in one
        your health?          sores or    had numbness or         chewing      you begin you completely  quit?     cigars/       have you      smoking      DO NOT       smoking in the smoking that week do you
                            irritations tingling in the hands     tobacco,
                                                                               this habit?    quit?               cigarettes   tried to stop sometime in   PROMPT:       next 6 months? you will need  consume
                                          or feet, other than smoking a pipe,
    1="Very healthy" on the feet                                                                        YEARS      did you       smoking?     your life? 1 = In the next                some sort of   alcoholic
                                         numbness /tingling smoking self-
      2="Somewhat            that took   from hands or feet rolled cigarettes,
                                                                                AGE IN 1= still smokes            consume                                    30 days         1 = yes    help to quit? beverages?
          healthy"          more than falling asleep, foot      or smoking      YEARS         (>>8)              now/before       1 = yes       1 = yes  2 = In the next     2 = no
      3="Somewhat          four weeks       aches or long        cigarettes/               2 = has quit             totally       2 = no        2 = no         year                        1 = yes
         unhealthy"           to heal?          walks?             cigars?                                        quitting?                     (>>13)   3 = In the next                   2 = no
      4="Unhealthy"                                                                                                                                          5 years
                              1 = yes           1 = yes            1 = yes                                         (>>14)                                   4 = Later
                               2 = no           2 = no         2 = no (>>14)                                                                             5 = When I get
                                                                                                                                                               sick
             1               2               3                 4            5             6             7            8               9            10            11             12            13           14
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 3, part i – ANTHROPOMETRY
NEW -- fill out for all household members
 ID Name of Household            Was        If not, why not?     Was height measured      Height        Weight   Hip Size   Waist Size         Arm
            Member             (NAME)                             standing of lying                                                       circumference
                              measured?   1 = not home during          down?                                                             (mid-upper arm)
                                              survey period
                                1 = yes         2 = too ill         1 = standing
                                2 = no     3 - handicapped or      2 = lying down
                                                deformed
                                             4 = not willing
                                           5 = other (specify)
                                                                                       MTRS        CM   KGS        CM          CM             CM
   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days
fill in entire sheet from GLSS5; complete entire sheet for new household members ages 7 and older and for household members currently doing jobs that weren't
      their primary or secondary occupations during GLSS5 (record job changes at the bottom, making sure to note HH ID number)
            Did [name] do any During In total,                                                                                 During      Has                            Are taxes
                                                                                                                                                   What is the amount
                work for pay,     the last 7   how                                                                             the last [name]                             already
             profit, family gain days, how many
                                                                                                                                                      (including any
                                                                                                                               7 days, received or                        deducted
            ID of Person Interviewed




                or did [name]                         During the last 7 days, what                               How long has                             bonuses,
                                    many      hours    were the main tasks and         What kind of trade,       [name] been     how       will        commissions,         from
              produce anything
                                   jobs did    did     duties in the job [name]    services, or industry is this   doing this long did [name]      allowances or tips)    [name's]
Member ID




             for barter or home
             use during the last
                                 [name] do [name] spent most of his/her time         work connected with?           work all   [name] receive            received?          pay?
                   7 days?            all    work in              on?                                              together?   actually money for
                   Yes = 1        together? all these                                                                         work on this work? (see time unit codes     1 = Yes
                   No = 2         (number) jobs                                                                               this job? Yes = 1            below)         2 = No
             (if no >> page 47)              over the                                                                          (hours)    No=2
                                              last 7        main            ISCO                         ISIC                           (if no >>                  time
                                                                                        industry                 years months                        amount
                                              days?      occupation          code                        code                               11)                    unit
                       1               2         3                 4                             5                     6          7          8                9              10
   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (cont.)
fill in entire sheet from GLSS5; complete entire sheet for new household member ages 7 and older and for household members currently doing jobs that weren't their primary
        or secondary occupations during GLSS5 (record job changes at the bottom, making sure to note HH ID number)
               What was       For    Does [name]                               When       Is there a In this job, Is [name] entitled    Will       Codes for question 11:
               the status whom receive any                                    [name]        trade     is [name] to paid sick leave [name]          Paid employee = 1
                                                                                           union in entitled to and/or maternity receive a         AGRICULTURE
             ID of Person Interviewed



               of [name]      did    payment for                              started
                                                      What is the value of                                        leave on this job?                 Self employed
                 in this    [name] this work in                              doing this the place        paid                        retirement
                                                        goods or services                                            1 = yes, sick                     2 = with employees
                  job?       work? the form of                               work, did      where holidays?                           pension?
 Member ID




                                                            provided?                                                    leave                         3 = without employees
                                      goods and                             he/she sign [name]                         2 = yes,                      4 = Contributing family
               See code, See code services?                                  a written works? 1 = Yes maternity leave                  1 = yes     worker
               If code is               1 = Yes                              contract?                  2 = No       3 = yes, both     2 = no       NON-AGRICULTURE
                02 - 07                 2 = No                                1 = Yes      1 = Yes                      4 = no                       Self employed
                                        (>>22)        (>> 15)                time   2 = No   2 = No                                                5 = with employees
                                                                value
                                                                             unit                                                                  6 = without employees
                                                                                                                                                 7 = Contributing family
                                          11     12     13              14           15       16       17             18             19         worker
     1                                                                                                                                          Domestic employee = 8
     2                                                                                                                                               (househelp)
                                                                                                                                                Apprentice = 9
     3                                                                                                                                          Other (specify) = 10
     4
     5
     6
     7
                                                                                                                                                Codes for question 12
     8
                                                                                                                                                GOVERNMENT SECTOR
     9                                                                                                                                           1 = Civil Service
    10                                                                                                                                           2 = Other public service
    11                                                                                                                                           3 = Parastatals
                                                                                                                                                NGO's = 4
    12
                                                                                                                                                Cooperatives = 5
    13                                                                                                                                          International Org.
    14                                                                                                                                           / Diplomatic Mission = 6
    15                                                                                                                                          Private Sector formal = 7
                                                                                                                                                  (including paid apprentice)
    16
                                                                                                                                                Private Sector informal = 8
    17                                                                                                                                          Agricultural business = 9
    18                                                                                                                                          Other (specify) = 10




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (cont.)
fill in entire sheet from GLSS5; complete entire sheet for new household members ages 7 and older and for household members currently doing jobs that
        weren't their primary or secondary occupations during GLSS5 (record job changes at the bottom, making sure to note HH ID number)
               Is [name]       Is    Where does                                 How many                                          Codes for question
              entitled to [name's]     [name]       How far                                  During the last 6
                                                                                  people                                          23:
                                                                                                months, has
             ID of Person Interviewed


                 free or   place of usually do his away is How often does altogether                                              Office = 1
              subsidized work in or her work? [name's]             [name] go                 [name] received
                                                                                work in the                                       Home = 2
                                                                                                any training    How long was the
                medical      this                                                                                                     (>> 26)
 Member ID




                                                    place of    between his or place where
                                                                                             related to his/her    training?      Factory = 3
              care in this village / (see codes) work from her house and          [name]
                  job?      town?                  his or her place of work?                  work, including                     Workshop = 4
                                                                                  works?
                                                     home?                                       on-the-job                       Own land/farm = 5
                1 = Yes 1 = Yes                                                                   training?                       Other land/farm = 6
                                                                                Code "DK"                                         River/ocean = 7
                2 = No     2 = No                                                                  1 = yes
                                                                no. of    time   for don't                                        Hotel/restaurant/
                                                      km.                                           2 = no      months weeks
                                                                 trips    unit     know                                             chop bar = 8
                   20         21          22           23              24           25                26               27         Store/shop/
     1                                                                                                                              tabletop = 9
                                                                                                                                  Street at a fixed
     2                                                                                                                              location = 10
     3                                                                                                                            Street not at a fixed
     4                                                                                                                              location = 11
     5                                                                                                                            Lorry park = 12
                                                                                                                                  Somebody's home
     6                                                                                                                               or veranda = 13
     7                                                                                                                            School = 14
     8                                                                                                                            Hospital/clinic = 15
                                                                                                                                  Other (specify) =
     9
                                                                                                                                     16
   10
   11
   12
   13
   14
   15
   16
   17
   18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (concluded)
fill in columns 29-32 from GLSS5; complete columns 29-32 for new household members ages 7 and older and complete 33 - 38 for household members present during GLSS5
also fill in columns 29-32 for job changes
                                                                                         Has this    How                           If no, why not?   Is [name]    Interviewer:
                What type of training                                 By how much was                           What is the
                                                                                           been      many                        1 = now secondary currently      check to see
                                        Who paid for the Did [name]            it?                                amount
                did [name] receive?                                                      [name's] hours                                   job
                                            training?        lose an                                                                                  working whether this new
                                                                                                              (including any 2 = sacked from job
            ID of Person Interviewed



                     Clerical = 1                                                        primary      did                                                            job was
                                      1 = [name] entirely entitlement                                                                                 outside
                Prof / managerial = 2                                  Write difference job for the [name]       bonuses,         3 = job completed              secondary job
                                          2 = Employer     or benefit                                                                                    the
                   Computer = 3                                        between normal      last 7   work in commissions,          4 = seasonal work              during GLSS5
Member ID




                                             entirely      during the                                                                                  home?
                   Marketing = 4                                         entitlement /    days?     this job allowances or         5 = firm closed                   1 = Yes
                                        3 = Both (shared   period of
                    Teaching = 5                                        benefit while                in the tips) received in 6 = found / preferred 1 = Yes; 2 = No (if no, fill
                                               cost)         his/her
                   Leadership = 6                                                        1 = Yes     past 7 the past 7 days?          other work      2 = No     out Q2 - Q32
                                             4 = Free       training?   training and
                    Medicine = 7                                                          2 = No     days?                            7 = retired    (if no >> starting on a new
                                        5 = International              before training                        >> second job
                  Accountancy = 8                                                         (if no,                                8 = other (specify) page 47) line on bottom of
                                              agency         1 = Yes
                  Skills / trade = 9                                                      >> 36)                                                                    page 39)
                                       6 = Other (specify)   2 = No    amount      time                      amount time
                Other (specify) = 10
                                                                    (cedis)     unit                         (cedis)     unit
                                       28   29             30              31              32        33             34                  35              36            37
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days
fill in entire sheet from GLSS5; complete entire sheet for new household members ages 7 and older and for household members currently doing jobs that weren't their primary
      or secondary occupations during GLSS5 (record job changes at the bottom, making sure to note HH ID number)
                                                                                                          Has                     What    For   Codes for question 8:
                                                                                         Did [name]     [name]    What is the was the whom Paid employee = 1
                                                                                                                                                AGRICULTURE
                                                                              During work on this job received      amount     status of  did
             Describe the main tasks                                                                                                              Self employed
                                                                How long has  the last at same time as or will (including any [name] [name]
            ID of Person Interviewed




              and duties in the other   What kind of trade,                                             [name]                                      2 = with employees
                                                                 [name] been 7 days, his/her main job              bonuses,      in this work?      3 = without employees
            kind of work that [name] services, or industry is                   how     over the last 7 receive
                                                                  doing this                                    commissions,      job?            4 = Contributing family
Member ID




            spent most time on, apart  this work connected                   long did        days?      money                                   worker
                                                                    work all                                    allowances or             See
                from his/her main              with?                          [name] If yes, how long for this                                  NON-AGRICULTURE
                                                                   together?                                    tips) received    See    codes
                   occupation?                                                actually did [name] do work?                                        Self employed
                                                                             work on         both       1 = Yes in the past 7    code,              5 = with employees
                                                                             this job? altogether?      2 = No       days?      If code             6 = without employees
                                                                                                                                                  7 = Contributing family
                                                                                       Less than 1 day (if no,                  is 02 -
                                                                                                         >> 8)                                  worker
                                                                              (hours)         =0                                   07           Domestic employee = 8
                secondary        ISCO                    ISIC                                                   amount time
                                          industry              years months             . . . No = 9                          (>>22)                  (househelp)
                occupation        code                   code                                                   (cedis) unit
                                                                                                                                                 Apprentice = 9
                                       1                 2                         3              4   5   6         7            8        9      Other (specify) = 10
  1
  2
  3
  4
  5
                                                                                                                                                Codes for question 9:
  6                                                                                                                                             GOVERNMENT SECTOR
  7                                                                                                                                               1 = Civil Service
  8                                                                                                                                               2 = Other public service
                                                                                                                                                  3 = Parastatals
  9                                                                                                                                             NGO's = 4
 10                                                                                                                                             Cooperatives = 5
 11                                                                                                                                             International Org.
                                                                                                                                                  / Diplomatic Mission = 6
 12                                                                                                                                             Private Sector formal = 7
 13                                                                                                                                             (including paid apprentice)
 14                                                                                                                                             Private Sector informal = 8
                                                                                                                                                Agricultural business = 9
 15                                                                                                                                             Other (specify) = 10
 16
 17
 18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days (continued)
fill in entire sheet from GLSS5; complete entire sheet for new household members ages 7 and older
note that these questions are NOT meant to be asked about new secondary jobs (only questions 1 - 9 are)
              Does [name]                            When      Is there a In this job, Is [name] entitled    Will     Is [name]     Are taxes Is [name] Where      Codes for question
               receive any                          [name]        trade    is [name] to paid sick leave [name]       entitled to     already entitled to does      19:
                                                    started     union in entitled to and/or maternity receive a         free or     deducted any other [name]
            ID of Person Interviewed




              payment for                                                                                                                                          Office = 1
                                                                                       leave on this job?                                                          Home = 2
              this work in  What is the value of doing this the place         paid                        retirement subsidized       from      social   usually
                                                   work, did     where     holidays?                       pension?    medical      [name's] security      do         (>> 26)
Member ID




               the form of   goods or services                                            1 = yes, sick
                                                  he/she sign [name]                                                 care in this     pay?     benefits his/her    Factory = 3
                goods and        provided?                                                    leave
                                                   a written    works?      1 = Yes                         1 = yes      job?                   on this  work?     Workshop = 4
                services?                                                                   2 = yes,
                                                   contract?                 2 = No                         2 = no     1 = Yes      1 = Yes      job?              Own land/farm = 5
                                                                                        maternity leave
                                                                                                                                                                   Other land/farm = 6
                 1 = Yes                                        1 = Yes                   3 = yes, both                2 = No        2 = No               See
                                                                                                                                                                   River/ocean = 7
                 2 = No                             1 = Yes      2 = No                      4 = no                                            1 = Yes   codes     Hotel/ restaurant/
                 (>> 12)      value     time unit 2 = No                                                                                       2 = No              chop bar = 8
                                                                                                                                                                   Store/shop /table top
            10               11                 12          13          14             15                    16           17           18        19        20      =9
  1                                                                                                                                                                Street at a fixed
  2                                                                                                                                                                  location = 10
  3                                                                                                                                                                Street not at a fixed
                                                                                                                                                                     location = 11
  4                                                                                                                                                                Lorry park = 12
  5                                                                                                                                                                Somebody's home or
  6                                                                                                                                                                  veranda = 13
  7                                                                                                                                                                School = 14
                                                                                                                                                                   Hospital/clinic = 15
  8                                                                                                                                                                Other (specify) = 16
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days (concluded)
fill in column 20 from GLSS5; complete column 20 for new household members ages 7 and older and complete 21 - 26 for household members present during GLSS5
             How many Has this          How                              If no, why not?      Does       Interviewer:
                                                What is the amount
                people       been      many                           1 = now primary job [name]         check to see
                                                   (including any
             altogether [name's]       hours                           2 = decided only to have a new whether this new
             ID of Person Interviewed


                                                      bonuses,
               work in    secondary     did                             work primary job secondary job was primary
                                                   commissions,
              this place job for the [name]                           3 = sacked from job     job?        job during
 Member ID




                                                allowances or tips)
                where    last 7 days? work in                          4 = job completed    1 = Yes         GLSS5
                                               received in the past 7
               [name]                 this job                         5 = seasonal work     2 = No        1 = Yes
                                                        days?
               works?      1 = Yes     in the                            6 = firm closed              2 = No (if no, fill
                            2 = No     past 7                         7 = found / preferred              out Q1 - Q9)
                                                  >> next person
             Code DK        (if no,    days?                          other secondary job             starting on a new
             for "don’t     >> 11)               amount                     8 = retired               line on bottom of
                                                            time unit
                know"                            (cedis)               9 = other (specify)                 page 43)
                  20          21         22              23                     24             25             26
     1
         2
         3
         4
         5
         6
         7
         8
         9
    10
    11
    12
    13
    14
    15
    16
    17
  18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part c - Underemployment
These questions are from GLSS5, but ask again to all HH members to capture current employment status
                                        Taking all [name's] How did [name] seek                                    Is [name] ready and have     Codes for question 3:
                                                                                   What was                                                     1 = increase his / her earnings
                                              jobs into      to change his / her                What steps did         the requirements to
                                                                                    the most                                                    2 = be more suited to his / her experience and
             ID of Person Interviewed



                                         consideration did work situation in the                 [name] take to       change his / her work     qualifications
                                                                                   important
                                          [name] seek to         last 7 days?                   change his / her    situation during the next   3 = be closer to his / her home
                                                                                     reason
 Member ID




                                          change his / her                                       work situation    7 days or within the next    4 = be in his / her village or town
                                                                                   that made
                                         work situation in   1 = more hours on                                               30 days?           5 = have improved safety at work
                                                                                     [name]
                                          the last 7 days?     current activity                 (most important      1 = Yes, next 30 days      6 = have less excessive hours
                                                                                   seek to do
                                                             2 = more hours on                       only)          2 = Yes, but within next    7 = have better social security / protection
                                                                                      that?                                                     8 = have improved working conditions
                                               1 = Yes       additional activity                                             30 days
                                               2 = No        3 = change activity                  see codes                   3 = No            9 = other (specify)
                                                                                   See codes
                                            (>> part 4E)     4 = other (specify)                                            >> part 4E
                                                1                    2                 3               4                       5
         1                                                                                                                                      Codes for question 4:
         2                                                                                                                                      1 = applied to prospective employer
                                                                                                                                                2 = checked at farms / factories / worksites
         3                                                                                                                                      3 = asked friends and relatives
         4                                                                                                                                      4 = took action to start business (capital,
         5                                                                                                                                      land, equipment, etc.)
                                                                                                                                                5 = took action to start agricultural activity
         6                                                                                                                                      6 = searched newspaper adverts
         7                                                                                                                                      7 = searched employment services
         8                                                                                                                                      8 = other (specify)
                                                                                                                                                9 = none
         9
    10
    11
    12
    13
    14
    15
    16
    17
    18
Section 4, part d - Unemployment in last 7 days
These questions are from GLSS5, but ask again to all HH members not currently working outside of the home
                                                                                   Why has        What did       During this How long      Codes for question 3:
                                                             Has [name] made any                                                           1 = thought no work available
                                            Was [name]                               [name] not [name] do       period what        has
                                                             effort during the last                                                        2 = awaiting reply to earlier enquiries
             ID of Person Interviewed



                                         available for work                           made any        in this      type of      [name]
                                                               7 days or past 30                                                           3 = waiting to start arranged job, business or agri.
                                          during the last 7                         effort to find period to    employment        been
                                                              days to find work?                                                           4 = off season in agri.
                                         days or within the                                                      was [name]
 Member ID




                                                                                        work?      find work?                   seeking    5 = occupied with home duties
                                           next 30 days?                                                           mainly                  6 = illness / injury
                                                              1 = Yes, last 7 days                                               and/or
                                                                                                                   seeking                 7 = full-time student
                                                                     (>> 4)             (most         (most                    available
                                        1 = Yes, last 7 days                                                    (available, if             8 = on vacation
                                                               2 = Yes, but only      important     important                   to find
                                         2 = Yes, but only                                                       not seeking               9 = other
                                                              within next 30 days       only)          only)                     work?
                                        within next 30 days                                                         for)?
                                                                     (>> 4)
                                          3 = No (>> 10)
                                                                    3 = No
                                                                                   see codes     see codes       see codes   see codes Code for question 4:
                                                                                                                                       1 = applied to prospective employer
                                                1                    2                  3             4              5            6
                                                                                                                                           2 = checked at farms / factories / worksites
         1                                                                                                                                 3 = asked friends and relatives
         2                                                                                                                                 4 = took action to start business (capital, land, equipment, etc.)
                                                                                                                                           5 = took action to start agricultural activity
         3                                                                                                                                 6 = upgrading skills
         4                                                                                                                                 7 = searched newspaper adverts
                                                                                                                                           8 = searched employment services
         5                                                                                                                                 9 = other
         6
         7
                                                                                                                                           Codes for question 5:
         8                                                                                                                                 Wage employment in:
         9                                                                                                                                   1 = government or state enterprise
                                                                                                                                             2 = large private firm
    10                                                                                                                                       3 = small / medium scale enterprise
    11                                                                                                                                     4 = Self employment
                                                                                                                                           5 = any job
    12
    13                                                                                                                                     Codes for question 6:
    14                                                                                                                                     1 = Less than one month
                                                                                                                                           2 = 1 month but less than 3 months
    15                                                                                                                                     3 = 3 months but less than 6 months
    16                                                                                                                                     4 = 6 months but less than 1 year
                                                                                                                                           5 = 1 year but less than 2 years
    17                                                                                                                                     6 = 2 years
    18                                                                                                                                     7 = more than 2 years
Section 4, part d - Unemployment in last 7 days continued
These questions are from GLSS5, but ask again to all HH members not currently working outside of the home (i. e. answered NO to page 42 question 37)
                                          What kind of work did [name] do in                                    Why was [name] not                        Codes for question 11:
                                                                                                              available for work during   Under what      1 = high income potential
                                                      his/her last job?
             ID of Person Interviewed



                                                                                   What is the lowest wage the last 7 days or within       conditions,    2 = availability of training
                                          (i. e. what was [name's] main task or                                                                           possibilities
                                                                                  for which [name] is willing     the next 30 days?          if any,
                                                           duties                                                                                         3 = well-defined earnings
 Member ID




                                                                                     to work for someone?           1 = in school             would       (secured)
                                                 -- describe activity fully)
                                                                                                                2 = household duties         [name]       4 = within easy reach of residence
                                                                                          >> part 4E                  3 = too old           become        5 = join spouse
                                        if never worked, write none and code 00                                        4 = sick                           6 = other (specify)
                                                                                                                                          available for
                                                       for ISCO                                                      5 = disabled             work?
                                                                          ISCO                                      6 = pensioner
                                                                                                                                           See codes
                                              OCCUPATION                               amount       time unit          7 = other
                                                                          CODE
                                                           7                                   8                          9                    10
         1
         2
         3
         4
         5
         6
         7
         8
         9
    10
    11
    12
    13
    14
    15
    16
    17
  18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part e - Time use
Fill in for all household members ages 7 and older (we ask time use questions again because we're interested in child care done while completing HH tasks
       and certain activities not mentioned in GLSS5)

How much time on a typical working day do you spend on any of the following activities for the household?
       Collecting                                                  Fetching                                                Shopping                                                  Running
        firewood?                             without                water?                              without               ?                               without            errands (other                        without
          1 = yes     while caring                                   1 = yes     while caring                               1 = yes    while caring                              than shopping?    while caring
                                              children                                                   children                                              children                                                 children
          2 = no      for children                                   2 = no      for children                               2 = no     for children                                   1 = yes      for children
                                              present                                                    present                                               present                                                  present
       (if no, next                                               (if no, next                                              (if no,                                                   2 = no
         activity)                                                  activity)                                                next                                                  (if no, next
                      hours       minutes   hours       minutes                  hours       minutes   hours       minutes activity)   hours       minutes   hours       minutes     activity)     hours    minutes   hours    minutes
            1                 2                     3                  4                 5                     6               7               8                     9                 10                  11                 12

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 4, part e - Time use continued
Fill in for all household members ages 7 and older (we ask time use questions again because we're interested in child care done while completing HH tasks
       and certain activities not mentioned in GLSS5)
How much time on a typical working day do you spend on any of the following activities for the household?
        Caring for clothes:                                                Washing                                                 Cleaning and                                                Cooking and
        washing, mending,                               without              dishes/                             without             upkeep of                             without               preparing                          without
       ironing, sewing new      while caring                                  pots?      while caring                                dwelling?     while caring                                     food?      while caring
                                                        children                                                 children                                                  children                                                 children
               clothes          for children                                1 = yes      for children                                 1 = yes      for children                                   1 = yes      for children
                                                        present                                                  present                                                   present                                                  present
              1 = yes                                                        2 = no                                                    2 = no                                                      2 = no
               2 = no                                                     (if no, next                                              (if no, next                                                (if no, next
       (if no, next activity)   hours       minutes   hours       minutes   activity)    hours       minutes   hours       minutes    activity)    hours       minutes   hours       minutes      activity)    hours    minutes   hours    minutes
                 1                      2                     3                 4                5                     6                 7                 8                     9                  10                 11                 12

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 4, part e - Time use concluded
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
          Taking                                                  Taking care                                                Caring for                                              Reading
          care of                                                   of sick?                                                  children –                                           newspapers,
         elderly?                                                   1 = yes                                                   while not                                             books, or                                                               In an
         1 = yes                                                     2 = no                                                   doing any     Helping with          Other activities magazines?                                                              average
                                              without                                                    without                                                                                                      without
          2 = no      while caring                                (if no, next   while caring                                    other       homework,             (e. g. playing     1=yes      while caring                                             week, how
       (if no, next                           children              activity)                            children              activity?                                              2=no                            children          Sleeping?
                      for children                                               for children                                                 teaching,           outside, giving                for children                                             many days
         activity)                            present                                                    present                1=yes                                                                                 present
                                                                                                                                            reading, etc.             a bath)                                                                              do you
                                                                                                                                 2=no
                                                                                                                                                                                                                                                            work?
                                                                                                                             (if no, next
                                                                                                                               activity)

                      hours       minutes   hours       minutes                  hours       minutes   hours       minutes                  hours       minutes    hours       minutes           hours    minutes   hours    minutes   hours    minutes     days
            1                 2                     3                  4                 5                     6                  7                 8                      9             10              11                 12                 13            14

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 5, part a - Migration
fill in entire sheet from GLSS5; complete entire sheet for new household members and complete columns 6 and 7 for HH members present during
      GLSS5 who answered YES to question 5 (who are missing migration data)
                Was      Has [name] Has [name]                         Does [name]    Where was [name] living previously?
              [name]      ever lived  ever moved                       intend to stay                                     What was [name's] main activity
                   ID of person interviewed




              born in away from this away from                          for a year or  1=Sekondi/        9=Bolgatanga        in [name of place in Q6]?
Household Member




                this      town for a this town for   How long ago more in this Takoradi/Shama               10=Wa             Write name and code of
                                                     did [name] last      village /   2=Cape Coast    11=Other urban (in   occupation or code as follows
               village year or more? a year or
                                                     move/return to        town?         3=Accra            Ghana)           9996 = full time education
             or town?      1 = Yes       more?                            1 = Yes         4=Ho           12=Rural area
                            (>> 4)      1 = Yes         this place?                                                           9997 = looking for work
                                                                           2 = No     5=Koforidua    96=Other ECOWAS
              1 = Yes       2 = No      2 = No                                                                             9998 = other activity (specify)
                                                                                       6=Kumasi      97=Africa other than
               (>> 3)      (>> next    ( >> next                                                                            9999 = no activity (specify)
                                                                                       7=Sunyani           ECOWAS
              3 = No        person)     person)                                         8=Tamale      98=Outside Africa
                                                      Years     Months                                                          Occupation           Code
                                              1   2   3    4               5                        6                                    7
           1
           2
           3
           4
           5
           6
           7
           8
           9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 5, part a -- Migration continued
fill in columns 8 - 10 from GLSS5; complete entire sheet for new household members and columns 11 - 16 for HH members present during GLSS5 who had migrated
      (i. e. responded YES to question 2 or 3 on previous page)
                                       Who was      What was                              Where was [name] born?
                                                                                                                                              What was What was
                                        [name]       the main                       In Ghana                              Outside of Ghana     [name's] [name's]
                                     working for? reason for
                                                                  1 = Kumasi
                                                                                                                                                  daily  daily wage
                                          1=          moving                                               REGION:                              wage in in the job
Household Member




                                                                  2 = Sunyani
                                      government       from                                               2=Western
         In what industry was this                              3 = Cape Coast
                                                                                                           3=Central
                                                                                                                                                the job that [name]
                                       2 = state-    [name of    4 = Koforidua
                   work?                                                                                 4=Gt. Accra                              that     had just
                                        owned         place in     5 = Accra
                                                                                                            5=Volta                             [name]      before
                                       company Q6] to this        6 = Tamale
                                                                7 = Bolgatanga
                                                                                give name of city          6=Eastern   give name of country    first had leaving the
                                      3 = private    village /                                            7=Ashanti
                                                                 8 = Koforidua                                                                   in this  previous
                                      company or town? (see         9 = Wa
                                                                                                        8=Brong Ahafo
                                                                                                          9=Northern                           village?     place?
                                       business        codes    10 = Sekondi-
                                                                                                        10=Upper East
                                       4 = other      below)        Takordi
                                                                                                        11=Upper West
              Industry        Code     (specify)                    11 = Ho                                                                     (cedis)    (cedis)
                   8                   9           10            11                   12                  13                    14                 15        16
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
REASONS FOR MOVING: 1 = job transfer; 2 = seeking employment; 3 = own business; 4 = spouse's employment; 5 = accompanying parent; 6 = marriage;
    7 = other family reasons; 8 = political / religious reasons; 9 = education; 10 = war; 11 = fire; 12 = flood/famine/drought; 13 = other (specify)
                                                                     5 part a _ migration3
Section 5, part a - Migration concluded
complete entire sheet for new and old household members who have migrated (i. e. responded YES to question 2 or 3 on previous page)
                                                    When [name] first moved to this village,
  If anyone (HH member or other village resident)     If [name] worked for a specific person just after If [name] knew anyone other than a
 other than him/herself helped [name] get his or her    arriving in this village, who was this person?     household member who was an
    first job in this village, who was this person?                                                      important reason for moving here,
                                                     List HH ID or name and village ID; or code NV             who was this person?
List HH ID or name and village ID; or code NV if      if this person does not appear on the village
 this person does not appear on the village roster                        roster                         Code NV if this person does not
                                                                                                            appear on village roster
                                  village                                            village                                       village
             name                           HH ID               name                           HH ID           name
                                    ID                                                 ID                                            ID
                        17                                                 18                                          19




                                                                             Page 48
Section 5, part b - Temporary migration
NEW -- complete for all household members ages 7 and older
                             Where was the PRIMARY location where [name] was?
                                            Has                                                                                                               Primary location
                                                                         In Ghana                           Outside of Ghana
                                          [name]
                                           spent
                                                                                                                                        What was [name]
            ID of Person Interviewed




                                       more than       1 = Kumasi                                                                                               Was this
                                                                                             REGION:                                        doing here?
                                         2 weeks       2 = Sunyani                                                                                               job the
                                                                                            2=Western                                    1 = working for
                                         sleeping    3 = Cape Coast                                                              How                             main or
                                                                                             3=Central
Member ID




                                                      4 = Koforidua                                                             many           salary
                                       outside of                                          4=Gt. Accra                                                         secondary What were the main tasks and
                                                        5 = Accra                                                                      2 = working for self
                                        the house                                             5=Volta                            days                         occupation
                                                       6 = Tamale                                                                         3 = helping out                  duties in this job of [name]?
                                       in the last   7 = Bolgatanga
                                                                      give name of city      6=Eastern    give name of country    did                          for [name]
                                                                                            7=Ashanti
                                                                                                                                      family or friends (>>
                                           year?      8 = Koforidua                                                            [name]                           over the
                                                                                          8=Brong Ahafo                                          9)
                                         1 = Yes         9 = Wa                                                                 spend                         last 7 days?
                                                                                            9=Northern                                    4 = education/
                                       2 = No (if    10 = Sekondi-                                                              here?                            1 = Yes
                                                                                          10=Upper East                                      schooling
                                       no >> next        Takordi                                                                                                 (>> 12)
                                                                                          11=Upper West                                        (>> 9)
                                         person)         11 = Ho                                                                                                 2 = No           main              ISCO
                                                                                                                                        5 = other (specify)
                                                                                                                                                                                 occupation       code
                                            1              2                  3                 4                  5               6             7                 8                      9
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 5, part b -- Temporary migration continued
NEW -- complete for all household members ages 7 and older
                                                                                Primary location (continued)
                                                                                                                               Where did [name] live
                                                                                                                                while in this place?
                                                                                               How does [name]
                                                                                       While
            ID of Person Interviewed




                                                                       Average                  get to this place? How much
                                                                                   [name] was                        did this         1 = rented
                                       What kind of trade, services, daily wage                      1 = walk
                                                                                    staying in                        trans-    appartment/dwelling
Member ID




                                        or industry is this work     (or earnings [place], how     2 = bicycle
                                                                                                                    portation       2 = dormitory
                                            connected with?             if self-                      3 = car
                                                                                   many times                      cost (each     3 = with friends
                                                                      employed) did [name]            4 = bus
                                                                                                                      way)?        4 = with family
                                                                                                     5 = train
                                                                                    come back                                   5 = hotel/guesthouse
                                                                                                     6 = boat
                                                                                      to your                                       6 = dormitory
                                                                                                   7 = animal
                                                                                     village?                                 7 = lodging provided by
                                                             ISIC                              8 = other (specify)
                                           industry                      cedis                                        cedis           employer
                                                             code                                                                8 = other (specify)
                                                   10                      11            12             13              14                15
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 5, part b - Temporary migration concluded
NEW -- complete for all household members ages 7 and older
            Where was the SECONDAY location (if any) where [name] was?
                                                                                                                                       Secondary location
                                  If none >> next person
                               In Ghana                    Outside of Ghana                                            What was [name]                       Where did [name] live
            ID of Person Interviewed




                                         1 = Kumasi                                                                        doing here?                         while in this place?
                                                                               REGION:
                                         2 = Sunyani
                                                                              2=Western
                                                                                                                        1 = working for                             1 = rented
                                       3 = Cape Coast                                                         How             salary         Daily wage       appartment/dwelling
Member ID




                                                                               3=Central
                                        4 = Koforidua                                                        many     2 = working for self
                                                                             4=Gt. Accra                                                     (or earnings         2 = dormitory
                                          5 = Accra                                                        days did      3 = helping out
                                                                                5=Volta                                                         if self-        3 = with friends
                                         6 = Tamale                                         give name of
                                                        give name of city      6=Eastern                    [name]    family / friends (>>
                                       7 = Bolgatanga                                          country                                        employed)          4 = with family
                                                                              7=Ashanti                      spend             23)
                                        8 = Koforidua                                                                                                         5 = hotel/guesthouse
                                                                            8=Brong Ahafo                                4 = education/
                                           9 = Wa                                                            here?                                                6 = dormitory
                                                                              9=Northern                                    schooling
                                       10 = Sekondi-
                                           Takordi
                                                                            10=Upper East
                                                                                                                             (>> 23)                        7 = lodging provided by
                                                                            11=Upper West                                                                           employer
                                           11 = Ho                                                                     5 = other (specify)      cedis
                                                                                                                                                               8 = other (specify)
                                            16                 17                18              19           20              21                 22                   23
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 5, part c - Migration History
fill in a page for each HH member with one or more migrations from previous pages
Member ID _____________________              ID of person answering ___________________
                                                                                                                              Migration Number
                                                                                                            To current
                                                                                                                           second most   third most   fourth most   fifth most
                                                                                                             residence
                                                                                                                              recent       recent        recent       recent
                                                                                                           (most recent)
                    1 = Kumasi; 2 = Sunyani; 3 = Cape Coast; 4 = Koforidua; 5 = Accra; 6 = Tamale; 7
                    = Bolgatanga; 8 = Koforidua; 9 = Wa; 10 = Sekondi-Takordi; 11 = Ho
  What is the
  name of the       name of city in Ghana
1
  […]               2=Western; 3=Central; 4=Gt. Accra; 5=Volta; 6=Eastern; 7=Ashanti; 8=Brong
  destination?      Ahafo; 9=Northern; 10=Upper East; 11=Upper West

                name of country
2 How old were you when you moved to destination?
  Why did you move (most important reason)?
   1 = job transfer; 2 = seeking employment; 3 = own business; 4 = spouse's employment; 5 =
3 accompanying parent; 6 = marriage; 7 = other family reasons; 8 = political / religious reasons; 9 =
  education; 10 = war; 11 = fire; 12 = flood/famine/drought; 13 = inability to access land; 14 = loss of
  land; 15 = other (specify)
     Is there another reason why you moved (second most important reason)? Use same codes
4
     as in question 3, above, or write 0 if none
     Whom did you know at destination? (1=parents, 2=children, 3=spouse/fiance, 4=Other
5
     relative, 5=acquaintance) -- for multiple entries, enter with commas
6 Did you ever work for wages at DESTINATION? (1=yes; 2=no, if no >> 13)
     How did you find a job at DESTINATION? (1=own search before moving, 2=arranged by family,
7 3=arranged by friends, 4=own search after moving)

  During the time between arriving at DESTINATION and finding a job, what was your main
8 means of support? (1=own savings, 2=family at DESTINATION, 3=family at PREVIOUS
  PLACE, 4=friends, 5=menial work/begging, 6=no means of support)
9 How long after coming to DESTINATION did you find a job for wages? (months)
10 Did you work for a family member at DESTINATION? (1=yes; 2=no)
12 What type of industry was your first job in DESTINATION? (see industry codes)
     Were you working for a wage just before you left PREVIOUS PLACE?
13
     (1=yes; 2=no, if no >> next migration)
     What type of industry was the job in PREVIOUS PLACE just before you moved?
14
     (see industry codes)
Section 6 (Agriculture), part a -- update on stocks and last year's spending by animal
Import column 1 from GLSS5; fill out columns 2 - 8
                                           Number     Current              In the past twelve months, how much did you spend on . . . for this animal
                                          household   number                                Veterinary    Enclosure,    Hired labor        Access to     Other
                                          possessed   owned         Fodder/feed --           expenses       shelter,      (cedis)            water      expenses
                                             when                      expenses               (cedis)    restraint and
                  Type                    responded                            Home                         related
                                          to GLSS5              Purchase     produced                      expenses
                                                                 (cedis)       (cedis)                      (cedis)
                                             1          2          3             4              5              6               7              8            9
Draught animal (donkey, horse, bullock)

Cattle

Sheep

Goats

Pigs

Rabbits

Chicken

Fish

Snail

Other
6 part a -- Other farm assets -- update and new tools
Import column 1 from GLSS5; fill out columns 2 and 3


                Number household possessed
                 when responded to GLSS5



                                             Current number owned




                                                                                      Current number owned
   Asked
    about                                                                    Other
 in GLSS 5                                                                   tools


                         1                      2                                        3
Tractor
                                                                    2 Wheel Tractor
Plough
                                                                    4 Wheel Tractor
Trailer/cart
                                                                    Cane crusher
Spraying
machine                                                             Hoe
Outboard
motor                                                               Axe
Canoe
                                                                    Rake
Fishing net
                                                                    Shovel

                                                                    Pick
                                                                    Sickle/
                                                                    reaping hook

                                                                    Harrow

                                                                    Tiller

                                                                    Water pump

                                                                    Irrigation pipe

                                                                    Cutlass
Section 6 (agriculture), part b – LAND INFORMATION
Fill in columns 1 - 12 from GLSS5. Complete entire sheet for any new farms owned or used since GLSS5, any fallow plots not reported in the GLSS5, and any
plots of land controlled but leased/sharecropped/rented/allocated out. Columns 13-15 should also be completed for all plots reported in the GLSS5.
                    Size of farm    Is the farm    Does the If the farm                            How        What      Was the Do you
                                     owned by     household were to be How did you obtain much did proportion             farm    still own/
                                         the    have the right sold now,       the land?                   of crops go cultivated operate If you obtained the land from
                                                                                                it cost to
                                    household? to sell the                    Bought = 1                        to     during the this plot a specific person, please give
                                                               how much                           rent it
          Person interviewed




                                                farm or use it           Rented for cash or in              landlord?    past 12 of land?
                                                                would it                        over the                                       his or her name if he or she
                               Farm Number




                                     Yes, with as collateral                    kind =2                    (see codes) months?      1=yes
                 UNIT OF AREA                                  be worth? Sharecropped by         past 12                                           lives in this village
 Holder




                                     deed = 1 for security?                                                                          2=no
                   Acres       1                                            household = 3       months?
                                        Yes,                                                                             1=yes    (if no >>
                   Poles       2      without      Sell = 1                     (>>11)                                    2=no    next plot)
                   Ropes       3     deed = 2    Security = 2            Use free of charge = 4                         (>> next skip for
                                      No = 3       Both = 3                     (>>12)                                    farm)      new     (or write NV if not currently a
                    Plot       4
                                       (>> 9)    No right = 4            Distributed by village                                      plots       resident of this village)
                                                             (>> 9)             or family = 5
                                             No. of   unit             value       (>>12)        (cedis)                                             name              ID
                                             units    code            (cedis)
  1      3   2                 6            7  4        5               98             10                      11          12        13                     14
         1
         2
         3
         4
         5
         6
         7
         8
         9
        10
        11
        12
        13
        14
        15
        16
        17
        18
PROPORTION CODES: 1 = 2/3 (67%); 2 = 1/2 (50%); 3 = 1/3 (33%); 4 = 1/4 (25%); 5 = 1/5 (20%)
                                                                                           6 part b _ land info 2

Section 6, part b – Land Information, continued
Answer about all plots of land currently owned or used.
       Year      Year        Year                  Soil                How long Is the land If so, what                                                                                                         Is this farm   How       How      Does this   If yes, did you or
                                                                                                           If pond or well,                                                   If pump,
      when       when        when Is this land Depth                     does it   watered   method?                                                                                                              bigger or many of many of land have         someone else do
       land       last        last  more or less 1 = Up                 take for    from a   (primary                                                                                                               smaller    the      these       clear        something to
    began to fallow         fallow wet than the to 1 foot              this land    source   method if                                                                                                             than the measured    farms    boundaries       create these




                                                                                                             Month filled (see code)




                                                                                                                                                                                       Hours/day in operation
                                                                                                                                                              Days/year in operation
                                                                                                                                       Month Dry (see code)
        be      period      period other lands 2 = 1 to Soil Soil Type to drain other than more than                                                                                                             measured     farms    would fit      ?        boundaries? (e.
 Farm number




     farmed      began       ended    in your     3 feet Colour          after a rainwater?     one)                                                                                                                 farm?   would fit into the    1= yes       g. plant trees,
                                                                 (see
      (enter (enter 888 (enter 000 community       3=     (see
                                                                codes    heavy               1=pump                                                                                                              1 = bigger in this measured       2 = no      make a fence)?
     888 for for "don't        if         ?       more codes below)    rainfall?    1=Yes     2=weir                                                                                                            2 = smaller farm?       farm?                       1 = yes
                know") currently 1 = more
      "don't                                     than 3 below)                                3=well                                                                                                               (>> 18)                                    2 = no, naturally
                           fallowed   2 = less
     know)                                         feet                 (hours)     2=No,   4=borewell                                                                                                           3 = about                                       occuring (for
                          or 888 for 3 = about
                             "don't                                               (if no >>                                                                                                                       the same                                    instance, a river)
                                     the same                                         16)
                            know")
               15   16     17        18         19      20       21        23         24           25        26                        27                     28                       29                           30         31        32          33              34
   1
   2
   3
   4
   5
   6
   7
   8
   9
10
11
12
13
14
15
16
17
18
Soil colour codes (column 6): Red =1; Black = 2; Grey = 3; Yellow = 4; Brown = 5; White = 6
Soil characteristic codes (column 7): Sand =1; Loam = 2; Light Clay = 3; Heavy Clay = 4; Gravely = 5; Mixed = 6
Code for columns 12 and 13: 1=January; 2=February; 3=March; 4=April; 5=May; 6=June; 7=July; 8=August; 9=Sept.; 10=Oct.; 11=Nov.; 12=December




                                                                                                 Page 56
Section 6, part b – Land Information, continued
Answer about all plots of land currently owned or used.
     What      From whom did you        Did this person occupy a special       Was this    Is this   If acquired from a specific person give      What was the          What was the     How many Could you If yes, how              If no, why
    year did obtain the land when        political or traditional position?    person a    person                name of person               payment when you        formality of the days after     leave the   long do you     would you lose
      you you began to own or use                    0 = None                  resident currently a                                          first began to own or     contract at that   reaching   land empty     think you         the land?
    begin to             it?               1 = Member of Parliament             of your resident of (or write NV if not currently a resident      use the land?             time?        agreement for a period could leave        1 = lose title
                                                                                                                                              1 = bought (cash, in       1 = formal         about     of several the land alone     2 = the land
    own or        1 = family head         2 = District Chief Executive         village at   your                 of your village)
                                                                                                                                                 kind, or both)       written contract owning or       months        without      would be given
 Farm Number




    use this         2 = chief             3 = Assembly Man/Woman             that time? village?                                               2 = used free of       2 = registered     using the    without      losing it?      to someone
     land? 3 = government (>> 42) 4 = Unit Committee Member                     1 = Yes   1 = Yes                                                    charge                 tenant      land did you    being      (answer in            else
              4 = other male relative     5 = National Political Office         2 = No 2 = No (if                                              3 = sharecropping      3 = oral contract begin to use   worried years, or code      3 = someone
             5 = other female relative [Minister, Deputy Minister, etc.]                  no >> 7)                                             4 = renting/leasing        4 = other       the land? about losing     888 for      else might start
                  6 = nonrelative                                                                                                               5 = other (specify)       (specify)                       it?     indefinitely)        using it
                    7 = no one            AND NEED TRADITIONAL                                                                                                                                         1 = yes                        4 = other
                8 = other (specify)                POSITIONS!                                                                                                                                          2 = no                         (specify)
                                                                                                                 name                  ID

               35         36                            37                       38          39                   40                   41               42                  43             44            45            46               47
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 6, part b – Land information (continued)
Answer about all plots of land currently owned (questions 47 through 53) or used (questions 54 through 58).
    Continue to use the same farm numbers from the previous pages.
                       for land currently owned (see question 6 of this section)                              For land not currently owned (Q6 in land ID section)
     How much, What is the [if money If so,            [if land Have you If yes, what was the         Contract type Nature of      Duration of        Is your   For how long
     if any, cash total value of paid for     how      was not ever had          type of dispute?     when the land the contract contract at first: current    have you been
     did you pay      in kind     land], did many? originally a dispute 1 = boundaries of land was first used when the               No fixed        landlord renting from the
                                 you buy the                                  2 = multiple claims to   rented = 1     land was     duration = 1         the   current landlord?
      in total for contribution                      owned], in with
 Farm number




                                   land on                                             land          sharecropped = first used     Seasonal = 2      original
       the land    you gave for                       what year anyone
                                    install-                                  3 = breach of contract        2        1 = written    Yearly = 3      landlord?
       when you      the land       ments?
                                                       did you over this         by former owner     no payment = 3 2 = oral Multiple year = 1 = yes
       began to     when you       1 = Yes             begin to     land?     4 = breach of contract mortgaged = 4 3 = other             4            (>> 59)
        own it?      began to       2 = No             own the     1=yes             by buyer        other (specify) (specify) Other (specify) 2 = no
                      own it?                           land?       2=no        5 = other (specify)        =5                          =5
        (cedis)       (cedis)
                                                                                                                                                               Years    Months

               48        49            50        51         52          53               54                  55            56            57            58              59
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 6, part b – Land information (continued)
Answer about all plots of land currently used but not owned. Continue to use the same farm numbers from the previous pages (some lines may be blank).
                                            For land not currently owned (from Q6) of land ID -- CONT. FROM PREVIOUS PAGE
       Is the     If this person is a resident of your                  Payment for land             Does the From whom did the landlord   How did the     Do you engage
      current         village, give his or her name                                                  landlord obtain the land (owned)? landlord obtain the     in other
    landlord a                                                                              Other                                                              business
                                                                    Sharecrop                        own the           1 = chief            land? (not
                                                                                        arrangements
    resident of                                                                                                    2 = family head            owned)        transactions
                   (or write NV for not currently a                                                    land?
        your                                                                                                                              1 = rent from        with the
                         resident of this village)                                                                 3 = government
                                                                                        How much 1 = Yes
 Farm Number




      village?                                                                                                                                                landlord?
                                                                                                               4 = other male relative        another
      1 = Yes                                                What is the      What      do you pay 2 = No                                                    (e. g. other
                                                           value of inputs percent (if                        5 = other female relative     household
    2 = No (if                                                                         in cash or in (>> 66)                                                agricultural,
    no >> 61)                                                provided by     any) of                             5 = another landlord    2 = allocated by household
                                                                                        kind to use
                                                            the landlord?   output is                             6 = another person       family head       enterprise)
                                                             (zero value given to the this land?                    77 = unknown         3 = allocated by      1 = Yes
                                                              possible)    landlord? (zero value                 88 = other (specify)      village head         2 = No
                                                                                         possible)
                                                                                                                        >> 67                4 = other
                                                                                                                                             (specify)
                           Name                    ID           cedis         (%)           cedis
               60                  61                          62           63            64          65                 66                     67              68
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 6, part b – Land information (continued)
Answer about all plots of land currently used but not owned. Continue to use the same farm numbers from the previous pages (some lines may be blank).
                                        For land not currently owned (from Q6) of land ID -- CONT. FROM PREVIOUS PAGE
      Do you engage in       Type of      Duration of       Do you have     Can you rent Have you and          If so, was this    Have you and If so, was this
        other business      contract       contract       complete control the land out? the landlord disagreement related to anyone other disagreement
    transactions with the 1 = written                     over the farming     1 = yes       ever had a               ...            than the     related to
           landlord?         2 = oral
 Farm Number




                                      No fixed duration decisions you       2 = yes, but disagreement 1 = breach of contract landlord ever            ...
          (e. g. other      contract
                                              =1           make regarding     must be     over this land?       by landlord?          had a    1 = boundaries
         agricultural,      3 = other
          household         (specify)
                                         Seasonal = 2         this land?    approved by        1=Yes      2=breach of contract by disagreement 2 = multiple
          enterprise)                     Yearly = 3            1=yes;        landlord         2=No                 tenant          over this       claims
            1 = Yes                   Multiple year = 4 2=no, landlord         3 = no                       3 = management of         land?       3 = other
            2 = No                     Other (specify) =    must approve                                            land?             1=Yes      (specify)?
                                               5                                                            4 = other (specify)?      2=No

               69            70             71                 72               73            74                  75                  76             77
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 6, part b – Land information (conclunded) LAND IMPROVEMENTS
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
In the past three years, have you made any land-related investment (e.g., bunding, leveling the terrain, fencing) on land you currently own or use? (Yes=1; No=2) _________
                                        Irrigation related investments                             Permanent and semi-permanent structures                                  Soil and water conservation improvements                                                 Other improvements




                                                                                                                                                              Any soil and water conservation
                                                                                                                                                              improvements made? [1 = Yes;
                                        If yes, list up       What was the total                                    If yes, list up    What was the total                                       If yes, list up to   What was the total                                  made (list)




                                                                                      Any permanent and/or semi-
                                                                                      permanent structures made?




                                                                                                                                                                                                                                           Number of trees planted
                                         to two most      cash/days spending on all                                  to two most     cash/days spending on                                          two most       cash/days spending on
               Any irrigation related




                                                                                                                                                                                                                                             in last three years
                                          important        the related investments/                                important such        all the related                                        important such         all the related
                investment made?
                [1 = Yes; 2 = No]




                                                                                          [1 = Yes; 2 = No]
 Farm Number




                                             such         improvements during the                                    invesments           investments/                                            investments      improvements during




                                                                                                                                                                          2 = No]
                                         investments             last 3 years?                                        (see code     improvements during the                                         (see code         the last 3 years?
                                          (See code                                                                     below)            last 3 years?                                              below)
                                            below)
                                                              Cash          Family                                                     Cash        Family                                                            Cash        Family
                                                                             labour                                                                 labour                                                                        labour
                                          a        b          (cedis)       (hours)                                  a       b        (cedis)      (hours)                                         a       b        (cedis)      (hours)

                      78                 79       80            81            82               83                    84     85          86           87                 88                        89      90          91           92            93                          94
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Code for columns 3-4: Bore well = 1 ; Deepening Well = 2; Dig a pond = 3; Installing dug well = 4; Other (list in column 18) = 5
Code for columns 8-9: Farm bunding = 1; Animal Shed = 2 ; Fence = 3; Other (list in column 18) = 4
Code for column 13-14: Leveling the terrain = 1; Land leveling/terracing = 2; Bunding for soil and water conservation = 3; Mulching = 4; Fencing = 5; Reclamation = 6; Other (list in column 18) = 7
Section 6, part c -- Output details, Season 1                                                                                                                                                 Unit codes:
Note that each crop planted on a particular farm should have its own line                                                                                                                     American tin = 02
                                                                                                                                                                                              Balls = 27
                                                       transportation to selling location
                                                                                                                                                    After being                               Bar = 28
                                                                                                                 While in                                             While in                Barrel = 03
                                                                  how far did                                                                      harvested but
                                                                                                                 the field, If yes,                                   the field,
                                                                 you transport did you                                               What          before being                     What      Basket = 04
                                                                                                                 was any     what                                     was any                 Beer bottle = 05
                                                                  the crops to transport                 Total                      was the           sold or                      was the
                             quantity                                                         total
  Farm number




                                                     Second-                                                       of the   percent                                     of the                Bowl = 06
                crop code




                                           primary                the primary     other                revenue                        crop         consumed at                       crop
                            harvested               ary outlet                             transpor-             crop lost of the                                     crop lost               Box = 07
                                            outlet                 location?    crops at tation costs from this                     lost to?      home, was any                    lost to?
                                                     (if any),                                                  to rotting/ crop                                     to rotting/              Bucket = 29
                                          see codes              (enter 000 if the same                  crop                         (see          of the crop                      (see     Bunch = 08
                                                    see codes                                                      pests,   planted                                    insects/
                                            below                crops picked    time?                  (cedis)                      codes        lost to rotting,                  codes     Bundle = 09
                                                      below                                                        etc.?      was                                     rodents?
                                                                 up by buyer) (if so, list                                          below)          pests, ec.?                    below)     Crate = 30
                                                                                                                  1=Yes      lost?                                      1=Yes
                                   unit                                                                                                               1 = yes                                 Dozen = 31
                                                                                 codes)                            2=No                                                 2=No
                            Amt.                                     (km.)                  (cedis)                                                   2 = no                                  Fanta /
                                   code                                                                                                                                                         coke bottle = 10
                  1          2      3         4         5             6             7          8          9           10          11        12           13              14          15       Fingers = 11
                                                                                                                                                                                              Fruits = 12
                                                                                                                                                                                              Gallon = 14
                                                                                                                                                                                              Kilogram = 14
                                                                                                                                                                                              Litre = 15
                                                                                                                                                                                              Loaf = 32
                                                                                                                                                                                              Log = 16
                                                                                                                                                                                              Margarine tin = 17
                                                                                                                                                                                              Maxi bag = 18
                                                                                                                                                                                              Mini bag = 19
                                                                                                                                                                                              Nut = 20
                                                                                                                                                                                              Pair = 33
                                                                                                                                                                                              Pieces = 34
                                                                                                                                                                                              Pots = 35
                                                                                                                                                                                              Pounds = 21
                                                                                                                                                                                              Set = 36
                                                                                                                                                                                              Sheet = 22
                                                                                                                                                                                              Singles = 37
                                                                                                                                                                                              Stick = 23
                                                                                                                                                                                              Tonne = 24
                                                                                                                                                                                              Tree = 25
                                                                                                                                                                                              Tubers = 26
                                                                                                                                                                                              Yards/metres = 38
                                                                                                                                                                                              Other (specify) = 99


OUTLET CODES: 1 = pre-harvest contractor; 2 = farm gate buyer; 3 = market trader; 4 = consumer; 5 = state trading org.; 6 = coop; 7 = exporter; 8= other (specify)
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease;
     77=other known (specify); 88 = unknown
Section 6, part c -- Output details, Season 2 (if applicable)                                                                                                                             Unit codes:
Note that each crop planted on a particular farm should have its own line                                                                                                                 American tin = 02
                                                       transportation to selling location                                                                                                 Balls = 27
                                                                                                                                                    After being                           Bar = 28
                                                                                                                 While in                                             While in
                                                                  how far did                                                                      harvested but                          Barrel = 03
                                                                                           Non-labor             the field, If yes,                                   the field,
                                                                 you transport did you                                               What          before being                   What Basket = 04
                                                                                              trans-             was any     what                                     was any
                                                                  the crops to transport                 Total                      was the           sold or                    was the Beer bottle = 05
                             quantity                                                       poration
  Farm number




                                                     Second-                                                       of the   percent                                     of the
                crop code




                                           primary                the primary     other                revenue                        crop         consumed at                     crop Bowl = 06
                            harvested               ary outlet                                 costs             crop lost of the                                     crop lost
                                            outlet                 location?    crops at              from this                     lost to?      home, was any                  lost to? Box = 07
                                                     (if any),                               (labor             to rotting/ crop                                     to rotting/          Bucket = 29
                                          see codes              (enter 000 if the same                  crop                         (see          of the crop                    (see
                                                    see codes                              discussed               pests,   planted                                    insects/           Bunch = 08
                                            below                crops picked    time?                  (cedis)                      codes        lost to rotting,                codes Bundle = 09
                                                      below                                in part d)              etc.?      was                                     rodents?
                                                                 up by buyer) (if so, list                                          below)          pests, ec.?                  below) Crate = 30
                                                                                                                  1=Yes      lost?                                      1=Yes
                                   unit                                                                                                               1 = yes                             Dozen = 31
                                                                                 codes)                            2=No                                                 2=No
                            Amt.                                     (km.)                   (cedis)                                                  2 = no                              Fanta /
                                   code
                                                                                                                                                                                            coke bottle = 10
                  1          2      3         4         5             6             7          8          9           10          11        12           13               14        15    Fingers = 11
                                                                                                                                                                                          Fruits = 12
                                                                                                                                                                                          Gallon = 14
                                                                                                                                                                                          Kilogram = 14
                                                                                                                                                                                          Litre = 15
                                                                                                                                                                                          Loaf = 32
                                                                                                                                                                                          Log = 16
                                                                                                                                                                                          Margarine tin = 17
                                                                                                                                                                                          Maxi bag = 18
                                                                                                                                                                                          Mini bag = 19
                                                                                                                                                                                          Nut = 20
                                                                                                                                                                                          Pair = 33
                                                                                                                                                                                          Pieces = 34
                                                                                                                                                                                          Pots = 35
                                                                                                                                                                                          Pounds = 21
                                                                                                                                                                                          Set = 36
                                                                                                                                                                                          Sheet = 22
                                                                                                                                                                                          Singles = 37
                                                                                                                                                                                          Stick = 23
                                                                                                                                                                                          Tonne = 24
                                                                                                                                                                                          Tree = 25
                                                                                                                                                                                          Tubers = 26
                                                                                                                                                                                          Yards/metres = 38
                                                                                                                                                                                          Other (specify) = 99


OUTLET CODES: 1 = pre-harvest contractor; 2 = farm gate buyer; 3 = market trader; 4 = consumer; 5 = state trading org.; 6 = coop; 7 = exporter; 8= other (specify)
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease;
     77=other known (specify); 88 = unknown
Section 6, part c – Output – Crop Stores                                                                                                                                           Unit codes:
Does your household typically keep any dried/preserved crops?_________ (1 = Yes; 2 = No, if no >> next page)                                                                       American tin = 02
                                                                                                                                                                                   Balls = 27
                                                                             Where is the stock                                                                                    Bar = 28
                                                                                                                                             During the
                                                                                    stored?                                                    previous
                                                                                                                                                                                   Barrel = 03
                                How much [ ]                                                                                                                                       Basket = 04
              How much [ ]                                                    1 = underground      Is the stock                               year, was
                               was left prior to the                                                                                                                         What Beer bottle = 05
                is stored                             How much [ ]          2 = above ground, in treated with                                 any of the
                                  most recent
                                                                                  household                                                                                  was Bowl = 06
               currently?                            was stored after the                               any                                  stored crop        If so,
                                    harvest?                                                                                                                                  the Box = 07
 Crop code




                                                        most recent         3 = in special storage chemicals?                                    lost to    how much?              Bucket = 29
                                                                                                                  If so, what chemical(s)?                                  source
             (zero response                               harvest?           facility (specific to                                              rotting,                           Bunch = 08
                                (zero response                                                                                                                               (see Bundle = 09
                possible)                                                         household)         1 = Yes                                   insects,
                                    possible)                                                                                                                               codes Crate = 30
                                                                               4 = in the bush        2 = No                                   rodents,
                                                                                                                                                                           below) Dozen = 31
                                                                             5 = in a community       (>> 6)                                      etc.?
                                                                                                                                                                                   Fanta /
                                                                                                                                               1 = Yes
                        Unit                   Unit                  Unit      storage facility                                                                      Unit            coke bottle = 10
                                                                                                                                                2 = No                             Fingers = 11
             Quantity   Code    Quantity       Code   Quantity       Code    6 = other (specify)                                                           Quantity Code
                                                                                                                                                                                   Fruits = 12
                    1                      2                     3                    4                 5                    6                                7           8        Gallon = 14
                                                                                                                                                                                   Kilogram = 14
                                                                                                                                                                                   Litre = 15
                                                                                                                                                                                   Loaf = 32
                                                                                                                                                                                   Log = 16
                                                                                                                                                                                   Margarine
                                                                                                                                                                                     tin = 17
                                                                                                                                                                                   Maxi bag = 18
                                                                                                                                                                                   Mini bag = 19
                                                                                                                                                                                   Nut = 20
                                                                                                                                                                                   Pair = 33
                                                                                                                                                                                   Pieces = 34
                                                                                                                                                                                   Pots = 35
                                                                                                                                                                                   Pounds = 21
                                                                                                                                                                                   Set = 36
                                                                                                                                                                                   Sheet = 22
                                                                                                                                                                                   Singles = 37
                                                                                                                                                                                   Stick = 23
                                                                                                                                                                                   Tonne = 24
                                                                                                                                                                                   Tree = 25
                                                                                                                                                                                   Tubers = 26
                                                                                                                                                                                   Yards/metres = 38




CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease; 77=other known (specify); 88 = unknown
Section 6, part d -- Input details -- chemical inputs for previous harvest (fertilizer, weedicide, pesticide, etc.)
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
                                     Chemical 1                                                             Chemical 2                                      Unit codes:
                                                                                                                                                            American tin = 02
                                                                                                                                                            Balls = 27
                                              amount used                                                             amount used                           Bar = 28
                                                                     To which                                                                To which       Barrel = 03
Farm Number




               type of                                               crops was     type of                                                   crops was      Basket = 04
                                                                                                                                                            Beer bottle = 05
              chemical    name of                                       this      chemical       name of                                        this        Bowl = 06
              (see code   chemical                                   chemical (see code          chemical                                    chemical       Box = 07
               below)                  number         unit    value applied (list below)                       number         unit    value applied (list   Bucket = 29
                                       of units       code   (cedis)                                           of units       code   (cedis)                Bunch = 08
                                                                        all)                                                                    all)        Bundle = 09
                                                                                                                                                            Crate = 30
                                                                                                                                                            Dozen = 31
                  1          2                    3            4         5           6               7                    8            9          10        Fanta /
                                                                                                                                                              coke bottle = 10
 1                                                                                                                                                          Fingers = 11
                                                                                                                                                            Fruits = 12
 2                                                                                                                                                          Gallon = 14
                                                                                                                                                            Kilogram = 14
 3                                                                                                                                                          Litre = 15
                                                                                                                                                            Loaf = 32
 4                                                                                                                                                          Log = 16
                                                                                                                                                            Margarine tin = 17
 5                                                                                                                                                          Maxi bag = 18
                                                                                                                                                            Mini bag = 19
 6                                                                                                                                                          Nut = 20
                                                                                                                                                            Pair = 33
 7                                                                                                                                                          Pieces = 34
                                                                                                                                                            Pots = 35
 8                                                                                                                                                          Pounds = 21
                                                                                                                                                            Set = 36
 9                                                                                                                                                          Sheet = 22
                                                                                                                                                            Singles = 37
10                                                                                                                                                          Stick = 23
                                                                                                                                                            Tonne = 24
11                                                                                                                                                          Tree = 25
                                                                                                                                                            Tubers = 26
12                                                                                                                                                          Yards/metres = 38
13                                                                                                                                                          Other (specify) = 99

14
15
16
17
18
TYPE CODES: 1 = Fertilizer (organic); 2= Fertilizer (inorganic) 3 = Herbicide; 4 = Insecticide; 5 = Fungicide; 6 = Other chemical input (specify purpose)
Page 66 -- Input details -- seeds used for previous harvest
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.

                                       Seed 1                                                   Seed 2                                                   Seed 3                                                   Seed 4

                                      How was the seed                                         How was the seed                                         How was the seed                                         How was the seed
                                         obatined?                                                obatined?                                                obatined?                                                obatined?
Farm Number

              crop code




                                                                       crop code




                                                                                                                                crop code




                                                                                                                                                                                         crop code
                                      1 = seed from own     spending                           1 = seed from own     spending                           1 = seed from own     spending                           1 = seed from own     spending
                           name of                                                  name of                                                  name of                                                  name of
                                            harvest          on seed                                 harvest          on seed                                 harvest          on seed                                 harvest          on seed
                          seed used                                                seed used                                                seed used                                                seed used
                                        2 = purchased        (cedis)                             2 = purchased        (cedis)                             2 = purchased        (cedis)                             2 = purchased        (cedis)
                                        3 = exchanged                                            3 = exchanged                                            3 = exchanged                                            3 = exchanged
                                            4 = gift                                                 4 = gift                                                 4 = gift                                                 4 = gift
                                      5 = other (specify)                                      5 = other (specify)                                      5 = other (specify)                                      5 = other (specify)
                1             2                 3              4         5             6                 7              8         1             2                 3              4         5             6                 7              8
 1

 2

 3

 4

 5

 6

 7

 8

 9

10

11

12

13

14

15

16

17

18
Section 6, part d – Inputs - Detailed labor (family and hired) use on crop production by plot and season
                Labor use on land preparations (e. g. clearing or weeding before planting),    Labor use on field management (weeding after planting, fertilizer and pesticide
                               seedling/nursery, planting and transplanting                                       applications, irrigation management, etc.)
 Farm number


                Casual Labour (hours)    Permanent Labour (hours)     Family (incl’d exch’ge     Casual Labour (hours)    Permanent Labour (hours)    Family (incl’d exch’ge
                                                                         labor) (hours)                                                                  labor) (hours)
               Male   Female     Child      M        F        C        M        F        C       M         F       C        M        F        C        M        F        C
               (M)      (F)       (C)
                2        3         4        5        6        7        8        9       10       11       12       13       14       15       16       17       18      19
Season 1 (_________________to ___________________)                                             Season 1




Season 2 (___________________to __________________)                                            Season 2
Section 6, part d – Inputs - Detailed labor (family and hired) use on crop production by plot and season
Note that each crop planted on a particular farm should have its own line
                                                    Labor use on harvesting                                                       Post harvest labor use
  Farm number

                Crop code

                            Casual Labour (hours)   Permanent Labour (hours)   Family (incl’d exch’ge    Casual Labour (hours)   Permanent Labour (hours)   Family (incl’d exch’ge
                                                                                   labor) (hours)                                                               labor) (hours)
                            M        F        C       M        F       C        M        F        C       M        F       C       M       F        C        M        F        C
                20          21       22       23      24       25      26       27       28       29      30       31      32      33      34       35       36       37       38
Season 1                                                                                                Season 1




Season 2                                                                                                Season 2
Section 6, part e – Transactions -- Characteristics of land leased/sharecropped/rented/allocated out
Fill out for all plots of land controlled but leased/sharecropped/rented/allocated out (i. e. farmed by someone not a member of this HH).
Continue to use the same farm numbers from the previous pages (some lines will likely be blank).
                            Nature of the Duration of Contract type at                            If not renting to original tenant,  Relationship
                            contract when contract at           first:                                                                  of current
                                                                                                   regarding the previous tenant
                              it was first      first:     rented out = 1 How long has it                                             tenant to you
      How long has the                                   sharecropped = 2
                                 rented/     No fixed                       been rented/                                               (see code)
       land been rented                                   no payment = 3                          Who
 Farm Number




                            sharecropped/ duration = 1                     sharecropped/                                        If
       / sharecropped /                                   mortgaged = 4                        terminated         If
                                                                             mortgaged                                     terminated
       mortgaged / lent mortgaged/ Seasonal = 2 other (specify) = 5                                 the      terminated
                                lent out    Yearly = 3                        out to the                                     by your
              out?                                                                              contract? by tenant,
                             1 = written     Multiple                     current tenant?                                  household,
                                                                                               1 = tenant why? (see
                                2 = oral     year = 4                                                                       why? (see
                                                                                                2 = your        code)
                               3 = other       Other                                                                          code)
                                                                                               household
        years months           (specify)   (specify) = 5                   years months
                 1                     2                  3                   4                       5                  6                7               8                 9
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Code for column 4 (TENANT TERMINATED) 1 = Find better land; 2=Better off-farm opportunity; 3=Reduction in labor; 4 = Other reason
Code for column 5 (HOUSEHOLD TERMINATED) 1 = Rent to other tenant; 2 = Fail to pay rent; 3 = Cultivate yourself; 4 = Other reason
Code for column 6: Relative/friend in this village = 1, Relative/friend outside village=2, Landlord within this village = 3, Landlord outside this village = 4, Landless inside
                this village = 5, Landless outside this village = 6, Other household in this village = 7, other household outside this village=8., government=9.
Code for column 8: Needed money = 1, plot undesireable = 2, wanted to leave farming = 3, already had enough land = 4, help recipient = 5, other (specify) = 6
Section 6, part e – Transactions -- Characteristics of land leased/sharecropped/rented/allocated out (concluded)
Fill out for all plots of land controlled but leased/sharecropped/rented/allocated out (i. e. farmed by someone not a member of this HH). Continue to use the same farm
numbers from the previous pages (some lines will likely be blank).
          Give name of current tenant           What is   Do you allow Nature of        Duration of contract       Contract type
                                               the main    the tenant to the contract No fixed duration = 1        rented out = 1                    If sharecropped out,
                                                 reason      make all     1 = written        Seasonal = 2        sharecropped = 2      If rented
         code NV if not included in the
                                               why you        farming       2 = oral           Yearly = 3         no payment = 3      out, rental
                   village roster
Farm Number




                                              decided to decisions about 3 = other        Multiple year = 4       mortgaged = 4        payment      value of percent of
                                                rent out     the land?     (specify)     Other (specify) = 5    other (specify) = 5        you    inputs your     output
                                              this land?       1=yes                                                                   received household given to
                 name                 ID          (see     2=no, I must                                                                this year   provided        your
                                                 codes)   approve some                                                                  (cedis)     this year household
                                                         or all decisions                                                                            (cedis)       (%)

                      10                      11            12              13                14                      15                 16           17          18
  1
  2
  3
  4
  5
  6
  7
  8
  9
10
11
12
13
14
15
16
17
18
Section 6, part e – Transactions -- Characteristics of sold
NEW -- fill out for all plots of land sold in the past three years
      When        Area      Was the If yes, with whom Were any            If yes, how How long was        How long was Main           Total    For what                                                                                                                                   Amount      Amount       Current
     did you (Acres) transaction was the transaction taxes or                much?       it from the        it from the    reason amount you   purpose                                                                                                                                   paid prior paid during   amount




                                                                                                                                                                                                                     Sold on installments? [Yes = 1,


                                                                                                                                                                                                                                                       If yes, number of installments
                                                                                                                                                                                                                       No = 2, if no >> next sale]
     sell it?             recorded in      recorded?       other fees        (cedis)   beginning of        beginning of      for    received     is the                                                                                                                                      to     the past 12 outstanding?
                            writing?                         such as                    the time that      the time that selling it               land                        Give name of buyer, if he or she is                                                                       the past 12   months       (cedis)




                                                                                                                                                          Who purchased it?
      (year)




                                                                                                                                                          (see code below)
                                        1. village head      registration                you tried to       you tried to (see code   (cedis)   used by                        currently a resident of your village                                                                        months      (cedis)
 Sale number




                            Yes=1        2. family head     fees paid on              start selling the     start selling below)                   the                                                                                                                                    (cedis)
                            No=2        3. administer of      the sale?                  land to the      the land to the                       buyer?                          (or write NV if not currently a
                                           stool lands                                    time you            time you                             (see                              resident of village)
                                           4. registry         Yes=1                       actually           received                          code)
                                       5. other [specify]       No=2                   received the       money for the
                                                                                             title?             land?
                                                                                           (weeks)             (weeks)                                                                  name                ID
               1   2          3                4                 5             6              7                            8          9          10          11                          12                 13          14                             15                                  16          17           18
   1

   2

   3

   4

   5

   6

   7

   8

Code for column 7:                                               8 = health,                                                                   Code for column                     Code for column 11:
1= consumption,                                                  9 = to buy ornaments                                                          8:                                  1=Relative/friends within this village
2 = education ,                                                  10=poor land quality,                                                         1=Using it for farm                 2=Relative/friend outside this village
3 = startup or expand non-farm enterprises                       11=poor accessibility of that subdivision,                                    purposes                            3=Landlord within this village
4 = migration,                                                   12=poor irrigation & drainage facility,                                       2=Using it for                      4=Landlord outside this village
5= house construction / repair,                                  13=litigation                                                                 Non-farm                            5=Other households in this village
6 = marriage,                                                                                                                                  purposes.                           6=Other households outside this village
7 = funeral / religious function / birth,                                                                                                      3=Not using it.                     7=Other (specify)
                                                                                               6 part e _ transactions _ bough

Section 6, part e – Land transactions -- Characteristics of land purchased
NEW -- fill out for all plots of land purchased in the past three years
      When        Area      Was the     If yes, with   Were any     If yes, how    How long was      How long was       Total                                                                                                                           Amount Amount paid      Current




                                                                                                                                                                                 Bought on installments? [Yes = 1,
     did you (Acres) transaction whom was the           taxes or       much?         it from the       it from the   amount you                                                                                                                        paid prior during the   amount




                                                                                                                                                                                                                     If yes, number of installments
                                                                                                                                                                                    No = 2, if no >> next sale]
     buy it?              recorded in    transaction   other fees      (cedis)      beginning of      beginning of      paid      From                                                                                                                     to      past 12   outstanding?
                                                                                                                                          Give name of seller, if he or she is
                            writing?      recorded?     such as                     the time that     the time that                                                                                                                                   the past 12  months       (cedis)
      (year)                                                                                                                    whom did currently a resident of your village
                                                               registration          you tried to      you tried to include the    you                                                                                                                  months     (cedis)
 Sale number




                                   Yes=1     1. village head fees paid on         start buying the    start buying value of in- purchase                                                                                                                (cedis)
                                                                                                                                           (or write NV if not currently a
                                   No=2       2. family head    the sale?            land to the     the land to the    kind    the land?        resident of village)
                                             3. administer of                         time you          time you      payments
                                                stool lands      Yes=1             received the      started using              See codes
                                                4. registry       No=2                   title?        the land ?      (cedis)    below
                                            5. other [specify]                         (weeks)           (weeks)
                                                                                                                                                   name                  ID

                  1        2         3             4                5         6          7                               8           9                      10                      11                               12                                  13          14           15
   1

   2

   3

   4

   5

   6

   7

   8

               Code for column 9:
               1=Relative/friends within this village
               2=Relative/friend outside this village
               3=Landlord within this village
               4=Landlord outside this village
               5=Other households in this village
               6=Other households outside this village




                                                                                                                Page 72
Section 7 (Information Seeking), part a – Information
                                                                    What type of
                                                                                                                                      What livestock did you
                                                                  information was                             What were your crop
                                                                                                                                        request assistance       What were your     Asked advice
                                                                     requested?                               concern(s) regarding
                                                                                                                                        about? (list all that livestock concern(s)     regarding:
                                                                                                               (list all that apply)
                                                                                                                                               apply)           regarding (list all
                                                                   1 = agriculture
                                                                                                                                        1 = draught animal         that apply)       1 = activities
                                                                      2 = non-                                 1 = use of fertilizer
                                                Did you have to                                                                      (donkey, horse, bullock)                       for household
                                Number of                            agricultural    What crops did you           2 = irrigation
                                                     pay?                                                                                    2 = cattle          1 = vaccination          only
                             contacts made in                        production       request assistance     3 = new seed varieties
    Type of organization                                                                                                                    3 = sheep              2 = disease       2 = activities
                               the past 12                          3 = resource     about? (list all crop     4 = pest infestation
                                                    1 = yes                                                                                  4 = goats          3 = feed/nutrition    related to a
                                 months                             management         codes that apply)           5 = weather
                                                    2 = no                                                                                    5 = pigs          4 = insemination business/enterp
                                                                    4 = business                                  6 = marketing
                                                                                                                                            6 = rabbits        5 = other (specify)         rise
                                                                      5 = other                              7 = blight/crop disease
                                                                                                                                           7 = chicken                                  3 = both
                                                                      (specify)                                8 = access to credit
                                                                                                                                              8 = fish               >> next            4 = other
                                                                                                             9 = general information
                                                                                                                                             9 = snail            organization          (explain)
                                                                  if answered 2-5,                             10 = other (specify)
                                                                                                                                       10 = other (specify)
                                                                        >> 9
          1                          2                 3                  4                    5                        6                       7                      8                  9
  Government Extension
        Office
       Input Supplier
Farmer Based Organization
       (registered)
Farmer Based Organization
      (unregistered)
 Nonprofit Organization /
     NGO (specify)
 Nonprofit Organization /
     NGO (specify)
 Nonprofit Organization /
     NGO (specify)
    Other agricultural
  organization (specify)

Did you receive any home visits from agriculture extension agents?                   Yes                     No
How many? __________________                   Were these visits solicited?          Yes                     No

Did you receive an extension service in any of the following media?
        Service
Gov't                        radio              television       newspaper           pamplet                 other _________________________
NGO                          radio              television       newspaper           pamplet                 other _________________________
Input Supp                   radio              television       newspaper           pamplet                 other _________________________
Other                        radio              television       newspaper           pamplet                 other _________________________

Did you receive agricultural advice from relatives/friends/neighbors in the past year?                   Yes                No
if so, how frequently?                            several times a week or more         about once a week
                                                  about once a month                   occasionally
Did you give agricultural advice to relatives/friends/neighbors in the past year?                        Yes                No
if so, how frequently?                            several times a week or more         about once a week
                                                  about once a month                   occasionally

Did you receive business/production/management advice from relatives/friends/neighbors in the past year?                         Yes      No
if so, how frequently?                       several times a week or more          about once a week
                                             about once a month                    occasionally
Did you give business/production/management advice to relatives/friends/neighbors in the past year?                              Yes      No
if so, how frequently?                       several times a week or more          about once a week
                                             about once a month                    occasionally
Section 8, part a -- Household enterprise update
whole page inputted from responses to GLSS5; fill out all items for new enterprises
                                                                                                                                                                                                                    Does the        What




                                                                      ID of person interviewed
                                                                                                                                                                                                      How
                                                                                                                                                                                                                   income of     percentage
                                                                                                                                                                                                      many
                                                                                                                                                                         How long has this                             the         of the
Enterprise number




                                               Person                                                 What is the principal activity What is the main secondary                                     months
                                                                                                                                                                         enterprise actively                       enterprise    income of
                       Name of               responsible                                                  of this enterprise?        activity of the enterprise?                                   during the
                                                                                                                                                                          been operating?                            belong         this
                      enterprise                                                                                                                                                                    past 12
                                                                                                                                                                                                                   entirely to   enterprise
                                                                                                                                                                                                    months
                                                                                                                                                                                                                      you?       belongs to
                                                                                                                                                                                                     did the
                                                                                                                                                                                                                  1 = yes (>>       you?
                                                                                                                                                                                                   enterprise
                                                                                                                                ISIC                              ISIC                                                 11)       (see codes
                                            Name             ID                                         Name of activity                 Name of activity                 years          months     operate?
                                                                                                                                Code                              Code                                               2 = no        below)
                           1                       2                       3                                                4                          5                             6                  7              8             9

           1

           2
                                                                                                                                                                                                                  Codes for column 13:
                                                                                                                                                                                                                  1 = household savings
                                                                                                                                           During the past 12 months, has this
                                                                                                                                                                                                                  2 = bank
                                                                                                                                         enterprise tried to get credit from banks                                3 = remittances from
                       Is this enterprise                                                                                                                                            During the
                                             What was the most                                             What is During the past 12         and other financial agencies?                        During the     abroad
                      registered with any                                                                                                                                              past 12
                                             serious difficulty in    What was                               the      months, has this          1 = no credit used (>> 19)                           past 12      4 = proceeds from
                     government agency?                                                                                                                                                months,
                                               establishing this       the main                                      enterprise tried to                  2 = bank                                   months,
Enterprise number




                                                                                                          nature of                                                                                               family farms
                              YES                                                                                                                                                    how much
                                                  enterprise?         source of                                       get credit from          3 = other financial agencies                        how much       5 = proceeds from
                    1 = Registrar general's                                                                  this                                                                     altogether                  family nonfarm
                                               1 = no difficulty      capital in                                      banks and other                 4 = cooperative                              of the total
                             Dept.                                                                        capital?                                                                     has the                    enterprise
                                             2 = Capital / credit     setting up                                    financial agencies?              5 = money lender                               loans has
                         2 = Dept. of                                                                     1 = loan 1 = Yes, succesfully                                               enterprise                  6 = income from family
                                            3 = Technical know-           this                                                                       6 = family/friend                                 this
                         Cooperatives                                                                      2 = gift                                                                  borrowed?                    propert(ies)
                                                     how             enterprise?                                         2 = Yes,          7 = procedes from other enterprise                      enterprise
                    3 = District Assembly                                                                                                                                            (new loans                   7 = NGO support
                                            4 = Govt. regulation     (see codes)                          3 = self-    unsuccesfully                 8 = govt. agency                                repaid?
                      4 = Other (specify)                                                                                                                                                only)                    8 = District assembly /
                                             5 = Other (specify)                                          financed        3 = No                         9 = NGO                                     CEDIS        town Dev. Assoc.
                            NO = 5                                                                                                                                                     CEDIS
                                                                                                                                                10 = community epicenter                                          support
                                                                                                                                                   11 = other (specify)                                           9 = church assistance
                               11                      12                                        13                             15                           16
                                                                                                                                                                                                                  10 = moneylenders
                                                                                                              14                                                                           17          18
                                                                                                                                                                                                                  11 = relatives/friends
                                                                                                                                                                                                                  12 = other partners
           1                                                                                                                                                                                                      96 = other (specify)

  2
SHARE CODES: 1 = 75% (3/4); 2 = 50% (1/2); 3 = 33% (1/3); 4 = 25% (1/4); 5 = 20% (1/5); 6 = 10% (1/10); 7 = 5% (1/20)
Section 8, part a -- Additional characteristics of HH enterprise
fill out for all current (i. e. currently operating or planning to resume operation within the year) HH enterprises and items 22 - 36 for new enterprises




                                                                                          ID of HH member responding now
                            Does your household still




                                                            business now? (give HH ID)
                                                             Who is responsible for the
                          participate in this enterprise?                                                                                                In a typical year, are your sales high, average, low, or none
                         1 = Yes, and [person named in                                                                                                 (i. e., business is not in operation) in the month of [MONTH]?
 Enterprise number




                          Q2] is still responsible (>> 8)
                         2 = Yes, but another household
                                                                                                                                                                                   1 = High
                           member is now responsible
                           3 = No (>> next enterprise)
                                                                                                                                                                                 2 = Average
                          (answer yes if business is not                                                                                                                           3 = Low
                          currently in operation but you                                                                                                                   4 = None: not in operation
                         plan to resume operation in the
                                       future)
                                                                                                                                  Jan   Feb    March      April      May        June      July      Aug.     Sept.       Oct.    Nov.     Dec.
                                        19                          20                     21                                     22    23       24         25        26          27       28           29    30          31      32       33

                     1

                     2




                          What is your      What is your    What is your
 Enterprise number




                         average level of average level of average level
                         sales in a "low"    sales in an    of sales in a
                             month?       "average" month? "high" month?



                              (cedis)               (cedis)                                                                (cedis)
                                                                                                                                              (24) Has this business operated in the last 3 months?
                                 34                    35                                                                    36
                                                                                                                                              (25) In this last 1 month?                                                   (1 = Yes; 2 = No)

                     1                                                                                                                        (26) In the last 2 weeks?

                     2                                                                                                                        (27) In the last 1 week?
Section 8, part b -- Detailed labor allocation of employees in household enterprise
NEW -- list all people who worked in one or both of the household enterprises you managed in the last year
                                                                                                                           Status    How is [name]                                         Enterprise 1           Enterprise 2
             Is worker a household member?
               1 = yes; 2 = no (if no, >> 3)

                                                                                                                        1 = skilled        paid?     What is the salary                              On
                                                                       Employee's name                                                                                                                                      On




                                                                                             (1 = Male; 2 = Female)
                                               If household member,
                                                                                                                          regular      1 = fixed     paid to [name], or     What                  average,      About
                                                                        and village ID                                                                                               About how                           average,
                                                                                                                         employee         salary    the value of in kind percentage many days how many        how many
                                                   list ID (>> 10)

                                                                                                                       2 = unskilled 2 = percent of                                                            days did how many
Worker no.




                                                                                                                                                      goods given to      of profits did [name] hours per




                                                                                                    Gender
                                                                      code NV if employee                                 regular         profits                        are given to work in                   [name]   hours per
                                                                                                                                                          [name]?                                 day does
                                                                       does not appear on                                employee         (>> 8)                           [name]?                             work in   day does
                                                                                                                                                                                         this      [name]
                                                                         village roster                               3 = apprentice  3 = in kind                                                                 this    [name]
                                                                                                                                                          (>> 10)                     enterprise work in
                                                                                                                        4 = casual    4 = not paid                                                            enterprise work in
                                                                                                                                                                                      during the     this
                                                                                                                          worker         (>> 10)                                                              during the    this
                                                                                                                                                                                      past year?
                                                                                                                       5 = working     5 = other       value       time                          enterprise   past year?
                                                                       name            ID                                                                                    (%)                                       enterprise?
                                                                                                                        proprietor      (specify)     (cedis)     code                                ?
                         1                             2                  3              4            5                     6              7                 8               9          10          11           12         13
 1
 2
 3
 4
 5
 6
 7
 8
 9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 8, part c -- Expenditures in household enterprise (enterprise 1)
From GLSS5 but repeat to get data on most current expenditure (also, this page was not filled in during GLSS5 if the enterprise hadn't been operational in the prior two weeks)
                                                                                             How                                                          During the past 12 months,
                                                         During the past Do you pay                                                        How much
                                                                                            many    How much did                                      was [ ] available when you
                                                         12 months, has      for                                  How much did               did you  needed / wished to purchase
                                                                                         times was you spend on you spend on                spend on
                                                          the enterprise [ ] at least                                                                              it?
                                                                                          [ ] paid [ ] during the [ ] during the           [ ] during
                             Item
                                                         spent anything    once a                      past 12                                                 1 = always
                                                                                         for during               past 3 months?           the past 2           2 = often
                                                              on [ ]?      week?                      months?
                                                                                           the past                                          weeks?          3 = not often
                                                             1 = Yes      1 = Yes
                                                                                              12                                                                4 = not needed
                                                         2 = No (>> 8)     2 = No
                                                                                          months?      (cedis)        (cedis)                (cedis)                5 = no
                                                                 2               3            4              5                  6                7                     8
   1 Taxes on product
   2 Articles for resale
   3 Rents on assets/land and buildings
   4 Raw materials
   5 Travelling and Transport (T & T)
   6 Fuel & lubricants
   7 Electricity
   8 Water
   9 Telephones
  10 Printing / stationary / postage / packing
  11 Spare parts
  12 Repairs / maintenance of fixed assets
  13 Lease of machinery or transport equipment
  14 Advertising / computer service
  15 Bank charges (excluding int.)
  16 Training
  17 Treatment / disposal of waste products
  18 Uniform and clothing
  19 Accident claims
  20 Other (specify)
Section 8, part c -- Expenditures in household enterprise (enterprise 2)
From GLSS5 but repeat to get data on most current expenditure (also, this page was not filled in during GLSS5 if the enterprise hadn't been operational in the prior two weeks)
                                                                                             How                                                          During the past 12 months,
                                                         During the past Do you pay                                                        How much
                                                                                            many    How much did                                      was [ ] available when you
                                                         12 months, has      for                                  How much did               did you  needed / wished to purchase
                                                                                         times was you spend on you spend on                spend on
                                                          the enterprise [ ] at least                                                                              it?
                                                                                          [ ] paid [ ] during the [ ] during the           [ ] during
                             Item
                                                         spent anything    once a                      past 12                                                 1 = always
                                                                                         for during               past 3 months?           the past 2           2 = often
                                                              on [ ]?      week?                      months?
                                                                                           the past                                          weeks?          3 = not often
                                                             1 = Yes      1 = Yes
                                                                                              12                                                                4 = not needed
                                                         2 = No (>> 8)     2 = No
                                                                                          months?      (cedis)        (cedis)                (cedis)                5 = no
                                                                 2               3            4              5                  6                7                     8
   1 Taxes on product
   2 Articles for resale
   3 Rents on assets/land and buildings
   4 Raw materials
   5 Travelling and Transport (T & T)
   6 Fuel & lubricants
   7 Electricity
   8 Water
   9 Telephones
  10 Printing / stationary / postage / packing
  11 Spare parts
  12 Repairs / maintenance of fixed assets
  13 Lease of machinery or transport equipment
  14 Advertising / computer service
  15 Bank charges (excluding int.)
  16 Training
  17 Treatment / disposal of waste products
  18 Uniform and clothing
  19 Accident claims
  20 Other (specify)
Section 8, part d -- Inventories and recent sales / purchases - FIRST ENTERPRISE
From GLSS5 but repeat to get data on most current inventory and purchases                                                                       Unit codes:
                                             How much of the following items does the              How much / what How much / what was          American tin = 02
                                                                                                                                                Balls = 27
                                                    enterprise currently possess?                 was the value of the the value of the items   Bar = 28
                                                                                                     items sold or     bought or imported in    Barrel = 03
                                                    (respondent can choose to give               exported in the past 3 the past 3 months?      Basket = 04
                                                                                                                                                Beer bottle = 05
                      Item                          answer in units, or the value of                    months?                                 Bowl = 06
                                                       the inventory as a whole)                                                                Box = 07
                                                                                                                                                Bucket = 29
                                          Product   Unit    Unit price                  Value                 Value                  Value      Bunch = 08
                                                                       Quantity                  Quantity               Quantity
                                           code     code     (cedis)                   (cedis)               (cedis)                (cedis)     Bundle = 09
                                                                                                                                                Crate = 30
                                              2       3          4           5            6          7          8          9          10
                                                                                                                                                Dozen = 31
  10 Principal finished product                                                                                                                 Fanta /
                                                                                                                                                  coke bottle = 10
  20 Principal raw material                                                                                                                     Fingers = 11
                                                                                                                                                Fruits = 12
  30 Principal product work in progress                                                                                                         Gallon = 14
  40 Principal goods for resale                                                                                                                 Kilogram = 14
                                                                                                                                                Litre = 15
       Secondary Finished Products                                                                                                              Loaf = 32
                                                                                                                                                Log = 16
  51                                                                                                                                            Margarine
                                                                                                                                                  tin = 17
  52                                                                                                                                            Maxi bag = 18
  53                                                                                                                                            Mini bag = 19
                                                                                                                                                Nut = 20
       Secondary Raw Materials                                                                                                                  Pair = 33
                                                                                                                                                Pieces = 34
  61                                                                                                                                            Pots = 35
                                                                                                                                                Pounds = 21
  62                                                                                                                                            Set = 36
  63                                                                                                                                            Sheet = 22
                                                                                                                                                Singles = 37
       Secondary Works in Progress                                                                                                              Stick = 23
                                                                                                                                                Tonne = 24
  71                                                                                                                                            Tree = 25
                                                                                                                                                Tubers = 26
  72
                                                                                                                                                Yards/metres = 38
  73
       Secondary goods purchased for resale
  81
  82
  83
Section 8, part d -- Inventories and recent sales / purchases - SECOND ENTERPRISE
From GLSS5 but repeat to get data on most current inventory and purchases
                                           How much of the following items does the               How much / what      How much / what       Unit codes:
                                                                                                                                             American tin = 02
                                                   enterprise currently possess?                 was the value of the was the value of the   Balls = 27
                                                                                                    items sold or       items bought or      Bar = 28
                                                    (respondent can choose to give               exported in the past imported in the past   Barrel = 03
                                                                                                                                             Basket = 04
                      Item                          answer in units, or the value of                  3 months?            3 months?         Beer bottle = 05
                                                       the inventory as a whole)                                                             Bowl = 06
                                                                                                                                             Box = 07
                                          Product   Unit Unit price                     Value                Value                Value      Bucket = 29
                                                                    Quantity                     Quantity             Quantity
                                           code     code  (cedis)                      (cedis)              (cedis)              (cedis)     Bunch = 08
                                                                                                                                             Bundle = 09
                                              2       3         4          5              6         5          6         5          6
                                                                                                                                             Crate = 30
  10 Principal finished product                                                                                                              Dozen = 31
                                                                                                                                             Fanta /
  20 Principal raw material                                                                                                                    coke bottle = 10
                                                                                                                                             Fingers = 11
  30 Principal product work in progress
                                                                                                                                             Fruits = 12
  40 Principal goods for resale                                                                                                              Gallon = 14
                                                                                                                                             Kilogram = 14
       Secondary Finished Products                                                                                                           Litre = 15
  51                                                                                                                                         Loaf = 32
                                                                                                                                             Log = 16
  52                                                                                                                                         Margarine
                                                                                                                                               tin = 17
  53                                                                                                                                         Maxi bag = 18
       Secondary Raw Materials                                                                                                               Mini bag = 19
                                                                                                                                             Nut = 20
  61                                                                                                                                         Pair = 33
                                                                                                                                             Pieces = 34
  62                                                                                                                                         Pots = 35
  63                                                                                                                                         Pounds = 21
                                                                                                                                             Set = 36
       Secondary Works in Progress                                                                                                           Sheet = 22
                                                                                                                                             Singles = 37
  71                                                                                                                                         Stick = 23
  72                                                                                                                                         Tonne = 24
                                                                                                                                             Tree = 25
  73                                                                                                                                         Tubers = 26
                                                                                                                                             Yards/metres = 38
       Secondary goods purchased for resale
  81
  82
  83
Section 8, part e – Revenue for enterprises in wholesale/retail trade                                                                               Unit codes:
From GLSS5 but repeat to get data on most current revenue                                                                                           American tin = 02
                                                                                                                                                    Balls = 27
                                                            Last purchased                                Sales during last two weeks               Bar = 28
                                                                                                                                                    Barrel = 03
                                                                                                  (answer about a typical two weeks if enterprise   Basket = 04
                                           (respondent can choose to give answer in units,                                                          Beer bottle = 05
                                             or the value of units purchased as a whole)               has not operated in past two weeks)          Bowl = 06
              Main Items sold                                                    Value of total                                                     Box = 07
                                        Product Unit Unit price Quantity                          Unit    No. units Unit price Value of total       Bucket = 29
                                                                                   purchases                                                        Bunch = 08
                                         code     code     (cedis) purchased                      code      sold     (cedis) sales (cedis)          Bundle = 09
                                                                                    (cedis)
                                                                                                                                                    Crate = 30
                                            1       2         3          4             5            6          7            8             9
                                                                                                                                                    Dozen = 31
FIRST ENTERPRISE                                                                                                                                    Fanta /
                                                                                                                                                      coke bottle = 10
   1                                                                                                                                                Fingers = 11
                                                                                                                                                    Fruits = 12
   2                                                                                                                                                Gallon = 14
   3                                                                                                                                                Kilogram = 14
                                                                                                                                                    Litre = 15
   4                                                                                                                                                Loaf = 32
   5                                                                                                                                                Log = 16
                                                                                                                                                    Margarine
   6                                                                                                                                                  tin = 17
                                                                                                                                                    Maxi bag = 18
   7                                                                                                                                                Mini bag = 19
   8                                                                                                                                                Nut = 20
                                                                                                                                                    Pair = 33
   9                                                                                                                                                Pieces = 34
                                                                                                                                                    Pots = 35
  10                                                                                                                                                Pounds = 21
SECOND ENTERPRISE                                                                                                                                   Set = 36
                                                                                                                                                    Sheet = 22
   1                                                                                                                                                Singles = 37
                                                                                                                                                    Stick = 23
   2                                                                                                                                                Tonne = 24
   3                                                                                                                                                Tree = 25
                                                                                                                                                    Tubers = 26
   4                                                                                                                                                Yards/metres = 38
   5
   6
   7
   8
   9
  10
Section 8, part e -- Revenue for nonretail enterprises
From GLSS5 but repeat to get data on most current revenue
                                                                                                                      Amount received during last two weeks
                                                                                                                                    (cedis)

                                                        Service rendered                                              (or typical two weeks if business has not
                                                                                                                             operated in last two weeks)

                                                                                                                        First enterprise    Second enterprise

                                                                3                                                              4                     8

a   Sales of passenger transport (e. g. taxi, trotro, passenger buses, etc.)

b   Sales of freight transport (e.g. haulage trucks, vehicles for conveying sand, refuse, etc.).

c   Agency fees, commissions receivable (e.g. estate agents, lotto receivers, insurance agents, sales agents, etc.)

d   Professional fes receivable (e.g. mechanics, hairdressers, barbers, lawyers, masons, painters, etc.)

e   Gross profit on foreign exchange business

f   Rents receivable (e.g. renting of machinery, equipment, etc.)

g   Other receipts for services rendered (e.g. porters, kayayo, etc.)

h   Other services not elsewhere classified

TOTAL
Section 8, part e -- Revenue for food enterprises                                                             Unit codes:
                                                                                                              American tin = 02
From GLSS5 -- if business has operated in last 7 days repeat to get current information; otherwise skip       Balls = 27
   In the past week, how much on       How many days during                                                   Bar = 28
                                                                                                              Barrel = 03
average did you earn from the sale of the past 7 days did you                                                 Basket = 04
           meals in a day?             prepare meals for sale?                                                Beer bottle = 05
          (amount in cedis)                                                                                   Bowl = 06
                                                                                                              Box = 07
                                                                                                              Bucket = 29
                                                                                                              Bunch = 08
                                                                                                              Bundle = 09
                                                                   What is the cost of the following inputs   Crate = 30
     What is the total cost of ingredients purchased in a day?                                                Dozen = 31
                                                                               used in 7 days?                Fanta / coke bottle = 10
                           Ingredient                                                                         Fingers = 11
          Item                                         Amount                                   Amount        Fruits = 12
                            code (see Unit Code                              Input                            Gallon = 14
     (from GLSS5)                                      (cedis)                                  (cedis)
                            part 9B)                                                                          Kilogram = 14
             1                  2            3             4                   5                   6          Litre = 15
                                                                                                              Loaf = 32
                                                                  1. Firewood / charcoal                      Log = 16
                                                                                                              Margarine tin = 17
                                                                  2. Gas                                      Maxi bag = 18
                                                                                                              Mini bag = 19
                                                                  3. Water                                    Nut = 20
                                                                                                              Pair = 33
                                                                  4. Soap                                     Pieces = 34
                                                                                                              Pots = 35
                                                                                                              Pounds = 21
                                                                                                              Set = 36
                                                                                                              Sheet = 22
All others                                                                                                    Singles = 37
                                                                                                              Stick = 23
                                                                                                              Tonne = 24
                                                                                                              Tree = 25
                                                                                                              Tubers = 26
                                                                                                              Yards/metres = 38
Section 8, part e -- Revenue for service enterprise and other enterprise
Fill out for service industries if enterprise has been operational in the past 1 or 3 months
                                                                                 ENTERPRISE 1                        ENTERPRISE 2
                                                                        How much was earned through the           How much was earned
                                                                        provision of service during the last     through the provision of
                                  SERVICE                                              . . .?                   service during the last . . .?
                                                                                 (amount in cedis)                   (amount in cedis)
                                                                                 1 month       3 months          1 month          3 months
                                                                                    1              2                 3                4
           1 Delivery of goods sold
           2 Provision of other services
           3 Rental of buildings
           4 Rental of machinery and transport equipment
           5 Commissions
           6 Royalties, copyrights, etc. belonging to the enterprise
           7 Storage and handling fees
           8 Inspection and valuation fees
           9 Sale of scrap
  10 Profit of sales and fixed assets
  11 Other (specify)


Revenue for other enterprise -- from GLSS5 but repeat to get data on most current revenue if enterprise has been operational in the past 1 or 3 months
                                Operating in the last 2 weeks                                                      Not operating in the last 2 weeks
     During the last 2 During the last 2 What was During the last 2      What was the How much revenue            Does the   What is the usual Are some of What is the value
  ENTERPRISE NUMBER




                         weeks, has this             weeks, have any of                  is usually received     enterprise      value of          the good    of the products
     weeks, how much                         the                          value of the
                            enterprise                  the goods and                      from the sale of usually receive payments in the         usually  usually consumed
     revenue has been        received    estimated      services been      products
                                                                                         goods and services payments in the form of goods consumed by by the household
     received from the payments in the    value?      consumed by the consumed by the                                                          the household
                                                                                         by this enterprise in form of goods and services in a                instead of being
     sale of goods and form of goods                      household     household in the                                                          instead of
                          and services?                                                   a 2 week period? and services? two week period? being sold? sold over a 2 week
      services by this                    (cedis) members instead of last 2 weeks?                                1 = Yes                                          period?
                             1 = Yes                     being sold?                                                                                1 = Yes
        enterprise?       2 = No (>> 8)                    1 = Yes
                                                                            (cedis)       (amount in cedis) 2 = No (>> 13)        (cedis)        2 = No (>>         (cedis)
                                                             2 = No (>> next                                                                     next page)
                      (amount in cedis)                           page)        >> next page
                              5           6          7             8                9              10               11                12            13              14

           1
           2
Section 9 -- INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS
Part a: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
                     Name                                                                               In what At what age Highest Age at first       Highest level       To what         Ethnic group




                                              Sex (1 = Male; 2 = Female)
                                                                                  Relationship:
                                                                                                                                                                                               codes
                                                                             1 = parent of HH head     year was did [name]     level of   marriage      of education     ethnic group
                                                                            2 = parent of HH head's              stop living education                                                       1=Asante
                                                                                                        [name]                                         completed of     does [name's]      2=Akwapim
 Relative number




                                                                                      spouse
                                                                             3 = sibling of HH head
                                                                                                         born? with his / her completed (if never or   current / most   current / most        3=Fanti
                                                                                                                   parents?
                                                                            4 = sibling of HH head's                                       not yet     recent spouse    recent spouse          4=Ga
                                                                                      spouse                                     (see     married                          belong?          5=Dangme
                                                                                                                (code 888 if                                                                 6=Krobo
                                                                           5 = child of HH head with                            codes    code 888       (see codes
                                                                                 current spouse
                                                                                                                 still living                                                                 7=Ewe
                                                                                                                with parents)   below)    and then        below)         (see codes)          8=Guan
                                                                           6 = child of HH head with
                                                                                 another person                                            >> 10)                                            9=Nzema
                                                                                                                                                                                            10=Hausa
                       1                           2                                  3                   4           5           6           7              8                9            11=Dagomba
                                                                                                                                                                                          12=Mamprusi
R1                                                                                                                                                                                          13=Gonja
                                                                                                                                                                                         14=Grussi/ Frafra
R2
                                                                                                                                                                                            15=Dagati
R3                                                                                                                                                                                          16=Kusasi
                                                                                                                                                                                           17=Kassena-
R4                                                                                                                                                                                           Nankani
R5                                                                                                                                                                                         18=Kankoma
                                                                                                                                                                                           19=Nanumba
R6                                                                                                                                                                                          20=Builsa
                                                                                                                                                                                             21=Other
R7                                                                                                                                                                                           (specify)
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Codes for col. 7 and 8: 1=None; 2=Primary; 3=Middle/JSS; 4=Voc/Comm; 5='O' level; 6=SSS; 7='A' level; 8=Training college; 9=Tech/prof; 10=Tertiary; 11=Koranic; 12=Don't know
Section 9 – INFO ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 2)
Part 1: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
                                          Has [name] ever held a          Is   Year of Number of     Year of last      How many         Current Total landholding of Does [name] Do you
                                                                       [name]   death      visits       visit          phone calls, number of current household live in your         farm
                                             political office?
                                                                         still            [name]                    letters, or other   people      Unit codes:         village?   together?
                                                 0 = None                                                           contacts (other
                                        1 = Member of Parliament        alive? >> next made to       code 888 if                       living in      1 = acre
 Relative number




                   Number of live                                                                                     than visits in
                                       2 = District Chief Executive            relative    your      [name] has                        [name]'s       2 = pole          1 = Yes;    1 = Yes
                     children                                                                                          person) has
                                       3 = Assembly Man/Woman           1=yes           household       never       [name] made to    household       3 = rope           2 = No     2 = No
                                           4 = Unit Committee          (>> 15)           last year   visited this    the household                    4 = plot       (if no >> 22)
                                                 Member                 2=no                          household      in the past 12                                                  >> 26
                                       5 = National Political Office                     (if more                       months?
                                       [Minister, Deputy Minister,                      than zero,
                                                                                                                                                              unit
                   sons    daughters                etc.]                                 >> 17)                                                amount
                                                                                                                                                              code
                    10        11                    12                   13       14        15            16             17            18                19              20           21
R1
R2
R3
R4
R5
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Section 9 – INFO ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 3)
Part 1: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
For columns 22-25, either fill out column 22 (if the respondent lives in a city in Ghana listed in column 22) OR columns 23 and 24 (if the respondent
      lives in a city in Ghana not listed in column 22) OR column 25 (if the respondent left Ghana)
                                                                                     What is       FOSTER STATUS FOR CHILDREN UNDER 18
                                Where does [name] live?                                                                                                 Codes for
                                                                                     [name's]         (who are not living with biological parents)      column 21:
                                                                                     primary    With whom does [name]                                   1=Professional
                             In Ghana                        Outside of Ghana
                                                                                   occupation?             live?                        Why did you     / technical
          1 = Kumasi
                                                  REGION:                                       [give relative number if               send [name] to 2=Administra-
                                                                                  (give primary                                                         tive /
 Relative number




          2 = Sunyani
                                                 2=Western                                         one of the relatives      Does         live away?    managerial
        3 = Cape Coast                                                             occupation
                                                  3=Central                                     named in this section or [name]        1 = availability 3=Clerical
         4 = Koforidua                                                                 while
                                                4=Gt. Accra
           5 = Accra                                                                working if             code             attend     of better school 4=Sales
                                                   5=Volta
          6 = Tamale                                          give name of            retired)   777 = another relative    school?     2 = to live in a 5=Service
        7 = Bolgatanga
                          give name of city       6=Eastern
                                                                                                                                                        6=Agric./Ani-
                                                 7=Ashanti        country                         (specify relationship)   1 = Yes family with better
         8 = Koforidua                                                                                                                                  Husb./Forest/
                                               8=Brong Ahafo                       (see codes)      888 = not with a        2 = No economic status Fishing/
            9 = Wa
                                                 9=Northern                                              relative                          3 = other
         10 = Sekondi-                                                                                                                                  Hunting
                                               10=Upper East                                                                                            7=Production
            Takordi
                                              11=Upper West
                                                                                                999 = don't know/can't                     (specify)
            11 = Ho                                                                                        say]                                         &
                                                                                                                                                         related works
                   22           23                 24               25               26                  27                 28              29          8=Workers
R1                                                                                                                                                      NEC
R2                                                                                                                                                      9=Homemaker
                                                                                                                                                        10=In school
R3                                                                                                                                                      full time
R4                                                                                                                                                      11 = other
                                                                                                                                                        (specify)
R5                                                                                                                                                      12=Don't know
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Section 9 - INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 4)
Part b: Applied to all absent spouses of any household member
                                                                          When At what age did Age of        To what What is the When did What is the      Number       Year of     Ethnic group
                                                                           was          [absent      [absent  ethnic    highest      [absent  profession   of visits   last visit        codes
                                                                                                                                                                                       1=Asante




                                               Present spouse's ID no.
                                                                         [absent spouse's name] spouse] at group        level of spouse] last      of          to
 Absent Spouse Number




                                                                                                                                                                                     2=Akwapim




                                                   from HH roster
                                                                         spouse's stop living with marriage    does   schooling     live with   [absent    [present                     3=Fanti
                                                                          name]        his / her        to   [absent completed      [present   spouse]?    spouse]                       4=Ga
                        Absent spouse's name                              born?        parents?     [present spouse's by [absent    spouse]?  (see codes    in past                   5=Dangme
                                                                                                                                                                                       6=Krobo
                                                                                                    spouse]   name]    spouse's                 below)       year
                                                                                                                                                                                        7=Ewe
                                                                                    (code 888 if             belong?    name]?   (code 888 if                                           8=Guan
                                                                                  still living with                   (see codes they have                  if more                    9=Nzema
                                                                                      parents)                 (see     below)    never lived              than zero                  10=Hausa
                                                                                                              codes)               together)                 >> 12                  11=Dagomba
                                                                                                                                                                                    12=Mamprusi
                                 1                     2                    3           4           5          6         7            8           9           10          11          13=Gonja
S1                                                                                                                                                                                    14=Grussi/
                                                                                                                                                                                         Frafra
S2                                                                                                                                                                                    15=Dagati
                                                                                                                                                                                      16=Kusasi
S3                                                                                                                                                                                   17=Kassena-
                                                                                                                                                                                       Nankani
S4                                                                                                                                                                                  18=Kankoma
S5                                                                                                                                                                                  19=Nanumba
                                                                                                                                                                                      20=Builsa
S6                                                                                                                                                                                     21=Other
                                                                                                                                                                                       (specify)
S7
S8
S9
S10
Codes for column 5: 1=None; 2=Primary; 3=Middle/JSS; 4=Voc/Comm; 5='O' level; 6=SSS; 7='A' level; 8=Training college;
    9=Tech/prof; 10=Tertiary; 11=Koranic; 12=Don't know
Codes for column 12: 1=Professional/technical; 2 = Administrative/managerial; 3 = Clerical; 4 = Sales; 5=Service;
    6=Agric./Ani-Husb./Forest/ Fishing/Hunting; 7=Production & related works; 8=Workers NEC; 9 = Homemaker;
    10=full time student; 11=other (specify) 12=Don't know
Section 9 - INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 5)
Part b: Applied to all absent spouses of each household members (concluded)
                           How many         Has [absent spouse's name]                            Where does [name] live primarily?
                           phone calls,     ever held political office?
                        letters, or other                                                       In Ghana                                Outside of Ghana
                        contacts (other               0 = None
 Absent Spouse Number




                                                                              1 = Kumasi
                          than visits in     1 = Member of Parliament                                                REGION:
                                                                              2 = Sunyani
                                                                                                                    2=Western
                           person) has      2 = District Chief Executive    3 = Cape Coast
                                                                                                                     3=Central
                        [absent spouse]     3 = Assembly Man/Woman           4 = Koforidua
                                                                                                                   4=Gt. Accra
                                                                               5 = Accra
                             made to            4 = Unit Committee                                                    5=Volta
                                                                              6 = Tamale
                             [present                 Member                7 = Bolgatanga
                                                                                             give name of city       6=Eastern        give name of country
                                                                                                                    7=Ashanti
                         spouse] in the     5 = National Political Office    8 = Koforidua
                                                                                                                  8=Brong Ahafo
                              past 12       [Minister, Deputy Minister,         9 = Wa
                                                                                                                    9=Northern
                            months?                      etc.]              10 = Sekondi-
                                                                                                                  10=Upper East
                                                                                Takordi
                                                                                                                  11=Upper West
                                                                                11 = Ho

                               12                        13                      14                 15                 16                     17
S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
Section 10 (Transfers), Part 1-- TRANSFERS OUT OF THE HOUSEHOLD
Is there anyone (including household members) not living in the household at the time to whom the household has sent money or goods in the past year?
Fill in columns 1-9 from GLSS5; fill out columns 10-13 for transfers mentioned during GLSS5 and entire page for new transfers
                                                              Were these         Will these   What was     What were the three         What was      What was      Where does this   Do you still      If not a   If this   Through what
                                                              remittances       remittances    the total  main uses of the cash          the total     the total   recipient live?    send this     household    person       means did
                                                              made on a         be repaid at amount of         sent / given?             value of      value of 1=this town/village individual      member, is was one of    you receive
                                                              regular basis?                              1 = daily consumption                                  2=Sekondi / Takordi money, or                                   the
                                                                                some future the cash sent                               food sent        other                                      this person     the
                                                              Yes,                                             2 = housing                                         3=Cape Coast       have you                               remittance?
                                                                                   time?     to or given                                   to or        goods                                         a blood   relatives
                                                                1 = weekly                                     3 = business                                           4=Accra        done so in
                                                                2 = monthly
                                                                                                to this       4 = education
                                                                                                                                         given to     sent to or        5=Ho         the past 12
                                                                                                                                                                                                               mentioned
                                                                                                                                                                                                     relative or              1 = Bank
                                    If household member, ID


                                                                3 = quarterly     1 = Yes    individual          5 = health                 this       given to     6=Koforidua        months?      spouse of a      in         account
                                                                4 = annually      2 = No     during the         6 = funeral            individual         this       7=Kumasi          1 = Yes;     household   previous     2 = Money
 Transfer number




                   Name of person                             No = 5                            past 12    7 = other ceremony          in the past   individual      8=Suyani           2 = No        member?   section,        transfer
                   to whom money                              Other                           months?           8 = savings                  12      in the past     9=Tamale         (if no, >>      1 = Yes;     give         agency
                       is sent                                  (specify) = 6                                    9 = agriculture         months?           12      10=Bolgatanga          next         2 = No    relative    3 = Sender
                                                                                                                   10 = other                         months?          11=Wa           transfer)               number or    him or herself
                                                                                                                                                                   12=other urban                    (if no >> code 999       4 = Cash
                                                                                                                                                                      13=rural          SKIP FOR                              carried by
                                                                                                                                                                                                         13)        if a
                                                                                                                                                                 96=Other ECOWAS          NEW                               someone else
                                                                                                                                                                                                                 relative
                                                                                                                                                                 97=Africa other than    TRANS-                               5 = Other
                                                                                                                                                                     ECOWAS               FERS                      not        (specify)
                                                                                                                                                                  98=Outside Africa                            mentioned


                                                                                                cedis        a         b           c      cedis        cedis
                         1                2                           3              4            5                    6                    7            8                9                10           11         12            13

    1

    2

    3

    4

    5

    6

    7

    8

    9

 10
Section 10, Part 2 -- TRANSFERS INTO THE HOUSEHOLD
Is there anyone (including household members) not living in the household from whom the household has received money / goods in the past year?
Fill in columns 1-10 from GLSS5; fill out columns 11-13 for transfers mentioned during GLSS5 and entire page for new transfers
                             Were these       Will these What was                  What were the three What was What was         Where does this   Do you still       If not a   If this
                             remittances                                          main uses of the cash the total the total      recipient live?    send this      household    person
                                             remittances the total Through what
                             made on a                                                 sent / given?      value of value of 1=this town/village individual         member, is was one of
                                             be repaid at amount of    means did
                             regular basis?                                       1 = daily consumption                        2=Sekondi / Takordi money, or
                                                                      you receive                        food sent    other                                        this person     the
                             Yes,            some future the cash                      2 = housing                               3=Cape Coast       have you
                                                                           the                              to or    goods                                           a blood   relatives
                               1 = weekly       time?      sent to or remittance?      3 = business                                 4=Accra        done so in
                                                                                                          given to sent to or                                                 mentioned
                                                                                                                                                                    relative or
                         If household member, ID



                               2 = monthly                  given to                  4 = education                                   5=Ho         the past 12
                               3 = quarterly                                             5 = health          this   given to      6=Koforidua        months?       spouse of a   in the
                                               1 = Yes        this     1 = Bank                         individual     this                                        household   previous
                               4 = annually                                             6 = funeral                                7=Kumasi          1 = Yes;
 Transfer number




       Name of person                          2 = No     individual    account
                             No = 5                                                7 = other ceremony in the past individual       8=Suyani           2 = No         member?   section,
                                                                      2 = Money
         from whom           Other                        during the                    8 = savings           12   in the past     9=Tamale         (if no, >>       1 = Yes;     give
                                                                        transfer
           money is            (specify) = 6                past 12     agency
                                                                                         9 = other        months?       12       10=Bolgatanga         next           2 = No    relative
           received                                        months?                                                  months?          11=Wa           tranfer)                 number or
                                                                      3 = Sender
                                                                                                                                   12=other urban                   (if no >>    999 =
                                                                         him or herself
                                                                                                                                      13=rural          SKIP FOR
                                                                           4 = Cash                                                                                    next     another
                                                                                                                                 96=Other ECOWAS          NEW
                                                                           carried by                                                                               transfer)   relative
                                                                                                                                 97=Africa other than    TRANS-
                                                                         someone else
                                                                                                                                     ECOWAS               FERS
                                                                           5 = Other
                                                                                                                                  98=Outside Africa
                                                                            (specify)

                                                               cedis                      a    b      c      cedis      cedis
                   1           2                   3   4         5             6               7               8          9              10                11          12         13
    1
    2
    3
    4
    5
    6
    7
    8
    9
 10
Section 11 (savings, credit, assets) part a – Borrowing
Input columns 1 - 6 from GLSS5; ask questions 7 - 13 about loans mentioned during GLSS5 and entire sheet about new loans
          What is the source of What was      For what purpose was     What kind of      How     Do you Do you     If so, How frequently                                          How                                      If land is
               this loan?                      the loan contracted?    guarantee was            still owe have to what is   do you make                                                                                   being used
                                  the total                                           much of                                                                                    much
              Which household member obtained the loan? (give ID)


             1 = State bank                   1 = Agricultural land / required by the              this     pay     the     payments on                                                                                  as collateral
            2 = Private bank     amount of          equipment             lender?      the loan                               this loan?                                        money is
                                                                                                money? interest interest                                                                                                      (see
            3 = Cooperative     the original 2 = Agricultural inputs     1 = None     has been                                1 = Daily                                         currently
                                                                                                          on this  rate?                                                                                                 question 5),
           4 = Govt. agency         loan?          3 = Business          2 = Land     repaid in                              2 = Weekly                                          owed?      To whom is this money
               5 = NGO                             4 = Housing           3 = Cattle
                                                                                                1 = Yes    loan?          3 = Forthnightly
                                                                                                                                                                                                                         then who is
                                                                                       the past                                                                                                   owed?
           6 = Business firm                 5 = Education / training   4 = House /                                 (%)    4 = Quarterly                                                                                   using the
                                   (cedis)                                              twelve   2 = No 1 = Yes                                                                  (cedis)                                     land?
             7 = Employer                           6 = Health            building                                          5 = Semester
                                                                                      months? (>> next 2 = No                                                                               (give name of person or       1 = person
Loan Number




           8 = Moneylender                       7 = Ceremonies        5 = Employer                                          6 = Annual
                                                                        9 = Trader             (weddings, funerals,   6 = Relatives             loan)           7 = Only one                  organization / bank)         to whom
                                                                       10 = Farmer                     etc.)            7 = Non-      (cedis)                   final payment                                              money is
                                                                      11 = Relative /              8 = Vehicle          relatives                                8 = No fixed                                                owed
                                                                     neighbor / friend         9 = Other consumer       8 = Other                                  schedule                                                    2=
                                                                     12 = Community                   goods             (specify)                                                                                          someone
                                                                         epicenter             10 = Other (specify)
                                                                                                                                                                                                                              else
                                                                    13 = other (specify)
                                                                                                                                                                                                                           8 = don't
                                                                                                                                                                                                               ID (if        know
                                                                                                                                                                                                name          village
                                                                                                                                                                                                             resident)


                           1                                                 2             3            4                  5             6        7     8   9        10            11            12             13            14

       1
       2
       3
       4
       5
       6
       7
       8
Section 11, part b -- Household assets
Fill in columns 1,3, and 5 from GLSS5 but and fill out rest of the columns during new survey
                                             During GLSS5 your household owned:
                                          1 = working; 2 = not working; 3 = none (>>2)                 Do you  Do you now              What was the
                                                                                                     now own a  own any              purchase price?
                                              For each owned during GLSS5, code
                                                                                                         [ ]?     more               (if gift put zero)
                                                  1 = still owned and working                                               How
                                                                                                                   [ ]?
                                                2 = still owned and not working                                           many do
 CODE




                Item                                  3 = sold / given away                           1 = Yes                       see currency codes
                                                                                                                          you now
                                                           4 = discarded                               (>> 9)   1 = Yes                   below
                                                                                                                           own?
                                          (>> and go to next item for each of the above)               2 = No    2 = No
                                          1                     2                      3              (>> next  (>> next
                                              current               current                current      item)     item)                           currency
                                  GLSS5                 GLSS5                 GLSS5                                                 amount
                                               status                status                 status                                                  code
                                    1            2        3            4         5            6         7          8         9               10
 301 Furniture
 302 Sewing machine
 303 Stove (kerosene)
 304 Stove (electric)
 305 Stove (gas)
 306 Refrigerator
 307 Freezer
 308 Air conditioner
 309 Fan
 310 Radio
 311 Radio cassette
 312 Record player
 313 3-in-one radio system
 314 Video player
 315 Desktop computer
 316 Laptop computer
 317 Printer
 318 Computer accessories
 319 Camcoder/video camera
 320 Satellite dish
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part b -- Household assets concluded
Fill in columns 1,3, and 5 from GLSS5 but and fill out rest of the columns during new survey
                                             During GLSS5 your household owned:
                                          1 = working; 2 = not working; 3 = none (>>2)                 Do you  Do you now
                                                                                                                                       What was the
                                                                                                     now own a  own any
                                              For each owned during GLSS5, code                                                      purchase price?
                                                                                                         [ ]?     more
                                                  1 = still owned and working                                               How      (if gift put zero)
                                                2 = still owned and not working
                                                                                                                   [ ]?
                                                                                                                          many do
 CODE




                Item                                  3 = sold / given away                           1 = Yes
                                                                                                                          you now   see currency codes
                                                           4 = discarded                               (>> 4)   1 = Yes
                                                                                                                           own?           below
                                          (>> and go to next item for each of the above)               2 = No    2 = No
                                          1                     2                      3
                                                                                                      (>> next  (>> next
                                                                                                        item)     item)
                                              current               current                current                                               currency
                                  GLSS5                 GLSS5                 GLSS5                                                  value
                                               status                status                 status                                                 code
                                                                1                                       2          3         4         5             6
 321 Washing machine
 322 TV
 323 Camera
 324 Iron (electric)
 325 Bicycle
 326 Motorcycle
 327 Car
 328 House
 329 Land / plot
 330 Shares
 331 Boat
 332 Canoes
 333 Outboard motor
 334 Microwave
 335 Food processor
 336 Box iron
 337 Mobile phone
 338 Generator
 339 Jewellery
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part c -- Saving
Input columns 1 - 3 from GLSS5; ask questions 4 and 5 about accounts mentioned during GLSS5 and columns 1 - 5 about new accounts
Ask also questions 6 and 7 about home savings
                                               Is the
               ID of member's name



                                           account still
                                               open?
                                                           What is the
                    on account
 Item Number




                 Balance during GLSS5
                                                         current balance?
                                              1 = Yes

                                                          2 = No
                                              currency   (>> next
                                     amount              account)   amount
                                                code
                      1                2         3          4         5

           1                                                                       (6) Does the household have any
           2                                                                       savings that are kept at home          _______ (1 = Yes; 2 = No)
                                                                                   (i. e., not in a bank or in a susu)?
           3

           4

           5                                                                       (7) If so, how much?                                          amount
                                                                                                                                   currency
           6                                                                                                                       code
           7                                                                                                                       (see below)

           8

           9

 10
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part d -- Lending
NEW -- Is any member of the household owed money? ______ (1 = Yes; 2 = No, if no >> next page)
                                                                                                                                                               How frequently are
                                                                                                                               What kind of
                                                                                                                                                               payments made on
                   To whom was                                                          When the                               guarantee was
                                                                                                                                                                    this loan?
                      this loan                                                         loan was                              required of the
                                 Give receiver's name, if a resident What was the                                                                                   1 = Daily
                       given?                                                         started, how                               receiver?        How much
                                           of your village            total amount                     How long ago                                                2 = Weekly
                   1 = Employee                                                       much in total                              1 = None          does the
 Loan Number




                                                                     of the original                    was the loan                                            3 = Forthnightly
                     2 = Tenant                                                          did the                                 2 = Land          recipient
                                  (or write NV if not a resident of  loan given to                       started?                                                4 = Quarterly
                    3 = Relative                                                     recipient have                              3 = Cattle     currently owe?
                                               village)              the recipient?                                                                               5 = Semester
                   4 = Neighbor                                                        to pay you                          4 = House / building
                                                                                                                                                                   6 = Annual
                       / friend                                                           back?                                5 = Employer         (cedis)
                                                                         (cedis)                                                                               7 = Only one final
                      5 = other                                                                                                6 = Relatives
                                                                                                                                                                     payment
                      (specify)                                                          (cedis)                             7 = Non-relatives
                                                                                                                                                                  8 = No fixed
                                         name                 ID                                      Years       Months    8 = Other (specify)
                                                                                                                                                                     schedule
                         1                         2                        3              4                  5                      5                 6                 7

               1

               2

               3

               4

               5

               6

               7

               8
                                                                                           governance and social capital
NEW – Community Participation                                                                                                Give household polling site (from village survey)
Ask of each household member
                                                                              Did you
                                                                                                                                                                                    CODE FOR
                                                                            attend the                                                                                              COLUMN 4:
                                                                             previous                                                                               How well do     1 = road or
                                                                                            If yes, did
                                                                              village                                         Did you vote                         you think your   transport
                                                                                            you speak
 Organization Number




                                                                             assembly                                             in the   ASK ISSER/GSS IF            current       2 = health
                                                                                            about any
                              List the social, political, and religious     meeting on                                          previous   THIS QUESTION IS        representative   3 = education
                                                                                           issue at the
                           organizations that you belong / participate in     [date]?                      What was/were this election on TOO SENSITIVE TO            is doing?     4 = irrigation
                                                                                             meeting?
                                                                                                               issue(s)?         [date]?      ASK: which            1 = excellent   or water
                                    (codes from village roster)               1 = yes                                                       candidate did you      2 = very good     5 = other
                                                                                              1 = yes
                                                                              2 = no                                             1 = yes        vote for?            3 = average    agriculture
                                                                                              2 = no
                                                                                                                                 2 = no                                4 = bad      related
                                                                                           (if no >> 5)
                                                                             (give date                                                                             5 = very bad    6 = ceremonies
                                                                            from village                                                                                            7=disputes
                                                                               survey)                                                                                              8 = sanitation
                                                 1                                2             3                   4              5                  6                   7          9=
                       1                                                                                                                                                            construction
                                                                                                                                                                                    other than
                       2                                                                                                                                                            roads or
                                                                                                                                                                                    irrigation
                       3                                                                                                                                                            10 = access to
                       4                                                                                                                                                            and use of
                                                                                                                                                                                    lands of the
                       5                                                                                                                                                            assembly
                                                                                                                                                                                    11 =
                       6                                                                                                                                                            unemployment
                       7                                                                                                                                                            schemes
                                                                                                                                                                                    12 = other
                       8                                                                                                                                                            (specify)




                                                                                                          Page 97
                                                         digits1
Section XXX, Part XXX: Digit Span Cognitive Assessment
Complete for each child under ages 5 - 12 in the household. Complete Part 1 first.

Child name:____________________________________                              Child Household ID:_____________________

Instructions:
(1) Read each digit span only once at an even rate of one digit per second.
(2) Read Part A of a question; pause for response, then score.
(3) Read Part B of a question; pause for response; then score.
(4) If child does not respond after reading the question, do not encourage further.
(5) Stop when child misses Part A and Part B of any one question.
(6) To be scored as "correct", no digits may be omitted or be in reversed order.


Part 1: Digits Forward

Read outloud to child: "I can only read these instructions to you one time. I cannot
repeat them. I am going to say some numbers. Listen carefully, and when I am through,
say them right after me"
0. Exact Time Now ______________________
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q1(a) "2-9"
Q1(b) "4-6"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q2(a) "3-8-6"
Q2(b) "6-1-2"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q3(a) "3-4-1-7"
Q3(b) "6-1-5-8"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q4(a) "8-4-2-3-9"
Q4(b) "5-2-1-8-6"
      If the child got both questions wrong >> Part 2

                                                        Page 98
                                                        digits1
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q5(a) "3-8-9-1-7-4"
Q5(b) "7-9-6-4-8-3"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q6(a) "5-1-7-4-2-3-8"
Q6(b) "9-8-5-2-1-6-3"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q7(a) "1-6-4-5-9-7-6-3"
Q7(b) "2-9-7-6-3-1-5-4"
      If the child got both questions wrong >> Part 2
                              Correct response:
                              1 = Child repeated the numbers exactly
                              0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q8(a) "5-3-8-7-1-2-4-6-9"
Q8(b) "4-2-6-9-1-7-8-3-5"
      >> Part 2




                                                       Page 99
                   digits1



_______________




                  Page 100
                                                            digits2
Section XXX, Part XXX: Digit Span Cognitive Assessment (concluded)
Complete for each child under ages 5 - 12 in the household. Complete Part 1 first.

                                             Child Household ID:_____________________
Child name:____________________________________
Part 2: Digits Backward

Read outloud to child: "Now, I am going to say some more numbers, but this time
when I stop, I want you to say them backward. For example, If I say 9-2-7, what
would you say?"

If child says "7-2-9", say: "That's right. Let's go on with the rest of the numbers"

If child does not say "7-2-9", say: "No, you would say 7-2-9. I said 9-2-7, so to say
it backwards you would say 7-2-9. Now try these numbers. Remember to say them
backward."

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO       answer exactly
                 Say "Ready", then      NOT READ         0 = Child did not repeat the
                       say:                              answer exactly
Q9(a)           "2-5"                "5-2"
Q9(b)           "6-3"                 "3-6"
                If the child got both questions wrong >> Question 16

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO       answer exactly
                 Say "Ready", then      NOT READ         0 = Child did not repeat the
                       say:                              answer exactly
Q10(a)          "5-7-4"              "4-7-5"
Q10(b)          "2-5-9"               "9-5-2"
                If the child got both questions wrong >> Question 16

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO
                                                         answer exactly
                                        NOT READ
                 Say "Ready", then                       0 = Child did not repeat the
                       say:                              answer exactly
Q11(a)          "7-2-9-6"            "6-9-2-7"
Q11(b)          "8-4-9-3"             "3-9-4-8"
                If the child got both questions wrong >> Question 16


                                                         Correct response:
                                        Answer: DO       1 = Child repeated the
                                        NOT READ         answer exactly
                 Say "Ready", then                       0 = Child did not repeat the
                       say:                              answer exactly

                                                          Page 101
                                                     digits2
Q12(a)       "4-1-3-5-7"         "7-5-3-1-4"
Q12(b)       "9-7-8-5-2"           "2-5-8-7-9"
             If the child got both questions wrong >> Question 16

                                                   Correct response:
                                                   1 = Child repeated the
                                   Answer: DO
                                                   answer exactly
                                   NOT READ
             Say "Ready", then                     0 = Child did not repeat the
                   say:                            answer exactly
Q13(a)       "1-6-5-2-9-8"       "8-9-2-5-6-1"
Q13(b)       "3-6-7-1-9-4"         "4-9-1-7-6-3"
             If the child got both questions wrong >> Question 16

                                                   Correct response:
                                                   1 = Child repeated the
                                   Answer: DO      answer exactly
             Say "Ready", then     NOT READ        0 = Child did not repeat the
                   say:                            answer exactly
Q14(a)       "8-5-9-2-3-4-2"     "2-4-3-2-9-5-8"
Q14(b)       "4-5-7-9-2-8-1"       "1-8-2-9-7-5-4"
             If the child got both questions wrong >> Question 16


                                                   Correct response:
                                   Answer: DO      1 = Child repeated the
                                   NOT READ        answer exactly
             Say "Ready", then                     0 = Child did not repeat the
                   say:                            answer exactly
Q15(a)       "6-9-1-6-3-2-5-8" "8-5-2-3-6-1-9-6"
Q15(b)       "3-1-7-9-5-4-8-2" "2-8-4-5-9-7-1-3"

16: Exact Time Now ______________________




                                                    Page 102
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 1 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
Record below the pictures which shape the child pointed to.

Example
Show the child the picture and then point to shape d
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 2 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK1. Shape pointed to ______________________                                                     EK2. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 3 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK3. Shape pointed to ______________________                                                     EK4. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 4 / 7)
Complete for each child under ages 5 - 12 in the household.

                                Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK5. Shape pointed to ______________________                                                     EK6. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 5 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK7. Shape pointed to ______________________                                                     EK8. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 6 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK9. Shape pointed to ______________________                                                     EK10. Shape pointed to ____________________________
Section XXX, Part XXX: Raven's Pattern Cognitive Assessment (page 7 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK11. Shape pointed to ______________________                                                    EK12. Shape pointed to ____________________________

				
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