MODULE A.

IDENTIFICATION
N Question Response Response Type
o.
Questionnaire Number Single Respons
e
Enumerator Code Test Cascade o
ption ( Single r
Date of interview
esponse per qu
County Name estion)
Name of Location
Name of sub-location
Name of village/Settlement/sch
ool

MODULE B. HOUSEHOLD PROFILE

Is respondent the Household H [Link]
ead [Link]
What is the sex of the respond [Link] Single Respons
ent [Link] e
What is the status of the HH he [Link] headed Single Respons
ad? [Link] headed e
3. Child headed
What is the age of the HH hea [Link] 18 years Single Respons
d? 2.18-35 years e
3.35-60 years
[Link] 60 years
What is the marital Status of H [Link] Single Respons
H head? [Link] e
[Link]
[Link] (If Child HH, ski
[Link]/Widower p question)
What is the highest level of edu 1. No formal school atten Single Respons
cation of HH head? ded e
[Link]-primary
3. Primary School
4. High School
5. College /University
Total number of people in the …………………… Write Number
HH
Total number of children in the …………………… Write Number
household

MODULE C: HOUSEHOLD WATER ACCESS

What is the Main Household so [Link] water into dwelling Single Respon
urce of human water during w [Link] water into se
et season yard/plot
[Link] tap/Stand pipe
(Kiosk)
[Link] well/borehole
[Link] dug well
[Link] dug well
 [Link] springs
[Link] springs
[Link] water collection
[Link] water
[Link] with small tank
[Link]/truck
[Link] water (River,
dam, lake, pond, stream,
canal, irrigation channels)
14. Other:
(Specify)__________

What is the Main Household so [Link] water into dwelling Single Respon
urce of human water during dr [Link] water into se
y season yard/plot
[Link] tap/Stand pipe
(Kiosk)
[Link] well/borehole
[Link] dug well
[Link] dug well
[Link] springs
[Link] springs
[Link] water collection
[Link] water
[Link] with small tank
[Link]/truck
[Link] water (River,
dam, lake, pond, stream,
canal, irrigation channels)
14. Other:
(Specify)__________

What is the Main Household so [Link] water into dwelling Single Respon
urce of livestock water during [Link] water into se
wet season yard/plot
[Link] tap/Stand pipe
(Kiosk)
[Link] well/borehole
[Link] dug well
[Link] dug well
[Link] springs
[Link] springs
[Link] water collection
[Link] water
[Link] with small tank
[Link]/truck
[Link] water (River,
dam, lake, pond, stream,
canal, irrigation channels)
14. Other:
(Specify)__________

What is the Main Household so [Link] water into dwelling Single Respon
urce of livestock water during [Link] water into se
dry season yard/plot
[Link] tap/Stand pipe
(Kiosk)
[Link] well/borehole
 [Link] dug well
[Link] dug well
[Link] springs
[Link] springs
[Link] water collection
[Link] water
[Link] with small tank
[Link]/truck
[Link] water (River,
dam, lake, pond, stream,
canal, irrigation channels)
14. Other:
(Specify)__________

Distance to main source of hu 1. Less than 500 meters Single Respon

man water during wet season 2. Over 500m-1km se
3. Over 1km- 2km
4. Over 2km – 5km
5. Over 5km
Distance to main source of hu 1. Less than 500 meters
man water during dry season 2. Over 500m-1km
3. Over 1km- 2km
4. Over 2km – 5km
5. Over 5km
Distance to main source of live 1. Less than 500 meters Single Respon
stock water during wet season 2. Over 500m-1km se
3. Over 1km- 2km
4. Over 2km – 5km
5. Over 5km
Distance to main source of live 1. Less than 500 meters Single Respon
stock water during dry season 2. Over 500m-1km se
3. Over 1km- 2km
4. Over 2km – 5km
5. Over 5km
Time taken to make roundtrip t [Link] than 15 minutes Single Respon
o main HH source of human wa [Link] 15 to 30 minutes se
ter during wet season [Link] 30 minutes to 1
hour
[Link] 1 hour to 2hours
[Link] 2 hours to 3 hours
[Link] than 3 hours
Time taken to make roundtrip t [Link] than 15 minutes Single Respon
o main HH source of human wa [Link] 15 to 30 minutes se
ter during dry season [Link] 30 minutes to 1
hour
[Link] 1 hour to 2hours
[Link] 2 hours to 3 hours
[Link] than 3 hours
Time taken to make roundtrip t [Link] than 15 minutes Single Respon
o main HH source of livestock [Link] 15 to 30 minutes se
water during wet season [Link] 30 minutes to 1
hour
[Link] 1 hour to 2hours
[Link] 2 hours to 3 hours
[Link] than 3 hours
Time taken to make roundtrip t [Link] than 15 minutes Single Respon
o main HH source of livestock [Link] 15 to 30 minutes se
water during dry season [Link] 30 minutes to 1
hour
[Link] 1 hour to 2hours
[Link] 2 hours to 3 hours
[Link] than 3 hours
Have you experienced a challe [Link] Single Respon
nge with your water source (hu [Link] se
man consumption)?
If No, skip to E
17
If yes, please specify [Link] water supply Multiple Resp
[Link] of poor quality onse
3. Conflicts at water
source
4. Other:
(Specify)__________
Have you missed water for 4 c [Link] Single Respon
onsecutive days in the last one [Link] se
month? (SKIP pattern)
If No, skip to E
17
If yes, why? [Link] Multiple Resp
[Link] breakdown onse
[Link]/conflict
4. Other:
(Specify)__________
Who manages the main water [Link] respondent Single Respon
source? [Link] elders se
[Link] Owner/Operator
[Link] Local Committee
[Link] Service Provider
[Link] of Water and
Natural Resources
[Link]
Is there anyone from your fami [Link] Single Respon
ly /HH who is involved in the co [Link] se
mmunity water management c
ommittee or Water Resource U If NO, skip to
ser Association Committee? E20
If yes, what is the gender of th [Link] Single Respon
e family member? [Link] se
Do you pay for the water servi [Link] Single Respon
ces that you get for your house [Link] se
hold? If No skip to E
25
How much do you pay for wate [Link] than KES 270
r per month using the method [Link] 270- 500
Single Respon
above (WATER MANAGEMENT [Link] 500-1000
se
COMMITTEE OR WRUA METHO [Link] 1000
D)
How much do you pay per 20 li [Link] than KES Single Respon
tres Jerrican during wet season 5/20LITRES se
[Link] 6 -10/20LITRES
[Link] 11 –15/20 LITRES
[Link] 16 -20/20LITRES
[Link] KES 20/20 LITRES
 [Link]
How much do you pay per 20 li [Link] than KES Single Respon
tres Jerrican during dry season 5/20LITRES se
[Link] 6 -10/20LITRES
[Link] 11 –15/20 LITRES
[Link] 16 -20/20LITRES
[Link] KES 20/20 LITRES
[Link]
What would make you pay mor [Link] distance to Multiple Resp
e for your household water water sources onse
[Link] quantity of
water
[Link] reliability of
water
[Link] quality of
water
[Link] conflict over
water sources
[Link] management
7. Other:
(Specify)___________

On average how much water is [Link] than 20 L/1 Jerrican Single Respon
used in your household per da [Link] 20L- 40 L/2 se
y in wet season? Jerricans
[Link] 40L - 60 L/3
Jerricans
[Link] 60L - 80 L/4
Jerricans
[Link] 80 L/4 Jerricans
On average how much water is [Link] than 20 L/1 Jerrican Single Respon
used in your household per da [Link] 20L- 40 L/2 se
y in dry season? Jerricans
[Link] 40L - 60 L/3
Jerricans
[Link] 60L - 80 L/4
Jerricans
[Link] 80L/4 Jerricans
Do you usually do anything to [Link] Single Respon
make the water safe before dri [Link] se
nking?
If No, skip to E
31

If Yes, Procee
d then skip E3
1
IF YES, what do you usually do [Link] Multiple respo
to make the water safer to drin [Link] Bleach/Chlorination nse
k? [Link]/Sieving
through a cloth
[Link] Filters
[Link] Treatment
[Link] It Stand and Settle
7. Other:
(Specify)__________
How often do you use the optio [Link] all times Single Respon
n in E28 above? [Link] se
[Link]
Where do you mainly obtain re [Link] Single Respon
commended household water t [Link] se
reatment product(s) [Link] Distributor
[Link] Facility Skip E31
[Link]/KRCS
[Link]
(Specify)____________
If no in E27, why? [Link] water is clean Multiple Resp
[Link] consuming onse
[Link] access to
firewood
[Link]'t know to treat
[Link] costly
6. Other:
(Specify)___________

When do you wash your hand 1. After defecation (multiple respon

s? 2. Before eating ses possible)
3. Before food preparation
4. Before feeding the child
5. After changing a baby
6. After touching dirty
things
7. Other
What do you use while washin 1. Soap and water
g your hands? (choose 1) 2. Ash and water
3. Only Water
4. Other
OBSERVE: Type of toilet facility [Link] Facility / Bush / Field If you cannot s
in compound and record witho  ee a latrine, a
ut asking the respondent. [Link] Pit Latrine sk owner if th
[Link] Improved Pit er is one and
Latrine where it is the
[Link] Toilet go and do obs
[Link] ground vault ervation
[Link] improved facility (Choose 1)
Refused to allow to see
Do all members of this househ
[Link] [Link]
old use this latrine
Is this latrine shared with anyo If yes-pop up :
ne outside your household? How many
1................................................
household share
2..................................................
this latrine?
______ # of
households
MODULE D: EDUCATION TOOL – Teachers
What is the name of your sc
hool
How many learners do you h Male
ave in the school? Female
What is the total number of Male
teachers in your school? Female
What is the total number of
built classrooms?
What is the total number of
desks in the school?
What is the total number of
textbooks (per subject) in th
e school
What is the total number of
boys latrines in your school?
What is the total number of
girls latrines in your school?
What is the total number of f
emale teachers latrines?
What is the total number of
male latrines
What is the source of drinkin
g water in your school?
What are the water storage f
acilities available in your sch
ool?
How do you get water durin
g drought situation?
What is the current average Grade 6
performance of children in y
our school? Grade 9
What are some other challe
nges experienced by learner
s in your school?
What are some of the challe
nges experienced by teache
s in your school
What is the status of the exi 1. Good
sting classrooms 2. Fairly good
3. Bad
4. Worst
What is the status of the exi 1. Good
sting Washrooms 2. Fairly good
3. Bad
4. Worst
What is the status of the exi 1. Good
sting desks 2. Fairly good
3. Bad
4. Worst
MODULE E: Livestock Health and Mortality
Do you raise cattle Yes
No
If yes which animals do you Camel (tick appropriatel
raise Cattle y)
shoats
donkeys
How many livestock suffered Camel
from common diseases in th Cattle
e last 12 months (insert the Shoats
number) donkeys
How many animals do you r Camel
aise now? cattle
shoats
donkeys
How many animals did you s Camel
ell, eat or give away from [s cattle
pecify the time period – e.g. shoats
from January until now]? donkeys
How many animals were kill Camel
ed by wild animals or were s Cattle
tolen from [specify the time shoats
period – e.g. from January u donkeys
ntil now]?

How many animals died fro Camel

m a health problem from [sp Cattle
ecify the time period – e.g. f shoats
rom January until now]? donkeys
MODULE F: AGRICULTURE
Are you involved in any sma Yes
ll-scale farming activities? No
What is the average acreage 0-1acres
under cultivation? 1-2 acres
2-5 acres
Over 5 acres
What is the average product List of crops un
ion per acre under cultivatio der cultivation
n? and production
in tonnes
What techniques have you b Use of fertilizers (Multiple response
een using in the last six mon Crop rotation s)
ths to improve your agricult Use of Gabions
ural production techniques? Irrigation
Weeding of crops
Use of certified crops
Others specify
MODULE G: INCOME
What is the household avera Source of income Income in Ksh / m
ge monthly income? Livestock sales onth
Livestock product sales (mi
lk ghee, skin etc.)
Farm produce (applicable t
o those practicing farming)
Trade/Business
Remittances
Salary
Others specify
THANK YOU FOR YOUR TIME