| User | 1. Please tell us your gender* (a) Male (b) Female (c) Other | Please write your feedback in the chat area | 2. Respondents Age(Choose)* (a) Under 24 years (b) Under 35 years (c) 35 -50 years (d) 50 years and above | 3. Which sub county do you live?* (a) Kisauni (b) Nyali (c) Likoni (d) Mvita (e) Changamwe (f) Jomvu (g) Other (specify). | 4. Health Facility visited in Mombasa County* (a) Kongowea Dispensary (b) Mlaleo health centre (c) Junda dispensary (d) Shimo La Tewa -Annex (e) Shimo La Tewa- Main (f) Ziwa La Ngombe (g) Bamburi Dispensary (h) Kisauni Dispensary(Frere Town) (i) Junda Dispensary (j) Tudor Sub county hospital (k) Port Reitz Hospital (l) Mrima Hospital (m) Likoni Hospital | 5. Do you strongly agree. agree, not sure, disagree or strongly disagree with the following statement? -I am satisfied with the services offered by the health facility- (a) Strongly agree (b) Agree (c) Not sure (d) Disagree (e) Strongly Disagree | 6. Which services did you seek? (a) In patient (b) Out patient (c) Other (specify). | 7. If you sought health services, how would you rate the way they served you? (a) Excellent (b) Good (c) Fair (d) Poor (e) Very poor (f) Other (specify). | 8. How long did you wait to be served from the time you entered the facility to the time you left the facility? (a) Less than 1 hour (b) More than 1 hour (c) Other (specify). | 9. Did you receive friendly service from the health personnel? (a) Yes (b) No (c) Other (specify). | 10. Were you informed of your illness and treatment being given? (a) Yes (b) No (c) Other (specify). | 11. Did you get all the drugs you needed? (a) Yes (b) No (c) Other (specify). | 12. Was the information that you gave to the health service provider treated with confidentiality? (a) Yes (b) No (specify). | 13. Was there availability of water (a) Yes (b) No (c) Other (specify). | 14. Was there garbage disposal (a) Yes (b) No (c) Other (specify). | 15. Was there cleanliness of toilets (a) Yes (b) No (c) Other (specify). | 16. What improvements do you suggest for this health facility? _Please type your answer below_ |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 254795047114 | b | b | f | m | b | b | c | a | a | a | b | a | a | b | b | improve on hygiene | |
| 254798632418 | a | a | a | g | a | b | a | a | a | a | a | a | a | a | a | more supply on medicines | |
| 254742768392 | a | b | e | k | b | b | b | a | a | a | a | a | a | a | a | establish ramps for plwds | |
| 254740808345 | female | b | b | a | d | b | b | c | a | a | a | a | a | a | a | a | avail drugs for patients |
| 254716478441 | b | c | a | d | b | b | b | a | a | a | a | a | a | a | a | they should provide more water in the toilets |