WHO | World Health Organization
0293370FORM 5. Caregiver Exit Interviews 020000FORM 5. Caregiver Exit Interviews Instructions: Meet at least 3 mothers/parents/caregivers bringing their child for vaccination services. If no vaccination services that day and time permits - go into the community to find caregivers of children under 24 months of age. Request the participation of the caregiver. Explain that this interview is for improving the immunization program in the country. If the caregiver refuses to participate, move on to another one.InterviewerDateDistrictHealth FacilityQuestionCaregiver 1Caregiver 2Caregiver 3Caregiver 4Caregiver 5What services did you receive today?Vaccination Growth monitoringCurative careOtherVaccination Growth monitoringCurative careOtherVaccination Growth monitoringCurative careOtherVaccination Growth monitoringCurative careOtherVaccination Growth monitoringCurative careOtherDo you have child’s health vaccination card? (check)Yes NoYes NoYes NoYes NoYes NoIs the child up to date on vaccinations? (check card)Yes NoYes NoYes NoYes NoYes NoIs it difficult to reach the health facility?Yes NoYes NoYes NoYes NoYes NoDo you have any concerns about the vaccine?Yes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowDo you believe vaccines protect your child from disease?Yes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowHave you ever refused vaccinations for your child?Yes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowDo you know when to bring child for next vaccination?Yes NoYes NoYes NoYes NoYes NoWere you ever turned away for any vaccination and told to come back later?Yes No If Yes, specify:Too few kids Staff not availableChild not correct age Child was too ill No vaccineOtherYes No If Yes, specify:Too few kids Staff not availableChild not correct age Child was too ill No vaccineOtherYes No If Yes, specify:Too few kids Staff not availableChild not correct age Child was too ill No vaccineOtherYes No If Yes, specify:Too few kids Staff not availableChild not correct age Child was too ill No vaccineOtherYes No If Yes, specify:Too few kids Staff not availableChild not correct age Child was too ill No vaccineOtherHow do you hear about immunization services?Radio/TV/poster Community groupsVillage volunteersHealth worker/nurse phone messageFamily FriendsOtherRadio/TV/poster Community groupsVillage volunteersHealth worker/nurse phone messageFamily FriendsOtherRadio/TV/poster Community groupsVillage volunteersHealth worker/nurse phone messageFamily FriendsOtherRadio/TV/poster Community groupsVillage volunteersHealth worker/nurse phone messageFamily FriendsOtherRadio/TV/poster Community groupsVillage volunteersHealth worker/nurse phone messageFamily FriendsOtherIf you had another baby today, would you want your baby to get all recommended vaccinations?Yes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowYes No Don’t knowIn general, are you satisfied with vaccinations services?Yes No If No, why?Yes No If No, why?Yes No If No, why?Yes No If No, why?Yes No If No, why?What are your suggestions for improvement? ................
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