Survey for TIST participants
ID #:______Date:______Interviewer Name:______(your name)
Name of person being interviewed: ______Mobile number: ______
District: ______Cluster name of person being interviewed: ______
TIST Small Group # of person being interviewed: ______Village: ______
A. Demographic and Basic Information
1. Name of the head of the household: ______
2. Gender of the head of the household: Male/Female (circle one)
3. Marital status: single/married (circle one)
4. Number of people living in the house: ______
5. Details of people living in the house: (Please fill out the table below, including the person being interviewed. Use blank paper on last page if there are more people living in the house).
Name / Gender (M/F) / Age(Years) / Literate (Yes/No) / Education:
P-Primary
S-Secondary
U-University / Occupation:
T- temporary work/day laborer
P- permanent job other than farming
F- farming
U – Unemployed
O – Other, please list
1 / (Person being interviewed)
2
3
4
5
6
6. How many hours does it take to travel to: (write a number in each blank)
a. School: ______hours
b. Hospital: ______hours
c. Market: ______hours
d. Water source: ______hours
e. Paved Road: ______hours
f. Small Group meeting: ______hours
g. Cluster meeting: ______hours
7. What is your personal monthly income? (circle one)
a. less than 1,000 KSh per month
b. 1,000 – 5,000 KSh per month
c. 5,000 – 15,000 KSh per month
d. 15,000 – 25,000 KSh per month
e. more than 25,000 KSh per month
8. What is your land tenure/ownership status? (circle one)
1)Freehold with registered deed
2)Freehold under customary tenure
3)Community Land
4)Leased out
5)Caretaker
6)Other: ______
9. Please fill out table below: (please indicate the amount of acres for each)
Total land size (acres) / Crop production (acres) / TIST tree-planting activities (acres) / Livestock production (acres) / Housing (acres) / Other:______
(acres)
10. Present ownership of animals (write the number of animals in the blanks)
______Cow / ______Goats / ______Chickens / ______Rabbits______Horse / ______Donkey / ______Sheep / ______Other
11. Where do you get firewood from? (please fill out the table below)
Location / Yes/No / How many bundles per week? (bundles/week) / How much time does it take? (hours/week) / Who gets firewood?M- man
W- woman
C- children
HL – Hired labor
Harvest from land
Gather from forest
Buy from market
Other:______
12. What kind of stoves do you use?
Stove Type / Number(Write number of stoves) / TIST Stove?
(Write Yes or No) / Fuel Type:
F – Firewood
C – Charcoal
G – Gas
K – Kerosene
O – Other (please specify) / How much fuel do you use per week with this stove?
Firewood: write number of small or large bundles
Charcoal: write number of small or large debes
For Gas or Kerosene: write number of liters
3-Stone Fire
Stationary Mud
Portable Manufactured
Other:______
B. Membership Information
13. When did you join TIST? ______(month and year)
14. How often do you attend Small Group meetings? ______times per month
15. How often do you attend Cluster meetings? ______times per year
16. What prevents you from attending TIST meetings? (please write exactly what they say) ______
______
17. Have you had a leadership position in your TIST Small Group or Cluster Group? Yes/No (circle one)
18. Please list your TIST leadership positions (Fill out the table below, using these position titles: SG Leader, SG Coleader, Cluster Leader, Cluster Coleader, Accountability Person, Trainer, Quantifier, or other)
Position Title / How long have you served in this role (total months)?19. If you have not had a leadership position, why? (please write exactly what they say) ______
______
______
20. What kind of trees do you grow for TIST and how many of each? (fill out the table below)
TIST Trees Grown / How many trees? / TIST Trees Grown / How many trees?Fruit trees / Medicinal trees
Nut trees / Trees for fuel wood
Trees for fodder / Other trees
Trees that will be harvested for timber / Total TIST trees
C. Benefits from TIST activities
21. Have you received additional income from TIST activities? Yes/No (circle one) (If they answer no, skip #22)
22. What do you spend your added income from TIST activities on? (fill out the table below; if they respond “no,” please write “0” in the last column)
Yes/No / How much? (ksh over past 12 months)Education (school fees, school materials, etc.)
Agricultural inputs (fertilizer, irrigation, seeds, etc.)
Medicine
Food (from market or neighbors)
Non-food items (TV, bicycle, radio, DVDs, etc.)
Other:______
23. Which of these have you personally been able to do because of your work in TIST? (please fill out the table below; if they respond “no,” you do not need to fill out the last three columns for that activity)
Activity / Yes/No(write Y or N in the boxes below) / How much since joining TIST?
(make sure you are asking the correct value unit shown in the boxes below) / Value
(ask the questions listed in the boxes below; you do not need to ask anything if the boxes below are blank) / Use
(ask the questions listed in the boxes below; you do not need to ask anything if the boxes below are blank)
Receive carbon stipend/tree payment / ______ksh
Receive incentive/ tea money for TIST work as a Quantifier, Trainer, or other role / ______ksh
Harvest fruits / ______kg / How much is 1 kg at market?
______ksh / How much did you sell? ______kg
How much did you use for food?
______kg
Harvest nuts / ______kg / How much is 1 kg at the market?
______ksh / How much did you sell?
______kg
How much did you use for food?
______kg
Harvest fodder / ______sacks / How much is 1 sack at market? ______ksh / How much did you sell? _____sacks
How much did you use for your own livestock? ______sacks
Harvest firewood from sustainable woodlots / ______small or large bundles (circle either small or large) / How much is:
1 small bundle at the market?
______ksh
1 large bundle?
______ksh / How much did you sell?
______(small/large) bundles
How much did you use for fuel?
______(small/large) bundles
Keep more animals because of extra fodder / ______goats
______poultry
______cows / How much is:
1 goat:______ksh
1 liter of goat milk ______ksh
1 chicken:______ksh
1 chicken egg:____ksh
1 cow:______ksh
1 liter of cow milk: ______ksh / How much did you sell?
______goats
______liters of goat milk
______chickens
______chicken eggs
______cows
______liters of cow milk
How much did you use for food?
______goats
______buckets of goat milk
______chickens
______chicken eggs
______cows
______buckets of cow milk
Produce extra tree seedlings for neighbors or market / ______seedlings (total seedlings)
______seedlings (indigenous) / How much is 1 seedling at market?
______ksh
______ksh (indigenous) / How many did you sell?
______seedlings
How many did you use for planting on your land?
______seedlings total
______indigenous seedlings
Start keeping honey bees / ______kg of honey / How much is 1 kg honey at market?
______ksh / How much did you sell?____kg
How much did you use for food?
______kg
Start fish ponds / ______fish harvested / How much is 1 fish at market?
______ksh / How much did you sell?
______fish
How much did you use for food?
______fish
Produce compost manure for your fields / sacks of compost manure / How much is onesack of compost manure at market? ______ksh / How much did you sell?
______sacks
How much did you use for planting?
______sacks
Start a business / What kind? ______
How many people work there? ______
Use less firewood because of an efficient TIST stove / How much less firewood do you use per week? ______small/large bundles
Built relationships with other TIST members / How have these relationships affected your life?
24. Have TIST activities had any negative impacts on your lives? Yes/No (circle one)
If yes, how? (please be as specific as possible; if an answer is unclear, ask them to clarify) ______
______
25. How can these negative impacts be avoided in the future? (please write exactly what they say; if you do not understand what they mean, ask them to clarify)
______
______
26. What health topics have you been trained on through TIST activities? How many times? (Write a number in the blank next to each topic)
a. HIV/AIDS ______
b. Malaria ______
c. Hygiene______
d. Clean drinking water______
e. Fuel-efficient cooking stoves______
f. Nutrition______
g. Other:______
27. How has this training on health topics affected your life? (please write exactly what they say; if you do not understand what they mean, ask them to clarify)
______
D. Specific questions on Conservation Farming and food security
28. Have you been trained on Conservation Farming techniques through TIST? Yes/No (circle one)
(If yes, go on to question 29. If no, SKIP to question 31)
29. Did you use conservation farming methods last year? Yes/No (circle one)
30. What were the five main crops grown on your land last year: (fill out the table below)
Crops (Type) / Total Production (kg or sacks?) / ValueHow much is 1 kg/sack in the market? / Did you use conservation farming practices for this crop?
(Write yes or no) / How did using these practices affect your crop yield compared to when you did not use conservation farming practices?
(circle decrease, no change, or increase; then write in the amount)
1. / ______kg/sacks / ______ksh / Decrease/no change/increase
By ______kg/sacks
2. / ______kg/sacks / ______ksh / Decrease/no change/increase
By ______kg/sacks
3. / ______kg/sacks / ______ksh / Decrease/no change/increase
By ______kg/sacks
4. / ______kg/sacks / ______ksh / Decrease/no change/increase
By ______kg/sacks
5. / ______kg/sacks / ______ksh / Decrease/no change/increase
By ______kg/sacks
31. What other benefits does conservation farming provide? (please write exactly what they say; if you do not understand what they mean, ask them to clarify)
______
______
32. Have using conservation farming methods had a negative impact on your life in anyway? Yes/No (circle one)
If yes, how? ______
How can these negative impacts be avoided in the future? ______
33. Did you buy any food from the market last year? Yes/No (circle one)
34. If yes, then for how many months?______
35. How much money do you spend on food from the market each month? ______ksh
36. What kind of foods do you buy from the market?
______
37. Please tell me whether the following sentences are “not at all true,” are “somewhat true” or are “very true” as a result of your participation in TIST programs: (please place an X in the appropriate box)
Perceived impacts / Not at all true / Somewhat true / Very trueMy children are healthier because of my participation in TIST
I make more money because of TIST
My family has more food to eat because of TIST activities
I have more ways to make money because of TIST activities
I use too much land planting TIST trees and not enough for food or livestock
I spend more money on education for my children
I spend more money on improving my house
My children go to school more often
My family can afford to go to the doctor when we need to
I am too busy with TIST to do important things I need to do
My friends and family are not happy that I am a TIST member
I lose money participating in TIST
I have made friends that support me through TIST
I feel more confident in myself because of my participation in TIST
TIST has improved the community
Perceived impacts / Not at all true / Somewhat true / Very true
My family has less food to eat because of TIST
TIST activities have improved soil conditions in my village
I know more about health because of TIST trainings
Other?
37. Is there anything else you would like to tell me about how TIST has affected your life? ______
38. What TIST seminars have you attended? ______
39. What impacts have TIST seminars had on your life? ______
Thank you!
Notes for Interviewer:
(Please write any additional information that you think is important about this interview that was not included in the questions above).