WASH, Early Reovery and Shelter
HOUSEHOLD SURVEY
/ Tropical Cyclone Mahasen
Team ID: ______
Team Information
Shelter ID : ______/ Date: ____ /_____/ 201_
Team ID : ______
Location ID: ______/ Team Leader: Signature:
Enumerator: Signature:
Introduction
Hello, my name is ______and I am collecting data for a consortium of local and international NGOs, organizations, UN and the Government.
I would like to ask you some questions about how tropical cyclone Mahasen affected your household . he survey is confidential and any answers you provide will remain private.
The questionnaire does not have “good” or “bad” answers. You don’t have to answer if you don’t want to. You may decline to answer any questions or stop the interview at any time. It will take around 30 minutes to complete.
Do you agree to let me ask you these questions? YES NO
Household details
1. Name: / 2. National ID:
3. Fathers/husbands name: / 4. Mothers name:
5. How many people live in your house? #Male:____ #Female:____
6. Are you a single headed household? / Yes No
If YesMale or Female
7. What is the age of those currently living in the household? / Under 1 years: # Male:____# Female:____ 19- 39 years: # Male:____# Female:____
1-5 years: # Male:____# Female:____ 40-60 years: # Male:____# Female:____
6-12 years: # Male:____# Female:____ Over 60 years: # Male:____# Female:____
13-18 years: # Male:____# Female:____
8. Is your family part of a minority group / No Yes If so which one______
9. How many pregnant or lactating women are there in the household? / # Pregnant:_____ # Lactating:______
10. Are there any members of the family with physical or mental disabilities? / No Yes (If no, go to question 3.7)
Physical disability / # Male:______# Female:______
Mental disability / # Male:______# Female:______
Blind / # Male:______# Female:______
Geographical Information
11. Where were you living before the cyclone Mahasen struck on 16 May?
District Barguna Bhola Putuakhali Pirojpur
12.Upazila: / 13. Union name:
14. Ward : / 15. Village:
16. How long have you lived here? <1 year 1 to 5 years 5 to 15 years More than 15 years
17. Category of the area affected by the disaster: / City Corporation Paurashava Rural
18. Description of the area (tick only one): / Char areaHaor Coastal
Island Flood plain Hilly
19. Where are you living now? in the same location in a different location.
If different complete the following section:
20. District: / 21.Upazilas:
22. Union: / 23. Ward:
24. What type of shelter or house are you living in now?
Living in the same location
Living in your own house which is only part damaged
Living in the part of your house which was not destroyed
Living on your own property in a temporary or makeshift shelter
Living on your own property in a tent
Other______/ Living in a different location
Living with relatives, friends, neighbors, etc
Living in an evacuation centre, e.g. cyclone shelter, school, public building
Living in a Tent on relocation site
Living in a temporary or makeshift shelter on a relocation site (not tents)
Other______
25. What is the main reasons why the family has not returned to their original house? / Because of continued rain/flooding
Because their house is uninhabitable due to damage
Access to water, food, relief items
Other______
House before the storm
26. Was your house damaged by the storm Yes No
27.What type of house did you live in before the cyclone
Pucca Semi Pucca Traditional/ Mud Temporary/Jhupri
28. What materials was your house made of:
Roof:
Thatch
CGI Sheet
Other
______/ Walls:
Bamboo matting
Timber planks
CGI
Bricks
Other
______/ Frame:
Bamboo
Timber
Concrete posts
Brick masonry
Other
______/ Floor:
Earth
Timber
Concrete
Other
______/ Foundation:
Clay plinth
Brick masonry
Concrete posts
Other
______
29. What is the size of your house (squared yards)?
10 10 to 20 20 to 40 40 to 60
60 to 100 More than 100
30.What is the type of property ownership or rights held by the household affected?
Private ownership Renting Squatter Other______
31.Do you have legal papers for the land?
Yes No / 32. Do you still have the legal papers?
Yes No
33. Is the household under threat of eviction? / Yes No
Reason ______
34. Damage to the House: Please tick relevant boxes to indicate the level of structural damage to the property:
Category 1
House collapsed / Roof missing
Walls collapsed
Structure collapsed
Foundation damaged / House is repairable
Yes No
Category 2
Partially damaged / Roof missing or significantly damaged (50-75%)
Walls significant damaged
Structure significant damaged
Foundation damaged / House is repairable
Yes No
Category 3
Minor damage / Roof moderately damaged (20-50%)
Walls moderately damaged
Structure significant damaged
Foundation damaged / House is repairable
Yes No
35. Is the household at risk of injury because of the level of damage in house? / Yes No
36. Have the members of the household begun to repair their house? / Yes No
37. What shelter assistance do you need / Help to repair your house
A new house
38. What shelter materials do you need: / CGI Timber Bamboo Bricks
Labour Cash Other
39. What do you think the value of the repair would be? / 5 to 10,000BDT 10 to 20,000BDT20 to 30,000BDT
30 to 40,000BDT 40 to 50,000BDT50,000BDT
Other ______
40. What do you think you can contribute / Salvaged materials from old house Labour Cash
41. What are the top 3 priorities in relation to shelter? Rank up to the top 3; 1st, 2nd, 3rd. / Want to move out of communal shelters
Want to return home
Need materials and tools to repair or rebuild their houses
Need skills/labour to repair or rebuild their houses
Need basic household items (NFIs)
Others______
42. What are the main problems the household faces to repair of rebuild their house.
Rank up to the top 3; 1st, 2nd, 3rd / Materials/tools for repair are not available
Materials/tools for repair are not accessible (not enough money)
Skilled/labour for repair not available
Skilled/labour for repair not accessible (not enough money)
There are potential grievances on land issues
Other______
WASH
43. What type of sanitation facility are you using before cyclone Mahasen / Sanitary (water-sealed)
Sanitary (non-water sealed)
Non-Sanitary
None
44. Was your latrine damaged by Cyclone Mahasen?
Note: if answer is yes, ask question 1.3 / Yes No
45. What type of sanitation facility are you using now?
Note: Enumerator have to do direct observation / Sanitary (water-sealed)
Sanitary (non-water sealed)
Non-Sanitary
None
46. Have your household members begun to rehabilitate sanitation facilities? / Yes No
47. What are the main problems the household faces to repair of rebuild their latrine?
Rank up to the top 3; 1st, 2nd, 3rd / Materials/tools for repair are not available
Materials/tools for repair are not accessible (not enough money)
Skilled/labour for repair not available
Skilled/labour for repair not accessible (not enough money)
There are potential grievances on land issues
Other
48. Do woman and adolescent girls have enough privacy to use latrine? / Yes No
49. Do Woman and adolescent girls have enough privacy for bathing? / Yes No
50. Where from you collect drinking water? / Before Cyclone
Tube wells
Dug wells
Pond Sand Filter
Rain Water Harvesting
Pipe water system
Ponds/River/Canals
If others ( Explain) / After Cyclone
Tube wells
Dug wells
Pond Sand Filter
Rain Water Harvesting
Pipe water system
Ponds/River/Canals
If others ( Explain)
51. What do you use for hand washing?
NOTE: Enumerator have to observe if soap available anywhere in the house ( nearer to toilet, water point , kitchen etc) / Soap Ash None
52. Have you notice any particular disease since recent cyclone? / Diarrhoea Skin Disease
Stomach pain Others
Early Recovery (Livelihood / Income)
53. What are your main sources of household income? / BEFORE / NOW
Farming / Farming
Livestock / Livestock
Fishing (boat owner) / Fishing (boat owner)
Fishing (labour) / Fishing (labour)
Shrimp Farming / Shrimp Farming
Small trade / Small trade
Forest dependent / Forest dependent
Private service / Private service
Govt service / Govt service
Day labourer / Day labourer
Fully dependent (no income) / Fully dependent (no income)
Agricultural labour / Agricultural labour
Van/rickshaw puller / Van/rickshaw puller
Other (specify) / Other (specify)
Before storm / Projected income after one month
54. What is your average monthly income?
(Only one amount)
The comparison has to be done with projected income after one month of the storm / Below 3000 BDT / Below 3000 BDT
3,000 - 5,000 BDT / 3,000 - 5,000 BDT
5,000 - 10,000 BDT / 5,000 - 10,000 BDT
10,000 above BDT / 10,000 above BDT
55. What is your monthly expenditure? (this has to be translated in % by the team) / BEFORE / NOW
Basic HH necessities (food)
Health
Children education
Fire wood/fuel
Cloths
Transportation
Loan repayment
Fodder
Others (specify)
56. What are the damages, which impacted on your livelihood?
(select 2 most affected livelihood options) / Agricultural crops damaged
fishing boats, nets, etc. damaged
Rickshaw, van damage
lost poultry
livestock loss
fisheries damage
Agricultural seeds
others (specify)
57. When do you expect to restart your main previous livelihood activity? / Already restarted
Within one month
Within three months
In more than three months
I don’t know
Agricultural land still under water
Plan for alternative livelihood option (specify)
58. What are your main constraints to restart your main livelihood activity? / Agricultural land under debris
Too much pressure on daily labor market
Shrimp farm damaged by storm
Fish pond damaged by storm
Livelihood assets damaged by storm
Livelihood assets has been sold to buy food
Other (specify)
59.What plans you have to cope with current loss of livelihood? / Selling of household assets or fix assets
Will migrate outside for work
Alternative livelihood
borrow loan with high interest
other (specify)
60. What are the main sources of energy you use for household? (cooking, lighting, etc.) / Firewood
Cattle dung
Kerosene
Others
61. Do you own land for agriculture? / Yes No
62. If yes, how much land do you own? / Less than 10 decimal
11 - 30 decimal
31 - 100 decimal
100 - 300 decimal
More than 300 decimal
Assistance already received
63. Has there already been support provided? / Yes No
64. What kind of support was provided? / Food, eg GR rice Shelter NFIs Temporary shelter
Shelter Material Cash(GR) Cash for work
Water Access Sanitation Seed, tools
Health Psycho-Social Child protection
Hygiene Kits Other:______
65. Who provided such support? / Local authorities Own funds
Private individuals Local charity associations
Local NGOs International NGOs / UN / Donors
Other:______
Name organisation :
66. What shelter assistance has been committed but not yet received? / Food, eg GR rice Shelter NFIs Temporary shelter
Shelter Material Cash(GR) Cash for work
Water Access Sanitation Seed, tools
Health Psycho-Social Child protection
Hygiene Kits Other:______
Question on Communication Needs and Access
67.1: What are your main sources of information you used before any disaster happened?
67.2: What are your main sources of information you used during any disaster happened?
67.3: What are your main sources of information you used after any disaster happened?
67.4: In your opinion what are your most favorable sources of information to get information regarding disaster responses (TICK ONLY THREE)?
DO NOT READ OUT. MULTIPLE CODES ALLOWED. / 1.1 Before / 1.2 During / 1.3 After / 1.4 Most Favorable
1 / Word of Mouth
2 / Notice Board
3 / Loudspeaker/mic
4 / Volunteers
5 / Television
6 / Radio
7 / Newspaper/magazine
8 / Internet (e.g. social media sites
9 / Mobile phone (e.g. news service)
10 / I don’t get any information on these issues
88 / Don’t know
99 / Refused
Those who ticked in 5 in Q 1.1 ASK Q 2.1
Those who ticked in 5 in Q 1.2 ASK Q 2.2
Those who ticked in 5 in Q 1.3 ASK Q 2.3
68.1 Now, I’m going to read you a list of some television channels available in your area, can you tell me which of these channels you watch to get the information before any disaster happened?
68.2 Now, I’m going to read you a list of some television channels available in your area, can you tell me which of these channels you watch to get the information during any disaster happened?
68.3 Now, I’m going to read you a list of some television channels available in your area, can you tell me which of these channels you watch to get the information after any disaster happened
TV Channel / 2.1 Before / 2.2 During / 2.3 After
01 / ATN Bangla
02 / ATN News
03 / Bangla Vision
04 / Boishakhi tv
05 / BTV
06 / Channel 24
07 / Channel 9
08 / Channel I
09 / Desh tv
10 / Diganta tv
11 / ETV
12 / Gazi tv
13 / Indepenent TV
14 / Islamic TV
15 / Maasranga
16 / Mohona TV
17 / My TV
18 / NTV
19 / RTV
20 / Somoy TV
21 / 71 TV
22 / Channel 16
23 / Don’t watch Bangladeshi Channels
88 / DK
99 / REF
Question 3
Those who ticked in 6 in Q 1.1 ASK Q 3.1
Those who ticked in 6 in Q 1.2 ASK Q 3.2
Those who ticked in 6 in Q 1.3 ASK Q 3.3
69.1 Now, I’m going to read you a list of some Radio channels available in your area, can you tell me which of these channels you listen to get the information before any disaster happened?
69.2 Now, I’m going to read you a list of some Radio channels available in your area, can you tell me which of these channels you listen to get the information during any disaster happened?
69.3 Now, I’m going to read you a list of some Radio channels available in your area, can you tell me which of these channels you listen to get the information after any disaster happened?
Radio Channels / 3.1 Before / 3.2 During / 3.3 After
01 / Bangladesh Betar
02 / BBC Bangla
03 / BBC World
04 / Radio ABC (89.2)
05 / Radio Amar (88.4)
06 / Radio Foorti (88.0)
07 / Radio Today (89.6)
08 / Voice of America (VOA)
09 / Peoples Radio (91.6)
10 / Dhaka FM (90.4)
Community Radio
11 / Radio Sundarban - Koyra, Khulna
12 / Lokobetar - West Sadar Road, Barguna
13 / Krishi Radio - Amtoli, Barguna
88 / Don’t know
99 / Refused
70. Do you agree or disagree that the following are the reason you do not/might not get any information about disaster responses
READ OUT EACH STATEMENT. SINGLE CODE ONLYON PROVIDING AN AGREE OR DISAGREE RESPONSE, FOLLOW UP WITH:
Would you say you [agree/disagree] a lot, or just a normal amount?
Strongly agree / Agree / Disagree / Strongly Disagree / Don’t know / Refused
4 / 3 / 2 / 1 / 88 / 99
A / I do not have enough time to collect the information
B / I have other priorities than getting information about disaster responses
c / I do not feel the information that was provided is useful
d / I do not feel the information that was provided is correct / accurate.
e / I do not have access (either TV or Radio or Newspaper) to the information.
f / It is very hard to get information about disaster responses from my area.

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