EDITOR:__________________________

INTERVIEWER:______________________

CONFIDENTIAL

INDONESIANFAMILYLIFESURVEY2000
COMMUNITYANDFACILITYSURVEY

DESA/KELURAHANWOMENSGROUP(PKK)
SECTIONS: LK, KR, I, J, PM, KSR,CP
COMMID00
NAMEOF DESA/KELURAHAN : _____________________________________

INTEVIEWBOOKPKK
DATE:

TIMEBEGIN:

TIMEFINISHED:

INTERVIEWI

INTERVIEWII

INTERVIEWIII

DAY/MONTH

DAY/MONTH

DAY/MONTH

HOUR/MINUTE

HOUR/MINUTE

HOUR/MINUTE

HOUR/MINUTE

HOUR/MINUTE

HOUR/MINUTE

INTERVIEWRESULTS:

INTERVIEWRESULTSCODE

PKK
1/18/2003 04:11:00 AM

Interviewlanguagecode:
CK1. Interview was entirely/mostly conducted in
what language?

Other___________________
CK2. Other language used (if any):

FP5. EDITEDSTATUSBY EDITOR

BOOKPKK- 1

Other___________________
FP6. MONITORINGBY LOCALSUPERVISOR

00. Indonesian
01. Javanese
02. Sundanese
03. Balinese
04. Batak
05. Bugis
06. Chinese
07. Maduranese
08. Sasak
09. Minang
10. Banjar
11. Bima
12. Makassar

13. Nias
14. Palembang
15. Sumbawa
16. Toraja
17. Lahat
18. Other South Sumatra
19. Betawi
20. Lampung
96. No other
91. Other______________

FP7. DATAENTRYSTATUS

COMFAS2000

1. Completed
2. Partially completed___________________________
4. Refused

PKK
1/18/2003 04:11:00 AM

1. Edited, no correcton necessary

2. Edited and corrected
3. Edited, but not corrected
4. Not edited,___________________________

Yes

No

a. Observed..............................

b. Edited...................................

BOOKPKK- 2

1.
2.
3.

Entered, no correction necessary

Entered and corrected
Entered, but not corrected____________

COMFAS2000

SECTIONLK: CONTROLSHEET

SAMPLINGINFORMATION
LK 01.

SUPERVISION

CODE

LK15. Name of Interviewer : _______________

Province_____________________________________

LK02. Kabupaten/Kotamadya_____________________

LK16. Name of Editor : ____________________________________

LK03. Kecamatan ___________________________________

LK17. Name of Local Supervisor : ____________________________

LK04. Village/Township ______________________________

LK05. Region : 1. Urban

2. Rural

CODE

LK18. Name of Assistant Field Coordinator: ____________________

LK19. Name of Field Coordinator : ___________________________

PKK

BOOKPKK- 3

COMFAS2000

SECTIONKR: IDENTITYOF RESPONDENT

(KRTYPE)
KR01. Name of respondent

RespondentA

RespondentB

RespondentC

_____________________________________

_____________________________________

_____________________________________

Years

Years

Years

KR02. Age
KR03. Position in Village/Township PKK

KR04. Length of tenure in position

KR05. Highest level of education attended
KR06. Highest class/grade of education completed

4 __________________

01 02 03 04 05 06 60 61 62 63

01 02 03 04 05 06 60 61 62 63

11 12 13 14 72 73 90 98 10

11 12 13 14 72 73 90 98 10

11 12 13 14 72 73 90 98 10

00

01 02 03 04 05 06 07 96

98

00

01 02 03 04 05 06 07 96

98

00

01 02 03 04 05 06 07 96

98

Years

Years

Years

RespondentD

RespondentE

RespondentF

_____________________________________

_____________________________________

_____________________________________

Years

Years

Years

KR04. Length of tenure in position

4 __________________

4 __________________

4 __________________

Years

Years

Years

01 02 03 04 05 06 60 61 62 63

01 02 03 04 05 06 60 61 62 63

01 02 03 04 05 06 60 61 62 63

11 12 13 14 72 73 90 98 10

11 12 13 14 72 73 90 98 10

11 12 13 14 72 73 90 98 10

00

01 02 03 04 05 06 07 96

KR07. Length of time residing in this village/township

PKK_KR

4 __________________

01 02 03 04 05 06 60 61 62 63

KR03. Position in Village/Township PKK

CodeKR03 :
1. Head of PKK
2. Organizer of PKK
3. Cadre of PKK
4. Other, mention ___________________

Years

KR02. Age

KR06. Highest class/grade of education completed

Years

(KRTYPE)

KR05. Highest level of education attended

Years

KR07. Length of time residing in this village/township

KR01. Name of respondent

4 __________________

CodeKR06:
Never completed class/grade 1...............
1 ..............................................................
2 .............................................................
3 ..............................................................
4 ..............................................................
5 ..............................................................
6 ..............................................................
Graduated ...............................................

98

00

01 02 03 04 05 06 07 96

Years

98

Years

00

01 02 03 04 05 06 07 96

98

Years

CodeKR05:
00
01
02
03
04
05
06
07

No school............................................. 01
Elementary School (SD) ..................... 02
Junior High School General............. 03
Junior High School - Vocational.......... 04
Senior High School - General.............. 05
Senior High School - Vocational.......... 06

BOOKPKK- 4

University S1 (Bachelor)....................... 61
University S2 (Masters)........................ 62
University S3 (Doctorate)......................63
Kejar Paket A (Adult Educ. A)...............11
Kejar Paket B (Adult Educ. B)...............12
Open University.................................... 13
Islamic School (Pesantren)...................14

Islamic Junior/Senior High School

(Madrasah Tsanawiyah).......................73
Kindergarten...........................................90
DONT KNOW........................................ 98
Other, mention_____________________ 10

COMFAS2000

SECTIONKR: IDENTITYOF RESPONDENT

No school................................................. 96
DONT KNOW.......................................... 98

PKK_KR

D1, D2, D3 (Junior College)................ 60

BOOKPKK- 5

Islamic Elementary School

(Madrasah Ibtidaiyah)......................... 72

COMFAS2000

SECTIONI: HISTORYOF THEPRESENCEOF SCHOOLS

Now,we wouldlike to ask aboutthe historyof the presenceof educationfacilitiesin this village.
A. ELEMENTARYSCHOOL
I11.

I12.

I13.

I14.

When was the first [] open in this

village/township or the neighboring
village/township?
Approximately how many years ago
has the first [] open in this
village/township or the neighboring
village/township?
With regards to the [] available to
the community in this
village/township, how many [] can
be used by the people from this
village/township?
What are the names of the []?

B. JUNIORHIGHSCHOOL

C. SENIORHIGHSCHOOL

1. I13 THISCOLUMN

1. I13 THISCOLUMN

1. I13 THISCOLUMN

8. DONT KNOW

8. DONT KNOW

8. DONT KNOW

years................................... 1

years................................... 1

years................................... 1

DONT KNOW.................................... 8

DONT KNOW.................................... 8

DONT KNOW.................................... 8

facilities............................... 1

facilities............................... 1

facilities............................... 1

DONT KNOW.................................... 8

DONT KNOW.................................... 8

DONT KNOW.................................... 8

1._________________________________________

1._________________________________________

1._________________________________________

2._________________________________________

2._________________________________________

2._________________________________________

3._________________________________________

3._________________________________________

3._________________________________________

4._________________________________________

4._________________________________________

4._________________________________________

5._________________________________________

5._________________________________________

5._________________________________________

6._________________________________________

6._________________________________________

6._________________________________________

7._________________________________________

7._________________________________________

7._________________________________________

8._________________________________________

8._________________________________________

8._________________________________________

9._________________________________________

9._________________________________________

9._________________________________________

10.________________________________________

10.________________________________________

10.________________________________________

11.________________________________________

11.________________________________________

11.________________________________________

12.________________________________________

12.________________________________________

12.________________________________________

13.________________________________________

13.________________________________________

13.________________________________________

14.________________________________________

14.________________________________________

14.________________________________________

I11 NEXTCOLUMN

I11 NEXTCOLUMN

RESPONDI. INTERVIEWERNOTE:
PKK,PKK_I

BOOKPKK- 6

COMFAS2000

SECTIONI: HISTORYOF THEPRESENCEOF SCHOOLS

CIRCLETHELETTERTHATCORRESPONDSTO THERESPONDENTTHATANSWEREDSECTIONI

PKK,PKK_I

BOOKPKK- 7

COMFAS2000

SECTIONJ: HISTORYOF THEPRESENCEOF HEALTHFACILITIES

J11.

Now,we wouldlike to ask abouthistoryof the existenceof healthfacilitiesin this village.

J10a.

Is there a Village Midwife (Bidan

Desa) located in this village?

Yes................................................... 1J10b

J13.

No..................................................... 3

J10a1. Has there ever been a village midwife

in this village?

No..................................................... 3 J11

J10a2. When did the village midwife leave

this village?

1. /

Yes................................................... 1

Month

How many Health Posts (Posyandu)

exist in this village?
How many times have staff from
Health Centers (Puskesmas) visited
the Posyandu in the last year?

J13a. In comparison to the previous years,

have visits in the past 12 months from
the Puskesmas staff changed?

............................................ 1
DONT KNOW.................................. 8

times.................................... 1
DONT KNOW......................................... 8
Increased................................................. 1
Decreased............................................... 2

Year
No change............................................... 3

8. DONT KNOW
DONT KNOW......................................... 8

J10c
J16.
J10b. How many village midwives are
located in this village?

1. people

How many Family Planning Assistants

(PPKBD) are located in this village?

b.

8. DONT KNOW
J10c. In what year did the first village
midwife begin to practice in this
village?

Year.......................... 1 J10e

J10d. How many years has the village

midwife practiced in this village?

Years.................................. 1

J18.

DONT KNOW.................................. 8

J19.

In this village is there a Delivery Post

(Pos Bersalin Desa/Polindes)?

J19a. In what year was the first Polindes

established in this village?

In the last year, how many times has a

Family Planning Field Worker (PLKB)
come to this village?

J18a. In comparison to the previous years,

have the number of visits in the past
12 months by PPKBD changed?

DONT KNOW.................................. 8
J10e. What type of support does/did the
village midwife (the first one) receive
from the local people or the village
office?

NONE...............................................A
Housing............................................ B
Food................................................. C
A place to practice............................ D
Salary/cash...................................... F
Other,________________________ E

J20.

J24.

DONT KNOW.................................. 8

beds................................... 1

DONT KNOW......................................... 8
Increased................................................. 1
Decreased............................................... 2

Is there a Medicine Post (Pos Obat

Desa) in this village?

No............................................................3
Yes.......................................................... 1

Year ........................1J19c

J19c. How many beds does the Polindes

have?

times..................................... 1

DONT KNOW......................................... 8

Yes................................................... 1

years.................................. 1

sub PPKBD

No change............................................... 3

No..................................................... 3 J11

J19b. How many years has the Polindes

operated in this village?

PPKBD

Since 1995, have there ever been any

mass immunization/vaccination for the
people in the village?

No............................................................3 J26
Yes.......................................................... 1

DONT KNOW.................................. 8

DONT KNOW.................................. 8

PKK

BOOKPKK- 8

COMFAS2000

SECTIONJ: HISTORYOF THEPRESENCEOF HEALTHFACILITIES

J25.
In what year were mass immunization/vaccination and what were the types of mass immunization/vaccination conducted since 1995?
YEAR

1.

A1

A2

G __________________________________

2.

A1

A2

G __________________________________

3.

A1

A2

G __________________________________

4.

A1

A2

G __________________________________

5.

A1

A2

G __________________________________

6.

A1

A2

G __________________________________

PKK

JA25B.

Types of mass immunization/vaccination.

[SEECODEJ.25, CIRCLETHEAPPROPRIATEANSWERCODE,THERECANBE MORETHANONEANSWER]

JA25A.

BOOKPKK- 9

CodeJ25:
A1.
A2.
B.
C.
D.
E.
F.
G.

Measles
Smallpox
BCG
Polio
DPT
Tetanus Toxoid
Hepatitis B
Other, _________________

COMFAS2000

SECTIONJ: HISTORYOF THEPRESENCEOF HEALTHFACILITIES

PKK

BOOKPKK- 10

COMFAS2000

SECTIONJ: HISTORYOF THEPRESENCEOF HEALTHFACILITIES

Aa. IntegratedCommunityHealth
Post (Posyandu)

J26.

J27.

With regards to the []

available to the community
in this village/township, how
many [] can be used by
the people from this
village/township?
What are the names of the
facilities?

A.

HealthCenters(Puskesmas)
andHealthSub-centers
(PuskesmasPembantu/Pustu)

B.

Privatehealthpractitionersuch C.
as doctors,clinics, medical
posts,maternityclinics,
nurses,midwives,medical
assistants,and other
paramedicalworkers

Traditionalhealthworkers,
suchas midwives,Chinese
healer (sinshe),shaman,etc.

D.

Publicor privatehospital

1. facilities

1. facilities

1. facilities

1. facilities

1. facilities

8. DONT KNOW

8. DONT KNOW

8. DONT KNOW

8. DONT KNOW

8. DONT KNOW

1._______________________

1._______________________

1._______________________

1._______________________

1._______________________

2._______________________

2._______________________

2._______________________

2._______________________

2._______________________

3._______________________

3._______________________

3._______________________

3._______________________

3._______________________

4._______________________

4._______________________

4._______________________

4._______________________

4._______________________

5._______________________

5._______________________

5._______________________

5._______________________

5._______________________

6._______________________

6._______________________

6._______________________

6._______________________

6._______________________

7._______________________

7._______________________

7._______________________

7._______________________

7._______________________

8._______________________

8._______________________

8._______________________

8._______________________

8._______________________

9._______________________

9._______________________

9._______________________

9._______________________

9._______________________

10.______________________

10.______________________

10.______________________

10.______________________

10.______________________

11.______________________

11.______________________

11.______________________

11.______________________

11.______________________

12.______________________

12.______________________

12.______________________

12.______________________

12.______________________

13.______________________

13.______________________

13.______________________

13.______________________

13.______________________

14.______________________

14.______________________

14.______________________

14.______________________

14.______________________

J26 COLUMNA

J26 COLUMNB

J26 COLUMNC

J26 COLUMND

RESPONDJ. INTERVIEWERNOTE:
A

CIRCLETHELETTERTHATCORRESPONDSTO THERESPONDENTTHATANSWEREDSECTIONJ

PKK

BOOKPKK- 11

COMFAS2000

SECTIONPM: CITIZENPARTICIPATION
Now,we wouldlike to ask aboutpeople'sprograms/activitiesin this village/kelurahan
(PMTYPE)
COMMUNITYPROGRAMSOR
ACTIVITIES
(THEHIGHESTLEVELIS THEVILLAGE)

1.

Save and Borrow group

PM02.
In this village is [] program
conducted?
1. It is presentlyconductedon a routinebasis.
2. It has beenconducted,but presentlyit is not
conductedin a routinemanner.
3. It has neverbeenconducted

1
2

PM03a.

PM03b.

PM04.

In what year was the []

program began to be conducted
in this village/township?

In what year was the []

program ended in this
village/township?

Approximately how many

people from this community
are members/usersof this
[] program?

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
2.

Village cooperatives

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
3.

Pharmacy Garden

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
5.

Child Development Group

(Bina Keluarga Balita)

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
6.

Adolescents Group (Bina

Keluarga Remaja)

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
7.

Senior Citizens Group

(Program Lansia)

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
8.

Youth Group (Karang

Taruna)

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW

SECTIONPM

BOOKPKK- 12

COMFAS2000

SECTIONPM: CITIZENPARTICIPATION
9.

Health Fund (Dana Sehat)

1
2

1. Year

1. Year

1. ,

8. DONT KNOW

3. Program has not ended

8. DONT KNOW

8. DONT KNOW
11.

Ten Household Program

(Dasa Wisma)

1
2

1. Year

1. ,

3. Program has not ended

8. DONT KNOW

8. DONT KNOW

SECTIONPM

BOOKPKK- 13

COMFAS2000

SECTIONPM: CITIZENPARTICIPATION
Now,we wouldlike to knowaboutassistancereceivedby the communityin this villageeitherfromgovernmentor non-governmentorganizationsover the last 6 months.
TYPEOF ASSISTANCE
(KSR1TYPE)

A.

B.

J.

K.

KSR01.

KSR02.

KSR03.

KSR06.

In the last 12 months were there any programs by local

government or community organizations in your community to
distribute []?

What was the

source of this
assistance []?

In the last 12 months, in what

months was [] offered by these
programs?
(CIRCLEALLTHATAPPLY)

For which groups was assistance

available?

Cash

Rice

Cooking Oil

Kerosene

3. No

1. Yes

3. No

1. Yes

3. No

1. Yes

3. No

1. Yes

A
B
C
D _____________ Y

A
B
C
D _____________ Y

A
B
C
D _____________ Y

A
B
C
D _____________ Y

B
G
B
G

KSR03:
A. January
B. February
C. March
D. April
E. May
F. June

L
F

K
E

J
G.
H.
I.
J.
K.
L.

J
D

F
K

I
C

E
J

H
B

D
I

KSR02:
A. Government
B. Non-government
C. Community self-reliant
D. Other, _______________
Y. DONT KNOW

C
H

L
F

C _______________

C _______________

C _______________

C _______________

KSR06:
A. Low-income
B. Everyone
C. Other, _______________

July
August
September
October
November
December

Now,we wouldlike to knowaboutwhethertherewereopportunitiesto purchasefoodat belowmarketpricethroughMarketOperation(OperasiPasar)or CheapPrice(PasarMurah)markets.

TYPEOF ASSISTANCE
(KSR2TYPE)
B.
D.
J.
M.

Rice
Sugar
Cooking oil
Other foods/goods
__________________

KSR07.
In the last 12 months, were there any programs
by regional or national government in your
community to sell [] at below market price?
3. No

1. Yes

3. No

1. Yes

3. No

1. Yes

3. No

1. Yes

KSR08:
A. Bulog/Dolog
B. Other government agencies
C. Non-government

PKK_PM

KSR08.
What was the
source of the
assistance []?

KSR09.
In the last 12 months, in what
months was [] offered by this
program?

A
C

B
Y

A
C

B
Y

A
C

B
Y

A
C

B
Y

B
G

C
H

B
G

C
H

B
G

KSR09:
A. January
B. February
C. March

BOOKPKK- 14

E.
F.
G.

E
E
J

May
June
July

, Rp/kg

C _______________

, Rp/kg

C _______________

, Rp/kg

C _______________

C _______________

F
K
F
K

KSR12.
For which groups was assistance
available []?

L
F

J
D

F
K

E
J

H
B

D
I

KSR11.
Approximately what was the
average savings per unit of
[]?

L
I.
J.
K.

September
October
November

KSR12:
A. Low-income
B. Everyone
C. Other, _______________

COMFAS2000

SECTIONPM: CITIZENPARTICIPATION
Y.

PKK_PM

DONT KNOW

D.

April

H.

BOOKPKK- 15

August

L.

December

COMFAS2000

SECTIONKSR:WELFARE
QUESTIONNUMBER
CP1.

Questions with doubtful answers

CP2.

Questions needing conversion of measurement unit

CP3.

Questions using secondary data source, data unclear

CP4.

Other problems

NOTES

INTERVIEWERNOTE

PKK_KSR1,PKK_KSR2

BOOKPKK- 16

COMFAS2000

SECTIONKSR:WELFARE

PKK_KSR1,PKK_KSR2

BOOKPKK- 17

COMFAS2000