AI-ENHANCED HEALTH EXPENDITURE & OUTCOME SURVEY Ai-Enhanced Health Expenditure & Outcome Survey Kaduna State Digital Meta-DataEnumerator IDVillage/WardGPS Coordinates (Lat/Long)Respondent IDSection A: Household and Socioeconomic InformationGender of RespondentMaleFemaleAge of RespondentUnder 1818–3536–6060+Marital StatusSingleMarriedWidowedDivorcedEducation LevelNo formalPrimarySecondaryTertiary...OccupationMonthly Household Income (₦)10,00010,000–30,00030,001–50,00050,000Household SizeNo. of Children (1–10)Teenagers (11–19)Adults (20+)Section B: Health Service Access and UtilizationDistance to Nearest Health Facility (km)<11–56–10>10Time to Reach Facility (minutes)<1515–3031–60>60Main Mode of TransportFootBicycleMotorcycleCar/BusFacility Type Used Most OftenPHCGeneral HospitalTraditional HealerPrivate ClinicFrequency of Health Facility Use in Last 6 Months (per age group)Children01 - 23- 55Teenagers01 - 23 - 55Adults01 - 23 - 55Perceived Quality of Services (1 = Poor, 5 = Excellent)Cleanliness12345Staff Attitude12345Availability of Drugs12345Waiting Time12345Do you have health insurance (e.g., NHIS)YesNo If yes, name of schemeSection C: Health Expenditures (Out-of-Pocket)Children (1–10 years)Malaria₦0–₦2,000₦2,001–₦5,000₦5,001–₦10,000Above ₦10,000Diarrhea₦0–₦2,000₦2,001–₦5,000₦5,001–₦10,000Above ₦10,000Typhoid₦0–₦5,000₦5,001–₦10,000₦10,001–₦20,000Above ₦20,000Cold/Flu₦0–₦1,000₦1,001–₦3,000₦3,001–₦5,000Above ₦5,000Delivery (if applicable)₦0–₦10,000₦10,001–₦30,000₦30,001–₦60,000Above ₦60,000Other illnesses₦0–₦5,000₦5,001–₦10,000₦10,001–₦20,000Above ₦20,000Teenagers (11–19 years)Malaria₦0–₦2,000₦2,001–₦5,000₦5,001–₦10,000Above ₦10,000Diarrhea₦0–₦2,000₦2,001–₦5,000₦5,001–₦10,000Above ₦10,000Typhoid₦0–₦5,000₦5,001–₦10,000₦10,001–₦20,000Above ₦20,000Cold/Flu₦0–₦1,000₦1,001–₦3,000₦3,001–₦5,000Above ₦5,000Other illnesses₦0–₦5,000₦5,001–₦10,000₦10,001–₦20,000Above ₦20,000Delivery (if applicable)₦0–₦10,000₦10,001–₦30,000₦30,001–₦60,000Above ₦60,000Adults (20 years and above)Malaria₦0–₦2,000₦2,001–₦5,000₦5,001–₦10,000Above ₦10,000Diarrhea₦0–₦2,000₦2,001–₦5,000₦5,001–₦10,000Above ₦10,000Typhoid₦0–₦5,000₦5,001–₦10,000₦10,001–₦20,000Above ₦20,000Cold/Flu₦0–₦1,000₦1,001–₦3,000₦3,001–₦5,000Above ₦5,000Other illnesses₦0–₦5,000₦5,001–₦10,000₦10,001–₦20,000Above ₦20,000Highest Single Treatment Cost in Past Year₦0–₦10,000₦10,001–₦30,000₦30,001–₦60,000₦60,001–₦100,000Above ₦100,000Source(s) of Funds for Treatment (select all that apply):Personal SavingsLoanSale of AssetsCommunity SupportHealth InsuranceOthersSection D: Health Outcomes and MortalityNumber of Illnesses in the Household in Last 12 Months: _______ casesAny Household Deaths in Past 3 Years?YesNoChildren (1–10)No. of Deaths ______Causes __________________________Care Received?YesNoLocationHomeFacilityTeenagers (11–19)No. of Deaths _____Causes __________________________Care Received?YesNoLocationHomeFacilityTeenagers (11–19)No. of Deaths _____Causes __________________________Care Received?YesNoLocationHomeFacilityAdults (20+)No. of Deaths _____Causes __________________________Care Received?YesNoLocationHomeFacilityChallenges in Seeking CareCostDistanceLack of DrugsStaff ShortageCultural BeliefsOthersSection E: Digital Health Engagement (for Predictive Modeling)Do you use a mobile phone?YesNoCan you receive health SMS or WhatsApp messages?YesNoDo you receive Health Based SMS/ WhatsApp messages?Do you receive Health Based SMS/ WhatsApp messages?YesNoDo you own a health card or digital health record?YesNoWould you be willing to use a health monitoring app or receive reminders?YesNoSection F: Community Feedback and SuggestionsWhat are the 3 biggest health problems in your community? (List three)What suggestions do you have to improve healthcare in your area?Willing to Participate in Future Studies or Follow-ups?YesNoStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweSubmit
