Use this form to collect information on stock availability in public health centers & hospitals, NGO/Mission clinics & hospitals and medical stores.

This survey is to be applied for public health clinics and hospitals only. Some questions may need to be adapted to reflect the role of the facility in procuring pharmaceuticals and other health commodities

Instructions: Ask to speak to the manager of the pharmacy or the person in charge. Explain the purpose of the study and the amount of time required to complete the questionnaire. Respond to any questions or concerns about confidentiality and obtain permission to continue.