Appendix II: Assessment Tools
Household Level Questionnaire LWF Refugee Needs Assessment 2015
Name of Enumerator: ____________ Date: ___ / ___ / 201___
Household characteristics Name of Respondent: _____________________________ Sex: M/F
Address: _____________________________ Category: CHH: ____Youth ___ Adult: ____
Elderly_____ UAM _____
PWD: _____ CWD: ______ Phone: ___________________
# HH members: ___ M ____F ____ # Houses in compound: __
1. Is the housing enough for your household? No / Yes b) If no, what do you plan to do?
_______________
2. What problems do you face with regard to housing?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Education
3. How far is the nearest primary school? _____ kms 4. How far is the nearest secondary
school? ___ kms
5. How far is the nearest tertiary institution? ___
6. # of HH members of school going age: M___ F___ 7. # of HH members going to school: Pr.
M___
F___ Sec. M___ F___ Ter. M___ F___ Others:
________________________________________________
8. What problems do you face with regard to education?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
WASH
9. Is there a latrine: No / Yes If yes, specify as per UNHCR standards_______________
Usage?:_________
10. Hand washing facility: No / Yes Functional?: ___11. Bathing shelter: No / Yes 12.
Garbage pit: No / Yes 13.
Drying racks: No / Yes Reasons:
____________________________________________________________________
Comment on general sanitation:
______________________________________________________________________
14. How far is the nearest water point? _____ kms 15. Type of water point:
_______________________________
16. Time spent at water source: _____ minutes/hours 17: Is the water available throughout
year? No/Yes
If no, what other water sources are there?
____________________________________________________________
18. What problems do you face with regard to safe water access?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Food and Nutrition
19. Sources of food: __________________ 20. Types of food:
____________________________________
__________________
_____________________________________
__________________
_____________________________________
21. # meals per day: 1 / 2 / 3 22. Type food eaten yesterday (day):
_______________+_________________
Type food eaten yesterday (night): ______________ +_________________
23. How long will the food stock you have now last?
____________________________________________________
24. Food storage for own consumption at the moment in kg/acres:
______________________ _____ ______________________ _____
______________________ _____ ______________________ _____
______________________ _____ ______________________ _____
Productive Assets
25. Type & # of animals: 26. # motorcycle: ____ # bicycle: ___ # Wooden bicycle__ Land:
___acres
______________________ _____ ______________________ _____
______________________ _____ ______________________ _____
______________________ _____ ______________________ _____
Income
27. Do you have any skills? No/Yes If yes, which ones
_____________________________________________
28. # of sources of income: __________________ Types of income:
__________________________________
__________________
__________________________________
__________________
__________________________________
29. Are you involved in business? No/Yes
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If yes, is your business providing you with a frequent income every month? Yes / No
If yes include the sources;
30. Type of business Monthly earning
______________________ ________________
______________________ ________________
______________________ ________________
31. What profitable enterprises exist in this refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
SGBV
32. Do you face any violence that affects you? Wife No / Yes: by
______________Type___________________
Husband No /
Yes: by ______________ Type__________________
Child
No / Yes: by ______________ Type__________________
33. When someone is a SGBV survivor what do they do?
1. Nothing 2. Report to RWC 3. Report to OPM 4. Report to Police 5. GBV Task Force
6. Goes to health center 7. Organization ___________________ 8. Others, Specify
___________________
Protection
34. Do you and your household feel safe? No/Yes If no, what is the problem
_____________________________
35. What have you done about it?
______________________________________________________________________
36. What can be done to make you feel safer?
__________________________________________________________
37. What can be done to improve protection of refugee children?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Environmental protection
38. What are your sources of fuel for cooking?
______________________________________________________
39. What type of cooking technologies do you use?
a) Improved energy saving Stoves b) Three Stones c) Others, specify
____________________________________
40. What common practices in the settlement endanger the environment?
______________________________
41. What are you doing to protect the environment?
____________________________________________________
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Community Services
42. How have you benefited from the host community?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
43. What services do you get from the local government?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
44. What problems do you face with host community?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
45. What problems do you face with the local government?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
46. How best can these problems be solved?
__________________________________________________________
47. What else would you want to be provided?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Coordination
48. Which agency is doing what in this refugee settlement?
Agency Service provided
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
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____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
49. How do you contribute in agency interventions?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
50. Any suggestions to make refugees live with dignity?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Thank you for sparing time to answer these questions
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Key Informant Interview Schedule LWF Refugee Needs Assessment 2015
Name Enum: ____________ Date: ___ / ___ / 201___
Housing
1. What problems do you see with regard to refugee housing?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
2. What can be done to improve refugee housing?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Education
3. What is the average distance to the nearest primary school? _____ kms What is the
average distance to
the nearest secondary school? _____ kms What is the average distance to the nearest
Vocational
Institution________________kms
4. What are the problems in the education sector in the settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
5. What can be done to improve education of refugee children?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
WASH
6. How far is the nearest water point? _____ kms Is the water available throughout year?
No/Yes
If no, what other water sources are there?
____________________________________________________________
7. What problems do refugees face with regard access to water?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
8. What can be done to improve refugee access to safe water?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Food and Nutrition
9. What can be done to improve food and nutrition for refugees?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
10. What profitable enterprises exist in the refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
SGBV
11. What are the most common SGBV issues in this refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
12. What can be done to reduce SGBV issues in the settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Protection
13. What are the protection issues in this refugee settlement?
14. What can be done to improve refugee protection?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
15. What are the child protection issues in this refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
16. What can be done to improve protection of refugee children?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Environmental protection
17. What are the common practices in the settlement endanger the environment?
_______________________
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18. What are refugees doing to protect the environment?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Community Services
19. What services do refugees get from the local community/government?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
20. What problems do refugees face with local community/government?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
21. What else can be provided to refugees?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Coordination
22. Which agency is doing what in this refugee settlement?
Agency Service provided
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
23. What can be done to improve actor coordination in the refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
24. How are the refugees participating in interventions by actors?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
25. How can refugee participation in interventions by actors be improved?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
26. Any suggestions to make refugees live with dignity?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Thank you for sparing time to answer these questions
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Focus Group Discussion Guide LWF Refugee Needs Assessment 2015
Name Enum: ____________ Date: ___ / ___ / 201___
Housing
1. What problems do you face with regard to housing?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
2. What can be done to improve refugee housing?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Education
3. What is the average distance to the nearest primary school? _____ kms What is the
average distance to
the nearest secondary school? _____ kms What is the average distance to the nearest
Vocational
Institution________________kms
4. What problems do you face with regard to education?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
5. What can be done to improve education of refugee children?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
WASH
6. Is there a latrine: No / Yes If yes, specify as per UNHCR standards_______________
Usage?:_________
7. Hand washing facility: No / Yes Functional?: ___8. Bathing shelter: No / Yes 9. Garbage
pit: No / Yes 10.
Drying racks: No / Yes Reasons:
_____________________________________________________________________________________
Comment on general sanitation:
______________________________________________________________________
11. How far is the nearest water point? _____ kms 12. Type of water point:
_______________________________
13. Time spent at water source: _____ minutes/hours 14: Is the water available throughout
year? No/Yes
If no, what other water sources are there?
____________________________________________________________
15. What problems do you face with regard to safe water access?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
16. What can be done to improve refugee safe water access?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Food and Nutrition
17. # of sources of food: __________________ 18. Types of food:
__________________________________
__________________
__________________________________
__________________
__________________________________
19. Where do you get food? ______________________ How long will the food stock you have
now last? ______
20. What can be done to improve food and nutrition for refugees?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
21. # of sources of income: __________________ Types of income:
__________________________________
__________________
__________________________________
__________________
__________________________________
22. What profitable enterprises exist in the refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
SGBV
23. What are the most common SGBV issues in this refugee settlement?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
24. What can be done to reduce SGBV issues in the settlement?
_____________________________________________________________________________________
_______________
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_____________________________________________________________________________________
________________
Protection
25. What can be done to improve refugee protection?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
26. What can be done to improve protection of refugee children?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
Environmental protection
27. What are your sources of fuel for cooking?
______________________________________________________
28. What type of cooking technologies do you use?
a) Improved energy saving Stoves b) Three Stones c) Others, specify
____________________________________
29. What common practices in the settlement endanger the environment?
______________________________
30. What are you doing to protect the environment?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Community Services
31. What services do you get from the local community/government?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
32. What problems do you face with local community/government?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
33. What else would you want to be provided?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Coordination
34. Which agency is doing what in this refugee settlement?
Agency Service provided
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
____________________________________________
_______________________________________________________
35. How are the refugees participating in interventions by actors?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
36. How can refugee participation in interventions by actors be improved?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
37. Any other suggestions to make refugees live with dignity?
_____________________________________________________________________________________
_______________
_____________________________________________________________________________________
________________
_____________________________________________________________________________________
________________
Thank you for sparing time to answer these questions
