Which clinic did you visit?
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Allessandras Urban Health Centre (Luanshya)
Agape Health Post (Mpongwe)
14 Miles Health Post (Mufulira)
21 Miles Health Post (Ndola) (Ndola)
When did you visit?
What was the main reason for your visit?
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HIV testing
PrEP or prevention services
Follow-up visit
Side effects or urgent care
Other service
Overall, how would you rate the clinic service?
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5 - Excellent
4 - Good
3 - Fair
2 - Poor
1 - Very poor
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How would you rate the waiting time?
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5 - Excellent
4 - Good
3 - Fair
2 - Poor
1 - Very poor
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Approximately how many minutes did you wait?
Did you receive the service you came for?
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Yes
No
Were the clinic opening hours convenient for you?
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Yes
No
How respectfully did staff treat you?
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5 - Excellent
4 - Good
3 - Fair
2 - Poor
1 - Very poor
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Did staff ask for your consent before tests, procedures, or sharing information?
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Yes
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Were your consultation and personal information kept private and confidential?
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Yes
No
Did you experience stigma, discrimination, harassment, or unfair treatment?
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Yes
No
Were the services or medicines you needed available?
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Yes
No
Did you receive clear information and answers to your questions?
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Yes
No
Was the facility clean, safe, and reasonably comfortable?
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Yes
No
Were you asked to make an unexpected payment for the service or supplies?
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Yes
No
Did you experience violence, abuse, a privacy breach, service refusal, or another serious incident?
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Yes
No
Would you recommend this clinic to someone else?
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Yes
No
Would you like a supervisor or health worker to follow up?
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Yes
No
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