2. Survey questionnaire

To guide the Country Managers and field interviewers a detailed questionnaire was prepared by IPA as a framework for conducting the community case studies and interviews. Translations of the questionnaire in Spanish and Chinese were provided by volunteers. The questionnaire form follows:

CASE - STUDY QUESTIONNAIRE

1. Identification

Country _______________________________ Date _____________________

Manager ___________________________ Interviewer ____________________

Organization______________________________________________________

Address_________________________________________________________

Phone ________________ Fax _________________ Email ________________

2. Local Government

2.1 Total population 1990 ________________ 1980 _____________________

2.2 Percent of population over 60 __________; Over 70 __________________

2.3 Percent of population over 60 who are disabled ______________________

2.4 Local government departments that exist in your City:

Health _____; Social Services _______; Housing _________;Transport ______

Water Supply ________, Waste Disposal _______

2.5 In your opinion, is the current annual funding for the needs of Older Persons adequate? (yes/no):

Health ____ Housing _____

Social Services ____ Transport______

3. The Low-income Community Environment

3.1 Name of community, neighbourhood or settlement ________________

____________________________________________________________

3.2 Size: _______ Hectares/Acres? Population (approx.) _______________

3.3 Distance from city centre: _____miles, or Kilometres _______?

Travel time by public transport: ___________minutes.

3.4 Character: Old? ______ Crowded, high density? _______

Built recently? ________ Squatter settlement? _________

Describe: _________________________________________________

3.5 Site conditions: Steep hillside? ______ Wetland ______ Other, describe:

________________________________________________________

3.6 Pollution conditions? Air ______Water______ Open dump______

Describe: _________________________________________________

3.7 Means of access: Road_____ Path_______ Stairs________

Describe__________________________________________________

3.8 Utilities and Public Services available: Piped - water _____Sewer____

Electricity ____Gas line ____Waste collection ____Police/Fire _______

3.9 In your opinion: are the monthly costs for these services too expensive for older people?

Water ____ Sewer ____ Electricity ____ Gas ____?

3.10 Are the following Public Facilities available?

Hospital or health clinic? _____ Distance? ______ km. Is it accessible by

Public transport? ________ Library _____ Distance ______ km.

By public transport? ______ Day Centre? _______ Distance _____ km.

By public transport? _____

3.11 Describe Day Centre facilities provided for older persons_______

________________________________________________________

3.12 Are there any private, non-governmental organizations (NGOs) or religious groups providing assistance or services to older or disabled persons in the community, such as: Home visits _______ Meals ______

Health visits ______ Describe ___________________________________________________

3.13 Are there any city or local government programmes for improving housing conditions or the environment underway or planned for in the community? ______ If yes, describe: ___________________________________

4. Home Interviews

Please interview at least 20 older persons living in this community to learn about their living conditions and problems. First, please note the condition of each dwelling, and then ask the following questions:

4.1 Building type: House? _____, or Apartment?______

4.2 Building material: Wood _____Block _____ Brick _____Earth_____

4.2 Size of dwelling: Number of rooms ________Yard/Garden?_______

4.3 Household description: Living alone? _____ With spouse?_______

Number of others: 1 - 3 persons _____; 4 - 6 persons_____

(Is this a Homeless person? ______)

4.4 Do you own: _____ or rent_______ your home?

Cost per month as a percent of income: 10-20%______; 20-30%_____

30 -50%_____; Over 50%______?

4.5 Sanitary facilities: Piped water in dwelling? _____. Public outdoor tap? _____;

Buy from tanker? ______.

Private _____ or Group _____Latrine?

Indoor _____ or Outdoor ______ Bath/Shower?

Is cost of water ______, or use of facilities ______affordable?

4.6 Utilities/Fuels available: Electricity? _____. Gas?_____

Oil? _____Coal? _____Charcoal?_____

Are fuel costs affordable? ________

Waste Disposal: Public? ______Private?_____

Night soil removal: Public? ____ Private? _____

At affordable cost? _____

4.8 Is Police/Fire protection adequate? Yes _____No____

Is street cleaning and lighting adequate? Yes ____No___

4.9 Community Services available? Hospital/Health clinic?_____

Park or Recreation facilities? _______Church? ______ Shops _____?

Elderly community centre? ________ School? Meal delivery _____?

Home visits?______ Which of these do you visit or use?___________

_______________________________________________________

Any Inter-generational programmes with youths?_________________

4.10 Public Transport Service to: shops?_____church?______Hospital or health clinic?_____Community centre?_____ Is the bus fare reduced for elderly persons?_______

4.11 Communication services: Do you have a Telephone? _____TV _______ Radio?

______; Postal service? ______

5. Personal/Family Description

5.1 Male _____ Female ______;Age? ______. Spouses age? ______

5.2 Health? Excellent ____Good _____Fair_____ Poor_____

5.3 Do you have any disabilities?

Respondent: Walking ____Sight _____Hearing _____ Other ______

Spouse: Walking ____Sight _____Hearing _____ Other ______

5.4 Moved to this City from? ______________ Year?______

How long have you lived in: This dwelling? _______ months/years

This community?_____

What place do you call your home? _______________________

5.5 Financial Situation

5.5.1 Do you have a job? _______Type of work _____________________

Hours per week? ___________

5.5.2 Do you receive a pension? ________Social Security?______

Is it enough for your living expenses? _______

5.5.3 Sources of funds for housing and other living expenses:

Job _____ %. Pension ______% Family _______% Savings ______%

Other ______%

5.6 Activities: Work _____ Social _____ Political ______ Voluntary ______ Housekeeping: Cleaning _____Cooking _____Watching children______

5.7 What are your most difficult Living Problems? For example:

Housing conditions: Size ______Needs repairs______

Access problems _____Too crowded? ______Too costly_______

Sanitary facilities: Lacking: ______Inadequate______

Transportation to: shops _____Health centres _____Church______

Environment: Hazardous location _____Unhealthy ____Polluted_____

Safety and Security: Inadequate police and fire protection.

How would you improve your living conditions?

_______________________________________________________

6. Evaluation by Interviewer and Manager

Please write your impressions of the living conditions of older people in this community, responding to the following questions:

- Most important living problems of older persons?
- Adequacy of local government services for older persons
- Are people in the local community trying to help the older people or improve living conditions?
- Involvement of older people in community improvement?
- Any other comments on the Case Study?