Exit Feedback

This survey tool measures the quality of HIV service delivery provided by healthcare providers or facilities. Clients or patients who accessed or received STI, HIV, and AIDS services within the last seven (7) days share their experiences during access to these services.

Questions in this tool are a combination of indicators on service quality, experiences of violence, harassment, stigma & discrimination in service providers, and out-of-pocket expense.

We appreciate your time and effort! Please remember that the feedback you will share should be about your latest access to STI, HIV, and/or AIDS services within the past seven (7) days.

Important: Please note that the data collected through www.commusta.ph will be responsibly used for monitoring, research, and advocacy to improve the HIV & AIDS response in the Philippines

Note: For multiple choice questions, 🔘 means only one answer can be selected and ☑️ allows multiple answers.

EFT
Do you consent to documenting your feedback on the healthcare provider you visited? To understand TLF Share’s Privacy Policy, you may access it here.

A. BASIC INFORMATION

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The staff asked for my consent before any procedure or activity.
I was treated with respect by my healthcare providers
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WHAT WAS THE REASON WHY THE TREATMENT WAS NOT GIVEN?
WHY WAS THE TREATMENT RECEIVED LESS THAN THE PRESCRIBED AMOUNT (3 MONTHS)?
Other services

Please list the other service/s that you needed

Tap 'Add' to list more services. Tap 'Remove' to remove an item. List one item per row.
Did you receive this service?
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Why did you not receive the services?
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Who is answering this form?

B. SERVICE SATISFACTION

How long did you wait before you were given the service you needed?
(hh:mm)
Did you wait too long before you were given the service you needed?
Did you receive all the information you needed and were all your questions answered?
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Was the staff professional during the interaction?
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Was the confidentiality of your information maintained all throughout your visit?
Which of the following was compromised?
Multiple selection allowed. You can choose more than one option.
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How was your experience in terms of:

🌏 How easy is it to get to the facility?
🔏 How safe is the area where the facility is located?
🕒 How well do the facility's operating hours work for its users?
🏡 How sanitary or hygienic is the facility?
₱ Affordability of Services
Would you return to this facility or organization or agency for your future sexual health or HIV service needs?
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Would you recommend this facility or organization or agency to anyone who needs HIV services?
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C. DEMOGRAPHICS

What is your gender?
Select "Woman" if you identify as a transgender woman, cisgender woman, or woman. Choose "Man" if you identify as a transgender man, cisgender man, or man.
Do you consider yourself as?
Multiple selection allowed. You can choose more than one option.
Do you have a disability?

D. VIOLENCE, HARASSMENT, STIGMA AND DISCRIMINATION

Did you experience violence, harassment, stigma and/or discrimination during this visit because of your actual or perceived HIV status?

VHSD Details

Which of the following forms of violence, harassment, stigma, and/or discrimination did you experience?
Multiple selection allowed. You can choose more than one option.
Please limit text to 300 words.
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Who committed this act against you?
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Will you avoid seeking HIV & AIDS-related care, testing, and/or treatment in this facility due to your experience of violence, harassment, stigma, and/or discrimination?
Is there a complaint desk or help desk in the facility that can assist you file a report?
How did you respond to your experience of violence, harassment, stigma, and/or discrimination?
Multiple selection allowed. You can choose more than one option.
What prevented you from doing something about it?
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Would you consider reporting the incident if there are organizations willing to provide you with free redress-related services?
Please provide your contact details for referral purposes.
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Where did you file a complaint or report the incident?
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Did they inform you about the progress of your complaint/report?
Did they resolve the issue?
Are you satisfied with how your report was handled?
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Where did you find out about commusta.ph?

◘ Where did you find out about commusta.ph?
Multiple selection allowed. You can choose more than one option.
◘ Social media post
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◘ Social media ad
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