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Annex 3 - Survey PDF
Annex 3 - Survey PDF
About this Survey
The Pan American Health Organization (PAHO/WHO) is conducting an information gathering exercise to learn about the
health impact of disasters on indigenous communities in Latin America and the Caribbean and the measures they
undertake to respond to disasters and to reduce their risk. Through this initial effort, indigenous peoples and their
stakeholders throughout the Region are encouraged to share their experiences and strategies on responding to disasters
and reducing their risk.
The results will permit the Organization of a dialogue with stakeholders and representatives from indigenous communities
and help to shape interventions and processes to reduce disaster risks and better protect health of indigenous and other
populations during disasters.
Thank you for completing this questionnaire before 15 November 2013.
TARGET AUDIENCE
The individuals targeted to complete the questionnaire are indigenous community leaders or designated community
members working in disaster preparedness and risk reduction.
1. If you are completing this questionnaire on the web, please answer all questions and use the ‘Submit’ button at
the end of the survey.
2. If you have received a PDF version of the questionnaire attached to an email, you may:
¡ open the attached PDF file document
¡ type your answers directly into the document (be sure to scroll down to the end of the survey)
¡ print the completed questionnaire before closing the document.
¡ send completed questionnaire by fax to: +2027754578 or scan the survey and return by email to
disaster@paho.org with copy to jcscott@cpsc.com.
¡ NOTE: some respondents may have the latest version of Adobe Acrobat Reader which allows you to save
the document with your imput to your hard drive. If this is the case, you can send this file directly by email.
3. If you have received a hard copy version of the questionnaire, please answer all questions and return the
completed questionnaire to the PAHO staff member or Office that delivered it to you or fax or email it back to the
contacts listed in option 2.
General Questions about the Respondent and the Community
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
*2. Name of the community or tribe and country of location
5
6
Other (please specify)
6
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
*7. If the answer to question 6 is 'yes,' does this person interact with any of the
following?
c Ministry of Health (national headquarters level or local level in health centers or health posts or community health workers)
d
e
f
g
c Civil Protection
d
e
f
g
c National Disaster Management Office
d
e
f
g
c United Nations
d
e
f
g
c NGOs
d
e
f
g
c I do not know
d
e
f
g
Others (please specify)
Please provide your email address
5
6
Vulnerability to Disasters
*9. What are the principal natural hazards the community faces?
c Floods
d
e
f
g
c Earthquakes
d
e
f
g
c Hurricanes
d
e
f
g
Others (please specify)
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
*10. What healthrelated problems have occurred in the community when a disaster
strikes?
c Severe injuries
d
e
f
g
c Disease outbreaks
d
e
f
g
c Damage to health clinics
d
e
f
g
c Water shortages/contamination
d
e
f
g
c Food shortages
d
e
f
g
Others (please specify)
*11. Based on your observations, are some groups in the community more affected than
others? If so, please indicate below.
c Older persons
d
e
f
g
c Disabled persons
d
e
f
g
c Children
d
e
f
g
c Women
d
e
f
g
Others (please specify)
*12. From past experience, what challenges did the community face in responding to or
as a consequence of disasters?
5
6
Preparing for Disasters
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
*13. Does the community have a disaster plan?
c Yes
d
e
f
g
c No
d
e
f
g
c I do not know
d
e
f
g
*14. Within the community, who participated in the development of the plan?
5
6
15. Outside the community, who helped to prepare and implement the plan?
c National government
d
e
f
g
c Nongovernmental organizations or voluntary organizations (please specify which in box below)
d
e
f
g
c United Nations agencies
d
e
f
g
c Voluntary groups
d
e
f
g
Others (please specify)
*16. Does the community disaster plan have a specific component on health?
c Yes
d
e
f
g
c No
d
e
f
g
c I do not know
d
e
f
g
17. How is the community made aware of the content of the plan?
5
6
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
*18. National authorities produce information on health, disaster preparedness and
response. Does the community know about and/or use this material?
c Yes
d
e
f
g
c No
d
e
f
g
c I do not know
d
e
f
g
*19. Is this material available in languages that are spoken or understood in the
community?
c Yes
d
e
f
g
c No
d
e
f
g
c Sometimes
d
e
f
g
c I do not know
d
e
f
g
20. Does this information help the community to prepare for and respond to disasters?
c Yes
d
e
f
g
c No
d
e
f
g
c Sometimes
d
e
f
g
c I do not know
d
e
f
g
*21. How does the community receive information about disasters or emergency
situations?
c Newspapers
d
e
f
g
c Family and friends
d
e
f
g
c Television / radio
d
e
f
g
c Internet
d
e
f
g
Others (please specify)
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
22. How are early warnings or other disaster information shared or disseminated?
5
6
*23. Based on experience from past disasters, please give an example(s) of how the
community prepared for and/or responded.
5
6
24. Tell us about the results of these preparedness and response efforts.
5
6
Disaster Legislation
25. Are there laws, policies or regulations that deal with disaster management in your
country?
c Yes
d
e
f
g
c No
d
e
f
g
c I do not know
d
e
f
g
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
*26. Does the community have its own policies, laws or regulations on disaster
preparedness and response?
c Yes
d
e
f
g
c No
d
e
f
g
c I do not know
d
e
f
g
27. What disasterrelated issues has the community faced that are not covered by national
or community level policies or regulations?
5
6
Next Steps
*28. What are the recommended next steps to reduce health risks in emergencies and
improve disaster preparedness?
5
6
Other (please specify)
*30. Who should be involved in planning the next steps to improve disaster
preparedness and reduce health risks?
5
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Questionnaire on Indigenous Peoples and Disaster Risk Reduction
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