MSTK Tool 6: Integrated Baseline Survey Example

This Baseline Survey is meant to show one example of a multi-sector, integrated project baseline which incorporates
measurement of Action Against Hunger’s key indicators for food security, livelihoods, and WASH sectors. The example survey is
not intended to be applied in whole to each Action Against Hunger project. The questions will need to be modified to reflect the
indicators/Monitoring & Evaluation Plans of particular projects. Project teams should strongly consider completing baseline or
other surveys using mobile data collection methods, rather than paper-based surveys.
Remember that the endline survey at the completion of a project should match the baseline survey, so it is important to put
adequate effort into the content of the baseline survey.
How to complete the questionnaire:
 Complete the survey information section with the relevant data:
o Title the survey (e.g. XX Project baseline in XX location - January 2011)
o Code the survey: 2 first letters of the intervention area, ACF contract code, Nature of the survey
o Organization name: ACF
o Survey period: month and year
 Where boxes are provided for answers, please insert the correct code number to the answer (e.g., 1, 2,).
 Where multiple choice answer options are provided without a box, circle the appropriate answer.

INTEGRATED BASELINE QUESTIONNAIRE EXAMPLE

1 - SURVEY INFORMATION

Q1. Questionnaire Number: | W || W |-| V || V |-| H || H |

Q2. Date of interview (Month/Day/Year): _ _/_ _/_ _ _ _
Q3. Location (country, village):__________________
Q4. Interviewer name (& number where appropriate): __________________________________________
Q5. Beneficiary name (& number where appropriate):__________________________________________

2. GENERAL HOUSEHOLD INFORMATION

Q6 Name of Household (HH) Head: __________________________________________________________
Q7 Gender of HH Head: 1 = Male ; 2 = Female

HH information (enter numbers in the relevant boxes, A B-Under 5 C-5 to 18 D-19-60 E-Over 60
including the respondent in calculations) Total M F M F M F M F
Q10 How many people live in the HH?
Q11 How many orphans live in the HH?
How many people in the HH work? (e.g., to
Q12
farming or other activities
How many have been sick continuously for
Q13
the past three months?
How many people in HH cannot work due to
Q14
health problems (illness, disability)?
How many members have earned money for
Q15
the past 3 months?

3. FOOD SOURCES AND STOCKS

Q16. In order of importance, what have been the 4 main ways the HH has sourced food in the past month?
(Rank the 4 main sources, with 1=most important, 4=least important)
1 Purchase 8 Bartered
2 Own agricultural production (crops etc) 9 Debt reimbursement in kind
3 Livestock own production 10 Income in kind

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 4 Food Aid 11 Exchange with assets
5 Assistance from friends & relatives 12 Wild food
6 Other donations 13 Seed stocks
7 Borrowed/taken on credit 14 Begging
15 Other (please specify) _________________________________________________________________

4. HH FOOD CONSUMPTION Responses

Currently, how many meals are eaten daily by the following HH members? 1 2 3 4 5
1=1, 2=2, 3=3, 4=4, 5=More than 4
Q16 HH members aged Under 5
Q17 HH members aged 5 to 18
Q18 HH members aged 19-60
Q19 HH members aged Over 60

Months of Adequate Household Food Provisioning

Q20. Now I would like to ask you about your household’s food supply during different Yes No
months of the year. When responding to these questions, please think back over the last
12 months, from now to the same time last year.
Circle the answer given (Q33 Months of Adequate Household Food Provisioning
Were there months, in the past 12 months, in which you did not have enough food to meet 1 0
your family’s needs?
Q21. Which were the months in the past 12 months during which you did not have enough food to meet
your family’s needs? (include any kind of food from any source, including own production, purchase,
exchange, from food aid, or borrowing)
(Do not read the list of months out. Circle the months that the respondent identifies as months in which the
household did not have enough food to meet their needs. Use a season calendar if needed to help the respondent
remember different months. Probe to make sure the respondent has thought about all the past 12 months.)
1 January 8 July
2 December 9 June
3 November 10 May
4 October 11 April
5 September 12 March
6 August 13 February
Total months (insert total number of months circled as months without enough food)
____________________________________________________

Household Dietary Diversity Score (HDDS)

The question should be asked of the person who is responsible for food preparation, or if that person is unavailable,
of another adult who was present and ate in the household the previous day. Consider only meals consumed at
home or in public kitchen but not in private restaurants or street food. DO NOT count food consumed in very
small amounts, i.e. less than a teaspoon per person or consumed by only one member of HH (list below to be
adjusted to context).
Q22. Household Dietary Diversity Q23. Main Sources of Food
Score What was the main source of
What foods have been in the the food in the past 24 hours?
household in the last 24 hours? (0=Not consumed; 1=Own
1=Yes; 0=No production; 2=Bought with
cash; 3=Exchanged;
4=Borrowed; 5=Received as
gift; 6= Food assistance;
7=Hunting/gathering/fishing
8=ACF Cash assistance)
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Cereals pasta, rice, ugali, chapatti, Q22.1 |___| Q23.1 |___|
sorghum, bread, millet, sesam etc.
Roots and tubers- potato, cassava, yam, Q22.2 |___| Q23.2 |___|
etc
Vegetables- spinach, pumpkin, tomato, Q22.3 |___| Q23.3 |___|
onion, pepper, regila, okra, kudura, etc

Fruits- mango, papaya, guava, banana, Q22.4 |___| Q23.4 |___|

orange, lemon, cucumber, etc
Meat, poultry, offal- goat, sheep, cow, Q22.5 |___| Q23.5 |___|
chicken, liver, kidney, etc.
Fish and seafood- dried or fresh Q22.6 |___| Q23.6 |___|
Eggs Q22.7 |___| Q23.7 |___|
Pulses/legumes/nuts- beans, lentils, Q22.8 |___| Q23.8 |___|
nuts, seeds, etc
Milk and milk products- fresh, Q22.9 |___| Q23.9 |___|
powdered, cheese, etc
Oil/fats- oil, fat, butter, ghee, etc Q22.10 |___| Q23.10 |___|
Sugar- sugar, honey, sweets Q22.11 |___| Q23.11 |___|
Miscellaneous- tea, coffee, condiments, Q22.12 |___| Q23.12 |___|
etc.

Minimum Dietary Diversity-Women (MDD-W)

This question should be asked to women of reproductive age, including PLW. Consider only meals consumed
at home or in public kitchen but not in private restaurants or street food.

Q24. What foods have been by the women in the

household in the last 24 hours?
1=Yes; 0=No
Starchy staple foods - Cereals and roots and tubers Q24.1 |___|
such as pasta, rice, ugali, chapatti, sorghum, bread,
millet, sesam, potato, cassava, yam, etc
Vitamin A-rich dark green leafy vegetables- Q24.2 |___|
Other Vitamin A-rich vegetables and fruits- Q24.3 |___|
Other vegetables - Q24.4 |___|
Other fruits- Q24.5 |___|
Beans and peas- Q24.6 |___|
Nuts and seeds- Q24.7 |___|
Dairy - Q24.8 |___|
Flesh foods- Q24.9 |___|
Eggs- Q24.10 |___|

Food Consumption Score

Q25. How many days, in the last 7 days, have you eaten the following food items? Number of times (0-7)
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Q25.1 Cereals (maize porridge, rice, sorghum, millet pasta, bread, rice or
other)
Q25.2 Roots and tubers (cassava, potatoes, sweet potatoes or other)
Q25.3 Pulses/legumes/nuts (beans, peas, chick peas, groundnuts, cashew nuts or
other)
Q25.4 Vegetables and leaves
Q25.6 Fruit
Q25.7 Meat, poultry, offal (beef, goat, lamb, poultry), eggs, fish, seafood
Q25.8 Milk/Dairy products (milk, yogurt, cheese or other)
Q25.9 Sugar, sugar products, honey
Q25.10 Oil/fats (oil, fat or butter)
Q25.11 Condiments (spices, tea, coffee) or other miscellaneous food
Q26 Food consumption score calculation (NOT A QUESTION FOR RESPONDENT)

Breastfeeding
Please circle the appropriate response
Q27 Is there at least one baby (between 6-23 months) in HH? 1=Yes, 2=No
Q27.1 Approximately how many months old? 1=less than 6 months
2=Between 6 and 11 months
3=Between 12 and 17 months
4=Between 18 and 23 months
Q27.2 Is the baby still breastfeeding? 1=Yes, 2=No

Household Food Insecurity Access Scale

Q28. In the past 4 weeks, did you have to worry about food for your household?
Question Response Options CODE
1 In the past four weeks, did you 0=No (skip to Q2)
worry that your household would 1=Yes
not have enough food?
1a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
2 In the past four weeks, were you or 0=No (skip to Q3)
any household member not able to 1=Yes
eat the kinds of foods that you
preferred because of a lack of
resources?
2a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
3 In the past four weeks, did you or 0=No (skip to Q4)
any household member have to eat 1=Yes
a limited variety of foods due to a
lack of resources?
3a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
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 weeks)
4 In the past four weeks, did you or 0=No (skip to Q5)
any household member have to eat 1=Yes
some foods that you really did not
want to eat because of a lack of
resources to obtain other types of
food?
4a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
5 In the past four weeks, did you or 0=No (skip to Q6)
any household member have to eat 1=Yes
a smaller meal that you felt you
needed because there was not
enough food?
5a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
6 In the past four weeks, did you or 0=No (skip to Q7)
any household member have to eat 1=Yes
fewer meals in a day because there
was not enough food?
6a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
7 In the past four weeks, was there 0=No (skip to Q8)
ever no food to eat of any kind in 1=Yes
your household because of a lack of
resources to get food?
7a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
8 In the past four weeks, did you or 0=No (skip to Q9)
any household member go to sleep 1=Yes
at night hungry because there was
not enough food?
8a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
9 In the past four weeks, did you or 0=No
any household member go a whole 1=Yes
day and night without eating
anything because there was not
enough food?
9a How often did this happen? 1=Rarely (once or twice in the past four weeks)
2=Sometimes (three to ten times in the past
four weeks)
3=Often (more than ten times in the past four
weeks)
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Q29. HFIAS calculation (NOT A QUESTION FOR RESPONDENT)

5. HOUSEHOLD LIVELIHOODS SOURCES

Q30. List in order of importance the 4 main sources of HH income? (1=most important, 4=least important)
1 Agriculture 6 Casual labour in agriculture
2 Livestock rearing/selling 7 Other casual labour
3 Other trading/business 8 Civil servant /Other Employee
4 Fishing 9 Remittances from abroad
5 Artisan: mason, carpenter 10 Renting out land to others
11 Other (please specify) __________________________________________________________

Q31 What is the HH weekly income (in local currency)? ________________________________________

Q32 What is the HH monthly income (in local currency)? _______________________________________
Q33 What is the HH annual income (in local currency)? _______________________________________

Q34. How is your current income compare to the previous month? (circle response)
1 Higher 2 Similar 3 Lower 4 Don’t know

Q35. In the past month what were the 4 greatest HH expenditures in order of importance? (1=most, 4=least)
1 Food 6 Livestock
2 House equipment purchase 7 Other productive assets: tools, machinery
3 Clothes 8 Health expenses
4 Fuel 9 Education expenses
5 Agricultural inputs 10 Social expenses (wedding, funerals)
11 Other (please specify) __________________________________________________________
Q36 What proportion of your total monthly income did food account for? Use the proportional piling
method _____________________________________________________________________________

Q37. Has there been any change in HH expenditure in the last month? (circle response)
1 Higher 2 Similar 3 Lower 4 Don’t know
Q38 If the spending pattern was different from the previous month, explain why? ___________________
____________________________________________________________________________________
Q39 Does the HH have any debt? 1 Yes 3 No 4 Don’t
know
Q40 How much debt approximately? Cash Wheat (kg) Other amount
Q40. If "other debt", please specify its nature? _________________________________________________
1 ____________________________________________________________________________________

6. CROP PORDUCTION
Q41 What area of land does the HH own? ___________________________________________________
Q42 What area of land does the HH cultivate (in last season)? ___________________________________
Q43 What area of rainfed land does the HH cultivate? _________________________________________
Q44 What area of land was not cultivated last season? ________________________________________

Q45. If you left land uncultivated last season, what was the main reason? (please circle)
1 Lack of labour 6 Fallow land
2 Lack of seeds 7 Lack of fertilizer
3 Lack of rain 8 Water logged land
4 Lack of tools to till land etc 9 Other (please specify) _____________________

Area Type of Main Amount Were you able If NO give

Crop planted last Planted seeds source of harvested to get quantity reason
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season (ha) 1= Hybrid seeds (kg) of seeds 1=can’t afford
2= OPV needed? 2=not
3=N/A 1=Yes, 2=No available 3=
3=N/A unable to
retain 4= N/A
Q46 Maize
Q47 Millet
Q48 Wheat
Q49 Sorghum
Q50 Rice
Q51 Beans
Q52 Cowpeas
Q53 Groundnuts
Q54 Potatoes
Q55 Coffee
Q56 Cocoa
Q57 Cotton

Q58 How many fruit trees do you 0 None 1 1-5 2 5-10 3 10-20 4 20-50 5 50+
have access to? (circle answer)

7. GARDENS
Q60 Does the household have a vegetable garden? (circle answer) 1 Yes 2 No
Q61 If yes, who owns the garden? (circle answer) 1 Individual 2 Community 3 Other
Q62 If yes, does the house have access to a water source? (circle answer) 1 Yes 2 No
Q63 If yes to Q84, is it (circle answer) 1 Perennial 2 Intermittent 3 Other
Q64 How far is nearest water point? (circle answer) 1 <0.5km 2 0.5-1km 3 1-2km 4 >2km

GARDEN PRODUCTION
Type of crop 1=Yes 2=No Average Output in Main source of seed /
last crop seedlings / cuttings
Q65 Tomato (Kg)
Q66 Carrots (Kgs)
Q67 Cucumber(Kg)
Q68 Onion/Shallot (Kg)
Q69 Cow Peas (kg)
Q70 Groundnuts(Kg)
Q71 Okra (Kg)
Q72 Potato (Kg)
Q73 Sweet Potato(Kg)
Q74 Pumpkin/Squash (Heads)
Q75 Rape (bundles)
Q76 Peas (Kg)
Q77 Beans (Kg)
Q78 Spinach (bundles)
Q79 Butternut (Kg)
Q80 Pawpaw (Heads)
Q81 Banana (Kg)
Q82 Cassava (Kg)
Q83 Avocado (Kg)
Q84 Orange/Lemon (Kg)

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Q85 Other (specify)

Which of the following tools do you have? 1=Yes 2=No

Q86 Plough
Q87 Cultivator
Q88 Hoe
Q89 Rake
Q90 Wheelbarrow
Q91 Shovel
Q92 Pick / Mattock
Q93 Axe
Q94 Cart

8. LIVESTOCK
How much livestock does the HH own now (in numbers by type)?
Type Number Type Number
Q95 Cattle Q120 Poultry
Q96 Goats/Sheep Q122 Horse
Q97 Donkey Q124 Camel
Q98 Other (please specify) ________________________________________________________________

How much livestock did the HH own a year ago (in numbers by type)?
Type Number Type Number
Q99 Cattle Q127 Poultry
Q100 Goats/Sheep Q129 Horse
Q101 Donkey Q131 Camel
Q102 Other (please specify) _______________________________________________________________

Could the following details about the livestock now? Number

Q103 Number of animals used for ploughing or transportation
Q104 Number of female cows
Q105 Number of female goats
Q106 Number of female sheep

Could the following details about the livestock a year ago? Number
Q107 Number of animals used for ploughing or transportation
Q108 Number of female cows
Q109 Number of female goats
Q110 Number of female sheep

Q111. If the number of livestock decreased since last year, what were the 4 most important reasons for
this? (1=most important, 4=least important)
1 Animal selling for cash 6 Killed for meat - daily family consumption
2 Death linked to pasture/fodder shortage 7 Killed for celebration
3 Animal given away / gift 8 Death following disease
4 Death of old age 9 Other (please specify) _____________________

Q112 Does the HH own some pasture? (circle answer) 1 Yes 2 No

Q113 If yes, how much? ____________________________________________________________________

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Q114. In order of importance, what are the 4 main products you get from your livestock?
1 Milk/dairy products for own 5 5. Skin/hides for selling
consumption
2 Milk/dairy products for selling 6 6. Skin/hides for own consumption
3 Meat for selling 7 Other (please specify)
4 Meat for own consumption ___________________________________

Q115. In order of importance, what are the 4 main constraints you are facing in livestock farming? (1=most
important, 4=least important)
1 Disease 5 Lack of fodder
2 Low selling price 6 Lack of water
3 Low production 7 Lack of access to veterinary services
4 Lack of pasture 8 Lack of safe livestock house
9 Other (please specify)? ________________________________________________________________

9. LIVELIHOOD COPING STRATEGIES

In the past fifteen days, to meet the basic needs of the family, did your family have to? 1=Yes 0=No
Q116 Send at least one member abroad for job 1 0
Q117 Sell non-productive assets (jewellery, carpets, house furniture) 1 0
Q118 Send son(s)work as casual labourer 1 0
Q119 Purchase less agricultural inputs 1 0
Q120 Beg 1 0
Q121 Get into debt, take out loan or mortgage 1 0
Q122 Send all family workers abroad for job 1 0
Q123 Sell productive assets (female livestock, grinder, sowing machine, tools, 1 0
piece of land)
Q124 Stop education/health expenditures 1 0
Q125 Sell harvest (fruits, wheat) early and at a loss 1 0
Q126 Reduce all expenses 1 0

Reduced Coping Strategy Index (rCSI)

Q127. During the last 7 days, did your household have to employ one of the following Number of times (0-7)
strategies to cope with a lack of food or money to buy it?
1 Rely on less preferred and less expensive foods?
2 Borrow food, or rely on help from a friend or relative?
3 Limit portion size at mealtimes?
4 Restrict consumption by adults in order for small children to eat?
5 Reduce number of meals eaten in a day?

Q128. In the past month, have you or members of the HH had to borrow money? 1=Yes 0=No
Q129. If yes, what were the 3 most important expenses? (1=most important, 4=least important)
1 Food purchases 5 Items for livestock
2 Health expenses 6 Does not know
3 Clothes/Hygiene items 7 Other (please specify)
4 Agricultural inputs ___________________________________

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 10. WATER, SANITATION, AND HYGIENE
Diarrhea Prevalence
Q130. Has any child less than 5 years of age in your household had loose or watery stools in Yes No
any day period during the last 2 weeks?
(If yes, how many children had loose or watery stools?) Number =
(If yes, how many of these children passed more than 3 stools in a day?) Number =
How many children under 5 years old are there in your household? Number =

Hand-Washing Enablers
Q131. Would you show me where you do when you wash your hands? (enumerator physical Yes No
spotcheck)
Handwashing spot (sink/station/area) available
Water available at hand-washing spot
Soap/ash available at hand-washing spot

Hand-Washing Knowledge
Q132. What are the key times for hand-washing, particularly among caregivers of young Yes No
children? (Note: Write yes for each of the following 5 times mentioned and ignore any other times
mentioned.)
After defecation    
After cleaning babies' bottoms    
Before food preparation    
Before eating    
Before feeding children    
No point No point
Other (optional. specify):
awarded awarded

Improved Water Point

Q133. Where do you collect your household's drinking water? Yes No
Piped water into dwelling    
Piped water to yard/plot    
Public tap or standpipe    
Tubewell or borehole    
Protected dug well    
Protected spring    
Rainwater (stored in a container until used)    
Unprotected spring    
Unprotected dug well    
Cart with small tank/drum    
Tanker-truck    
Surface water    
Bottled water    
Other, specify    

Toilet Use
Q134. Is there a toilet or latrine in the household?  Yes No
(If yes), do household members use the household toilet/latrine?
(If no), do household members use a public toilet/latrine?

Child (<2 years) stool disposal

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Q135. What do you do with the stools of your baby/infant? Yes No
Dropped into toilet (household or public toilet)
Washed or rinsed into sink or tub / sewage pit or network / soakaway pit
Buried
Burnt    
Thrown in trash/solid waste
Left on ground in yard
Left or thrown outside premises
Thrown into waterway
Other unsafe; thrown/rinsed/washed elsewhere in the environment (specify)
Not applicable (ex. No children under 2)
Don’t know    

Additionally, the following question should be included in every survey on health centers and other medical
centers for baseline and endline, through a physical check:

Survey Questions: Facility WASH Enabler Inspections YES NO

Is there water for hand-washing publicly available at this facility?    
Is there soap or ash for hand-washing publicly available at this facility?    
Is there a publicly available toilet at this facility?    

QUALITY CONTROL

M&E supervisor_____________________________ Date___________________

Data entry_________________________________ Date____________________

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