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Community Voices

SANAC Civil Society Forum

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Community Health Dashboard

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Discussion Topics

1

What are the main health challenges in your community?

2

How can health services be improved in your area?

3

What support do you need from health authorities?

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Personal Information

First Name *

Last Name *

ID Number *

Date of Birth *

Gender *

Phone Number *

Address Information

Physical Address *

Province

Postal Code

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone *

Relationship to Emergency Contact

Health Services

Services Interested In:

HIV Testing & Counseling TB Screening Mental Health Support Family Planning General Health Checkup