Transcript Public Expenditure Tracking Surveys

Tracking Public Expenditure:
A Guide
Waly Wane
Development Research Group
The World Bank
Are You Being Served?
June 2009
Presentation Overview
Why PETS
PETS Key Features
PETS and Resources Allocation Rules
An Example: Tracking in Chad
Lessons to date
PETS Next Steps…
Why PETS
Weak correlation between public spending
and outcomes
Poor information systems and need for
accountability mechanism
Need for better understanding of service
delivery performance
Improve transparency and budget
execution
Improve efficiency and poverty reduction
impact of public expenditure
PETS - Key Features
Diagnostic tool for flow of resources
through the system
Delays
Leakage
Data collected at all involved
administrative levels and at the frontline
provider
Quantitative versus perceptions
PETS - Key Features
No “standard” approach
Survey methods are complex and context
specific
Design is difficult
Data collection based on records
Poor record keeping practices
Multiple sources of financing
Allocation rules are defining characteristic
Hard vs. soft allocation rules environments
Hard Allocation Rules
Donor
contributions
MoF
MoF
Budget
allocation
Capitation
grant
Sector
Ministry
Sector
Ministry
Sub-national
Level 1
Sub-national
Level 1
Sub-national
Level 2
SDU
SDU
Contracting of
staff
Procurement
of materials
Procurement
of other inputs
Soft Allocation Rules
Donor
contributions
Budget allocation
MoF
Sector
Ministry
Procurement &
distribution of materials
and other inputs
Sub-national
Level 1
Sub-national
Level 2
SDU
Contracting &
allocation of
staff
Tracking & Hard Allocation Rules
 First PETS – Uganda 1996
 Zambia 2002 & Mali 2005
 Hard Allocation Rules make
 Tracking easier & more reliable
 Results more reliable, though…
 Sampling issues still remain
 Do Hard Allocation Rules reduce leakage?
 Zambia’s leakage of rule-based resources is scant
 Capitation grant leakage in Uganda (1996) is 87%
 Leakage of books in Mali (2005) is 60%
 In Uganda, information helped reduce leakage
Tracking & Soft Allocation Rules
Soft Allocation rules change the game
Leakage is not always defined
No denominator because what provider should
receive does not exist
Need to broaden the concept
Serious sampling issues
Broadening the Concept of Leakage
Lack of allocation rules and no allocation
on the budget for providers makes leakage
in the traditional sense hard to come by
Leakage is here defined as the share of
earmarked regional resources that
effectively reaches them
Need to account for all public resources
that 1) should and 2) do reach the regions
Administrative Data is Crucial
 Primary Data collected from
Regional and District Health Administrations
Regional and District Pharmacies
Frontline Provider, Staff & Patients
 Is important to address problems at the facility
level such as staff morale, stock-outs of drugs,
efficient use of resources, etc.
 Secondary data is crucial to estimate “leakage”
and hence effective public spending
Administrative Data is Crucial
Record keeping practices are often poor
even within the administration, data rarely
on magnetic support
Collect as much admin. data as possible,
carry them, xerox them if necessary
Recall period over one fiscal year are risky
Necessary to triangulate the data
Tracking the “petty” helps build confidence
in the data but it also has a cost
An Example: Tracking in Chad
Decentralized administrations, and
Providers receive public resources under
three channels:
Decentralized credits
Procured goods from the MoH centralized
Ad hoc allocations
“Leakage” Rates in the Health Sector
Health Sector Ressources Distribution
100
90
80
MoPH
60
Initial DRH Allocation
50
Effective DRHS Alloc.
40
Provider Ressources
30
20
10
Non-Wage Recurrent
03
20
02
20
03
20
02
0
20
% Budget
70
Total Recurrent
Figure 1: Official vs. Effective Expenditures
by Regional Health Delegations
1000
45
900
40
35
700
30
600
25
500
20
400
15
300
Resources Received
Percentage
Average
0
.E
Lo
go
ne
B
La
O
c
cc
Lo
id
e
go
ne nta
l
O
r ie
M
nt
ay
al
o
K
eb
M
oy
bi
en
C
ha
ri
O
ua
id
da
ï
S
al
am
at
Ta
nd
jilé
0
B
C
ilt
ha
in
rie
B
ag
ui
rm
i
G
ué
ra
K
an
em
5
.T
.
100
at
ha
Initial Allocation
10
200
B
Percentage Received
Millions of CFA Francs
800
• On average, RHDs received only 26,7% of their official non-wage
budgetary expenditures from the MoH
An Example: Tracking in Chad
Public Resources Reaching Health Centers
 We estimate from reports of heads of facilities that
they received about 50 million CFAF of medical
materials accounting for 17.8% of materials received
by all RHDs
 Only 4 centers (2%) report receiving financial
resources from the health administration in 2003.
 Total value of drugs received by HC is estimated at
3% of the MOH official budget for drugs which has
been fully executed.
Impacts of Public Resources
 Do public expenditures have an impact
on output in the health sector?
 Public expenditures do have an impact
…when leakage is controlled for.
 Official vs. effective health expenditures
in a regional delegation and utilization
of health centers in Chad
Transmission Channels
How does the receipt of public resources
improve outcomes?
Only one channel explored here is
reduction in drugs costs which increase
financial accessibility to health care
Transmission Channels
Rec. Pub. Res
Mkup
Mkup
Mkup
Mkup
-27.9**
-23.3**
-15.9**
-19.0*
30.9**
20.6*
14.7*
25.6
9.7***
13.4**
-16.1
Comp
60
Private
0.3*
Competition
Drugs
N
G
O
fo
rp
ro
f it
N
ot
-fo
r-p
ro
fit
Other Controls
NO
NO
YES
YES
YES
R-squared
0.03
0.04
0.06
0.16
0.5
Pr
iv
at
e
Pu
bl
ic
0
Visit
N
G
O
N
ot
-fo
r-p
ro
fit
fo
rp
ro
f it
Pr
iv
at
e
Pu
bl
ic
0
20
1,000
40
2,000
percent
3,000
4,000
80
5,000
100
Patients' Payments at the Facility
Tests
Visit
Drugs
Tests
 Drugs costs account for 65% of total costs
 Mark-ups decrease with the receipt of public
resources
 Why would monopolistic providers that receive
public resources reduce prices?
Lessons to date
 Large discrepancies between budget allocations
and actual spending
Uganda: 13 percent of intended funds arrived
 Resource flows are endogenous to facility
characteristics (rural vs. urban)
Tanzania: rural schools and health centers can expect
longer delays and receive smaller proportions of funds
 Resource flows are endogenous to resource
type
Zambia: rule-based versus discretionary
Salaries less prone to leakage and delays than material
Lessons to date…
Decentralization matters
Senegal: central level responsible for delays
Senegal: leakages happen mostly at the local
level
Information matters
Uganda: empowerment of users through
newspaper campaign effective in reducing
capture
Information System matters
PETS – Next steps…
Expenditure tracking only part of the story
Need to strengthen the facility component QSDS
Understanding impact on households
Linking facility and household surveys