Publication: Leakage of Public Resources in the Health Sector : An Empirical Investigation of Chad
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Date
2009
ISSN
09638024
Published
2009
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In the public sector in developing countries, leakage of public resources could prove detrimental to users and affect the well-being of the population. This paper empirically examines the importance of leakage of government resources in the health sector in Chad, and its effects on the prices of drugs. The analysis uses data collected in Chad as part of a Health Facilities Survey organised by the World Bank in 2004. The survey covered 281 primary health care centres and contained information on the provision of medical material, financial resources and medicines allocated by the Ministry of Health to the regional administration and primary health centres. Although the regional administration is officially allocated 60% of the ministry's non-wage recurrent expenditures, the share of the resources that actually reach the regions is estimated to be only 18%. The health centres, which are the frontline providers and the entry point for the population, receive less than 1% of the ministry's non-wage recurrent expenditures. Accounting for the endogeneity of the level of competition among health centres, the leakage of government resources has a significant and negative impact on the price mark-up that health centres charge patients for drugs. Furthermore, it is estimated that had public resources earmarked for frontline providers reached them in their entirety, the number of patients seeking primary health care in Chad would have more than doubled.
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Publication Leakage of Public Resources in the Health Sector : An Empirical Investigation of Chad(2007-09)In the public sector in developing countries, leakage of public resources could prove detrimental to users and affect the well-being of the population. This paper empirically examines the importance of leakage of government resources in the health sector in Chad, and its effects on the prices of drugs. The analysis uses data collected in Chad as part of a Health Facilities Survey organized by the World Bank in 2004. The survey covered 281 primary health care centers and contained information on the provision of medical material, financial resources, and medicines allocated by the Ministry of Health to the regional administration and primary health centers. Although the regional administration is officially allocated 60 percent of the ministry's non-wage recurrent expenditures, the share of the resources that actually reach the regions is estimated to be only 18 percent. The health centers, which are the frontline providers and the entry point for the population, receive less than 1 percent of the ministry's non-wage recurrent expenditures. Accounting for the endogeneity of the level of competition among health centers, the leakage of government resources has a significant and negative impact on the price mark-up that health centers charge patients for drugs.Publication Delivering Service Indicators in Education and Health in Africa : A Proposal(2010-06-01)The Delivering Service Indicators seek to provide a set of indices for benchmarking service delivery performance in education and health in Africa in order to track progress in and across countries over time. It seeks to enhance effective and active monitoring of service delivery systems and to become an instrument of public accountability and good governance in Africa. The main perspective adopted by the Delivering Service Indicators index is one of citizens accessing services and facing potential shortcomings in those services available to them. The index is thus presented as a Service Delivery Report Card on education and health. However, unlike traditional citizen report cards, it assembles objective information from micro level surveys of service delivery units.Publication Bypassing Health Providers : The Quest for Better Price and Quality of Health Care in Chad(World Bank, Washington, DC, 2008-01)This paper investigates individuals' bypassing behavior in the health sector in Chad and the determinants of individuals' facility choice. The authors introduce a new way to measure bypassing using the patients' own knowledge of alternative health providers available to them instead of assuming that information as previously done. The authors analyze how perceived health care quality and prices impact patients' bypassing decisions. The analysis uses data from a Quantitative Service Delivery Survey in Chad's health sector carried out in 2004. The survey covers 281 primary health care centers and 1,801 patients. The matching of facility data and patient data allows the analysis to control for a wide range of important patient and facility characteristics, such as income, severity of illness, quality of health care, or price of services. The findings show that income inequalities translate into health service inequalities. There is evidence of two distinct types of bypassing activities in Chad: (1) patients from low-income households bypass high-quality facilities they cannot afford to go to low-quality facilities, and (2) rich individuals bypass low-quality facilities and aim for more expensive facilities that also offer a higher quality of care. These significant differences in patients' facility choices are observed across income groups as well as between rural and urban areas.Publication Zambia Health Sector Public : Accounting for Resources to Improve Effective Service Coverage(Washington, DC: World Bank, 2009)Over the past few years, three nagging problems have bedeviled Zambia's health sector: the country is falling off-track from reaching the Millennium Development Goals (MDGs), it is facing severe financing constraints on the government front, and the health and HIV/AIDS sector is increasingly being fragmented by the reemergence of global disease initiatives. This health sector pubic expenditure review (PER) seeks to assist the Government of the Republic of Zambia (GRZ) and its development partners take stock of the resources in the health sector and how these resources can be better used to produce better health services. The results of the PER are expected to be the used for a variety of purposes, including the preparation of the health sector strategic plan, and succeeding rounds of the global fund request for proposals. Policy dialogue between the Bank and GRZ, both at the macro and sector levels, can also be enriched by the PER. The PER also provides critical inputs into the Medium-Term Expenditure Framework (MTEF) process, and in the assessment of the Poverty Reduction Strategy Paper (PRSP). Likewise, the PER can provide inputs to fine-tune the process of the pooled basket funding mechanism under the sector-wide approach (SWAp).Publication Informal Payments and Moonlighting in Tajikistan's Health Sector(World Bank, Washington, DC, 2008-03)This paper studies the relationship between gender and corruption in the health sector. It uses data collected directly from health workers, during a recent public expenditure tracking survey in Tajikistan's health sector. Using informal payments as an indicator of corruption, women seem at first significantly less corrupt than men as consistently suggested by the literature. However, once power conferred by position is controlled for, women appear in fact equally likely to take advantage of corruption opportunities as men. Female-headed facilities also are not less likely to experience informal charging than facilities managed by men. However, women are significantly less aggressive in the amount they extract from patients. The paper provides evidence that workers are more likely to engage in informal charging the farther they fall short of their perceived fair-wage, adding weight to the fair wage-corruption hypothesis. Finally, there is some evidence that health workers who feel that health care should be provided for a fee are more likely to informally charge patients. Contrary to informal charging, moonlighting behavior displays strong gender differences. Women are significantly less likely to work outside the facility on average and across types of health workers.
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