PETS - QSDS in Health 2003
Namibia, 2003
Identification
NAM_2003_PETSH_v01_M
PETS - QSDS in Health 2003
| Name | Country code |
|---|---|
| Namibia | NAM |
Public Expenditure Tracking Survey (PETS)/Quantitative Service Delivery Survey (QSDS)
A Public Expenditure Tracking Survey (PETS) is a diagnostic tool used to study the flow of public funds from the center to service providers. It has successfully been applied in many countries around the world where public accounting systems function poorly or provide unreliable information. The PETS has proven to be a useful tool to identify and quantify the leakage of funds. The PETS has also served as an analytical tool for understanding the causes underlying problems, so that informed policies can be developed. Finally, PETS results have successfully been used to improve transparency and accountability by supporting "power of information" campaigns.
PETS are often combined with Quantitative Service Delivery Surveys (QSDS) in order to obtain a more complete picture of the efficiency and equity of a public allocation system, activities at the provider level, as well as various agents involved in the process of service delivery.
While most of PETS and QSDS have been conducted in the health and education sectors, a few have also covered other sectors, such as justice, Early Childhood Programs, water, agriculture, and rural roads.
In the past decade, about 40 PETS and QSDS have been implemented in about 30 countries. While a large majority of these surveys have been conducted in Africa, which currently accounts for 66 percent of the total number of studies, PETS/QSDS have been implemented in all six regions of the World Bank (East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, South Asia and Sub-Saharan Africa).
After gaining independence in 1990, Namibia prioritized spending on social sectors such as education and health in order to address poverty and disparity in access to quality education and health care. The education and health sectors have received the highest budget allocations over the last three decades.
In order to evaluate efficiency of budget expenditures in health and education sectors, the Namibian government decided to implement Public Expenditure Tracking Survey (PETS) combined with Quantitative Service Delivery Survey (QSDS) in 2003. PETS methodology has been employed to analyze the distribution and use of financial resources at the national, sub-national and frontline service provider levels. The QSDS goes beyond tracing of funds and tries to explore the determinants of poor service delivery.
The guiding hypothesis for the survey was an assumption that actual service delivery is much worse than budgetary allocations would imply, because public funds do not reach the intended facilities as expected. As the result outcomes cannot improve. To verify this hypothesis, a sample of schools and health facilities in seven of Namibia's thirteen regions was randomly selected.
Documented here is the survey conducted in Namibia health sector. Enumerators obtained data from records from the Ministry of Health and Social Services, district health offices and health facilities. They also interviewed heads of health facilities, medical doctors, nurses and patients. Forty five health facilities in twelve districts were covered by the survey.
Sample survey data [ssd]
- Ministry of Health and Social Services;
- regional health offices;
- health facilities;
- patients.
Scope
| Topic | Vocabulary |
|---|---|
| Health | World Bank |
| Health Systems & Financing | World Bank |
Coverage
Hardap, Kavango, Khomas, Kunene, Omaheke, Omusati and Oshana regions
Producers and sponsors
| Name |
|---|
| World Bank |
| Ministry of Health and Social Services |
| Name |
|---|
| Ministry of Finance |
| National Planning Commission Secretariat |
| Office of the Prime Minister |
| Office of the Auditor General |
| Name |
|---|
| World Bank |
Sampling
A convenient sample of seven of Namibia's thirteen administrative regions was chosen for the survey. Hardap, Kavango, Khomas, Kunene, Omaheke, Omusati and Oshana regions were selected.
The regions in Namibia are divided into health districts. The number of districts depends on the size of the region and varies between one and four. If regions had one or two health districts, all districts were part of the sample. If the number of districts was larger than two, investigators randomly chose two districts. In total, 12 districts were selected.
There were usually one hospital and one health centre in each district. Every hospital and health center in selected districts was included in the sample, while clinics were chosen randomly.
Rundu, Windhoek and Aranos districts did not have district hospitals. Instead, they housed referral hospitals, specialized health facilities that cater for patients across regions and receive funds directly from the Ministry of Health and Social Services.
Overall, 48 facilities were selected: nine district hospitals, ten health centers, 25 clinics and four referral hospitals.
Researchers planned to interview the head of a health facility (clinic, health centre, hospital, referral hospital), two nurses (matrons at hospitals), two medical doctors, two patients at clinics, five patients at health centers, five inpatients and five outpatients at hospitals. However, it was not always possible to interview all of them. Since the Principal Medical Officer was the head of the hospital and was also in charge of the health district in general, enumerators interviewed him in his capacity as PMO to collect information on the district and not as head of the hospital. Instead, where possible, nurses were interviewed on general hospital matters.
All but three health facilities were covered. At one facility no one could be found, and staff at two others did not co-operate.
Survey instrument
Questionnaires were developed for the Ministry of Health and Social Services, regional health directors, regional chief medical officers, principal medical officers, heads of health facilities, medical doctors, nurses and patients (both inpatients and outpatients).
A pilot survey covering six health facilities (three in Windhoek, two in Okahandja and one in Groot-Aub) was carried out to test the questionnaire. The pilot survey did not indicate any major problem with the questionnaires.
Data collection
| Start | End |
|---|---|
| 2003 | 2003 |
| Name |
|---|
| Namibian Economic Policy Research Unit |
The project members were divided into five teams. Four teams started gathering data from Kavango region in 28 July 2003. One team remained in Khomas region.
Each team consisted of one Namibian Economic Policy Research Unit (NEPRU) staff member and one or two enumerators. After being trained at NEPRU, enumerators received one-day refresher instructions when they joined the teams in the field.
One of the major challenges enumerators encountered during the survey - besides locating health clinics in remote areas - was the poor communication infrastructure. Even health facilities and other institutions that had phones and fax machines often could not be contacted because the equipment was not working or in some areas, the telephone wires were stolen because of the copper content. Thus, except for the Windhoek region, schools and health facilities were usually not informed about survey team visits and were not prepared. Subsequently, enumerators spent much more time at the facilities than planned to collect all the data and information needed.
Furthermore, clinics in remote areas were often run by only one nurse and closed in the afternoon when there were no patients. On the other hand, so many patients were queuing at some clinics that it was difficult to interview nurses and the head of a facility. Since finances are administered at the district hospital on behalf of clinics and health centers, financial information could only be collected from hospitals. Records on patients and payments of fees by patients were often incomplete.
In many instances, team members had to return to the same institution more than once to collect missing information.
Data Access
Public use file
The use of this survey must be acknowledged using a citation which would include:
- the identification of the Primary Investigator (including country name)
- the full title of the survey and its acronym (when available), and the year(s) of implementation
- the survey reference number
- the source and date of download (for datasets disseminated online).
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Contacts
| Name | Affiliation | |
|---|---|---|
| Hooman Dabidian | World Bank | hdabidian@worldbank.org |
| Cindy Audiguier | World Bank | caudiguier@worldbank.org |
Metadata production
DDI_NAM_2003_PETSH_v01_M
| Name | Affiliation | Role |
|---|---|---|
| Antonina Redko | DECDG, World Bank | DDI documentation |
2011-10-07
Metadata version
v01 (October 2011)