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).
The financing of the public health sector in Madagascar has gone through significant changes over the last years. Before the new government came to power in the middle of 2002, it adhered strictly to a patient fee policy. After the new government took office, the user fee policy was abolished in an effort to mitigate the effect of the large poverty increase after the political crisis in 2002 on formal health care.
The objectives of this study were to evaluate health facilities' efficiency, measure patients' satisfaction and determine the impact of the suspension of user fees in the health sector.
Madagascar PETS-QSDS in Health also known as Etude sur l'Efficience et Equité des Formations Sanitaires à Madagascar (EEEFS) was fielded in May - June 2003. The sampling frame was the same as used for the nationwide household survey, the Enquête Permanente auprès des Ménages (EPM) in 2002.
Kind of Data
Sample survey data [ssd]
Health Systems & Financing
Antananarivo, Fianarantsoa, Toamasina, Mahajanga, Toliara and Antsiranana provinces.
Producers and sponsors
National Statistical Institute
The sampling frame for PETS-QSDS in Health 2003 was the same as used for the nationwide household survey, the Enquête Permanente auprès des Ménages (EPM) in 2002. The primary sampling units of the EPM were "zones de denombrement" (ZDs) or groups of ZDs; each ZD corresponds generally to the fokontany administrative level which in turn is equivalent to a village. Eighty out of 303 of the ZDs from the original EPM survey were randomly chosen to be re-surveyed for the PETS-QSDS in Health. This was done to allow the study to build on the earlier EPM data collection. Twenty seven (34%) of the 80 ZDs were rural, reflecting the oversampling of urban areas in the EPM (the population of the country as a whole is about 80% rural).
For the household survey, the objective was to re-interview all the households in selected ZDs. This effort was quite successful (1010 of the original 1066 households were re-interviewed), reflecting the fact that the EPM survey had been carried out just several months earlier. Households lost to attrition were replaced by other households in the cluster. Since the usual range of information on household characteristics and activities was collected for the EPM for the re-interviewed households, the new survey was an abbreviated one that focused in detail on health-related behavior.
Dates of Data Collection
Data Collection Mode
The data were collected using the following survey instruments:
- the health district questionnaire,
- the facility questionnaire,
- the community questionnaire,
- the user exit questionnaire,
- the household questionnaire.
For the user exit survey, patients were randomly selected to be interviewed upon exiting each facility. They were asked questions about their impressions of the quality of care and the condition of the health care facility, the welcome provided by the facility, the actions taken and information provided to them by the health practitioner during their consultation, and the cost of the consultation and of drugs provided. The user survey also collected information about the characteristics of respondents and their families.
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.