Questionnaires
Tracking public expenditure in the health sector requires designing appropriate instruments in order to collect budget data at each level public resources went through before reaching frontline providers. In Tajikistan, this includes at local level Rayons, Central Rayon Hospitals, Jamoats and health facilities. This section describes the survey questionnaires that were designed in close collaboration with the key government counterparts in Ministries of Health, Finance, and Executive Office of the President (EOP). A consultation workshop with key counterparts was held with representatives of these agencies to discuss comments. Their inputs were incorporated in the final draft questionnaires. The field survey was administered by Zerkalo, a local survey company.
Six questionnaires were designed for this study.
1) Rayon (District) Questionnaire was applied to the rayon administration and responded by rayon financial department. The rayon questionnaire tracked budgetary revenues (tax and non tax and transfers from republican budget and subsidies) as well as additional resource both in cash and in kinds contributed to the health sector budget by government at various levels, donors, local communities, etc. On the expenditures side, the rayon questionnaire tracked allocation of budgetary resource to key sectors (general administration, education, health, and housing and communal services), allocation of resource within the health sector (by economic classification, function, and by budget institution unit). The questionnaire also examined the role and responsibilities of the rayon chairman in budget preparation, execution as well as issues in financial reporting, internal and external audit. Information from the rayon questionnaire can be cross validated with information from central rayon hospital and jamoat questionnaires. However, cross validation of information with the facility questionnaire is not possible as rayon allocates budgetary fund to health through central rayon hospitals and jamoats.
2) Central Rayon Hospitals (CRH) Questionnaire was applied to central rayon hospital administration responded by Head Doctor of Central Rayon Hospitals or by delegated staffs. Central rayon hospital plays an important role in allocating budgetary resources to health facilities included in the CRH network. These health facilities are not legal entities and therefore they do not have approved budgets based on organization. The questionnaire examines the role and responsibilities of the Head doctor of the central rayon hospitals. It tracks budgetary and non-budgetary revenues (in cash and in-kinds) as well as expenditure by economic, functional and budget institution of a central rayon hospital. Tracking of economic classification focuses on wage bill and other inputs including goods and services (foods, drugs, and travel expenses), repair and maintenance and communal services. However, cross validation of expenditures with health facilities is limited to payments of wage. Cross validation of expenditure on other inputs can not be done as there is no record on how much inputs health facilities received from the central rayon hospital. Central rayon hospital and jamoat have no financial relations as they both play role as paymaster to health facilities. Finally, the questionnaire examines the role of head doctor of the central rayon hospital in financial management as well as human resource management.
3) Jamoat Questionnaire was applied to jamoat administration responded by jamoat chairman or an accountant. Similar to the rayon and central rayon hospital questionnaires, the jamoat questionnaire tracks budgetary and non-budgetary revenues as well as budgetary expenditure allocation (economic and functional). The wage expenditure can be cross validated with the facility questionnaire.
4) Facility questionnaire was applied to health facilities and responded by Head doctor of the facility. As a facility is a service delivery unit, the questionnaire collected basic information about health facility that affects the ability to deliver health services. These include the number of population served, catchment areas, distance from centre/town, physical infrastructure, utility connections and availability, operating hours, medical infrastructure (beds, medical equipments, vehicles, etc). It also examines personnel management (recruitment, firing, and incentive), tracks revenues and expenditures both in cash and in kinds (drugs, food, fuel, and other material inputs) received and spent by a health facility. As a health facility other than a central rayon hospital has no approved budget, the questionnaire did not ask for approved and executed budget of a health facilities but asked for the estimated amount of resource received from either central rayon hospital or jamoat for delivery of health services in 2005. For tracking purpose, only payment of wage by health facilities can be cross validated with wage payments reported by central rayon hospitals and jamoats. Tracking of expenditures on inputs other than wages is limited due to poor keeping of payment records and time consuming in cross validation at both levels.
5) Staff Questionnaire was applied to staff in sampling health facilities included in the survey. The questionnaire is designed to track payment of wage as it contributes to 60-80 percent of total health budget. In addition, the questionnaire is used to examine staff qualifications and training, workloads, pay and incentive, informal payments and other related human resource management issues that affect health service delivery. Finally, it examines service delivery activities to enable linkages with resource utilization.
6) Immunization Questionnaire was part of PETS in order to fill in knowledge gaps on execution and distribution of immunization resources (funds and commodities) both at the country level and more globally. The result will shed light on policy areas where the budgeting, resource allocation, and budget execution processes can be strengthened to achieve maximal health impact. The questionnaire will track the flows of funds allocated specifically for immunization, their distribution, and sources (government and external resources). It will track a share of budgetary funds available to immunization services (as a proportion of total funds available to primary health care) and evaluate vaccine and safe injection commodities flows and distribution.