Public Expenditure Tracking Survey in Health 1996
Uganda, 1996
Identification
UGA_1996_PETSH_v01_M
Public Expenditure Tracking Survey in Health 1996
| Name | Country code |
|---|---|
| Uganda | UGA |
Public Expenditure Tracking Survey (PETS)
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 Uganda Public Expenditure Tracking Survey 1996 was the first study that applied PETS tools to evaluate the flow of public resources to intended destinations.
The principal motivation for this study was the observation that since 1987 public spending on basic services had substantially increased in Uganda, while several officially reported outcome and output indicators remained stagnant.
The hypothesis for the study was that actual service delivery is much worse than budgetary allocations would imply because public funds do not reach the intended facilities as expected, and hence outcomes cannot improve. Reasons for facilities not receiving the funds could range from competing priorities at various levels of government to misuse of public funds. To test this hypothesis, budgets and actual spending were compared in two selected sectors, primary education and health care.
As adequate public accounts have not been available in many African countries, including Uganda, a field survey of schools and clinics was carried out to collect actual spending data.
Documented here is the Public Expenditure Tracking Survey conducted in Uganda health sector. Researchers gathered data covering the period 1991-1995 from close to 100 health clinics in 19 districts.
The success of Uganda PETS 1996, especially of the survey in the education sector, encouraged researchers to apply PETS techniques in other countries to trace public funds flow and indentify possible delays or leakages.
Sample survey data [ssd]
Scope
| Topic | Vocabulary |
|---|---|
| Health | World Bank |
| Health Systems & Financing | World Bank |
Coverage
Districts: Kampala; Arua, Moyo (Northwest); Apac, Gulu (North); Soroti, Moroto, Kapchorwa (Northeast); Jinja, Kamuli, Pallisa (East); Mukono, Mubende, Kiboga (Central); Bushenyi, Kabale (Southwest); and Kabarole, Hoima, Bundibugyo (West).
Producers and sponsors
| Name |
|---|
| World Bank |
| Economic Policy Research Centre, Makerere University, Kampala |
| Name |
|---|
| Swedish Development Agency |
Sampling
For the sample selection, the country was first divided into regions. In order to bring out regional differences more clearly, the traditional four regions (North, East, West and Central) were reconfigured into seven regions: Northwest, North, Northeast, East, Central, Southwest and West. Kampala was treated as a separate region because it enjoys many advantages over the rest of the country. The 39 districts were then arrayed into three groups, based on the fiscal year in which a particular district first received a separate budget vote under the decentralization program that commenced in 1993. The objective was to pick one district per region in each successive phase of decentralization. In practice, only two districts were selected from the smaller regions. After some other minor adjustments, the following 19 districts were selected: Kampala; Arua, Moyo (Northwest); Apac, Gulu (North); Soroti, Moroto, Kapchorwa (Northeast); Jinja, Kamuli, Pallisa (East); Mukono, Mubende, Kiboga (Central); Bushenyi, Kabale (Southwest); and Kabarole, Hoima, Bundibugyo (West). Kiboga, which is a new district, had to be subsequently dropped due to limited data availability.
There are many more schools than health facilities in every district. Surprisingly, some districts (Kapchorwa and Kisoro) had no government health centers at all, while others had as many as ten. Of course, lack of government facilities could be compensated for by the availability of missionary, private or NGO facilities, which often benefit from government support. Five primarily government facilities were visited in each district, comprising two health centers, two dispensaries/maternal units and one aid-post, or some other combination of these facilities, decided in consultation with the district medical officer.
Kiboga, which is a new district, had to be subsequently dropped due to limited data availability.
Data collection
| Start | End |
|---|---|
| 1996 | 1996 |
| Name |
|---|
| Management Systems and Economic Consultants Limited |
Enumerators who collected the data from clinics were mainly former health workers. Standardized forms were used. In addition, interviewers made qualitative observations to supplement the quantitative data. Enumerators were trained and closely supervised by a local research team to ensure quality and uniformity of data collection and to assess the standard of record keeping in schools.
Unlike primary education, there is very little official data on service delivery in health care. Similarly, the field survey found no systematic facility level information on outputs, such as the number of in- or out-patients. One explanation for such a marked difference in facility-level behavior between the two sectors could be that the parent-teacher associations (PTAs) who financed most of the school level expenditure in 1991- 1995, demanded record keeping and accountability, while in health clinics there was no such pressure from users. A long term relationship between providers and beneficiaries that characterizes primary education in contrast to health care, where the relationship is typically short and more ad hoc, clearly favors better organization on the demand side. The supply side (schools) has to take this into account and cannot treat parents as individuals as clinics typically do.
The private sector is a major player in health care in Uganda. Since 1987 the number of private and NGO-operated facilities has increased rapidly, while there has been virtually no change in the number of government facilities. Health centers and other facilities are very unevenly distributed across the country.
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_UGA_1996_PETSH_v01_M
| Name | Affiliation | Role |
|---|---|---|
| Antonina Redko | DECDG, World Bank | DDI documentation |
2011-10-21
Metadata version
v01 (October 2011)