Public Expenditure Tracking Survey in Health 2005
Cambodia, 2005
Identification
KHM_2005_PETS_v01_M
Public Expenditure Tracking Survey in Health 2005
| Name | Country code |
|---|---|
| Cambodia | KHM |
Public Expenditure Tracking Survey
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 primary objective of this study was to help the government of Cambodia diagnose issues and propose directions for improving effectiveness and efficiency of public financing in the health sector.
The study was part of the broader process to reform public finance and health sectors in Cambodia. This research assesed to what extent resources reach frontline health facilities, and what were the main issues related to the management of resources. The study also hopes to contribute to the building of global knowledge base on the design and implementation of public expenditure tracking instruments.
17 Provincial Health Departments (PHD), 30 Operational Districts (OD), 200 Health Centers, and 29 Referral Hospitals were covered in the survey. The study examined public health sector expenditures for 2003 and 2004. The fieldwork was conducted from August to December 2005.
In parallel with collecting quantitative data, the PETS also interviewed the following officials: PHD directors or deputy-director, PHD accountants, OD directors, OD accountants, referral hospital directors, and health center chiefs. Semi-structured interviews were conducted following for respondents to explain and quantify the flow of funds and resources from PHD down. They also focused on fund management issues related to delays in funding, leakages and coping mechanisms.
Sample survey data [ssd]
- Provincial Health Departments;
- Operational Districts;
- Health Centers;
- Referral Hospitals.
Scope
| Topic | Vocabulary |
|---|---|
| Health Systems & Financing | World Bank |
Producers and sponsors
| Name |
|---|
| Ministry of Health, Cambodia |
| Ministry of Economy and Finance, Cambodia |
| World Bank |
| Name |
|---|
| World Health Organization |
| International Monetary Fund |
| United Nations Development Programme |
| Name |
|---|
| World Bank |
| Bank Netherlands Partnership Program |
| World Health Organization |
Sampling
The sampling approach was designed to meet the numerous requirements of all stakeholders (Ministry of Economy and Finance, Ministry of Health, donors, researchers) while ensuring that results would be nationally representative, and could later be linked to Cambodia Socio-Economic Survey data.
Facilities were selected as a random sample from the National Institute of Statistics (NIS) database of public health facilities. The sample was representative of all Cambodia, and was stratified to represent specific characteristics to be able to compare among facilities that were:
- Located in urban vs. rural and remote areas;
- Included or not included in government Priority Action Program - a special modality of government budget disbursement;
- Included or not included in the contracting operational districts - a health services management and financing modality where the management of district level health services was contracted to non-governmental organizations.
Data was then collected at the two levels of government administration: provincial health department (PHD) and operational district (OD); and, from sampled referral hospitals and health centers.
Survey instrument
Questionnaires were prepared for the three types of institutions: Provincial Health Department (PHD), Operational Health District Office (OD) and health facilities. The PHD and OD questionnaires consisted of four sections.
Questionnaires for health facilities consisted of five sections as follows:
Section 1: General information on the institution, including identification, distance to higher and lower-level institution, number of staff members, level of supervision, and any NGOs support to the institution.
Section 2: Financial and accounting information, including budget and expenditures in 2003 and 2004 by chapter and by lower level institution, mode of expenditure, cash received and cash transferred, in-kind contribution received and transferred, and user fees collected under the institution.
Section 3: Drug and medical consumables, drugs and medical consumables received, dispensed and/or distributed to lower-level institutions.
Section 4: Health information focusing on key outputs of health services such as the number of outpatient consultations (OPD), deliveries and number of day of inpatients.
Section 5: Client profile. This section was administered to health facilities only. It covers the age, gender, and address of clients, their diagnoses, and treatments received.
Data collection
| Start | End |
|---|---|
| 2005-08 | 2005-12 |
| Name |
|---|
| BN Consult |
Provincial Health Departments (PHD) questionnaires were conducted by a team leader and one senior research assistant.
The team leader was responsible for interviewing the PHD director/deputy director and the accountant, senior research assistant was responsible for interviewing the chief of drug bureau and staff responsible for HIS. After interviews, required documents were copied for data entry and later analysis.
Operational Districts (OD) and health facility questionnaires were conducted by enumerators. Enumerators (15) were grouped into three field work groups. Each group consisted of five enumerators with at least one specialized in accounting and one having health background. One senior enumerator in the group was assigned as group leader. The group leader was
responsible both administrative and technical aspects and daily communication with overall PETS team leader.
Each group was assigned to work one Operational District. Typically the team was working for one week in one OD. The team started from the OD office by filling in OD questionnaires and thereafter proceeded with health facility questionnaires. Usually the group leader worked on general and accounting information while other team members worked with other sections.
During the preparation for the PETS, it became evident that the complexity of the health sector and issues affecting budget execution and service delivery required a step-by-step approach for applying research to cover all issues affecting service delivery. The preparatory process identified four research clusters: (i) flow of funds, in-kind transfers, utilization of user fees; (ii) human resources issues, including deployment, motivation, incentives, career management, links between private and public sector; (iii) resource allocation issues, including both the government and donor funds, financial management and leakage; (iv) service delivery in health centers and referral hospitals, including quality and quantity of facility based services and outreach, management of exemption schemes (equity funds). One study cannot address all the potential research questions entailed in these clusters. The current PETS mostly focuses on the first research cluster and provides limited insights to others. It is hoped that further follow-up research agenda will emerge from the discussion of the results of this PETS.
It is also important to note that the intent of the PETS is to make a positive contribution to the improvement of services. It is not intended to be an auditing instrument for the public finances. Some issues such as leakages can occur in many ways and some of these ways would be very difficult to track in a survey. But the PETS is intended to be able to point to generalized problems of public finance management that effect service delivery and the effectiveness of public finance management itself.
The survey work for the health PETS was conducted from August to December 2005. The main survey was preceded by a pilot survey in July 2005 to test and make necessary adjustments in the survey instrument. Time between January and April 2006 was spent on data cleaning and analysis.
Enumerators were carefully selected. Because of the complexity of the study, enumerators were specialized into three groups: accounting background, medical background and general information. The enumerators received two weeks of training about the questionnaire design and lessons learned during the pilot field study.
At each level, the PETS collected information from face-to-face interviews and from written records. It was difficult to obtain and compare information between institutions, as there was no standardized reporting mechanism. Significant part of data was thus obtained from secondary reports and from unprocessed invoices and receipts of expenditure. The PETS team had to verify the consistency of records between levels and to estimate amounts by triangulating qualitative information when no record was available.
PETS team also collected various documents (e.g. reports by financial inspectors, supervision reports) related to resource management in the provinces visited and at the national level in the Ministry of Health. The team reviewed these documents to understand the processes of fund management and the existing practices in the locations surveyed.
Data Access
Public Use File
Use of the survey data 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.
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_KHM_2005_PETS_v01_M
| Name | Affiliation | Role |
|---|---|---|
| Antonina Redko | DECDG, World Bank | DDI documentation |
2011-09-20
Metadata version
v01 (September 2011)