Public Expenditure Tracking Survey in Health 2007, Second Round
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 study was designed to assess the effectiveness of spending in Madagascar public health sector. The research evaluated the flow of financial and material resources, medication and wages from central/district to local health facilities. The survey also looked into absenteeism among basic health centers' employees.
The research was conducted in two rounds. The first round was carried out in October-November 2006 and the second round - in April-May 2007. The study was implemented using stratified random sampling. Data from 100 health centers in six provinces was analyzed.
Public Expenditure Tracking Survey in Madagascar primary education sector was conducted at the same time with this research.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
- Centre de Santé de Base/Basic Health Centers;
- Pharmacie à Gestion District/District Pharmacies;
- Service de Santé de District/District Health Authorities;
- Basic Health Centers' employees.
v01 - Final, edited datasets.
Documented here are final, cleaned datasets prepared by the World Bank based on raw datasets provided by the study researchers.
The description of the difference between raw and edited datasets is taken from "Data Cleaning Guide for PETS/QSDS Surveys" (p.10):
"Each country set includes two data files. The first file, the "raw" data file, presents the data as collected and entered by the survey teams. While field teams do conduct very high-level coherence tests with regards to responses collected, the data contained therein has generally not been thoroughly checked for internal coherence across questions, variable outliers and other such involved data cleaning procedures.
Finally, independently of the values presented in the questionnaires, missing values are replaced across all "final" data sets to ensure consistency across countries. Following industry best practices, negative 3-digit integers are used in order to ensure there is no confusion between missing values and valid data points. "
"Data Cleaning Guide for PETS/QSDS Surveys" is available in external resources.
The scope of the study includes:
- drug supply chain, SALAMA (Central drug purchasing unit), PhaGeCom (Pharmacie à Gestion Communautaire/Commune Pharmacy), PhaGDis (Pharmacie à Gestion District/District Pharmacy), CSB (Centre de Santé de Base/Basic Health Center), SSD (Service de Santé de District/District Health Authority), FANOME (Fandraisan’Anjara No Mba Entiko/Cost recovery policy), CoSan (Comité de Santé/Community Health Committee), health worker characteristics, health center and commune characteristics, health worker absenteeism, salary of health workers, drug flow from SALAMA to PhaGDis, drug flow from PhaGDis to PhaGeCom/CSB, SSD (Service de Santé de District/District Health Authority).
Health Systems & Financing
Provinces: Antananarivo, Fianarantsoa, Toamasina, Mahajanga, Toliara and Antsiranana.
The survey covers public basic health centers (CSB), district pharmacies (PhaGDis), district health authorities (SSD) and CSB workers in all six Madagascar provinces.
Producers and sponsors
Ministere de la Sante et de la Planification Familiale (Department of Health and Family Planning)
The study was conducted using stratified random sampling.
The stratified sample was set up to be representative at the national level. Madagascar has 22 regions and 111 districts, and at least one district was visited in each region. Two districts were selected in the six largest regions. 28 districts were visited in total. The selected districts were obtained through random selection, giving greater (less) weight to districts with more (less) health centers within the district. In each district, three communes were randomly selected.
Two types of health centers - CSB (Centre de Santé de Base/Basic Health Center) Type I and CSB Type II - provide basic health care in Madagascar. In the selected communes, all public health centers of Type II were visited. If public health centers of Type I were present in the commune, one was visited based on random selection.
In the province of Antananarivo 23 public primary health centers were visited, 27 facilities were visited in Fianarantsoa, 19 - in Toamasina, 24 - in Mahajanga, 12 - in Toliara and 8 - in Antsiranana.
In total, 113 health centers were visited. Approximately one-third of the health facilities (35%) were Type I. Due to closure of some health centers during either the first or the second round (or both rounds), researchers ended up with reliable panel data on 100 health centers.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The survey collected totals on budgets at SSD (Service de Santé de District/District Health Authority) level, but there was often ambiguity as to whether this total corresponded to the actual total budget or the total of the line items investigated in the questionnaires. In several cases, the total reported in the questionnaire amounted to less than the total of the line items listed. This suggests considerable problems in the financial capacity at the decentralized levels (and in survey design). In addition, it proved impossible to track resources from MINESAN (Ministère de la Santé et du Planning Familial/Ministry of Health and Family Planning) to SSD level with the available data.
The following survey instruments are available:
- Enquête au Niveau des Centres de Sante, Visite 1er Jour;
- Enquête au Niveau des Centres de Sante, Visite 2ème Jour;
- Enquête au Niveau des Centres de Sante de Base, Enquete Personnel;
- Enquête au Niveau des Centres de Sante, Enquete Phagdis;
- Questionnaire auprès des S.S.D.
In order to accurately investigate the resource flows through the different decentralized facility levels, surveys were organized at PhaGDis (Pharmacie à Gestion District/District Pharmacy) and CSB (Centre de Santé de Base/Basic Health Center) levels. At CSB level, the director was interviewed independently from the rest of the staff. To ensure compatibility, the surveys were organized at the same time. The discrict health authorities (SSD) questionnaire was administered during the second round.
Detailed information about data editing procedures is available in "Data Cleaning Guide for PETS/QSDS Surveys" in external resources.
STATA cleaning do-files and data quality reports can also be found in external resources.
Public use file
The use of this dataset 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).
World Bank, UNICEF, Ministere de la Sante et de la Planification Familiale. Public Expenditure Tracking Survey in Health, Second Round (PETSHr2) 2007. Ref. MDG_2007_PETSHr2_v01_M. Dataset downloaded from http://microdata.worldbank.org on [date].
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.