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This study of Chadian health sector in 2004 compared resource access and level of services in health centers of all the country’s regional delegations at the primary, secondary, and tertiary levels of the health care system.
Using data collected as part of a Health Facilities Survey (a combined Public Expenditure Tracking Study - Quantitative Service Delivery Survey) organized by the World Bank in 2004, the survey covered 281 primary health care centers and hospitals and contains information on the provision of medical material, financial resources and medication allocated by the Ministry of Public Health (MoH) to the regional administration and primary health centers.
Contact: Waly Wane * firstname.lastname@example.org
analyzing the impact of and bottlenecks and constraints in resource allocation and their impact on efficiency and performance of health care facilities;
providing data on basic characteristics of health centers, in particular those that significantly affect public service quality;
explaining differences in performance between health facilities and types of ownership (public, private for-profit, nonprofit) and identifying means to improve the situation;
analyzing the impact of service quality on households’ demand for health care service.
In addition to the facility level data, information was collected at all levels of the public administration (MOF, MOH, regional delegates, district head doctors and regional pharmacy managers). Information was collected on resource use, delivery processes, health output and pricing behavior. The focus was on all health center ownership categories, public, private for-profit and non-profit. A staff questionnaire and a patient exit poll were also administered.
Executive Summary (English, February 2006)
Leakage of Public Resources in the Health Sector: An Empirical Investigation of Chad
Bernard Gauthier, Institut d’économie appliquée, HEC Montréal and Waly Wane, Development Research Group, World Bank, Washington, D.C., March 16 2006. Full text
It is estimated that if 100% of public resources had reached the frontline providers, the number of patients seeking primary health care in Chad would have more than doubled.
While the regional administration officially allocated 60% of the MoH’s non-wage recurrent expenditures, the share of the resources that actually reach the regions is estimated to be 18%.
The health centers, which are the frontline providers and the entry point for the population, receive less than 1% of the MoH’s non-wage recurrent expenditures.
Accounting for the endogeneity of the level of competition among health centers, the leakage of government resources has a significant and negative impact on the mark-up of medication sold to patients by health centers.
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