Journal of African Economies Advance Access originally published online on July 1, 2008
Journal of African Economies 2009 18(1):52-83; doi:10.1093/jae/ejn011
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Leakage of Public Resources in the Health Sector: An Empirical Investigation of Chad
a Institut d'Économie Appliquée, HEC Montréal, Canada
b Development Research Group, The World Bank
* Corresponding author: Bernard Gauthier, Institut d'économie appliquée, HEC Montréal, 3000 Côte Ste-Catherine, Montréal (Québec), Canada H3T 2A7. E-mail: bernard.gauthier{at}hec.ca.
In the public sector in developing countries, leakage of public resources could prove detrimental to users and affect the well-being of the population. This paper empirically examines the importance of leakage of government resources in the health sector in Chad, and its effects on the prices of drugs. The analysis uses data collected in Chad as part of a Health Facilities Survey organised by the World Bank in 2004. The survey covered 281 primary health care centres and contained information on the provision of medical material, financial resources and medicines allocated by the Ministry of Health to the regional administration and primary health centres. Although the regional administration is officially allocated 60% of the ministry's non-wage recurrent expenditures, the share of the resources that actually reach the regions is estimated to be only 18%. The health centres, which are the frontline providers and the entry point for the population, receive less than 1% of the ministry's non-wage recurrent expenditures. Accounting for the endogeneity of the level of competition among health centres, the leakage of government resources has a significant and negative impact on the price mark-up that health centres charge patients for drugs. Furthermore, it is estimated that had public resources earmarked for frontline providers reached them in their entirety, the number of patients seeking primary health care in Chad would have more than doubled.
JEL classification: H51, K49
The findings, interpretations and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the World Bank, its Executive Directors or the countries they represent.