#  Proportion of pharmaceutical sales that consist of counterfeit drugs

One way to calculate these indicators would be to use administrative data on local health facilities that is known to be reliable. This is not the case in most countries and, therefore, a more fruitful approach is to use representative facility surveys. In order to be most useful to public policymakers, these surveys should ideally be expanded beyond the more common exclusive focus on public health care services to include surveys of all health care providers in proportion to their share of clients served.

Fortunately, work on health facility surveys has advanced significantly in recent decades. Two particular initiatives that deserve mention are the Public Expenditure Tracking Surveys (PETS) and Quality of Service Delivery Surveys (QSDS). Together, they can be used to measure three of the five core health governance performance indicators (absenteeism, funds reaching facilities, and stock-out rates).The proportion of informal payments can be calculated from questions asked in household surveys, but more reliable measures can be extracted from patients who have just left a facility. Detecting counterfeit medicines, by contrast, requires special surveys that may include visits to border crossings, warehouses, and pharmacies, as well as health facilities.

_Share of funds reaching facilities and Public Expenditure Tracking Surveys (PETS)_ For measuring the share of funds reaching health facilities, the Public Expenditure Tracking Survey represents the best model. Public Expenditure Tracking Surveys (PETS) follow the flow of government resources through the often-complex system of delivering public services. These studies commonly gather information about the funds that are budgeted, authorized and disbursed through different levels of the public service system and then survey a representative sample of facilities to determine how much of those funds are actually available in the form of services. When these studies are successful, they can measure the share of funds that fail to reach their intended goal and identify how much is lost at different points in the system. This information is useful for focusing investigations of diverted funds but more often is used to improve public policies (e.g. reallocating resources), financial management (e.g. monitoring, reporting and controls) and administration (e.g. simplifying procedures) (Reinikka & Svensson 2006). In countries with sophisticated and reliable financial administration, the share of funds reaching facilities can be extracted from public sector data. However, such systems are lacking in most countries, leaving the PETS approach as the only viable method.

More than two dozen PETS have been conducted in a range of low- and middle-income countries and the experiences demonstrate that the instrument is useful but difficult to compare across countries, particularly in the health sector (Lindelow 2006). PETS differ from country to country precisely because they are implemented with different policy concerns and because the traceability of resource flows differs in each setting. PETS tend to be most useful where they have been repeated in the same country and can be used to monitor the effects of policy initiatives over time (Dehn 2003). For those interested in conducting a PETS, the 2004 PETS/QSDS instrument used in Chad (that was largely based on the Mozambique 2002 PETS/QSDS) is a good template to begin with.

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