regarding informal payments tend to be less precise and more vulnerable to misinterpretation by respondents (Lewis 2000).

Other than exit surveys, data on informal payments has been extracted from national expenditure surveys, such as the Hungarian household budget survey, and the World Bank‟s Living Standard Measurement Surveys (LSMS Team 2006). A list of survey results and different study designs on informal payments can be found in a review of informal payment surveys in Lewis (2000).

# _Usefulness of population surveys_

In practical terms, facility level surveys are likely to be the main source of information in most developing countries, but they can be usefully complemented by population surveys in a number of ways. One of the most important would be to rely on population surveys to determine the relative weight of different kinds of facilities in providing health care services. Beginning from a sample frame constructed from answers to health care utilization in a population survey is the most reliable way of developing a clear picture of what kinds of facilities are most important to health care provision. Developing a sampling frame for health care facilities based on the population‟s use of those services can give a fully representative picture of governance performance across the entire health sector, across different forms of provision and across different geographic and socioeconomic categories.

Two important population survey initiatives include the World Bank‟s Living Standards Measurement Survey (LSMS) project and the Demographic and Health Surveys (DHS) initiated by USAID. The LSMS tends to have relatively few questions on health care utilization and health status compared to the DHS. By contrast, DHS tends to have relatively few questions on socioeconomic characteristics and concentrates on the health of mothers and children.

If the effort to measure governance performance were to include additional measures – such as satisfaction or perceptions of quality and corruption – then public opinion surveys can be helpful. For example, Afrobarometer is an example of a large-scale household survey that measures governance performance in many political dimensions as well as with regard to service delivery. Afrobarometer tracks trends in public attitudes towards the institutions that serve them on a regular basis, asking questions about whether public health care services are affordable, whether medicines are available, whether individuals feel they are treated respectfully, whether doctors are absent, whether waiting times were long, and whether illegal payments were demanded (Afrobarometer 2009). The answers to these questions are comparable across countries in terms of being representative of the national sample; however, they do not account for differences in the structures of health care services across countries and ways in which the units of analysis – the facility or health care organization – may differ across contexts. That is, the questions are often too general to link respondents‟ views to specific health care service providers. Such population perception surveys can be useful complements to facility surveys but are decidedly second best options.

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