the facilities depend are highly complex and context specific. However, the studies have demonstrated the value of collecting data "upstream" from the facility. Specifically, the PETS have helped to show how inequities, inefficiencies and resource inadequacies observed at facility level are the product not only of low levels of financing, but also of the capacity constraints, incentives, and information asymmetries that characterize the systems upstream from the facility.

In other surveys the focus has been on the service delivery unit, although with an eye on the relationship between the facility and the administrative system upstream. This is in recognition of the fact that even if budget outturns reflect allocations, ultimate impact also requires that financial resources are efficiently transformed into appropriate services.<sup>53</sup> This can include facility surveys, but also citizen surveys or scorecard approaches. For example, the original "Bangalore Scorecard", designed and implemented by the Public Affairs Centre (PAC), a local NGO, questioned a sample of both rich and poor users on their perceptions of the city's public services. The survey was used to rate different agencies in terms of staff behavior, quality of service, and information provided, and proved a powerful tool to generate feedback on public services, identify weaknesses in service delivery, and advocate for change (Paul 2000).

Both tracking surveys and service delivery surveys are increasingly used as monitoring and accountability mechanisms in contexts where routing management information systems are weak. Indeed, Uganda intends to place the conduct of regular service delivery surveys at the center of its strategy for improving public services, with baseline surveys to establish strategies and targets, and public dissemination of survey findings.<sup>5 4</sup>

# _Research_

Qualaity and health outcomes As data on health care quality has become increasingly available, the body of empirical research on the link between health care quality and health outcomes has grown. There is now evidence that certain characteristics of health care providers and their relationship with clients are important determinants of health outcomes. For example, a number of studies have found a positive correlation between health service infrastructure and characteristics, such as the number of clinics or doctors per capita, and health indicators, including child mortality, fertility, nutritional status and anthropometric indicators (see e.g., Benefo and Schulz 1994; Frankenberg 1995; Frankenberg and Thomas 2001; Hossain 1989; Lavy and others 1996; Rosenzweig and Schultz 1982; Rosenzweig and Wolpin 1982; Thomas, Lavy, and Strauss 1996). There is also a literature based on DHS data, focusing specifically on family planning and contraceptive use (see, Beegle 1995; Feyisetan and Ainsworth 1996; Mroz and others 1999; Steele, Curtis, and Choe 1999).

> 53 These surveys have been referred to as Quantitative Service Delivery Surveys (QSDS) (Dehn, Remiikka, and Svensson 2000).

> 54 Government of Uganda, Letter of Development Policy for World Bank Poverty Reduction Support Credit, 2001.

> 55 See Wouters (1991), Frankenberg (1995), and Alderman and Lavy (1996) for discussion of the evidence.

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