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118 Fighting the Diseases of Poverty
importation, recalled all “repackaged” drugs, and ensured that
drugs meet a basic standard of potency, labels are clear and correct,
distribution is achieved through legal channels and oversight of provision,
storing and handling are systematically regulated. Evidence
from elsewhere, however, is scarce as this is an area where little
action has taken place at the country level and/ or these have not
been evaluated. Middle income countries, like Costa Rica, tend to
deal with the problem more aggressively (Cohen, 2002), but regulation
remains inadequate given the ease and lucrative nature of drug
corruption.
More information to citizens about resource flows from
central and local governments and clarity on the roles and
responsibilities of local authorities. Though it requires better data
on performance, tying local outputs and resource allocations from
central government (conditional resource transfers) offers a structure
to undermine corruption and improve service delivery. Where
citizens are informed and empowered to oversee the process, they
have both a financial stake and the tools to enforce policies.
Without the latter, citizens will be far less likely to view involvement
as worthwhile.
Citizen report cards offer another possible means of engaging
citizens in oversight to improve the quality and integrity of public
services. Pioneered in public services generally, report cards have
not yet been assessed as a means of improving health services, but
through investigative studies they equip citizens with information
on the shortcomings or failures of health services. Use of press
reports based on the studies provides both evidence (rather than
anecdotes) as well as a public forum for debate, which together help
localities identify where change is needed (Gopakumar, 1998; World
Bank 2004). Like information more generally, having authority to
take action is the sine qua non of effectiveness in report card use.
Voice
Although not strongly associated with health outcomes, voice
captures citizens’ ability to get information, challenge government