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118 Fighting the Diseases of Povertyimportation, recalled all “repackaged” drugs, and ensured thatdrugs 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. Evidencefrom elsewhere, however, is scarce as this is an area where littleaction has taken place at the country level and/ or these have notbeen evaluated. Middle income countries, like Costa Rica, tend todeal with the problem more aggressively (Cohen, 2002), but regulationremains inadequate given the ease and lucrative nature of drugcorruption.More information to citizens about resource flows fromcentral and local governments and clarity on the roles andresponsibilities of local authorities. Though it requires better dataon performance, tying local outputs and resource allocations fromcentral government (conditional resource transfers) offers a structureto undermine corruption and improve service delivery. Wherecitizens are informed and empowered to oversee the process, theyhave both a financial stake and the tools to enforce policies.Without the latter, citizens will be far less likely to view involvementas worthwhile.Citizen report cards offer another possible means of engagingcitizens in oversight to improve the quality and integrity of publicservices. Pioneered in public services generally, report cards havenot yet been assessed as a means of improving health services, butthrough investigative studies they equip citizens with informationon the shortcomings or failures of health services. Use of pressreports based on the studies provides both evidence (rather thananecdotes) as well as a public forum for debate, which together helplocalities identify where change is needed (Gopakumar, 1998; WorldBank 2004). Like information more generally, having authority totake action is the sine qua non of effectiveness in report card use.VoiceAlthough not strongly associated with health outcomes, voicecaptures citizens’ ability to get information, challenge government