Aligning public financial management system and free healthcare policies: lessons from a free maternal and child healthcare programme in Nigeria

Table 1 Misalignment of PFM and health financing functions in FMCHP in Enugu State

PFM system	Health financing functions	Themes	Sub-themes
Budget formulation	Revenue raising	Level of funding	Weak budgeting with promised funding remaining static since inception
Budget formulation	Revenue raising	Level of funding	Weak enforcement of revised contribution rule
Budget execution	Pooling and fund management	Level of pooling	Only Local Government sustained contribution to FMCHP fund
		Level of administrative efficiency	Weak Steering Committee
			No spending cap in the FMCHP guidelines
			High unauthorised expenditure from FMCHP fund
Budget monitoring	Purchasing	Payment of providers	Delayed payment of providers
Budget monitoring	Purchasing	Payment of providers	Fraction of claims paid to some providers
		Level of administrative efficiency	Non-remittance of administrative costs to LHAs
		Level of administrative efficiency	Over-reporting of attendance by providers (gaming)
		Transparency	Unclear reimbursement process
			Lack of financial information disclosure
			No regular auditing of FMCHP account
			Resistance to financial monitoring committee from SIC officials

ISSN: 2191-1991