The challenges of budgeting in a newly introduced district health system: a case study

Nigeria operates a three-tier political system consisting of a national government: 36 states, Federal Capital Territory and 768 local governments. There are three levels of health care: primary, secondary and tertiary levels corresponding to and funded by local, state and national governments, respectively. A budget prepared at the district level was not possible until 2006 when the 2007 annual budget was prepared.

The goal of this study was to identify the key challenges of budgeting in a newly introduced District Health System and to share our experience with other scholars.

This study is a descriptive case study using interviews and focus group discussions of district and local health officers and the District Health Management Team as well as field notes made from participant observers and reviews of relevant documents.

The study showed that a bottom-up approach was used at the district level, while the concept of business planning was introduced to underscore the seriousness of health planning and efficient resource allocation. The two systems of expenditure classifications, i.e., functional and economic classification, were used in a complementary manner. The capacity for planning and budgeting was found to be lacking among the district health officers. The crosscutting contextual issues constraining budgeting included the inadequate Health Management Information System (HMIS), a non-functional Financial Management System (FMS) and an unreliable Human Resources Management System (HRMS).

There is a need for further study to be carried out to determine the factors that constrain the collection, analysis and dissemination of HMIS. In addition, there is a need to study the constraints to proper implementation of the FMS, HRMS and the linkage between the quality of the essential data-set with the efficiency of resource allocation in budgeting.