Improving Public Spending Efficiency in Primary Health Care-Public Expenditure Tracking Survey, a Boon for Policymakers: An Experience from Nigeria

Gombe State, facing demographic shifts and growth challenges, partnered with UNICEF to undertake a Public Expenditure Tracking Survey (PETS). The “PETS” examined health budget allocations and funds flow, offering insights into delays, potential leakages, disparities in resource allocation, service delivery assessments, and analyzing staff incentives, behavior, and input quality. The “PETS” covered the entire state comprising 11 Local Government Areas (LGAs) and 114 facilities with the participation of varied stakeholders. A mixed approach of quantitative and qualitative techniques to collect, analyze, and interpret data was used. Quality control measures, including real-time monitoring to enhance data accuracy, were observed. The survey results and data analysis show a worrying decline in Routine Immunization (RI) funding by 47% from the central level to local areas, signaling potential threats and compromise to the successful implementation of crucial immunization programs. A critical finding underscores 88.4% discrepancies between the funds disbursed by the State Primary Health Care Development Agency (SPHCDA) and the funds reported to be received at the LGA level. This inconsistency raises pertinent questions about reporting accuracy and the potential for paucity of documentation at the LGA level. In addition, “PETS” revealed the delays in funds transfers which ranged from four to thirty-five days. The study also found discrepancies in the reporting of RI visits, with 2588 numbers reported at the Local Government Area (LGA) compared to 1939 reported at the Primary Health Center (PHC) level. The report led to enhanced budgetary allocation for RI and improved documentation. In the long term, the findings will ensure a more transparent use of public health funds, reduce waste, pilferage of funds, and enhance healthcare quality and accessibility.