Financial information at district level: experiences from five countries

Management information systems are intended to help managers make decisions. But few management information systems in primary health care include information on costs, even though resource allocation and budgeting are key functions of primary health care managers. Drawing on five papers presented to a WHO conference on strengthening district health systems, this article illustrates the potential usefulness of financial data to district managers. The examples come from individual districts in Ethiopia, Indonesia, Kenya, Sri Lanka and Tanzania.No original data were collected for the studies - much can be learned from budgets and expenditure ledgers. Some problems were encountered with the reliability of the data - a particular confusion was between allocated and realized budgets. Allocated budgets area stated intention to spend money; realized budgets show that the expenditure actually occurred. For planning purposes, realized amounts are of more interest.Managers can use financial information to question the allocation of resources in various ways. Providing information on how much is being spent on what activities enables an explicit consideration of the desirability of the existing use of resources, relative to priorities. Comparing unit costs can raise questions about the relative efficiency of different units, be they health centres, vaccination points or wards. Looking at the distribution of resources according to geographical areas, or other ways of grouping people, provides background data for the consideration of equity. Finally, the paper discusses how financial information might be used to identify areas of wastage.The paper concludes that health systems already produce a good deal of financial information. At present, however, this information is often only used by accountants or finance officers. Financial information should be incorporated into the larger management information system.