Table 6.

Characteristics of funding flows in terms of services purchased, target population, provider payment and accountability mechanisms.

Funding source	Funding flow	Services purchased and target population	Provider payment mechanism	Accountability mechanism
Government budget	Personnel (Salaries)	Staff salaries	Staff salaries are paid monthly	Electronic transfer of staff salaries in FG-owned hospitals Periodic financial audits of staff payroll in both FG-owned and SG-owned hospitals
	Recurrent budget	Direct subventions for overhead and other recurrent expenditure This is applicable for FG-owned hospitals	Monthly payments for overhead and other recurrent budgets	Electronic transfer, Documentation of income and expenditure, monthly reporting, monitoring visits by Ministry of Health
	Capital budget	Capital vote for infrastructure and equipment	Capital projects are implemented when needed, depending on funds available	Tendering receipts for capital expenditure; inspection of capital projects for quality and compliance to standard
	Free-MCH payments	State government funds free MCH which covers maternity and child health services for eligible mothers and children under 5 years of age	For free-MCH, periodic reimbursements are made on a case-by-case basis	Periodic financial audits
	Drug-revolving fund	Drugs that are purchased through direct out-of-pocket payments or cash transfers	One-off payment to FG-owned hospitals	Documentation of income and expenditure, periodic reporting, monitoring visits
Out of pocket payment		OOP can be used to purchase all services provided in public hospitals—consultations, laboratory tests, drugs, and other procedures. Also used to pay for utility bills and other consumables for service delivery	Cash payments direct from clients at the point of receiving care for services utilized (or yet to be utilized). Funds are transferred to Treasury Single Account and returned to hospitals	Automated electronic payment system tracks all payments made by clients Cash invoice to clients as evidence of payment. Monthly financial reporting Internal and external financial audits
NHIS	Capitation	Consultations, laboratory tests, drugs, and simple procedures listed in the NHIS benefit package. Also contributes to hospital revenue used for utility bills, infrastructure maintenance, and purchase of equipment FSSHIP covers federal government employees and beneficiaries. TISHIP covers students of registered tertiary institutions	Monthly capitation for primary level care. Capitation for FSSHIP is a fixed rate of ₦ 750/beneficiary and for TISHIP is ₦ 1,000/student	Authorization is required from HMOs for services not listed under capitation or FFS payments Periodic audits of hospital accounts by NHIS and HMOs. Periodic verification of payments made by HMOs' to the hospitals Technical committee approvals
	Fee for service	Secondary and tertiary level care as listed in the benefits package—surgeries, complex procedures, admissions	Monthly payments based on calculations. FFS rates vary depending on service type. Clients make 10% co-payment for FFS and drugs
Donations		Cash or in-kind donations earmarked for specific services such as drugs and test kits for HIV, vaccines for immunization Overseas and local missions provide free surgical procedures. Philanthropists offset hospital bills of indigent clients	Donations are sometimes paid directly into the hospital account or given to the clients. Drugs and commodities for HIV treatment and care are given directly to the pharmacy unit of the HIV clinic	Similar to accountability mechanisms for government budget and OOP