The John F. Kennedy Medical Center (JFKMC) is Liberia’s national medical center and one of two tertiary hospitals in Monrovia – Montserrado. Montserrado County is one of fifteen (15) counties that comprise the first level of administrative division in Liberia, and it is composed of four districts. It has over one million people (about 29% of the total population), making it the most populous county in Liberia. 

Finance management is a critical component of providing good quality health services to the people. Its role is interwoven in all facets of care provision, such as recruitment of appropriate human resources, availability of the right infrastructure, equipment, and commodities, to mention but a few. Evidence suggests that weak financial management systems hamper health service provision, and a well-managed facility with adequate governance is better positioned to provide qualitative and sustainable healthcare services. 

HSDF is working as a core partner in the Health Systems Accelerator program. An initial comprehensive evaluation of the health system involved a scoping exercise to understand the current financial systems and resources at the center, a detailed assessment of the center’s financial management and governance systems, development of improvement recommendations, and support for the implementation of identified improvement plans.

Following the scoping exercise, a customized financial systems assessment tool was developed through desk review and adaptation of validated tools, experts’ inputs, and customization to the local context. The assessment tool was structured along 12 key domains of financial management systems, namely: (i) Financial Governance, (ii) Budget and Planning, (iii) Audit and Internal Control, (iv) Financial Accounting and Reporting, (v) Information Systems for Financial Reporting, (vi) Grant Management, (vii) Revenue Management, (viii) Cash Management, (ix) Fixed Asset Management, (x) OPEX Management, (xi) Payroll Administration, and (xii) HMO Administration. Besides, Procurement and Stock Management were handled under the Supply Chain Management Systems intervention. 

The assessment was conducted using key informant interviews, document reviews, process observation, and data analysis. Direct questions were asked to ascertain the presence or operation of specific components of the FMS as highlighted in the tool. Detailed documentation of the findings and necessary evidence were made against each of the assessment questions. In addition to the documented findings, each question was given a quantitative score of “0” (never true), “1” (sometimes true), “2” (mostly true), or “3” (always true). “Never true” means there has been no such practice, system, document, or evidence in the period under review (usually the past three months). “Sometimes true” indicates that the required practice, system, policy, or document existed only a few times within the period. “Mostly true” means the expected practice or policy existed most times but not always within the period, while “always true” indicates that the evidence exists consistently during the period. The assessment’s quantitative element was scored per domain and aggregated to give an overall score for the center’s financial management systems. Grant management and internal control systems have the lowest scores, while budget and planning have the highest score.

The assessment revealed challenges and existing weaknesses in the center’s financial management systems. Following the assessment, a comprehensive improvement recommendation was co-developed with inputs from process owners and key end-users in the organization. Ongoing support is being provided to put in place needed financial policies and procedures, pricing strategy, internal control and audit systems, frameworks for grant advocacy, credit control, and management of receivables. HSDF is also providing technical support for automating the center’s activities through Local Area Networking (LAN) of key service points; and the planned implementation of Information Systems for financial reporting and Electronic Medical Records (EMR) systems.