PUBLIC FINANCIAL MANAGEMENT AND SERVICE DELIVERY QUALITY OF PUBLIC HEALTH INSTITUTIONS IN NIGERIA’S NORTH-EASTERN REGION: THE MODERATING EFFECT OF PUBLIC ACCOUNTABILITY

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Abstract

This study investigated the impact of Public Financial Management (PFM) practices on the quality-of-service delivery in public health institutions across Nigeria’s North-East geopolitical zone, with a particular focus on the moderating role of public accountability. Anchored in stewardship theory, systems theory, and New Public Management theory, the study employed structural equation modelling to test the relationships among revenue mobilization, budget practices, auditing, regulatory frameworks, and financial reporting, alongside their interactions with public accountability. The findings revealed a significant positive relationship between 
revenue mobilization and service delivery quality, indicating that effective revenue collection mechanisms enhance institutional capacity. In contrast, budget practices showed no significant effect, highlighting implementation gaps and bureaucratic inefficiencies. Surprisingly, auditing exhibited a significant negative effect, suggesting that overly punitive audit systems may hinder service innovation. Regulatory frameworks also showed a negative and insignificant relationship with service delivery, underscoring the ineffectiveness of outdated or weakly enforced regulations. Conversely, financial reporting demonstrated a strong positive effect on service delivery quality, emphasizing the value of transparency in planning and resource mobilization. The moderating effects of public accountability were mixed. It positively enhanced the relationship between revenue mobilization and service delivery, but had a negative and insignificant moderation on budget practices. Accountability marginally improved the impact of auditing, while its moderation on regulatory frameworks was insignificant and negative. Notably, public accountability significantly and negatively moderated financial reporting, suggesting that increased scrutiny can reveal inefficiencies, initially dampening service performance. The study concluded that there is a complex interplay between financial governance mechanisms and accountability in shaping 
service delivery outcomes. Therefore, the study recommended that public health institutions should adopt digital revenue collection systems and improve transparency to ensure funds are efficiently used for service enhancement.