Beyond Budget Execution: Financial and Operational Indicator Profiles in Bacău County's Maternal and Child Health Programme, Romania, 2021-2024.

Background/Objectives: Financial monitoring of public health programmes frequently relies on budget execution indicators, which may not fully reflect operational performance. This study evaluated the financial and operational performance of Romania's National Programme for Women's and Children's Health at the county level and examined how resource utilisation coexisted with programme activity, coverage of the eligible population, and local implementation profiles during 2021-2024. Methods: A longitudinal descriptive observational study was conducted using aggregated administrative data from Bacău County, Romania. Financial indicators included annual budget allocations, actual expenditures, budget execution rates, and mean cost per beneficiary. Operational indicators included activity volume, reported coverage of eligible populations, and continuity of implementation. Monetary values were converted into constant 2024 prices. Descriptive and comparative trend analyses were performed. Results: The mean budget execution rate was 84.08%, ranging from 68.70% to 94.93%. Screening interventions generated the highest activity volumes and lowest unit costs, whereas prophylactic and nutritional interventions accounted for most programme expenditure. Reported coverage varied substantially across interventions, particularly for neonatal hearing screening. Similar budget execution rates were associated with distinct operational profiles. Conclusions: Budget execution alone did not adequately reflect programme performance. Integrated monitoring of financial and operational indicators may support more effective programme management and resource allocation.