BACKGROUND:
Public healthcare institutions increasingly operate under conditions of financial pressure, rising service demand, and heightened expectations regarding service quality. Strengthening public health service delivery requires coherent managerial approaches that align financial accountability with quality management.¹,² Although both dimensions are recognized as critical, empirical evidence on their combined contribution to organizational performance in public healthcare institutions remains limited, particularly in systems facing resource and governance constraints.³

METHODS:
This study employs a management-focused case study approach supported by descriptive financial and performance analysis. Data were collected through document analysis of public healthcare institutions, including financial statements, internal control procedures, budgeting reports, quality management documentation, and performance monitoring records. The analytical framework integrates financial accountability mechanisms, such as budget planning and internal control, with quality management practices focused on process standardization and performance evaluation.⁴

RESULTS:
The findings indicate that institutions implementing structured financial accountability and formal quality management systems demonstrate measurable improvements in service delivery. The introduction of standardized budgeting and internal control mechanisms was associated with a reduction in unplanned expenditures of approximately 12–18%, alongside budget execution rates exceeding 90%. Quality management practices supported higher process compliance, with standardized service protocols applied in over 85% of monitored activities. Furthermore, institutions aligning financial monitoring with quality performance indicators reported improved organizational efficiency, reflected in reduced administrative delays and enhanced coordination between managerial and operational units.³,⁵

CONCLUSIONS:
The integration of financial accountability and quality management represents a key pathway for strengthening public health service delivery. Aligning economic control with quality-oriented managerial processes enhances organizational performance and supports service continuity under financial constraints.¹,²,⁶ These findings provide transferable insights for public healthcare systems across diverse contexts, including settings characterized by limited resources and structural challenges, and inform management and policy strategies aimed at improving the sustainability and effectiveness of public health services.