Purchasing is a health financing function that involves the transfer of pooled resources to providers on behalf of a covered population. Little attention has been paid to the extent to which the views of that population are reflected in purchasing decisions.

This article explores how purchasers in two financing mechanisms: the Formal Sector Social Health Insurance Programme operating under the Nigerian National Health Insurance Scheme, and the tax-funded health system perform their roles in light of their responsibilities to the populations.

The results reveal that both the tax-funded system and the FSSHIP include mechanisms that allow purchasers to reflect people's needs, choices and preferences in purchasing decisions. The mechanisms include:

• quantitative and qualitative assessment of health needs
• mechanisms to raise awareness on benefit entitlements
• mechanisms to allow choice

However, purchasers are not using the mechanisms effectively to engage and hold themselves accountable to people they represent. The paper provides recommendations for bridging the implementation gaps.