Occupations and Terms of Reference › Chief financial officer (CFO)
Universal terms of reference · POS-007 · version 1.0 · status: draft · next review 2027-10-27
Chief financial officer (CFO)
To protect the financial health of the organisation, so that services are funded, budgets are controlled, money is spent for value, and the organisation can keep providing safe care.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You are responsible for the organisation's finances. You lead budgeting, financial reporting, cash management, procurement and financial controls, so that the organisation can pay for safe services and meet its legal and donor obligations.
Reports to: Chief executive officer; reports to the board finance committee.
Leads or supervises: Finance, accounts, budget, payroll, procurement and insurance claims teams.
What you do on a typical day
- Review cash position and payments due each week.
- Lead the budget cycle with service leads; approve budget changes within delegated limits.
- Prepare monthly financial reports for the CEO and board.
- Review procurement and major contracts before approval.
- Check financial controls, reconciliations and fraud risk.
- Work with the external auditor on the annual audit.
Working conditions and demands
- Accountable for financial controls and reporting.
- Deadline-driven at month end, year end and audit time.
- Handles confidential financial and patient payment information.
What good looks like
- Accounts are closed on time with clean audit opinions.
- Cash flow is forecast and the organisation can pay its bills.
- Budgets are followed and variances explained early.
- Money is spent for value, with clear procurement and contract control.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- Every decision that affects patient safety is made on evidence and recorded.
- Patient safety and quality come before financial targets; no trade-off that puts patients at risk is accepted.
- Every staff member can raise a concern without fear of reprisal, and every concern is answered.
- Legal, licensing and accreditation duties are known, owned and reviewed.
- Finances, people and information are managed openly and within the law.
- Mandatory training and policies apply to the executive as much as to frontline staff.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-007 |
| ISCO-08 | 1211 (skill level 4) |
| ESCO | to map |
| Department | Governance |
| Facility types | Hospital, Ambulatory, Transport, Medevac, Fitness, Aesthetic |
3. Reporting line and working relationships
Reports to: POS-003. Supervises: POS-156, POS-157, POS-161, POS-160, POS-158, POS-159, POS-162, POS-171, POS-155.
| Works with | Nature of the relationship |
|---|---|
| Chief executive officer | Financial strategy and investment decisions. |
| Chief operating officer | Operating budgets and supplier contracts. |
| Board finance committee | Financial reporting and assurance. |
| External auditor | Annual audit and assurance. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Financial reporting | Makes sure accurate, timely financial reports reach the CEO and board. | Monthly reports issued by working day 10; annual accounts audited without material weakness | Monthly | C-01 | T-06 | – | – |
| Budget and cash | Leads the budget cycle and manages cash so that the organisation can pay for services. | Budget approved; cash forecast reviewed weekly | Monthly | C-02 | T-06 | – | – |
| Financial controls and fraud | Designs and checks financial controls, and investigates irregularities fairly. | Reconciliations complete; no unresolved fraud cases over policy limits | Monthly | C-03 | T-05 | POL-WHISTLE | – |
| Procurement and contracts | Makes sure procurement is fair, transparent and value for money. | Major contracts reviewed before signature; tender records complete | Quarterly | C-02 · C-03 | T-06 | POL-EQUAL | – |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Day-to-day financial payments within delegated limits | Changes to the approved budget or investment decisions (CEO and board) |
| Financial controls and reconciliation procedures | Suspected fraud or financial irregularity (board audit committee) |
| Budget reallocation within agreed limits | Cash shortfalls that threaten payment of staff or suppliers |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Professional accounting qualification (ACCA, CPA, CIMA or national equivalent) | Yes | Lifetime |
| Q-02 | Degree in accounting, finance or economics | Yes | Lifetime |
| Q-03 | Health finance or MBA | No | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Senior finance management, including budgeting, financial reporting and audit | 8 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | C-03 |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | C-01 · C-02 |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | – |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | C-04 |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Financial reporting and control | Records transactions accurately | Prepares management accounts | Designs financial control and reporting for the organisation | Audit of financial controls | Every 12 months | T-06 |
| C-02 | Budgeting and forecasting | Monitors a budget | Builds and monitors a service budget | Leads the organisational budget and forecast | Budget review | Every 12 months | T-06 |
| C-03 | Financial risk, fraud and compliance | Reports financial irregularities | Leads financial risk reviews | Designs anti-fraud and financial risk controls | Fraud risk review | Every 12 months | T-05 |
| C-04 | Leading finance teams | Works in a team | Leads a finance team | Leads organisational financial change | 360 feedback | Every 24 months | T-08 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Monthly financial reports issued on time | 100% by working day 10 | finance calendar | Monthly |
| PI-02 | Budget variance | within agreed tolerance | management accounts | Monthly |
| PI-03 | Audit recommendations closed on time | 100% | audit tracker | Quarterly |
| PI-04 | Supplier invoices paid within terms | set by facility | accounts payable data | Monthly |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Chief financial officer (CFO) | 8 years (recommended) | Q-01 | C-01 expert, C-02 expert | T-06 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |