Examining the influence of budget execution processes on the efficiency of county health systems in Kenya (original) (raw)
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IntroductionPublic Finance Management (PFM) processes guide the translation of government resources to services and determine health system efficiency. PFM processes are implemented within the budget cycle which entails the formulation, execution, and evaluation of government budgets. We examined how the budget formulation structure and processes influence health system efficiency at the county level in Kenya.MethodsWe conducted a mixed methods case study using counties classified as relatively efficient (n=2) and relatively inefficient (n=2) as our cases. We collected qualitative data through document reviews, and in-depth interviews (n=70). We collected quantitative data from secondary sources, including budgets and budget reports. We analyzed qualitative data using the thematic approach and carried out descriptive analyses on quantitative data.ResultsBudget ceilings were historically allocated, insufficient, late, or not availed at all. This led to development of budgets that wer...
Background Public finance management (PFM) practices influence the attainment of health system goals. PFM processes are implemented within the budget cycle which entails the formulation, execution, and monitoring of government budgets. Budget monitoring and accountability actors, structures, and processes are important in improving the efficiency of health systems. This study examined how the budget monitoring and accountability processes influence the efficiency of county health systems in Kenya. Methods We conducted a qualitative case study of four counties in Kenya selected based on their relative technical efficiency . Data were collected using in-depth interviews with health and finance stakeholders (n=70), and document reviews. Data were analyzed using a thematic approach, informed by our study conceptual framework. Results We found that weak budget monitoring and accountability mechanisms compromised county health system efficiency by a) weakening the effective implementation...
The International Journal of Health Planning and Management, 2021
Introduction In 2012, Kenya enacted a new Public Finance Management Act to guide the public‐sector planning and budgeting process. This new law replaced the previous line item budgeting, with a new program‐based budgeting (PBB) process. This study examined the experience of health sector PBB implementation at the county level in Kenya. Methods We carried out a review of the literature documenting the health sector application and utility of PBB in low‐ and middle‐income countries. We then collected empirical data to examine the experience of health sector application of PBB at County Level in Kenya. Results In the financial year 2017/18, counties utilised the PBB approach for health sector planning. The PBB approach was perceived by key stakeholders; to have improved the alignment of technical priorities with budgetary allocation, and to have increased transparency, accountability and openness of the process. Its challenges included lack of clear tools and guidelines to support impl...
EFFECTS OF FINANCING ON OPERATIONAL PERFORMANCE OF PUBLIC HEALTH INSTITUTIONS IN KISII COUNTY, KENYA
This research report presents the effects of sources of financing on operational performance of public health service provision in Kisii County. This research study sought to establish whether inequity in budget allocation affect financing of health care provision. Since the county government of Kisii came into power in 2013, it has managed to allocate five percent (5%) in 2013, seven percent (7%) in 2014 and 2015 of the county budget to financing of medical care. By highlighting the effects of funding health services, ministers of health and finance will be made aware of the nature of project challenges and this will influence application of strategies that influence delivery of quality health care. The study findings indicate that health facilities are fairly funded by donors, county and central governments. It also indicates that most people seeking health services are willing to pay for health care but, corruption in the county government is the major factor affecting financing of county health care therefore contributing to poor operational performance. Once the county government enforces laws that lead to equitable health care greater operational performance can be achieved. The study recommends that governance of Public health institutions should be strengthened and professionalized to improve the level of service delivery. Proper mechanisms should be installed for checks and balances on both internally generated funds and funding from various organs so that one function does not over burden or rely on the other function to deliver more.
This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers , and frontline practitioners in the case study hospitals (n ¼ 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of-and somewhat satisfied with-the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent , with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement , and incorporating community values) conditions.
2022
Background: Health systems are complex, consisting of multiple interacting structures and actors whose effective coordination is paramount to enhancing health system goals. Poor health sector coordination is a potential source of ine ciency in the health sector. We examined how the coordination of the health sector affects health system e ciency in Kenya. Methods: We conducted a qualitative cross-sectional study, collecting data at the national level and in two purposely selected counties in Kenya. We collected data using in-depth interviews (n = 36) with national and county level respondents, and document reviews. We analyzed the data using a thematic approach. Results: The study found that while formal coordination structures exist in the Kenyan health system, duplication, fragmentation, and misalignment of health system functions and actor actions compromise the coordination of the health sector. These challenges were observed in both vertical (co-ordination within the ministry of health, and within the county departments of health, and between the national ministry of health and the county department of health) and horizontal coordination mechanisms (coordination between the ministry of health or the county department of health and non-state partners, and coordination among county governments). These coordination challenges are likely to impact on the e ciency of the Kenyan health system by increasing the transaction costs of health system functions. Inadequate coordination also impairs the implementation of health programmes and hence compromises health system performance. Conclusion: The e ciency of the Kenyan health system could be enhanced by strengthening the coordination of the Kenyan health sector. This can be achieved by aligning and harmonizing the intergovernmental and health sector speci c coordination mechanisms, strengthening the implementation of the Kenya health sector coordination framework at the county level, and enhancing donor coordination through common funding arrangements and the integration of vertical disease programmes with the rest of the health system. The ministry of health and county departments of health should also review internal organizational structures to enhance functional and role clarity of organizational units and staff respectively. Finally, counties should consider initiating health sector coordination mechanisms between counties to reduce the fragmentation of health system functions across neighboring counties.
Budgeting at the County Level in Kenya: What has Worked, Challenges and Recommendations
Public Health Research, 2020
The objective of this paper is to assess policy implementation from the perspective of budget allocations and actual expenditures in the context of the health care sector in a poor country. The study is limited to the case of the health care system of Kenya, more specifically whether there was a change in the Kenyan government’s allocation and spending of health care resources in relation to their set priorities in distribution of funds.
Budget Execution and Service Delivery of Public County Health Facilities
2020
The health sector has the overall goal of providing equitable and affordable health care to Kenyans at the highest affordable standards. Therefore, this study examined the influence of budget execution on the service delivery of devolved County Health Facilities. The study was anchored on the tenets of the Resource-Based Theory. An explanatory survey research design was adopted for this study. The ideal target population in the study comprised of 15,160 doctors and clinical officers (COs) and nurses from 1423 hospitals in Kenya. The study employed stratified sampling technique to select the 390 respondents from three levels of public hospitals in Kenya. This included 14 doctors, 24 COs, and 352 nurses. The study used a questionnaire as a research instrument. Data analysis wаs conducted using Mean, Standard Deviation, Frequencies and Percentages. Factor Analysis and Structural Equation Modelling were used to identify the significant indictors of budget execution and service delivery....