Examining the influence of budget execution processes on the efficiency of county health systems in Kenya.
Public financial management
budget execution
efficiency
Journal
Health policy and planning
ISSN: 1460-2237
Titre abrégé: Health Policy Plan
Pays: England
ID NLM: 8610614
Informations de publication
Date de publication:
16 Mar 2023
16 Mar 2023
Historique:
received:
27
06
2022
revised:
06
10
2022
accepted:
11
11
2022
pubmed:
12
11
2022
medline:
22
3
2023
entrez:
11
11
2022
Statut:
ppublish
Résumé
Public financial management (PFM) processes are a driver of health system efficiency. PFM happens within the budget cycle which entails budget formulation, execution and accountability. At the budget execution phase, budgets are implemented by spending as planned to generate a desired output or outcome. Understanding how the budget execution processes influence the use of inputs and the outcomes that result is important for maximizing efficiency. This study sought to explain how the budget execution processes influence the efficiency of health systems, an area that is understudied, using a case study of county health systems in Kenya. We conducted a concurrent mixed methods case study using counties classified as relatively efficient (n = 2) and relatively inefficient (n = 2). We developed a conceptual framework from a literature review to guide the development of tools and analysis. We collected qualitative data through document reviews and in-depth interviews (n = 70) with actors from health and finance sectors at the national and county level. We collected quantitative data from secondary sources, including budgets and budget reports. We analysed qualitative data using the thematic approach and carried out descriptive analyses on quantitative data. The budget execution processes within counties in Kenya were characterized by poor budget credibility, cash disbursement delays, limited provider autonomy and poor procurement practices. These challenges were linked to an inappropriate input mix that compromised the capacity of county health systems to deliver health-care services, misalignment between county health needs and the use of resources, reduced staff motivation and productivity, procurement inefficiencies and reduced county accountability for finances and performance. The efficiency of county health systems in Kenya can be enhanced by improving budget credibility, cash disbursement processes, procurement processes and provider autonomy.
Identifiants
pubmed: 36367746
pii: 6823804
doi: 10.1093/heapol/czac098
pmc: PMC10074769
doi:
Types de publication
Review
Journal Article
Langues
eng
Pagination
351-362Subventions
Organisme : Medical Research Council
ID : MR/R01373X/1
Pays : United Kingdom
Organisme : MRC/DFID/Wellcome Trust
ID : MR/R01373X/1
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
Références
Health Syst Reform. 2018;4(4):336-345
pubmed: 30398392
PLoS One. 2017 Aug 3;12(8):e0182440
pubmed: 28771558
Int J Equity Health. 2017 Sep 15;16(1):151
pubmed: 28911325
Soc Sci Med. 2017 Apr;179:74-80
pubmed: 28260637
Cost Eff Resour Alloc. 2021 Dec 6;19(1):78
pubmed: 34872560
Int J Health Plann Manage. 2018 Oct;33(4):1159-1177
pubmed: 30074642
BMC Health Serv Res. 2006 Aug 17;6:105
pubmed: 16916445
Bull World Health Organ. 2010 Jun;88(6):402
pubmed: 20539847
Int J Health Plann Manage. 2018 Apr 15;:
pubmed: 29658138
Health Policy Plan. 2023 Mar 16;38(3):351-362
pubmed: 36367746
Health Res Policy Syst. 2007 Mar 29;5:3
pubmed: 17394640
Health Syst Reform. 2018;4(3):214-226
pubmed: 30081685
PLOS Glob Public Health. 2021 Dec 23;1(12):e0000077
pubmed: 36962100
Health Policy Plan. 2022 Feb 8;37(2):189-199
pubmed: 34718555
Vaccine. 2014 Feb 19;32(9):1036-42
pubmed: 24384055