Abstract
SummaryBackgroundHealthcare priority setting research has focused at the macro (national) and micro (patient level), while there is a dearth of literature on meso‐level (subnational/regional) priority setting practices. In this study, we aimed to describe and evaluate healthcare priority setting practices at the county level in Kenya.MethodsWe used a qualitative case study approach to examine the planning and budgeting processes in 2 counties in Kenya. We collected the data through in‐depth interviews of senior managers, middle‐level managers, frontline managers, and health partners (n = 23) and document reviews. We analyzed the data using a framework approach.FindingsThe planning and budgeting processes in both counties were characterized by misalignment and the dominance of informal considerations in decision making. When evaluated against consequential conditions, efficiency and equity considerations were not incorporated in the planning and budgeting processes. Stakeholders were more satisfied and understood the planning process compared with the budgeting process. There was a lack of shifting of priorities and unsatisfactory implementation of decisions. Against procedural conditions, the planning process was more inclusive and transparent and stakeholders were more empowered compared with the budgeting process. There was ineffective use of data, lack of provisions for appeal and revisions, and limited mechanisms for incorporating community values in the planning and budgeting.ConclusionCounty governments can improve the planning and budgeting processes by aligning them, implementing a systematic priority setting process with explicit resource allocation criteria, and adhering to both consequential and procedural aspects of an ideal priority setting process.
Highlights
IntroductionPriority setting occurs at all levels of the health system and is one of the most important health policy questions in recent years.[1,2] Priority setting has been recognized as a key determinant of success in healthcare delivery.[3,4,5] health sector priority setting research has focused on macro and micro levels, while neglecting meso‐ level priority setting practices.[4,6,7] in low‐ and middle‐income countries (LMICs), there is limited research on priority setting and resource allocation practices at the meso‐level in regional and/or district health systems.[4,8] This is perhaps surprising given that decentralization has formed a key part of health sector reforms in LMICs.[9]
When we do the Annual Work Plan, we look at some indicators, how they are performing, and where we are not performing well based on the last year's performance we pick some items which we prioritize
Under the devolved system of government, county governments play a critical role in the delivery of healthcare services and control a significant proportion of healthcare resources
Summary
Priority setting occurs at all levels of the health system and is one of the most important health policy questions in recent years.[1,2] Priority setting has been recognized as a key determinant of success in healthcare delivery.[3,4,5] health sector priority setting research has focused on macro and micro levels, while neglecting meso‐ level priority setting practices.[4,6,7] in low‐ and middle‐income countries (LMICs), there is limited research on priority setting and resource allocation practices at the meso‐level in regional and/or district health systems.[4,8] This is perhaps surprising given that decentralization has formed a key part of health sector reforms in LMICs.[9]. Examples of priority setting activities in the health sector include strategic planning processes, budgeting processes, decision making about development of benefit packages, medicines selection, and distribution and allocation of human resources for health
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