Examining health sector application and utility of program-based budgeting: County level experiences in Kenya.

Benjamin Tsofa,Protus Musotsi,Edwine Barasa,Dennis Waithaka,Thomas Maina,Nancy Kagwanja,Sassy Molyneux,Jane Chuma

doi:10.1002/hpm.3174

Abstract

IntroductionIn 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.MethodsWe 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.ResultsIn 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 implementation, low capacity at county level, political interference and the organisation of the public sector electronic financial management system around line item budgeting system.ConclusionPBB is potentially a useful tool for aligning health sector planning and budgeting and ensuring the Annual Work Plan is more result oriented. However, realisation of this goal would be enhanced by the developing clear tools and guidelines to support its implementation, building capacity for county health sector managers to better understand the PBB application, and reforming the public‐sector budgetary management system to align it with the PBB approach.

Highlights

In 2012, Kenya enacted a new Public Finance Management Act to guide the public‐sector planning and budgeting process
We searched for grey literature from websites of organisations with interest in healthcare planning, budgeting and financing including those of the International Monetary Fund (IMF), World Bank (WB), World Health Organization (WHO), Collaborative African Budget Reform Initiative and International Budget Partnership
We later progress to present our empirical findings focussing on the county level health sector program‐based budgeting (PBB) process and content in theory, progress to present findings on the process in practice, followed by a description of the roles of actors in theory and practice

Summary

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. Even with the wide adoption of these planning and budgeting tools and frameworks in many LMICs, the process of health sector planning and budgeting has often resulted in a mismatch between the technical priority options identified as part of the broader health sector strategic goals, and actual budgetary allocations often because of local political realities and processes.[1,6]

Methods

Results

Discussion

Conclusion