Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya.
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 = 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.
KEMRI Centre for Geographic Medicine Research - Coast, and Wellcome Trust Research Programme, Nairobi, Kenya.|Health Economics Unit, University of Cape Town, Cape Town South Africa.
Edwine W
EW
Barasa
Health Economics Unit, University of Cape Town, Cape Town South Africa.
Susan
S
Cleary
KEMRI Centre for Geographic Medicine Research - Coast, and Wellcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine, University of Oxford, Oxford, UK.
Sassy
S
Molyneux
KEMRI Centre for Geographic Medicine Research - Coast, and Wellcome Trust Research Programme, Nairobi, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Mike
M
English
D002017:Budgets; D003659:Decision Making, Organizational; D006288:Health Planning Organizations; D006292:Health Priorities; D006766:Hospitals, County; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D019982:Organizational Case Studies / Q000379:methods; D036301:Qualitative Research
Budgeting and planning; Kenya; deliberative democracy; hospitals; priority-setting
J Health Serv Res Policy. 2003 Oct;8(4):197-201
14596753
BMC Health Serv Res. 2004 Sep 08;4(1):25
15355544
PLoS Med. 2011 Aug;8(8):e1001079
21886488
Health Policy Plan. 2015 Apr;30(3):386-96
24604831
BMC Health Serv Res. 2006 Oct 06;6:127
17026761
Health Care Anal. 2003 Mar;11(1):59-68
14510309
Soc Sci Med. 2003 Jul;57(2):239-51
12765705
Int J Health Plann Manage. 2016 Jul;31(3):260-76
25783862
Health Econ. 2016 Feb;25 Suppl 1:140-61
26804361
BMC Health Serv Res. 2013 Jul 12;13:273
23849730
Health Policy. 1999 Oct;49(1-2):45-61
10827290
BMJ. 1998 Oct 10;317(7164):959-60
9765158
Health Care Anal. 2010 Jun;18(2):129-47
19288200
Int J Health Policy Manag. 2015 Sep 16;4(11):719-32
26673332
Soc Sci Med. 2017 Feb;174:104-112
28024239