Hospital priority setting

Why it matters  

A fundamental challenge for health system managers and administrators is deciding how and where to spend limited resources. Priority setting is a particular challenge in Kenya’s county hospitals, which faced highly constrained budgets and unpredictable funding from the central government at the time of this study. Within hospitals, health services and departments compete for scarce resources.

What  we did  

KEMRI-Wellcome Trust conducted research to understand how county hospitals in coastal Kenya set priorities and allocate resources between services. This was an in-depth qualitative study between two hospitals in Kilifi and Mombasa counties. Data was collected in 2012 and 2013.

At a later date, researchers explored priority setting practices at County level in Kilifi County, Kenya. The findings from this study can be found in the health sector planning and budgeting page

 What we found  

  • Hospitals lack explicit processes for setting healthcare priorities.
    This provides room for the use of inappropriate priority setting criteria such as lobbying and favouritism. As a result, hospital resources are not aligned with healthcare needs and are inequitably distributed across departments.
  • Hospitals are under-resourced and prioritise services that generate revenue through user fees. 
    Services with limited moneymaking potential, including those for young children, elderly and disabled groups, are systematically underfunded.
  • Many key stakeholders including middle level managers, clinicians and community members, are not included in priority setting processes.
    The perceived unfairness of allocations by clinicians and mid-level managers has also led to frustration and reduced motivation, which impacts negatively on the wider functioning of the health system.

Implications for policy and practice

  1. Systematic and explicit priority setting procedures: Hospital managers should ensure that the priority setting process has clearly defined procedures, roles and responsibilities for different actors, and explicit decision-making criteria that are responsive to hospital needs and health systems goals.

  2. Strengthen inclusivity and stakeholder engagement: Hospital decision-making structures should be designed so that all actors (senior and middle level managers, front line staff, community) are represented. This will improve the legitimacy and responsiveness of priority setting processes. Further, ensuring that decision-making meetings include relevant stakeholders, and structuring meetings to allow all participants a chance to share their views, will improve the inclusivity and sense of fairness in priority setting.