Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya

September 2016
Edwine Barasa, Susan Cleary, Sassy Molyneux, Mike English

This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. Researchers at the Kemri Wellcome Trust research programme used a qualitative case study approach to examine processes in two public hospitals in Kenya.  

The research showed that the budgeting and planning process in the case study hospitals was characterised by: lack of alignment, inadequate role clarity and use of informal priority-setting criteria. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included.

“It is clear that to improve priority-setting practices, decision makers in charge of these hospitals will need to focus their attention not only on the content and outcomes of priority setting but also - equally important - on the process.”


Public hospitals in Kenya could improve their budgeting and planning processes by:

  • aligning budgeting and planning practices
  • clarifying composition and roles of decision-making structures
  • using explicit and formal priority-setting criteria
  • incorporating both efficiency and equity in decision making
  • following deliberative democratic principles such as stakeholder engagement and empowerment, transparency, use of evidence and incorporating community values
Governance Priority setting Kenya