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.”

Recommendations

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