Sharing the pie: what can be done to improve priority setting for healthcare at the county level in Kenya?

, 2018
Kemri Wellcome Trust

County departments of health play a critical role in the Kenyan health system. Since devolution in 2013, they have been responsible for the provision of preventive and curative, primary and secondary care health services. They now control the biggest proportion of healthcare resources in the country, with collective budgets amounting to KES 90 billion (USD 900 million) in 2016/2017. To effectively deliver health services, it is imperative to have strong and systematic budgeting, planning and priority-setting processes so that scarce resources are optimally used.

Kemri Wellcome Trust Research Programme has undertaken research that examines the planning and budgeting as the main priority setting activities at the county level in Kenya. Similar research has taken place within hospitals and at the national level revealing significant misalignment in planning and budgeting and priority-setting practices based on informal considerations. This brief summarises the key findings from the research and concludes with recommendations for county policymakers.

Key points

  • County level planning and budgeting processes are misaligned, meaning that budgets are not informed by health priorities and plans are unlikely to be implemented.
  • Political interests dominate decision-making, resulting in inequitable and inefficient allocation of resources.
  • There are few opportunities for meaningful involvement of stakeholders and frontline health managers in decision-making processes.

Related resource

Describing and evaluating healthcare priority setting practices at the county level in Kenya

Policy brief | Financing