This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya.

Priority setting and resource allocation in healthcare organisations often involves balancing competing interests in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organisations.

Researchers from the Kemri Wellcome Trust Research Programme used a qualitative case study approach to examine priority setting resource allocation practices in two public hospitals in coastal Kenya.

The results showed that power imbalances resulted in the exclusion of middle level managers (in one hospital) and exclusion of clinicians and the community from decision making processes (in both hospitals). Leading to perceptions of unfairness and reduced motivation of hospital staff.

The paper shows that priority setting practices could be improved through:

• redesigning hospital decision making structures to strengthen stakeholder participation
• empowering stakeholders to contribute to decision making
• strengthening soft-leadership skills of hospital managers
• managing power dynamics among actors in hospital priority setting processes