ReviewHealth policy and planning2023
Examining the influence of budget execution processes on the efficiency of county health systems in Kenya.
Review in Health policy and planning, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 12 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 22 citations in OpenAlex.
- Financial autonomy of facilities providing primary care services in low- and middle-income countries: assessing the evidence to inform the development of a typology and conceptual framework.BMC health services research · 2025Article
- Sustainability starts with spending: public financial management lessons from Kenya's universal health care pilot.BMC health services research · 2025Article
- Strengthening the sustainability of neglected tropical disease programs in Rwanda: An assessment of access and utilization of domestically-financed services for soil-transmitted helminthiases and schistosomiasis.PLoS neglected tropical diseases · 2025Article
- Surviving the first five years: the economic and healthcare determinants of child mortality in Sri Lanka.Journal of health, population, and nutrition · 2025Article
- Management capacity of primary healthcare facilities in low- and middle-income countries: A scoping review.PLOS global public health · 2025Article
- Financing immunisation in Kenya: examining bottlenecks in health sector planning and budgeting at the decentralised level.Cost effectiveness and resource allocation : C/E · 2024Article
- Evaluating the effects, implementation experience and political economy of primary healthcare facility autonomy reforms within counties in Kenya: a mixed methods study protocol.BMJ public health · 2024Article
- Unsalaried health workers in Sierra Leone: a scoping review of the literature to establish their impact on healthcare delivery.International journal for equity in health · 2023Article
- Examining the influence of budget execution processes on the efficiency of county health systems in Kenya.Health policy and planning · 2023Review
- Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya.PLOS global public health · 2023Article
- The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya.BMJ global health · 2022Review
- Management of human resources for health: implications for health systems efficiency in Kenya.BMC health services research · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
12 authors at 5 institutions in 3 countries.
Funding
Abstract
Public financial management (PFM) processes are a driver of health system efficiency. PFM happens within the budget cycle which entails budget formulation, execution and accountability. At the budget execution phase, budgets are implemented by spending as planned to generate a desired output or outcome. Understanding how the budget execution processes influence the use of inputs and the outcomes that result is important for maximizing efficiency. This study sought to explain how the budget execution processes influence the efficiency of health systems, an area that is understudied, using a case study of county health systems in Kenya. We conducted a concurrent mixed methods case study using counties classified as relatively efficient (n = 2) and relatively inefficient (n = 2). We developed a conceptual framework from a literature review to guide the development of tools and analysis. We collected qualitative data through document reviews and in-depth interviews (n = 70) with actors from health and finance sectors at the national and county level. We collected quantitative data from secondary sources, including budgets and budget reports. We analysed qualitative data using the thematic approach and carried out descriptive analyses on quantitative data. The budget execution processes within counties in Kenya were characterized by poor budget credibility, cash disbursement delays, limited provider autonomy and poor procurement practices. These challenges were linked to an inappropriate input mix that compromised the capacity of county health systems to deliver health-care services, misalignment between county health needs and the use of resources, reduced staff motivation and productivity, procurement inefficiencies and reduced county accountability for finances and performance. The efficiency of county health systems in Kenya can be enhanced by improving budget credibility, cash disbursement processes, procurement processes and provider autonomy.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.