Reversing the trend of weak policy implementation in the Kenyan health sector? – a study of budget allocation and spending of health resources versus set priorities

Abstract

BackgroundPolicy implementation in the context of health systems is generally difficult and the Kenyan health sector situation is not an exception. In 2005, a new health sector strategic plan that outlines the vision and the policy direction of the health sector was launched and during the same year the health sector was allocated a substantial budget increment. On basis of these indications of a willingness to improve the health care system among policy makers, the objective of this study was to assess whether there was a change in policy implementation during 2005 in Kenya.MethodologyBudget allocations and actual expenditures compared to set policy objectives in the Kenyan health sector was studied. Three data sources were used: budget estimates, interviews with key stakeholders in the health sector and government and donor documentation.ResultsBudget allocations and actual expenditures in part go against policy objectives. Failures to use a significant proportion of available funds, reallocation of funds between line items and weak procurements systems at the local level and delays in disbursement of funds at the central level create gaps between policy objectives and policy implementation. Some of the discrepancy seems to be due to a mismatch between responsibilities and capabilities at different levels of the system.ConclusionWe found no evidence that the trend of weak policy implementation in the Kenyan health sector was reversed during 2005 but ongoing efforts towards hastening release of funds to the districts might help solving the issue of low absorption capacity at the district level. It is important, however, to work with clear definitions of roles and responsibilities and well-functioning communications between different levels of the system.

A review of the trends of lymphomas in the equatorial belt of Africa

“…In Kenya, for example, the first national health sector strategic plan 1999–2004 was not successfully implemented in relation to the priorities. The total government spending was 7%, far below the requirements of the Abuja Declaration on spending at least 15% national budget on health by AU member countries 33. In 2007/2008, the country allocated only 8.4% of its national budget on health 34.…”

Barriers to Sexual and Reproductive Health Programming for Adolescents Living with HIV in Uganda

“…Nonetheless, as is evident from the discussion in this paper, the process of developing, disseminating and implementing the guidelines might be hampered by a number of factors. These include available budgetary allocations, political and cultural acceptability of discussion of issues relating to SRH of adolescents in general and those living with HIV in particular, available infrastructure and human resources, as well as the institutional capacity of the HIV/AIDS treatment, care and support programs to implement the guidelines (Brock et al 2002;Glenngård and Maina 2007;Haines et al 2004;Hardon 2005;Innvaer et al 2002;Neema et al 2004;Parent et al 2005;Philpott et al 2002). Whereas the other potential barriers can be surmounted through support from donors and other international and national organizations involved in adolescent SRH, political and cultural acceptance of any given policy considered to be sensitive remain the greatest challenge for effective implementation (Brock et al 2002;Neema et al 2004).…”

“…The actual implementation, on the other hand, faces a number of local realities including the socio-economic, socio-cultural, and political environment in a particular country. The implementation process is, for instance, influenced by the available infrastructure and human resources, budgetary allocation, personal interaction between policy-makers and implementers, the political establishment, as well as the cultural acceptability of the programs put in place in response to the policies (Brock et al 2002;Glenngård and Maina 2007;Haines et al 2004;Hardon 2005;Innvaer et al 2002;Neema et al 2004;Parent et al 2005;Philpott et al 2002).…”

Health sector operational planning and budgeting processes in Kenya—“never the twain shall meet”

“…A lack of linkages between budgetary allocations and sector priorities have been cited as one of the reasons why Kenya has failed to achieve its health‐related targets (Glenngard and Maina, ; Ministry of Public Health and Sanitation and M. o. M. Services, ). As with many other developing countries, the government of Kenya (GoK) has for many years been undergoing major health systems reforms aimed at improving resource priority setting, planning and budgeting, including the involvement of communities and sub‐national level units in planning and budgeting decision‐making (Ministry of Health, ; Ministry of Health, ; Ministry of Health, ; Ministry of Health, ).…”