When Opportunity Beckons: The Impact of the Public Service Accountability Monitor's Work on Improving Health Budgets in South Africa

Fölscher, Alta; Kruger, John

doi:10.2139/ssrn.2326587

Cited by 5 publications

(7 citation statements)

References 4 publications

(1 reference statement)

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“…Auditors paid to 'look away' took away resources from the health system leading to wastage of health system resources. Similar findings were reported in South Africa where failure to impose sanctions for misuse of public funds led to years of non-performance and bad audit reports [26,27]. In Kenya, this is compounded by the conflict of interest among actors who are responsible for budget monitoring.…”

Section: Discussionsupporting

confidence: 72%

Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya

Musiega,

Nyawira,

Tsofa

et al. 2023

PLOS Glob Public Health

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Public Finance Management (PFM) practices influence the attainment of health system goals. PFM processes are implemented within the budget cycle which entails the formulation, execution, and monitoring of government budgets. Budget monitoring and accountability actors, structures, and processes are important in improving the efficiency of health systems. This study examined how the budget monitoring and accountability processes influence the efficiency of county health systems in KenyaWe conducted a qualitative case study of four counties in Kenya selected based on their relative technical efficiency. We collected data using in-depth interviews with health and finance stakeholders (n = 70), and document reviews. We analyzed data using a thematic approach, informed by our study conceptual framework. We found that weak budget monitoring and accountability mechanisms compromised county health system efficiency by a) weakening the effective implementation of the budget formulation and execution steps of the budget cycle, b) enabling the misappropriation of public resources, and c) limiting evidence-informed decision-making by weakening feedback that would be provided by effective monitoring and accountability. Devolution meant that accountability actors were closer to implementation actors which promoted timely problem solving and the relevance of solutions. Internal audit practices were supportive and provided useful feedback to health system managers that facilitated improvements in budget formulation and execution. The efficiency of county health systems can be improved by strengthening the budget monitoring and accountability processes. This can be achieved by increasing the population’s budget literacy, supporting participatory budgeting, synchronizing performance and financial accountability, implementing the existent budget monitoring and accountability mechanisms, rewarding efficiency, and sanctioning inefficiency.

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Section: Discussionsupporting

confidence: 72%

Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya

Musiega,

Nyawira,

Tsofa

et al. 2023

PLOS Glob Public Health

View full text Add to dashboard Cite

show abstract

“…Auditors paid to 'look away' took away resources from the health system leading to wastage of health system resources. Similar ndings were reported in South Africa where failure to impose sanctions for misuse of public funds led to years of non-performance and bad audit reports (23,24). In Kenya, this is compounded by the con ict of interest among actors that are responsible for budget monitoring.…”

Section: Discussionsupporting

confidence: 68%

“…In Thailand, enhanced public accountability, through active social media handles, was shown to improve health system e ciency (25). In South Africa, because of con icts of interest, most health workers were protected from sanctions (23).…”

Section: Discussionmentioning

confidence: 99%

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Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya: a qualitative case study

Musiega

Nyawira

Tsofa

et al. 2023

Preprint

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Background Public finance management (PFM) practices influence the attainment of health system goals. PFM processes are implemented within the budget cycle which entails the formulation, execution, and monitoring of government budgets. Budget monitoring and accountability actors, structures, and processes are important in improving the efficiency of health systems. This study examined how the budget monitoring and accountability processes influence the efficiency of county health systems in Kenya. Methods We conducted a qualitative case study of four counties in Kenya selected based on their relative technical efficiency . Data were collected using in-depth interviews with health and finance stakeholders (n=70), and document reviews. Data were analyzed using a thematic approach, informed by our study conceptual framework. Results We found that weak budget monitoring and accountability mechanisms compromised county health system efficiency by a) weakening the effective implementation of the budget formulation and execution steps of the budget cycle, b) enabling the misappropriation of public resources, and c) limiting evidence-informed decision-making by weakening feedback that would be provided by effective monitoring and accountability. Devolution meant that accountability actors were closer to implementation actors which promoted timely problem solving and the relevance of solutions. Internal audit practices were supportive and provided useful feedback to health system managers that facilitated improvements in budget formulation and execution. Conclusion The efficiency of county health systems can be improved by strengthening the budget monitoring and accountability processes. This can be achieved by increasing the population’s budget literacy, supporting participatory budgeting, synchronizing performance and financial accountability, implementing the existent budget monitoring and accountability mechanisms, rewarding efficiency and sanctioning inefficiency

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“…PSAM monitors the budget cycle in the health sector of the Eastern Cape provincial government in South Africa (Fölscher and Kruger ). When its analyses reveal difficulties in financial management and service delivery, it raises public awareness through the media and key stakeholders, such as the legislature, trade unions, CSOs, and the executive itself.…”

Section: Demanding Accountabilitymentioning

confidence: 99%

How Civil Society Organizations Close the Gap between Transparency and Accountability

Zyl¹

2014

Governance

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When Opportunity Beckons: The Impact of the Public Service Accountability Monitor's Work on Improving Health Budgets in South Africa

Cited by 5 publications

References 4 publications

Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya

Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya

Budget monitoring, accountability practices and their influence on the efficiency of county health systems in Kenya: a qualitative case study

How Civil Society Organizations Close the Gap between Transparency and Accountability

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