Setting healthcare priorities

A description and evaluation of the budgeting and planning process in county hospitals in Kenya

Datos Bibliográficos

ID11491833
AutoresEdwine W Barasa, Edwine Barasa (0000-0001-5793-7177, University of Cape Town), Susan Cleary (0000-0002-9071-7958, University of Cape Town), Sassy Molyneux (0000-0001-9522-416X, Kenya Medical Research Institute), Mike English (0000-0002-7427-0826, Kenya Medical Research Institute)
Año2016
Volumen32
Número3
Páginasczw132
Fecha de publicación2016-09-26
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHealth Policy and Planning (JOURNAL)
Identificadores de la revistaISSN: 0268-1080 • E-ISSN: 1460-2237
EditorialOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czw132
PMID27679522
OpenAlexW2524215656
IdiomaEN
Citas recibidas9
Referencias citadas20

This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions.

Allocative efficiency · Business · CLARITY · Economic growth · Economics · Equity (law) · Health care · Political science · Process (computing) · Public hospital · Public relations · Qualitative research · Quality (philosophy) · Sociology · Global Maternal and Child Health · Health Systems, Economic Evaluations, Quality of Life · Medicine · Nursing · Patient Satisfaction in Healthcare