RELATIVE SIGNIFICANCE OF SELECTED PREDICTORS OF ALIGNED ANNUAL HEALTH SECTOR PLANNING AND BUDGETING AMONG HEALTH MANAGERS IN BUNGOMA COUNTY, KENYA

Abstract

priorities that guide budgetary allocations to improve health outcomes. Over the years, progress has been made to strengthen this process through the development of guiding frameworks. However, challenges abound in the practical applicability of these frameworks contributing to misalignment between identified priorities and budgetary allocations. In Kenya, the annual health sector planning and budgeting process is largely misaligned. Bungoma County is among the few counties that disproportionately allocates over 90% of its health budget to recurrent expenditure contrary to the recommended 70%. Therefore, informed by a framework of successful priority setting, this study sought to determine the relative significance of selected predictors of aligned annual health sector planning and budgeting among health managers across the county health system. A descriptive cross-sectional study design using quantitative and qualitative methods was employed. Quantitative data were collected from 170 health managers and qualitative data from 3 department of health executives and 8 community health committees. The county health executives, county, sub-county, and level 4 health managers were purposively recruited while level 2 and 3 health managers and community health committees were randomly selected. Quantitative data were analyzed using the statistical package for social sciences (SPSS v. 29.0). Descriptive statistics were presented in tables and graphs. Qualitative data were coded using NVIVO-12 and analyzed thematically. Hierarchical multiple regression was conducted to determine the relative significance of the predictors on the development of aligned health sector plans and budgets after controlling for level of education and length of experience. The results showed that all the predictors significantly predicted the dependent variable, transparency β = .275, p<.001, knowledge level of the health managers β = .254, p<.001, use of evidence, β = .203, p<.001, community engagement β = .168, p=.004, the attitude of the health managers β = .139, p=.011 and health partners engagement β = .125, p=.027, with a combined variance accounted for of 61.1%. Ttransparency of the leadership had the highest absolute value of β and therefore was the strongest predictor. These findings suggest that transparency of leadership is at the core of a successful health sector planning and budgeting process. It is therefore recommended that the county department of health should give top priority to building the leadership competencies of their leaders and establishing clear communication channels to enhance transparency in the annual health sector planning and budgeting process.