Health Managers’ Utilization of Evidence to Inform Annual Health Sector Planning and Budgeting Process in Bungoma County, Kenya

Mildred Nanjala Wamalwa; Maximilla Wanzala; Benedict Ondiek Alala

doi:10.51867/ajernet.4.2.25

Authors

Mildred Nanjala Wamalwa
mildrednanjala@gmail.com
PhD Candidate (Department of Public Health), Masinde Muliro University of Science and Technology, P. O. Box 190-50100, Kakamega, Kenya https://orcid.org/0000-0002-5514-8104
Maximilla Wanzala Senior Lecturer, Department of Public Health, Masinde Muliro University of Science and Technology, P. O. Box 190-50100, Kakamega, Kenya https://orcid.org/0000-0002-6155-9794
Benedict Ondiek Alala 3Associate Professor, Department of Accounting and Finance, Masinde Muliro University of Science and Technology, P. O. Box 190-50100, Kakamega, Kenya https://orcid.org/0000-0001-9672-8984

Keywords:

Annual Performance Reviews, Devolution, Evidence, Health Managers, Planning and Budgeting

Abstract

Evidence-based planning and budgeting within the health sector are essential in strengthening the health system building blocks. Decentralization has presented opportunities for collecting local and reliable data to facilitate evidence-based planning and budgeting. Despite the increasing availability of routine health information at all levels of the health system, its effective utilization among health managers in lower and middle-income countries remains inadequate. This study, therefore, aimed to assess the health managers’ utilization of evidence to inform the annual planning and budgeting process. The study utilized a descriptive cross-sectional design, incorporating quantitative and qualitative research methods. Quantitative data were collected from 170 health managers, while qualitative data were gathered from three county department of health executives and 83 community health committee members across eight functional community health units. Statistical Package for the Social Sciences (SPSS v. 29.0) was employed for analyzing the quantitative data, while thematic analysis was used for the qualitative data. Only 42.4% of health managers received training in planning, budgeting, and annual performance reviews (APRs). Among the 45.9% who conduct APRs, only 47.4% use the findings to inform the process. A significant association was found between training and conducting of APRs, χ² (1, N = 170) = 21.73, p < .001, and between training and the utilization of APR findings in decision-making, χ² (1, N = 78) = 14.72, p < .001. Although 75% of health managers acknowledged the availability of health information, 71% disagreed that they have skills in data use for planning and budgeting and 54% disagreed regarding the reliability of the available data. The health managers who were trained in health sector planning, budgeting, and APRs were more likely to use findings to inform the process. To improve evidence-based planning and budgeting, the county health department should allocate additional funding towards conducting APRs as a critical first step in guiding the identification of priorities. Additionally, there is a need to implement capacity-building initiatives targeting health managers across all tiers of the county health system, focusing on data management and its effective utilization in planning and budgeting.

Dimensions

REFERENCES

Aboubacar, I., Essono, M., Mailfert, M., Barroy, H. (2020). Health financing and budgeting reforms in Gabon: progress and challenges on the road to universal health coverage. Geneva: World Health Organization.

Akaco, E., Erastus, M., Edward, E., & Scott, M. (2015). "Data demand and use in the health sector in central and eastern Kenya." Presented at Population Association of America: 11-13 April 2013. New Orleans: Princeton University.

Ally, R. O. (2019). Determinants of Utilization of Routine Health Management Information System (HMIS) Data for Effective Decision Making at Selected Health Facilities in Zanzibar (Master's thesis, Mzumbe University, Dar es Salaam). Retrieved from http://scholar.mzumbe.ac.tz/handle/11192/3182.

Barasa, E. W., Molyneux, S., English, M., & Cleary, S. (2015). Setting healthcare priorities at the macro and meso levels: a framework for evaluation. International journal of health policy and management, 4(11), 719. https://doi.org/10.15171/ijhpm.2015.167.

https://doi.org/10.15171/ijhpm.2015.167 DOI: https://doi.org/10.15171/ijhpm.2015.167

Barasa, E. W., Cleary, S., Molyneux, S., & English, M. (2017). Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya. Health policy and planning, 32(3), 329-337. https://doi.org/10.1093/heapol/czw132 DOI: https://doi.org/10.1093/heapol/czw132

Bendavid, E., & Bhattacharya, J. (2014). The relationship of health aid to population health improvements. JAMA internal medicine, 174(6), 881-887. https://doi.org/10.1001/jamainternmed.2014.292 DOI: https://doi.org/10.1001/jamainternmed.2014.292

Bhattacharyya, S., Issac, A., Girase, B., Guha, M., Schellenberg, J., & Iqbal Avan, B. (2020). There Is No Link Between Resource Allocation and Use of Local Data: A Qualitative Study of District-Based Health Decision-Making in West Bengal, India. International Journal of Environmental Research and Public Health, 17(21), 8283. https://doi.org/10.3390/ijerph17218283.

https://doi.org/10.3390/ijerph17218283 DOI: https://doi.org/10.3390/ijerph17218283

Cashin, C., Bloom, D., Sparkes, S., Barroy, H., Kutzin, J., O'Dougherty, S., & World Health Organization. (2017). Aligning public financial management and health financing: sustaining progress toward universal health coverage (No. WHO/HIS/HGF/HFWorkingPaper/17.4). World Health Organization.

Chatora, R., & Tumusiime, P. (2004). Health sector reform and district health systems. Brazaville: WHO.

Dagnew, E., Woreta, S. A., & Shiferaw, A. M. (2018). Routine health information utilization and associated factors among health care professionals working at public health institution in North Gondar, Northwest Ethiopia. BMC health services research, 18(1), 1-8. https://doi.org/10.1186/s12913-018-3498-7 DOI: https://doi.org/10.1186/s12913-018-3498-7

Dale, E., Prieto, L., Seinfeld, J., Pescetto, C., Barroy, H., & Montañez, V. (2020). Budgeting for results in health: key features, achievements and challenges in Peru. Geneva: World Health Organization (Health financing case study; no. 17. Budgeting in health).

Government of Kenya. (2010). The Constitution of Kenya. Nairobi: Government Printer.

Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 114523. https://doi.org/10.1016/j.socscimed.2021.114523 DOI: https://doi.org/10.1016/j.socscimed.2021.114523

Henriksson, D. K. (2017). Health systems bottlenecks and evidence-based district health planning: Experiences from the district health system in Uganda (Doctoral dissertation, Acta Universitatis Upsaliensis, Uppsala). Retrieved from https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1139476&dswid=9911.

Henriksson, D. K., Ayebare, F., Waiswa, P., Peterson, S. S., Tumushabe, E. K., & Fredriksson, M. (2017). Enablers and barriers to evidence based planning in the district health system in Uganda; perceptions of district health managers. BMC Health Services Research, 17(1), 1-11. https://doi.org/10.1186/s12913-017-2059-9 DOI: https://doi.org/10.1186/s12913-017-2059-9

Kimathi, L. (2017). Challenges of the devolved health sector in Kenya: teething problems or systemic contradictions?. Africa development, 42(1), 55-77.

Lippeveld, T. (2017). Routine health facility and community information systems: creating an information use culture. Global Health: Science and Practice, 5(3), 338-340. https://doi.org/10.9745/GHSP-D-17-00319 DOI: https://doi.org/10.9745/GHSP-D-17-00319

Mboera, L. E., Rumisha, S. F., Mbata, D., Mremi, I. R., Lyimo, E. P., & Joachim, C. (2021). Data utilisation and factors influencing the performance of the health management information system in Tanzania. BMC Health Services Research, 21, 1-8. https://doi.org/10.1186/s12913-021-06559-1 DOI: https://doi.org/10.1186/s12913-021-06559-1

Ministry of Health. (2014). Kenya Health Policy 2014-2030: Towards attaining the highest standards of health. Nairobi. Republic of Kenya.

Ministry of Health. (2018). Ministry of Health Guidelines and Standard Operating Procedures for County Level Health Sector Annual Work Planning and Annual Performance Review Processes. Ministry of Health. https://cog.go.ke/health-committee

Ministry of Health. (2020). National and County Health Budget Analysis, FY 2019/20. Nairobi: Republic of Kenya.

Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. European journal of general practice, 24(1), 9-18. https://doi.org/10.1080/13814788.2017.1375091 DOI: https://doi.org/10.1080/13814788.2017.1375091

Nabyonga-Orem, J. (2017). Monitoring Sustainable Development Goal 3: how ready are the health information systems in low-income and middle-income countries?. BMJ global health, 2(4), e000433. https://doi.org/10.1136/bmjgh-2017-000433 DOI: https://doi.org/10.1136/bmjgh-2017-000433

Seixas, B. V., Dionne, F., & Mitton, C. (2021). Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks. Health Economics Review, 11(1), 1-11. https://doi.org/10.1186/s13561-020-00300-0. DOI: https://doi.org/10.1186/s13561-020-00300-0

Shiferaw, A. M., Zegeye, D. T., Assefa, S., & Yenit, M. K. (2017). Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. BMC medical informatics and decision making, 17(1), 1-9. https://doi.org/10.1186/s12911-017-0509-2 DOI: https://doi.org/10.1186/s12911-017-0509-2

Taherdoost, H. (2016). Validity and reliability of the research instrument

how to test the validation of a questionnaire/survey in a research. How to test the validation of a questionnaire/survey in a research (August 10, 2016). http://dx.doi.org/10.2139/ssrn.3205040

https://doi.org/10.2139/ssrn.3205040 DOI: https://doi.org/10.2139/ssrn.3205040

Tsofa, B., Molyneux, S., & Goodman, C. (2016). Health sector operational planning and budgeting processes in Kenya-"never the twain shall meet". The International journal of health planning and management, 31(3), 260-276. https://doi.org/10.1002/hpm.2286 DOI: https://doi.org/10.1002/hpm.2286

Waithaka, D., Tsofa, B., Kabia, E., & Barasa, E. (2018). Describing and evaluating healthcare priority setting practices at the county level in Kenya. The International journal of health planning and management, 33(3), e733-e750. https://doi.org/10.1002/hpm.2527 DOI: https://doi.org/10.1002/hpm.2527

Wickremasinghe, D., Hashmi, I. E., Schellenberg, J., & Avan, B. I. (2016). District decision-making for health in low-income settings: a systematic literature review. Health Policy and Planning, 31(suppl_2), ii12-ii24. https://doi.org/10.1093/heapol/czv124 DOI: https://doi.org/10.1093/heapol/czv124

World Health Organization. (1987). Report of the Interregional Meeting on Strengthening District Health Systems Based on Primary Health Care, Harare, Zimbabwe, 3 to 7 August 1987 (No. WHO/SHS/DHS/87.13, Corr. 1, Rev. 1. Unpublished). World Health Organization.

World Health Organization. (2007). Everybody's business--strengthening health systems to improve health outcomes: WHO's framework for action. World Health Organization.

World Health Organization. (2008). Health Metrics Network: Framework and standards for country health information systems. Geneva: World Health Organization.

World Health Organization. (2013). Service availability and readiness assessment (SARA): an annual monitoring system for service delivery: reference manual (No. WHO/HIS/HSI/RME/2013/1). World Health Organization.

World Health Organization. (2016). Strategizing national health in the 21st century: a handbook. World Health Organization. https://doi.org/10.1007/978-3-319-08467-1_3 DOI: https://doi.org/10.1007/978-3-319-08467-1_3