An In-Depth Review of Health Sector Budget Transparency in Kenya’s Counties

Health is one of the most decentralized functions in Kenya’s dual-tier system of governance. Within this system, county governments are responsible for managing all health facilities except national referral hospitals, placing them at the point of contact between public resources and health services. Consequently, the transparency and accountability of county health budgets assume a pivotal role in guaranteeing equitable decision-making and the efficacy of service delivery, particularly within marginalized populations. The granularity present in county budget documents provides a critical perspective on governmental health strategies, reflecting the alignment between sanctioned priorities and their practical implementation.

The County Budget and Transparency Survey 2022 included a module focused on evaluating the level of health sector information provided in county budget documents. Building on this, the 2023 edition of the module seeks to further illuminate health sector budget transparency and uncover good practices from across Kenya’s 47 county governments.

Summary findings

  • On average, counties provide 56 out of 100 points of budget information on health.
  • County governments are improving how they explain their health budgets, with the average score on narrative information rising from 50 points in the previous survey to 69 points.
  • The percentage of counties that did not have their approved health budget broken down into programmes and sub- programmes fell sharply to 2% in CBTS 2023, from 23% in CBTS 2022.
  • The survey found a disparity between the kind of information provided at the programme and sub-programme level in county health budgets, with counties providing more financial than non- financial information.
  • Only six out of the 34 counties evaluated provided information on health personnel in their health budgets, with an average score of 13 out of 100 points.

Kenya’s County Budget Transparency Survey 2023 - Health Modular

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