The National Government will periodically release funds to the county governments. The amount of funding per county depends on several factors: population, poverty index, land area, basic equal share, and fiscal responsibility. The release of funds from the national government will depend on whether a county has prepared an integrated development plan with the Commission on Revenue Allocation setting the payment formula (Government of Kenya, 2016).

Before the disbursement process, the Ministry of Finance sets 3-year budget ceilings for each sector rather than each sector submitting a budget request based on actual needs. This is done through the Budget Review and Outlook Paper or the County Budget Review and Outlook Paper which is released in September and must be approved by the Cabinet and legislative assembly at each level of government (Ministry of Health, 2016b). The Ministry of Health (MoH) then disburses the funds through the county health Management Boards in each County (Nyakundi et al., 2011) and this depends on the population, poverty levels, land share etc.

The process of budget allocation to the specific sectors in counties is the same as at the national level where the county communicates to the various sectors the budget ceilings. National and county health departments determine how their budget is distributed to programs, but they are not allowed by the law to transfer funds between approved projects and recurrent allocations. They can shape the allocations in an efficient way while prioritizing cost-effective and efficient programmes (Ministry of Health, 2016b). Although, it is important to note that each county department of health decides using their own criteria or formula on how health services should be distributed. There is little information on how finances for health services should be distributed within specific departments. Each county department of health decides using their own criteria or formula on how health services should be distributed (Otieno, 2016). However, ministries and departments are required to prioritize allocations towards the achievement of “Big Four Plan”. The sector working groups then conduct a thorough review of the proposed budgets to ensure that they are not only directed towards improving productivity but also in achieving the “Big Four Plan” agenda. This is done by establishing resources required for different programmes and projects and the level of provision are within the ceilings provided by the sector working groups (Republic of Kenya, 2018a).

References:

Government of Kenya, E. of the K. N. (2016). Kenyan Healthcare Sector. Kenyan Healthcare Sector, 86.

Ministry of Health. (2016b). National and county health budget analysis FY 2016/17. Nairobi, Kenya. http://www.healthpolicyplus.com/ns/pubs/6138-6239_FINALNationalandCountyHealthBudgetAnalysis.pdf

Nyakundi, C. K., Teti, C., Akimala, H., Njoya, E., Brucker, M., Nderitu, R., & Changwony, J. (2011). Health Financing in Kenya: The case of RH/FP. Nairobi, Kenya. https://silo.tips/download/kenya-health-financing-in-t-h-e-c-a-s-e-o-f-r-h-f-p

Otieno, M. (2016). Resource allocation to health sector at the county level and implications for equity, a case study of Baringo county. University of Nairobi. http://erepository.uonbi.ac.ke/handle/11295/98703

Republic of Kenya. (2018a). Guidelines for the preparation of the medium-term budget for the period 2019/20 -2021/22. Nairobi, Kenya.