Examining the effect of budget deviations on provision of health services in Kilifi County

Abstract

This study examined the effect of budget deviations on the provision of healthcare services in Kilifi County, Kenya. Specifically, it sought to determine the effect of recurrent budget deviations on immunization coverage, examine the effect of County Own Source Revenue (OSR) budget deviations on outpatient department (OPD) utilization rate, and analyze the effect of capital budget deviations on the level of completion of health sector capital projects. Corresponding null hypotheses were tested at the 5% level of significance. The study was anchored on Fiscal Decentralization Theory, the Resource-Based View (RBV), and Budgetary Theory. It was conducted in Kilifi County, Kenya, using data covering the period from FY 2013/14 to FY 2022/23. A mixed-methods approach, combining quantitative and qualitative techniques, was adopted. Quantitative data were obtained from the Office of the Controller of Budget reports, Kilifi County budget documents, and the Ministry of Health, Kenya. Qualitative data were collected through Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs). Quantitative data was analyzed using descriptive and inferential statistics, specifically multiple linear regression, while qualitative data were analyzed using thematic and content analyses. The findings revealed persistent underperformance in OSR, high volatility in recurrent budget execution, and systematic under-execution of capital budgets. Regression results indicated that recurrent budget deviations have a negative and statistically significant effect on immunization coverage, while OSR deviations significantly affect both immunization coverage and OPD utilization. Capital budget deviations were found to significantly influence OPD utilization and the level of completion of capital projects, but not immunization coverage. Qualitative findings corroborated these results, highlighting challenges such as delayed fund disbursement, procurement inefficiencies, and weak project planning. The study concludes that budget execution efficiency is a key determinant of healthcare service delivery in Kilifi County. It recommends strengthening revenue mobilization, improving budget credibility and execution, enhancing procurement and project management systems, and strengthening performance-based budgeting to improve health outcomes at the subnational level. Keywords: Budget deviations; Healthcare service delivery; Immunization coverage; Outpatient department utilization; Capital project completion; County Own Source Revenue; Budget execution efficiency Kilifi County.