Enhancing Kenya’s health system accountability through integration of financial and non-financial information

At the beginning of this year, Kenya narrowly avoided a nationwide doctors’ strike, only for clinical officers to down their tools weeks later. The recurring cycle of health worker unrest highlights a system in crisis, one where billions are spent, yet essential services remain out of reach for many. Funding and accountability are at the heart of the problem: how well do financial investments translate into actual health improvements?

A typical example illustrates this challenge: on a routine visit to a public hospital in Nairobi, a pregnant woman waits hours to receive prenatal care. Despite the billions allocated to maternal health programs, the understaffed clinic struggles to provide basic services. Meanwhile, financial reports paint a different picture, one of well-funded initiatives and absorbed budgets. How can a system absorbing vast financial resources leave its workforce in turmoil and patients without care? This disconnect is not just an inconvenience but a crisis of accountability in Kenya’s healthcare system.

The numbers tell a damning story. Despite an annual health budget exceeding an average of Ksh 115 billion, a critical measure like maternal mortality rate has barely improved. The Government of Kenya Fourth Medium Term Plan 2023 – 2027, shows a slight shift in maternal mortality from 362 to 355 deaths per 100,000 live births between 2018 and 2022. This is below the SDG target 3.1: Reducing the global maternal mortality ratio to less than 70 per 100,000 live births. Meanwhile, Kenya’s doctor-to-patient ratio remains dismally low at 1 doctor per 5,263 Kenyans, five times the WHO-recommended ratio of 1 doctor for every 1,000 people. These figures expose a harsh truth: budgets are allocated and expenditures tracked, but no precise mechanism exists to measure how these funds translate into improved health services. But how did we get here?

IDinsight conducted a study in which we reviewed policy documents, interviewed key stakeholders, and analysed Kenya’s health budget processes. We found systemic inefficiencies stemming from the lack of financial and non-financial performance data integration. Currently, financial and health performance data in Kenya exist in silos. The Kenya Health Information System (KHIS) and the Integrated Financial Management Information System (IFMIS) operate independently, with no direct interoperability. Without a system that links financial investments to actual health outcomes, the National Treasury cannot allocate resources to actual planned health outcomes. The consequence? Accountability remains elusive.

Financial planners are left in the dark, unable to determine whether the billions allocated to healthcare make a difference. Are resources being used efficiently? Are critical health programs cost-effective? Could the resources be deployed better elsewhere? They cannot answer these questions due to a lack of integrated data. Meanwhile, health officials face an uphill battle when justifying budgetary needs. Without clear performance data, they struggle to demonstrate whether increased spending translates into tangible improvements in patient care. As a result, decision-making is often based on assumptions rather than concrete evidence, perpetuating inefficiencies in a system that cannot afford them.

The problem runs deeper than just inefficiency. Kenya’s programme budgeting process primarily focuses on inputs, salaries, medical supplies, and infrastructure rather than outcomes such as lower maternal mortality rates or increased access to skilled healthcare providers. This misplaced emphasis means that even as funds are disbursed and absorbed, little accountability exists for whether they are actually improving health services.

Political influence only worsens the problem. Parliament frequently overrides strategic health spending plans, diverting funds to politically motivated projects that may have little impact on public health. Without a transparent and data-driven approach, healthcare spending continues to be shaped by political maneuvering rather than patient needs. This is Kenya’s reality.

Kenya must bridge the gap between financial planning and health performance data. The Performance-based budgeting (PBB) framework presents a viable solution. A practical starting point is achieving interoperability between KHIS and IFMIS. This would allow for real-time tracking of budget allocation at programme and sub-programme level against health outcomes. By tying funding to health outcomes, such as reducing maternal deaths, PBB incentivizes efficiency and ensures financial resources directly impact service delivery. Countries that have adopted PBB have seen improved fiscal transparency and better-targeted health investments. In Latvia, for example, performance metrics are included within budget documents as a performance scorecard for each health policy area. Each year, the results of the performance scorecard are analysed and can be used as a justification for increasing or decreasing funding during the budget formulation stage. For Kenya, this approach would mean prioritizing cost-effective interventions, such as scaling prenatal care in high-risk regions.

Fifty years from now, will we still discuss unfulfilled health promises, or will we have built a system that truly serves its people? Kenya cannot afford to treat financial and health performance data as separate entities. A fully integrated system would empower policymakers, oversight bodies, and citizens to hold health institutions accountable for spending and results. If Kenya is committed to improving health outcomes, it must ensure that every shilling spent is traceable to a measurable impact on people’s lives.