Abstract
This chapter examines the budgeting and management issues in health sectors of Nigeria, Kenya, and Tanzania, relating to their goal of achieving universal health coverage (UHC) by 2030. Highlighting the World Health Organization’s 2010 report, it points out financial inefficiencies accounting for 30–40% of health spending, which obstruct progress towards the Sustainable Development Goal (SDG) target 3.8. It identifies key obstacles including poor planning, corruption, inadequate skills, weak governance, and lack of social accountability. The text evaluates the effectiveness of budgeting tools and guidance provided by international organizations like the World Bank and WHO, finding them insufficient for national advancement. It discusses the benefits and limitations of budget reforms, such as Public Expenditure Reviews (PERs) and Medium-Term Expenditure Frameworks (MTEF), emphasizing the importance of participatory and transparent practices. It notes political interference as a significant barrier to aligning health policies with resource allocation. Concluding, the chapter advocates for program-based budgeting reforms to enhance health spending alignment with sector priorities, flexibility in fund usage, and transparency. It suggests capacity building, improved community engagement, open government collaboration, and evidence-based practices as ways to advance towards UHC. These reforms are seen as critical for fostering transparent, high-quality budget management in the health sector.
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