Financing Immunisation in Kenya: Examining bottlenecks in health sector planning and budgeting at decentralised level

Abstract Background Decentralisation has increasingly been adopted by countries as an important health sector reform with the aim of increasing community participation in decision making while enhancing swift response at decentralised levels, thereby accelerating the attainment of health system goals. Kenya adopted a devolved system of government where health services delivery became a function of the 47 semi-autonomous county governments with planning and budgeting functions practised at both levels of government. This study sought to explore challenges facing health sector planning and budgeting and how they affect immunisation service delivery at the county level. Methods Data were collected through 77 in-depth interviews of senior county department of health officials across 15 counties in Kenya. We applied an inductive thematic approach in analysing the qualitative data using NVIVO software. Findings: The study found a lack of alignment between planning and budgeting processes, with planning being more inclusive compared to budgeting. Inadequate capacity in conducting planning and budgeting and political interference were reported to hinder the processes. Delayed and untimely disbursement of funds was reported to affect execution of health and immunisation budgets. Low prioritisation of preventive health interventions like immunisation influenced resource allocation to the programs. Conclusion The findings highlight the need for effective strategies to address bottlenecks facing planning and budgeting to ensure adequate immunisation and health sector funding at the county level.