Elevating Public Health: Insights from Dr. Mercy Mwangangi, Health Economist and Analyst

In the ever-evolving landscape of public healthcare, strategic planning is not just a tool—it’s a necessity. As public health systems contend with limited resources, shifting political priorities, and the challenge of delivering equitable care, effective planning becomes a cornerstone for success. Dr. Mercy Mwangangi, a health economist and policy analyst, joined students of the MBA Healthcare Management Programme for a guest speaker session. During her session, Dr. Mwangangi offered critical insights into the nuances of strategic health planning, design, and development in the public sector.

The Core Difference: Effectiveness versus Efficiency

In the public sector, particularly in healthcare, the objective is to maximize effectiveness rather than efficiency. While private organizations focus on cutting costs and optimizing processes for maximum output, public institutions are tasked with ensuring that the services they provide meet the needs of the community—especially underserved populations. Dr. Mwangangi highlights that in government, success is measured not by how fast or how cheaply something is done, but by how impactful and accessible the health outcomes are for all citizens.

This mission-driven approach requires public health systems to navigate complexities that the private sector doesn’t face, such as balancing broad mandates with limited resources, often under stringent regulatory and legal frameworks.

Unique Characteristics of Public Sector Health Planning

Several unique features define public health planning in government institutions, setting it apart from private sector healthcare:

• The public sector mission and goals are bound by legal regulations: Public sector organizations operate under strict legal and regulatory frameworks that dictate their actions. These frameworks ensure accountability to the public but can limit flexibility and adaptability. Unlike private institutions that can pivot quickly in response to market demands, public health organizations must adhere to established laws and policies, making rapid adjustments challenging.
• Lack of competition: In the absence of competitive forces, public healthcare systems don’t face the same pressure to innovate or increase efficiency. Instead, they are often the sole providers of critical health services, which means they must rely on internal strategies to drive improvement and meet the health needs of the population.
• General Objectives: Public health policies often come with broad and sometimes unclear objectives. Where private sector goals are typically specific and measurable, public health strategies may have to address a wide range of needs—many of which are influenced by political, social, and economic factors. This lack of precision can make it difficult to implement targeted, actionable plans.
• Short-Term Planning Cycles: A common challenge in public health is the short time frames imposed by political and budgetary cycles. Even when long-term strategies are developed, the influence of elections and changing political priorities can disrupt their implementation. This constant flux can undermine the sustainability of health initiatives, as incoming governments may deprioritize existing plans in favor of new agendas.

One of the most significant constraints in public sector health planning is the reliance on annual budget cycles, which limit the ability to plan and execute long-term projects. Dr. Mwangangi emphasized the importance of the Mid-Term Expenditure Framework (MTEF) as a solution to this problem. The MTEF allows governments to extend their financial planning horizon beyond the typical one-year cycle, adopting a medium-term perspective for budgeting.

By shifting to a multi-year outlook, the MTEF ensures that critical health projects are not hampered by annual budget revisions or political shifts. It provides continuity and stability for health programs, enabling governments to align resources with strategic objectives and plan for sustainable health improvements over several years. This tool also helps to mitigate the disruptions caused by political transitions, as longer-term funding commitments ensure that essential health services remain a priority regardless of political leadership changes.

Dr. Mwangangi highlighted the critical role that strategic health planning plays in ensuring that public health systems can meet the needs of the population. With the growing complexity of healthcare demands, especially in regions where resources are scarce, governments must adopt a more sophisticated approach to planning—one that not only addresses immediate challenges but also prepares for the future. The balance between short-term solutions and long-term sustainability is delicate. Governments must ensure that pressing health issues are addressed without compromising the development of resilient health systems. This is where the MTEF and other strategic tools become invaluable, allowing public health planners to design policies and programs that are responsive, adaptive, and forward-looking.

As public health continues to evolve in an increasingly uncertain world, strategic planning will be more critical than ever. Dr. Mwangangi advocated for a mindset shift, where public health leaders prioritize effectiveness, flexibility, and long-term thinking. By addressing the unique constraints of public sector planning—such as legal mandates, lack of competition, and political cycles—governments can create more resilient health systems that deliver consistent, high-quality care to all citizens.

The implementation of frameworks like the MTEF signals a move in the right direction. It provides a roadmap for overcoming the inherent limitations of short-term budget cycles, ensuring that health programs are adequately funded and can survive political transitions.

About the MBA Healthcare Management Programme

This Programme aims to equip healthcare managers with relevant skills for leading and managing the various facets and challenges that confront professional hospital and clinic managers, managers of NGO and faith-based health providers, and professionals in the emerging insurance, pharmaceutical, biotechnology and medical device industries.

The 2025 intake is ongoing. Learn more here

Article by Juliet Hinga