Reforms to make budgeting more transparent and accountable
try to relate expenditures to objectives, seeking to make
budgeting more rational (Lewis 1952; Wildavsky 1978). Recent
public finance reforms, such as the Medium Term Expenditure
Framework (MTEF) and performance-based budgeting (PBB)
fall within the paradigm of rational budgeting (Radin 1998;
Schiavo-Campo and Tommasi 1999), and are currently being
implemented in dozens of countries (Schiavo-Campo 2008). The
success of public budgeting reforms also has implications for
health systems strengthening (World Health Organization
2007). If successful, budget reform could help improve health
sector governance, strengthening the capacity of governments
to implement health policies efficiently and fairly and achieve
better outcomes (Veenstra and Lomas 1999; Siddiqi et al. 2009).
Therefore, the study of how public budget reforms actually
work in the health sector is of critical importance