further within health budgets there is even less standardisation and transparency on allocation decisions improving the capacity of district hospitals and managers of district health offices in budget formulation would be an important first step to ensure their needs are better reflected in budgets and ultimately more strategic purchasing however despite good aggregate spending levels there is great disparity in the way provinces execute their budget giving health facilities greater decisionmaking power and clarifying and simplifying the delegation framework could help health facilities increase their responsiveness to changing needs during the fiscal year