Vol.5 No. 1 (2025) [e- 2504] MANAGEMENT- Advanced Journal © E-ISSN:3028-9408 https://gestiones.pe/index.php/revista Research of Advanced Studies
Perceptions of budget execution in the management of public health services
(Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos)
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Preserved in ZenodoDOI: https://doi.org/10.5281/zenodo.15096795 The authors are responsible for the information in the article.
Perceptions of budget execution in the management of public health services
Maria Jesus Torres Paredes 1 Doris Juro Saavedra1 Carmen del Pilar Ramos Cortegana2
1 César Vallejo University, Graduate School, Peru
2 Technological University of Peru
*Contact for correspondence: mtorrespar@ucvvirtual.edu.pe
Received: 01/28/2025 Accepted: 02/26/2025 Published: 03/27/2025
Abstract: Public health management faces challenges in budget execution, affecting the quality and coverage of services due
to poor management. Objective: To understand public workers' perceptions of budget execution in public health budget
management. Method: A mixed approach was used to assess the perceptions of workers with at least three months of
experience in public health management; dimensions of budget management were assessed . Results: Maximum and
minimum percentages in the budget execution of Health Services were identified to overcome deficiencies such as lack of
awareness of regulations, mismatches between expenses and goals, and payment failures, which affect effectiveness.
Conclusions/contribution: Understanding public workers' perceptions of budget execution (by dimensions) in public health
budget management will provide arguments for optimizing financial resources.
Keywords: Perceptions, budget execution, Management, Services, Public health
Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos
Resumen: La gestión pública de salud enfrenta desafíos en la ejecución de presupuestos, afectando la calidad y cobertura
de los servicios debido a deficientes gestiones. Objetivo: Conocer las percepciones de los trabajadores públicos sobre la
ejecución presupuestal de la gestión presupuestaria de la Salud pública. Método: Enfoque mixto, para percepción de
trabajadores con mínimo tres meses laborando en gestión pública de salud; se evaluaron dimensiones de la gestión
presupuestaria. Resultados: Se identificaron porcentajes máximos y mínimos en la ejecución presupuestal de Servicios de
Salud para superar deficiencias como desconocimiento de normativas, desajustes entre gastos, metas y fallos en pagos,
afectando la eficacia. Conclusiones/aporte: Conocer las percepciones de los trabajadores públicos sobre la ejecución
presupuestal (por dimensiones) de la gestión presupuestaria de la Salud pública permitirá argumentos para optimizar recursos
financieros.
Palabras clave: Percepciones, ejecución presupuestal, Gestión, Servicios, Salud pública
Percepção da execução orçamentária na gestão dos serviços de saúde pública
Resumo: A gestão da saúde pública enfrenta desafios na execução orçamentária, afetando a qualidade e a cobertura dos
serviços devido à má gestão. Objetivo: Determinar as percepções dos funcionários públicos sobre a execução orçamentária
na gestão do orçamento da saúde pública. Método: Abordagem mista, para a percepção dos trabalhadores com pelo menos
três meses de trabalho na gestão da saúde pública; foram avaliadas as dimensões da gestão orçamentária. Resultados:
Foram identificados percentuais máximos e mínimos na execução orçamentária dos serviços de saúde para superar
deficiências como desconhecimento das normas, descompasso entre despesas, metas e falhas nos pagamentos, afetando a
eficiência. Conclusões/contribuição: Conhecer as percepções dos funcionários públicos sobre a execução orçamentária
(por dimensões) da gestão orçamentária da saúde pública fornecerá argumentos para otimizar os recursos financeiros.
Palabras clave : Percepções; Execução orçamentária; Gestão; Serviços; Saúde pública.
Perception de l'exécution du budget dans la gestion des services de santé publique
Résumé : La gestion de la santé publique est confrontée à des défis en matière d'exécution du budget, ce qui affecte la qualité
et la couverture des services en raison d'une mauvaise gestion. Objectif : déterminer la perception qu'ont les agents publics
de l'exécution du budget dans le cadre de la gestion du budget de la santé publique. Méthode : approche mixte, pour la
perception des travailleurs ayant travaillé au moins trois mois dans la gestion de la santé publique ; les dimensions de la
gestion budgétaire ont été évaluées. Résultats : des pourcentages maximums et minimums ont été identifiés dans l'exécution
du budget des services de santé afin de surmonter les déficiences telles que le manque de connaissance des réglementations,
l'inadéquation entre les dépenses, les objectifs et les défauts de paiement, ce qui affecte l'efficacité.
Conclusions/contribution : Connaître les perceptions des agents publics sur l'exécution du budget (par dimensions) de la
gestion du budget de la santé publique fournira des arguments pour optimiser les ressources financières.
Mots-clés: Perceptions ; Exécution budgétaire ; Gestion ; Services ; Santé publique.
Vol.5 No. 1 (2025) [e- 2504] MANAGEMENT- Advanced Journal © E-ISSN:3028-9408 https://gestiones.pe/index.php/revista Research of Advanced Studies
Perceptions of budget execution in the management of public health services
(Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos)
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1. Introduction
The public management of health services faces significant challenges in the allocation and
execution of budgets, which directly affects the quality and efficiency of the services provided to
the population.
1.1. Contextualization of the problem
Various studies indicate that inefficient allocation of financial resources and poor budget planning
can generate a series of problems in public management. This not only affects institutions' ability
to meet their objectives but also reduces the quality of the services provided, resulting in
disadvantages for public health. Process management emerges as a strategic solution to address
these problems, allowing institutions to analyze and optimize their internal processes, facilitating
improvements in the quality of services.
1.2. Some research:
López Regalado et al. (2023) : This work highlights the importance of leadership and personnel
management in sports activities for students' mental health. The research demonstrates how
effective management can improve both the mental well-being and performance of participants,
which is essential for optimizing the use of resources and promoting public health in a
comprehensive manner.
This thoughtful analysis of educational infrastructure management and investment for health
emergency prevention provides valuable lessons for public health management. Multifunctional
approaches to infrastructure can optimize resources and improve emergency response, which is
essential for budget management in the health sector (Gonzales Ttito et al., 2023).
Research on strategic planning and process management applied to sports activities shows how
these approaches can contribute to improving public services. This type of planning can also be
adapted to the public health context to optimize budget execution and ensure service quality
(Ramos-Moreno & Torres Paredes, 2023).
The analysis of budget compliance and the psychomotor management of hospital staff during the
pandemic highlights the importance of efficient budget management, especially in times of crisis.
This management also has a direct impact on the quality of services provided to the population
(Vargas Montejo & Salas Sánchez, 2023).
Vol.5 No. 1 (2025) [e- 2504] MANAGEMENT- Advanced Journal © E-ISSN:3028-9408 https://gestiones.pe/index.php/revista Research of Advanced Studies
Perceptions of budget execution in the management of public health services
(Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos)
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Likewise , understanding digital competencies is being used as a tool to improve post-COVID-19
educational processes. Applying this type of digital competencies in public health management
can help improve efficiency in budget management and service delivery (Aguilar Chávez et al.,
2023); The importance of collaborative strategic planning highlights the importance of the
participation of all stakeholders in decision-making. In the context of public health, similar
planning could be key to optimizing the use of resources and ensuring the effectiveness of
interventions (Galindo Caro et al., 2019).
In line with the information presented, the following research objective is to understand budget
execution in the context of public health services from the perception of public health institution
workers for a possible design of a strategic model that efficiently uses available resources.
2. Methodology
2.2. Population and sample: The study population consisted of 55 public health sector workers
, both permanent and contracted , with more than three months of experience in public health
management. The sample was intentionally selected, comprising 55 workers with direct
knowledge of the internal processes of public health institutions and budget execution.
2.3. Variable
The main variable in this study was budget execution : The process of planning, allocation and
control of financial resources in public health institutions.
2.4. Data collection instruments. The following instruments were used to collect data, using a
survey : A questionnaire containing 21 questions on budget execution was administered , using a
Likert-type ordinal scale to determine opinions on the efficient use of resources.
Validity and reliability: The instruments were validated by a panel of experts in the areas of public
administration and health, obtaining a validity of 0.91 . The reliability of the questionnaires was
measured using Cronbach's alpha .
2.5. Study phases. The research procedure was divided into two key phases:
2.5.1. Diagnostic Phase : In this phase, the current budget execution situation was analyzed , and
the main problems and challenges in resource management were identified. Data were collected
through interviews, surveys, and review of key documents, which provided a deep understanding
of the barriers and opportunities for improving efficiency.
2.5.2. Propositional Phase : In this phase, a process-based management model was designed to
optimize budget execution. This model was formulated taking into account the findings of the
diagnostic phase and best practices in public management. The proposed model was validated by
a group of experts in public health management, who provided feedback to improve its
applicability.
2.6. Data analysis: Data were processed using SPSS Version 24 software , performing both
descriptive and inferential analyses . The descriptive analyses allowed for an understanding of
general trends in participants' responses, while the inferential analyses helped identify
relationships between process management variables and budget execution .
2.7. Ethical aspects: The research was conducted in compliance with the ethical principles
established by the World Medical Association in the Declaration of Helsinki . Participation was
Vol.5 No. 1 (2025) [e- 2504] MANAGEMENT- Advanced Journal © E-ISSN:3028-9408 https://gestiones.pe/index.php/revista Research of Advanced Studies
Perceptions of budget execution in the management of public health services
(Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos)
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guaranteed to be completely voluntary , participant confidentiality was respected, and their rights
were protected throughout the research process.
3. Results
The results have been summarized in the following table:
Table 1. Characteristics of Budget Execution for each dimension
Never
Hardly
ever
Sometimes
Almost
always
Always
Total
Fi
%
fi
%
fi
%
fi
%
fi
%
fi
%
Dimension 1: Certification
He is informed about the current
regulations governing the execution of
the budget.
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
How often is it ensured that the available
budget credit is free of impact before
committing an expenditure?
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
Believes that requests for budget credit
certification are made in a timely manner
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
Considers that the area in charge
requests budget availability with the
necessary technical support
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
He believes that the Budget Office
issues the budget credit certification
within the established timeframes
according to current regulations and
guidelines.
7
12.7%
10
18.2%
11
20.0%
19
34.5%
8
14.5%
55
100%
Dimension 2: Commitment
You perceive if the expense
commitments are affected by each
activity scheduled in each goal
3
5.5%
25
45.5%
10
18.2%
13
23.6%
4
7.3%
55
100%
To what extent do you consider that the
allocation of the annual commitment
programming by the Document follows
the guidelines established by the
Ministry of Economy and Finance -MEF?
4
7.3%
22
40.0%
14
25.5%
7
12.7%
8
14.5%
55
100%
How regularly do you consider that the
OGESS Alto Mayo prioritizes the Annual
Commitment Programming in
accordance with the Annual
Procurement Plan (PAC)?
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
Every expense, before being committed,
is verified to have the corresponding
commitment schedule.
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
How often do you find the monthly
commitment phase is carried out
efficiently?
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
The authorization provided by the
Administration Office is evaluated in the
monthly commitment phase.
15
27.3%
6
10.9%
11
20.0%
23
41.8%
0
0%
55
100%
Dimension 3: Accrued
Vol.5 No. 1 (2025) [e- 2504] MANAGEMENT- Advanced Journal © E-ISSN:3028-9408 https://gestiones.pe/index.php/revista Research of Advanced Studies
Perceptions of budget execution in the management of public health services
(Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos)
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Never
Hardly
ever
Sometimes
Almost
always
Always
Total
Fi
%
fi
%
fi
%
fi
%
fi
%
fi
%
The user area, after receiving the goods
or services, grants the confirmation of
receipt in a timely manner.
4
7.3%
22
40.0%
14
25.5%
7
12.7%
8
14.5%
55
100%
Know that the user area, after receiving
the contracted services, grants
conformity of the service after verifying
the terms of reference.
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
How often is compliance with the criteria
established for the recognition of
accruals in your entity ensured?
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
How frequently is it verified that the
recognition of accrual is adequately
allocated to the corresponding
institutional budget?
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
It is verified that all committed expenses
are accrued
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
Dimension 4: Payment or Drawn
The treasury office reviews that all
accrued expenses have supporting
documentation.
7
12.7%
10
18.2%
11
20.0%
19
34.5%
8
14.5%
55
100%
It is the treasury office that proceeds to
enter the payment obligations into the
SIAF
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
The treasury office makes payments
only through your supplier or contractor's
interbank account.
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
Suppliers confidently accept payment
through the interbank system
10
18.2%
12
21.8%
15
27.3%
14
25.5%
4
7.3%
55
100%
The user areas request the release of
the budget credit certification, as there is
an expenditure execution less than the
certified amount.
4
7.3%
15
27.3%
18
32.7%
18
32.7%
0
0%
55
100%
Note: Questionnaire applied to workers in public health management offices
Interpretation of Table 1 :
Dimension 1: Certification
The results reveal a marked disconnect between workers and their knowledge of current
regulations. Only 7.3% of respondents claim to be "always" informed about budget regulations,
while 27.3% acknowledge that they "sometimes" ensure that budget allocations are free of impact
before committing expenditures. This reflects a critical gap in institutional communication and
technical training. The lack of clarity in certification processes, coupled with observed delays
(only 14.5% perceive that the Budget Office meets established deadlines), suggests that
bureaucratic rigidity and the lack of timely updates could be hindering operational efficiency.
These findings underscore the need to implement agile dissemination systems and ongoing
training programs to ensure that staff not only understand the regulations but also internalize
them in their daily practices.
Dimension 2: Commitment
The alignment between spending commitments and institutional goals presents significant
challenges. Forty-five percent of respondents indicated that expenditures are "almost never"
Vol.5 No. 1 (2025) [e- 2504] MANAGEMENT- Advanced Journal © E-ISSN:3028-9408 https://gestiones.pe/index.php/revista Research of Advanced Studies
Perceptions of budget execution in the management of public health services
(Percepción de la ejecución presupuestaria en la gestión de los servicios sanitarios públicos)
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adequately linked to planned activities, and 40% perceived that annual programming does not
follow MEF guidelines. This points to a lack of strategic coordination between planning and
execution, which could lead to under-execution or misappropriation of resources. Furthermore,
32.7% considered that the monthly commitment phase is "sometimes" carried out efficiently,
highlighting the need to strengthen real-time monitoring and adjustment mechanisms. The
heterogeneity in responses regarding authorization evaluation (41.8% "almost always") suggests
that, while specific efforts exist, they are not systematic. To mitigate these problems, it would be
key to adopt management tools that prioritize traceability and accountability at every stage of the
budget cycle.
Dimension 3: Accrued
The timely compliance of received goods and services emerges as a critical issue: 40% of
respondents indicate that the user department "almost never" grants receipt on time. This delay
not only delays the recognition of accruals but also creates bottlenecks in the payment chain.
Furthermore, no participant states that the criteria for accrual recognition are "always" met,
evidencing weaknesses in internal controls and possibly in process standardization. The
discrepancy between committed and accrued expenses (32.7% "almost always" verify that all
committed expenses are accrued) reflects an operational risk that could compromise
transparency and supplier trust. To address these weaknesses, it is recommended to implement
clear verification protocols and specific training in contract management and regulatory
compliance.
Dimension 4: Payment or Drawn
Payment processes show a worrying duality. While 34.5% believe that the treasury "almost
always" reviews supporting documentation , 27.3% indicate that payments are "almost never"
made exclusively through interbank channels, increasing the risk of embezzlement or errors.
Suppliers' distrust of the interbank system (18.2% "never" trust it) exacerbates this situation,
suggesting the need to strengthen transparency and communication with external stakeholders.
Furthermore, the absence of responses in the "always" category for the release of budget credits
(32.7% "almost always") reflects reactive rather than preventive management. To optimize this
dimension, it would be strategic to integrate real-time monitoring technologies and establish
partnerships with financial institutions that guarantee transaction security.
Each dimension analyzed reveals a network of challenges that, although distinct, converge on a
common denominator: the need for more integrated, transparent, and capable budget
management. Implementing the model proposed in the article will require not only technical
adjustments but also a cultural shift that prioritizes inter-agency collaboration and accountability.
Public health, as the cornerstone of social well-being, deserves financial management that reflects
both rigor and humanity in its execution.
4. Discussion
Furthermore, budget management in the public sector presents particular challenges, such as
inefficient resource allocation, rigid administrative procedures, and a lack of flexibility to adapt to
unexpected changes. (8) In the authors' view, these challenges require an integrated approach that
not only considers process optimization but also the adaptability of the organizational structure
in the face of a dynamic environment.
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Perceptions of budget execution in the management of public health services
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,
Furthermore, the Ministry of Economy and Finance (MEF, 2024) analyzes budget execution, a vital
process for public management, linking theories such as budget execution and punctuated
equilibrium. It highlights the importance of transparency, institutional commitment, and
oversight during budget execution, emphasizing the need for adequate monitoring to ensure
compliance with deadlines and project quality.
Artificial intelligence applied to competency-based university curriculum management can offer
an interesting parallel in public health process management. The integration of technologies into
the planning and execution of health budgets can improve the efficiency of public administration
(Moreno Muro et al., 2023).
The impact of communications from educational institutions and local governments highlights the
importance of strategic communication in public management. This approach can be key to
improving citizen participation and resource allocation in the health sector (Rosales Urbano et al.,
2023).
The budget allocated to public health is crucial to ensuring the well-being of the population.
Barrenechea and Encinas (2022) highlight the importance of democracy in Peru, which can
influence key decisions about resource distribution. Regarding the multifaceted crisis and its
effects on health, Roberts (2023) points out that economic hardship increases the challenges for
health systems. Villar et al. (2024) analyze how the economic system can influence health
outcomes, as happened in Peru during the pandemic. Furthermore, the commodification of health,
discussed by Brito and Bardález (2023), reflects how privatization can distort access to care.
Emergency Decree No. 012-2020 (Peru, 2021) demonstrated the state response to the crisis, while
the WHO (2010) underscores the importance of adequate financing to achieve universal coverage.
Finally, the public budget for 2024 (Ministry of Economy and Finance, 2023) will be key to
addressing these challenges.
Innovative strategies to improve institutional image have significant implications for the
management of public services. Improving the image of health institutions can generate public
trust and facilitate budget execution in the sector (Silva Herrera et al., 2023).
The 2018 study on nursing staff motivation and job performance offers lessons on how to manage
staff in public health. Effective staff performance is critical to ensuring that resources are used
efficiently and public health goals are achieved (Romero Mestanza, 2023), and results-based
strategic planning for emotional well-being shows how results-oriented management can
contribute to the success of public health programs. In the health context, similar planning could
improve budget efficiency and ensure better outcomes (Sáenz Avila et al., 2023).
Also with respect to Public Health Services Management, according to
of the Faculty of Medicine
The study of perceptions about budget execution in the management of public health services is
crucial to understanding the dynamics and challenges facing health systems. The proper
allocation and use of resources directly influences the efficiency and quality of care and is a key
area of evaluation in public policies.
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The perceptions of health professionals and managers can offer valuable information on possible
improvements in budget planning and execution, as indicated by :
Sánchez, M., & Pérez, J. (2022) also analyzed how the allocation and execution of health budgets
affect the quality of services in several Latin American countries. The authors suggest that proper
budget management is essential to achieving universal health coverage and improving efficiency
in service delivery. They conclude that health workers' perceptions of available resources directly
influence health system outcomes.
García, F., & Mendoza, T. (2022) examined public hospital managers' perceptions regarding
budget execution, highlighting the difficulties in aligning available funds with hospitals' actual
needs. The authors observe that a lack of transparency in resource allocation and insufficient
budgets are constant challenges that affect the quality of public health services.
López , R., & Martínez, L. (2022) focused on the relationship between the perception of financial
resources and the effectiveness of public health services. The authors conclude that health
professionals' perceptions of budget allocation impact their motivation and performance, which
in turn affects the quality of the service provided. Adequate budget management and the active
participation of professionals in decision-making are key to improving health outcomes.
The study's results show that workers' perceptions of public health budget execution are
intrinsically linked to structural challenges. For example, the lack of regulatory awareness (only
7.3% of respondents are "always" informed) reflects a critical gap in institutional communication,
which could exacerbate inequities in access to health services ( Marmot & Friel , 2008 ). This
disconnect not only limits the effectiveness of interventions but also perpetuates inequalities,
especially in contexts where transparency is key to accountability ( Savedoff , 2010 ).
Suppliers' distrust of interbank payment systems (18.2% "never" trust) suggests systemic risks,
such as corrupt practices or embezzlement, a phenomenon widely documented in systems with
weak internal controls (Hutchinson et al., 2021). These findings are consistent with studies linking
opacity in financial management with inefficiency in service delivery ( Kruk et al., 2018). In Latin
America, where administrative rigidity often hampers crisis adaptation, the lack of alignment
between expenditures and institutional goals (45.5% "almost never" aligned) highlights the
urgency of evidence-based reforms (Frenk & Gómez-Dantés, 2019).
Furthermore, delays in confirming receipt of goods (40% are "almost never" timely) not only
affect the payment chain but also compromise the quality of services, a problem that is
exacerbated in systems with unclear price regulations (Barber et al., 2019). To advance toward
universal coverage, it is essential to link budget execution with public health indicators, as
proposed by global models that prioritize the strategic allocation of resources ( Savedoff et al.,
2012).
In short, the perceptions identified are not mere anecdotes, but indicators of structural failures
that require multifaceted interventions. Continuous training, the adoption of tracking
technologies, and citizen participation emerge as viable strategies for optimizing resources, as
suggested by international frameworks ( Kruk et al., 2018). These adjustments, aligned with
public policies focused on transparency, could transform budget management into a driver of
equity and efficiency in public health.
5. Conclusions
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The public management of healthcare services faces significant challenges in the allocation and
execution of budgets, which directly affects the quality and efficiency of the services provided to
the population. The implementation of a process-based management model to improve budget
execution in a OGESS is valid, according to experts, and will contribute to the efficient and timely
use of public spending. This model could be adopted by other similar institutions involved in
public health management.
By optimizing internal processes, it is possible to make more efficient use of financial resources,
which contributes to improved quality in the health services offered to the population. This study
provides a solid foundation for future interventions in public health management and for the
development of policies that allow for a more equitable and efficient allocation of resources in the
health sector.
6. Recommendations
6.1. In implementing process management, public managers should adopt a process management
approach to optimize budget execution, promoting efficient, results-focused public
administration. It is also crucial to map and document key processes, which would strengthen
budget execution and consistency in the use of resources.
6.2. Implement a continuous training, awareness-raising , and capacity-building program on
process management for all employees, with the aim of reducing ignorance and ensuring that staff
are aligned with regulations, institutional objectives, and public health management.
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Journal of Epidemiology & Community Health 62
Contributions of co-authors : All co-authors have contributed to this article by common
agreement and are responsible for all information in this article.
María Jesús Torres Paredes: Conceptualization, Data Curation, Methodology
Carmen del Pilar Ramos Cortegana: Software, Supervision, Visualization
: Formal Analysis, Validation
Research funding : With own resources.
We declare no conflict of interest: The authors declare no conflict of interest that could have
influenced the results obtained or the interpretations proposed.
Informed consent statement: The study was conducted in compliance with the Code of Ethics
and Good Editorial Practices for Publication.
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