This chapter explores health budgeting and management practices in Low and Middle-Income Countries (LMICs) through case studies of Nigeria, Kenya, and Tanzania. It highlights financial inefficiencies that obstruct progress toward Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs), as identified in the World Health Organization's 2010 report. Key obstacles include poor planning, corruption, inadequate skills, weak governance, and lack of social accountability. The chapter evaluates the effectiveness of budgeting tools and reforms such as Public Expenditure Reviews (PERs) and Medium-Term Expenditure Frameworks (MTEF), emphasizing the need for participatory and transparent practices. It advocates for program-based budgeting reforms to enhance the alignment of health spending with sector priorities, flexibility in fund usage, and transparency. Recommendations include capacity building, improved community engagement, open government collaboration, and evidence-based practices as essential steps toward achieving UHC in LMICs.

Samson Oboche Agbo is a distinguished public health practitioner with over 25 years of experience improving health outcomes for children and women in Africa and globally. He excels in designing and implementing innovative, low-cost, high-impact health strategies that strengthen primary health care, build resilience in humanitarian responses, and achieve Universal Health Coverage (UHC). Agbo holds an MSc in epidemiology and a diploma in health policy and finance from the University of London, an MBA from the University of Liverpool, and an MPH and MBBS from the University of Lagos. He has served as senior health advisor for the Foreign Commonwealth and Development Office Nigeria and senior health specialist for UNICEF ESARO Kenya. His expertise includes strategic planning, project//budget management, health policy formulation, and stakeholder engagement. Agbo has led significant health programs, such as the £235 million Lafiya flagship program in Northern Nigeria, and revised immunization policies in various countries. An active member of the Royal Society of Medicine, Agbo has received numerous awards, including the SPOBA Professional Excellence Award and the Senior New Voices Fellowship. He is dedicated to leveraging his experience to support global health systems and equitable access to quality health services for all.