Abstract
The main aim of this article is to explore how performance-based budgeting has an effect on primary health care service delivery in the Eastern Cape. This article assessed the performance-based budgeting system in the Eastern Cape Department of Health in an attempt to advocate for effective and efficient health service delivery. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article is premised on a constructivist paradigm that adopts a qualitative approach where document analysis was employed for collecting data. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article employed the Public Choice Theory and the Concept of New Public Management. Three main findings emerged from the article of the crippled funds in the province, the human resources crisis, poor public finance management, and shortage of health equipment. Data were analyzed using thematic analysis to examine the distinctive themes and sub-themes identified from within the reviewed literature. Recommendations were thus given based on the discussed and derived themes to ensure that there is an appropriate budgeting system to ensure efficient and effective provision of health care services in the Eastern Cape Department of Health.