Table 3. Themes and subthemes of challenges and issues related to HB.

Budgeting Phase	Theme	Subtheme	Code Frequency
Budget Formulation and Approvement	Inappropriate budget structure	·Existence of a traditional budgeting model (not using modern budgeting models such as activity-based budgeting) ·Inappropriate techniques for expenditure estimation ·Lack of budget prioritization ·Poor and unclear connection between development plans and other upstream documents and the annual budgets ·Absence of comprehensive and intersectoral overview in budgeting ·Shortage of specialized and trained staff needed to change the budget structure ·Complex, costly, and time-consuming processes of budget preparedness and approvement	245
	Conflicts of interest and infringement	·Existence of conflict of interest between budgeting officials and authorities ·Predominance of lobbying and bargaining culture in preparing the budget ·Existence of financial and structural corruption ·Lack of responsibility and accountability of the government and officials ·Absence of consensus to reform/modify the budgeting model ·Deficiency of actual participation of all stakeholders, especially from the health sector ·Non- or incomplete implementation of some laws and regulations ·Lack of knowledge and scientific attitude to budgeting and new methods among decision-makers and top managers	192
	Lack of financial sustainability	·Unrealistic and unscientific estimations of resources and expenses ·Obscurity of exact sources of funds in the annual budgets ·Instability conditions and the unpleasant economic situation ·Failure to calculate the standard costs instead of the actual costs ·Dependency highly on the government's financial resources due to the sale of capital assets, such as oil	151
	Lack of transparency	·Multiple funding flows and streams ·Numerous budget lines for programs and organizations ·Multitudinous responsible and interruptible institutions in this phase ·Absence of an integrated and comprehensive information system to access accurate and required data ·Diverse enormous laws and legal documents ·Lack of transparency in some law and regulation content ·Prolonged process of drafting and approving the budget	211
Budget Execution	Non-executable approved budget	·Budget deficit caused by unrealistic approval of resources and expenses (obligations over credit) ·Absence of budget prioritization at a fiscal deficit ·Inflation and other macroeconomic issues ·Unrealistic program budgeting ·Interference of processes during the formulation of the budget	127
	Complicated allocation processes	·Innumerable program and budgetary rules at the execution phase ·Prominent role of the treasury and other organization institutions at the high level in the allocation process ·Rigidity in/between some budget lines ·Bargaining during the budget allocation process, especially in a cash shortage ·Delay in fund release and sectional or quarterly releases ·Acting without regard to the approved budget,especially chancellors of MUs ·Multiple allocations to a program or an institution ·Financial corruption in spending resources ·Absence of an integrated information system for budget allocation	219
	Ineffectiveness allocation funds	·Inappropriate spending of dedicated revenues of service providers and MUs ·Waste of resources via construction plans in the conditions of delay in allocations and cash deficit ·High share of salary and pension and prioritizing it ·Inefficient payment methods to providers ·Spent the allocated budget on unnecessary actions, especially at the end of the fiscal year ·Lack of accountability of relevant officials and managers for the fiscal resource preservation	134
Budget Monitoring, Reporting, and Evaluation	Fragmentation of MR&E processes	·Interference of responsibilities between numerous responsible institutions ·Lack of direct access to data by audit bodies ·Numerous rules and regulations for monitoring and supervision ·Absence of intersectoral collaboration in supervision ·Lack of comprehensive and integrated reporting system ·Need comprehensive supervisory design at the macro level to estimate the number and kind of expertise required	106
	Ineffective monitoring and evaluation	·Absence of performance and outputs monitoring and supervising ·Use of inappropriate evaluation methods ·Not define acceptable metrics and measures for budget monitoring ·Weakness of knowledge and expertise of suitable supervisory methods in responsible bodies ·Lack of specialty knowledge of inspectors from the supervised areas ·Lack of valid and comprehensive data registration system ·Time-consuming preparation of reports due to no access to information ·Lack of precise performance data ·Lack of preventive approach in budget supervision ·Mismatch of the supervision levels with the responsible supervisory bodies ·Lack of responsibility and accountability from supervisory institutions (absence of authority to monitor their performance) ·Inadequacy of the organizational structures of audit institutions to carry out efficient supervision	227
	Weak evaluation and audit platform	·Unclear relation between the spending of resources and achieving goals in NDPs and other upstream documents ·No defining standard audit and evaluation criteria during budget formulation and allocation phases ·Failure to record sufficient data or inadequate data quality from of budget execution phase	128
	Inadequate transparency	·Public's Inappropriate access to budget and audit reports ·Complex reporting and its procedures about how funds were spent and their results ·Irregular publication of budgetary reports	68