Responsibility for planning and budgeting is often dispersed among several institutions of government without any effective coordination. The situation is worsened when departments have a long-standing rivalry for political power.
The plan is often disregarded as the budget is prepared for reasons such as: (a) plans may not be sufficiently detailed to provide guidance in budgeting; (b) the budget process is often rushed and subject to many short-term pressures; (c) planners may have less influence than budgeters, because the budget is the authoritative legal document, while the plan typically does not have the force of law; (d) traditional stereotypes tend to separate "short-term" budgeters from the "long-term" planners concerned with questions over which the government has little control.
Responsibility for public health policy may be divided between government departments as well as being dependent on input from external private agencies, such as the Food and Drug Administration in the USA. When internal government departments and external agencies are too concerned with maintaining political power, public health can be endangered. An example is the failure of the American and other governments to introduce timely screening of blood banks when new viruses have been discovered.
The most obvious example of this is the tension that often exists between the ministries of finance and planning. Few countries have managed to integrate the planning and budgeting functions well. Problems of coordination can also exist between core ministries and spending agencies, whether sectoral ministries, subnational levels of government, or state-controlled enterprises. Coordination can also break down during implementation. Central ministries often react to tight budget constraints, over-programmed budgets, or simple mistrust of spending agencies by slowing the disbursement of funds or by erecting unnecessarily cumbersome procedures in areas such as procurement, land acquisition, or contractor eligibility. Such indirect forms of control delay the implementation of projects.