The National Department of Health is the executive department of the South African government which is assigned to the national health issues of the country. This research was however aimed specifically on the budgeting process within the Eastern Cape Provincial Department of Health. This was provisioned by assessing the significance of the budgeting system and its correlation to efficient and effective healthcare service delivery. The aim of the research was to highlight on how policies have an effect on the budgeting system at the provincial level, considering the provincial health department is responsible for the provision of publicly funded health services. This research assessed the budgeting system in the Eastern Cape Department of Health in an attempt to propagate effective and efficient health service delivery for the general citizenry. This was a qualitative study design which harnessed the merits of secondary data as the main code of the research design which enabled the comprehension of the budgeting system in the Eastern Cape Department of Health. Data was analysed using thematic analysis to examine the distinctive themes and sub-themes identified from within the reviewed literature. The Eastern Cape Province is succumbing to insufficient funding at provincial level and this has a clear-cut reflection on the administration of services within respective departments, particularly the Health Department. This is despite the fact that the Public Finance Management Act, 1999 promotes the objectives of good financial management aimed at maximizing service delivery through the effective use of the limited resources. Resultantly it was fundamental to comprehend on the issues underpinning the scope of budget reporting as well as budget accountability and the effect it has on service delivery in the Eastern Cape Department of Health. 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.