The objective of this study was to examine the influence of process alignment on organizational performance in public health facilities in Busia County, Kenya. The study aimed to investigate the relationship between process alignment and organizational performance, and to identify the key factors that affect process alignment in public health facilities. The study employed a mixed approach, combining descriptive and explanatory research designs. A total of 312 respondents were targeted, representing approximately 19.6% of the target population of 1,590 personnel involved in strategic planning, implementation, and oversight of public health facilities in Busia County. The data collection instrument was a structured questionnaire designed to collect quantitative data about strategic alignment practices and organizational performance. The study found that process alignment has a significant positive influence on organizational performance in public health facilities in Busia County, Kenya. The results show that process alignment explains 48.7% of the variance in organizational performance, indicating a strong positive relationship between the two variables. The study also found that clear roles and responsibilities, process measures aligned with strategy, and continuous improvement culture are the key factors that affect process alignment in public health facilities. The study concludes that process alignment is a critical factor in achieving organizational performance in public health facilities in Busia County, Kenya. The study recommends that healthcare managers and policymakers prioritize process improvement and alignment initiatives, focusing on areas such as cross-departmental collaboration, regular process reviews, and continuous improvement culture. The study's findings have implications for healthcare management practices, suggesting that investments in process improvement and alignment initiatives can yield significant returns in terms of organizational effec