guide for the institutionalization of national health accounts in

GUIDE FOR THE INSTITUTIONALIZATION OF

NATIONAL HEALTH ACCOUNTS IN THE

AFRICAN REGION

November 2021

GUIDE FOR THE INSTITUTIONALIZATION

OF NATIONAL HEALTH ACCOUNTS IN

THE AFRICAN REGION

NOVEMBER 2021



THE AFRICAN REGION

NOVEMBER 2021

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR AFRICA

BRAZZAVILLE bull 2021

Guide for the institutionalization of national health accounts in the African Region

ISBN 978-929023461-6

copy WHO Regional Office for Africa 2021

Some rights reserved This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 30 IGO licence (CC BY-NC-SA 30 IGO httpscreativecommonsorglicensesby-nc-sa30igo)

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Suggested citation Guide for the institutionalization of national health accounts in the African Region Brazzaville WHO Regional Office for Africa 2021 Licence CC BY-NC-SA 30 IGO

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Designed in Brazzaville Congo by the TIP Unit WHO Regional Office for Africa

Page | iii

CONTENTS

ACRONYMS iv

FOREWORD v

ORGANIZATION OF THIS GUIDE v i i

ACKNOWLEDGEMENTS v i i i

DEFINITIONS OF KEY TERMS ix

EXECUTIVE SUMMARY x

National Health Accounts governance capacity and funding x

Data demand and use production dissemination and translation into policies xi

1 BACKGROUND 1

2 RATIONALE SCOPE AND INTENDED AUDIENCE OF THIS GUIDE 1

21 Rationale 1

22 Scope and intended audience of this guide 2

3 FRAMEWORK FOR THE INSTITUTIONALIZATION OF N ational Health

Accounts 2

4 STEPS FOR THE INSTITUTIONALIZATION OF N ational Health Accounts 3

41 Governing ensuring capacity and financing National Health Accounts 3

42 Meeting the needs for the demand and use production and dissemination of National Health Accounts and translation of data into policies 16

43 Monitoring National Health Accounts institutionalization progress 19

44 Gantt Chart for National Health Accounts institutionalization 20

5 CONCLUSION 21

RECOMMENDED LITERATURE 22

LIST OF TABLES

Table 1 Illustrative list of stakeholders in the health sector in African countries 6

Table 2 Country leadership for National Health Accounts in Africa 9

Table 3 Planning for National Health Accounts governance capacity and financing 11

Table 4 Meeting National Health Accountsneeds in terms of institutionalization 12

Table 5 Situation analysis results and resources needed 13

Table 6 Analysis of potential National Health Accounts hosts for sustainability 16

Table 7 Assessing country status on the demand and use of National Health Accounts 17

Table 8 Assessing country status on data production 18

Table 9 Assessment country National Health Accounts dissemination data translation 19

Table 10 Progress indicators towards National Health Accounts institutionalization 20

Table 11 Gantt chart for National Health Accounts institutionalization 21

Page | iv

ACRONYMS

EMR electronic medical records

HMIS health management information systems

IFMIS integrated financial management systems

IMF International Monetary Fund

MoH ministry of health

NHA national health accounts

SDGs Sustainable Development Goals

SIDA Swedish International Development Agency

UHC universal health coverage

UNAIDS Joint United Nations Programme on HIVAIDS

UNDP United Nations Development Programme

UNFPA United Nations Population Fund

UNICEF United Nations Childrenrsquos Fund

USAID United States Agency for International Development

WHO World Health Organization

Page | v

FOREWORD

The World Health Organizationrsquos (WHO) mission is to work for better health for everyone To

that end the WHO Regional Office for Africa translates this complex global mission into goals

and activities that require considerable resources at both regional and country levels Given

that resources are ever limited smart investments with enhanced value are required for

decision-making Smart decisions need answers to key questions on health expenditure Who

is financing the health services and how much are they spending What type of services are

available and who provides them Who is benefiting from these health expenditures To

answer these questions national health accounts (NHA) a standardized international system

of accounting for health care expenditure was developed (OECD 2000) It has been improved

over time and scaled up

Now more than ever smart investments are needed to achieve the Sustainable Development

Goals In that context NHA has become a key evidence base to inform decisions at all levels

NHA is even more important in the current context of the COVID-19 pandemic that has

plunged the world economy into recession With countries facing lower resource levels and

higher service demands NHA provides them the much-needed basis for assessing priorities

in health In addition scrutiny from an increasingly informed population and academia

requires greater accountability for committed resources

NHA is an indispensable tool in our time and there is an urgent need to address the

bottlenecks to its effective institutionalization in Africa During the 27th African Union Summit

in 2016 the Heads of State and Government adopted the Africa Scorecard on Domestic

Financing for Health for measuring progress towards meeting domestic and external health

financing commitments The quality of the data related to the scorecard depends on the

timely production of health accounts

WHO and other partners are supporting countries in strengthening NHA To that end an

assessment of the status of NHA institutionalization in African countries was undertaken in

2020 One of the recommendations from that assessment was to support African countries

to institutionalize the demand use production and dissemination of NHA data This guide

builds on the findings of that assessment to move forward the NHA agenda in Africa by

fostering country ownership of the process and sharing best practices This guide intends to

provide practical steps to strengthen systems structures and institutions that ensure timely

provision of quality National Health Accounts (NHA) data This guide is intended for the WHO

African Region Member States to be used by the ministries of health and finance the

parliament academia civil society donor organizations regional bodies and the private

sector for supporting institutionalisation of NHA The guide will be adapted to each countryrsquos

context In terms of expected benefits NHA is an effective tool to provide evidence on who is

covered and who is not where are the uncovered and what services have low coverage how

Page | vi

much more money is needed to achieve agreed targets In this perspective NHA indicators

support the monitoring of health spending and critically analyze health care financing to

ensure evidence-based resource mobilization pooling purchasing of health care services and

benefits distribution and provide rationale for policy options The institutionalization of

process would result in timely availability of NHA data at country level which will help in

health financing policy decisions by the member states to advance towards universal health

coverage It is my sincere hope that this guide will be used extensively for that purpose

Dr Kasonde Mwinga

Director Universal Health CoverageLife Course Cluster

Page | vii

ORGANIZATION OF THIS GUIDE

This guide has been developed to support the progress towards the use of evidence for

decision-making with the necessary policy institutional legal and funding arrangements to

mainstream national health accounts (NHA) within African countriesrsquo routine data systems

The assessment of the status of NHA institutionalization in the African Region that inspired

the production of this guide and which was undertaken in seven countries adequately

selected to account for country location and performance levels showed that greater efforts

were needed to achieve full NHA institutionalization

This guide has four main sections

bull The background is an introduction to the general NHA concept and its importance for the

Sustainable Development Goals (SDGs) towards which all countries are currently

marching

bull The rationale intended audience and scope of the guide present the justification for

producing evidence for sound investment decision-making in health This section covers

the boundaries and intended users of the guide

bull The third section is on the World Bank framework for the institutionalization of NHA

which is the basis for understanding the components required for NHA institutionalization

at the country level (1) governance needed capacities and finances (2) demand and use

(3) production and quality assurance (4) dissemination and (5) translation of NHA data

into specific policies

bull The steps for the institutionalization of NHA are this guidersquos originality in defining the four

major components necessary to make progress towards the full institutionalization of

NHA appropriate leadership structures an implementation plan an appropriate host

institution and funding options for sustainability A country situational analysis provides

evidence on country context and gaps in mainstreaming NHA in national data systems

including comprehensive guidance on the approach to address the gaps related to the

demand and use of NHA its production and dissemination and data translation into

policy

Page | viii

ACKNOWLEDGEMENTS

This guide was prepared by the WHO Regional Office for Africa - Health Financing and

Investment Programme under the leadership of the Director of the Universal Health

CoverageLife Course Cluster Dr Kasonde Mwinga The key people involved in the process

were Dr Juliet Nabyonga Ms Diane Karenzi Muhongerwa Dr Benjamin Nganda Dr Seydou

Coulibabby Mr Farba Sall and Mr Brandan Kwesiga We thank Chandrakant Laharia for

reviewing the draft guide The Regional Office would like to thank Angelique K Rwiyereka

who led the process of developing this guide

Page | ix

DEFINITIONS OF KEY TERMS

National health accounts are a way for countries to monitor health spending across multiple

streams regardless of the entity or institution that financed and managed that spending NHA

reflects the main functions of health care financing resource mobilization pooling

purchasing of care and distribution of benefits NHA classification schemes are designed to

be compatible with those used internationally for comparison Maeda et al1 provide the

main definitions

Institutionalization of national health accounts is the routine government-led and country-

owned production and utilization of an essential set of policy-relevant health expenditure

data using an internationally accepted health accounting framework The World Bank

framework for institutionalization of NHA outlines the key components for the

institutionalization of NHA to be effective including (1) ensuring country ownership of the

governance capacity and financing for NHA leading to a complete routinization of the

demand and use of NHA data and (2) producing and managing data and ensuring their

quality disseminating results and translating the data into relevant policy decisions

Stakeholders are any people groups or organizations that have a stake in the subject of

interest Stakeholders are positively or negatively impacted by a prospective policy

programme initiative or project In the context of NHA stakeholders are defined as actors

who have an interest or obligation to contribute to the financing production or use of NHA

data or who may be impacted positively or negatively by the use of NHA data

1 Maeda Akiko Harrit Margareta Mabuchi Shunsuke Siadat Banafsheh Nagpal Somil 2012 Creating Evidence for

Better Health Financing Decisions A Strategic Guide for the Institutionalization of National Health Accounts Directions in Development--Human Development Washington DC World Bank (httpsopenknowledgeworldbankorghandle1098613141)

Page | x

EXECUTIVE SUMMARY

National health accounts (NHA) are an accounting system adopted internationally as the

global standard for health care expenditure tracking to support decision-making A situational

analysis of the institutionalization of NHA in Africa was conducted in 2020 using the World

Bank framework on the institutionalization of NHA The analysis revealed that despite its

relevance NHA had not been institutionalized in African countries mostly owing to the

limited political attention and funding and the poorly harmonized and unsustainable efforts

that did not build on existing resources and that resulted in expensive outdated and difficult-

to-read reports

NHA has been used inadequately for discussions in health The process has not been fully

institutionalized to ensure that such data is available in regular and timely manner With

adequate support NHA has the potential to be fully institutionalized2 in Africa this time

around because of the renewed momentum on the Sustainable Development Goals (SDGs)

building on the current knowledge on what worked or did not over the last two decades and

capitalizing on the current digital revolution in Africa In an effort to guide countries towards

the successful institutionalization of NHA and based on the World Bank framework this guide

presents a few general principles as detailed in the following paragraphs

NHA governance capacity and funding

Based on the World Bank NHA institutionalization framework governance capacity and

financing mechanisms will ensure NHA institutionalization will have a focus on sustainability

This implies the integration of health accounts within countriesrsquo governance systems and

capacity adequacy in terms of data infrastructure and funding The two key components are

bull Leadership and funding for NHA ndash These form the foundation for NHA institutionalization

To succeed three levels of leadership are needed

minus A champion to advocate for political attention and resources raise awareness

monitor the countryrsquos performance and build high-level consensus on key

milestones The champion will be a high level national leader

minus Steering and technical committees to oversee and implement the NHA

institutionalization processes and

minus Resource mobilization leadership to digitize and mainstream NHA in existing vital

statistics and data systems The resources will encompass both infrastructure and

human resources

2 The institutionalization of the National Health Accounts has been defined as routine government-led and

country-owned production and utilization of an essential set of policy relevant health expenditure data using

an internationally accepted health accounting framework

Page | xi

bull Country situational analysis ndash NHA institutionalization should build on an in-depth

country situational analysis NHA institutionalization is a customized and unique journey

for each country and to succeed it requires tailoring of its approach to the countryrsquos

reality This individualized journey will highly depend on the extent to which local leaders

understand the value of NHA for policy decisions Whether at the country level the

concept is novel or not the institutionalization of NHA will always require a thorough

situational analysis to set the baseline of the countryrsquos existing gaps prior experiences

and resources A situation where NHA is a novel concept presents an opportunity for

raising awareness and building capacity on NHA and working towards its

institutionalization from the get-go In general however NHA is not a novel concept and

most countries have produced at least one round of NHA reports sponsored and

supported by ad hoc funding and consultancy teams with minimal attention to

sustainability

Data demand and use production dissemination and translation into policies

Two important principles are highlighted here

bull Sustainability of NHA is central to its institutionalization ndash For a country to sustain NHA

there must be demand and use of NHA routine production as well as capacity for its

production and dissemination and ultimately translation of the results into relevant

policies the end goal of the overall process In regard to NHA sustainability the situational

analysis will achieve two main goals

minus Map stakeholders ndash This is of utmost importance in understanding the potential

drivers of NHA institutionalization The stakeholders include government ministries

departments agencies service providers and the parliament as well as

nongovernment players such as multilateral and bilateral stakeholders civil society

academia nongovernmental organizations the private sector etc

minus Assess past NHA demand production and dissemination and the use of evidence in

policy-making and evaluation ndash The assessment will include analyses of gaps political

commitment policy-making processes fiscal context public administration public

finance management and the extent of decentralization Included also will be the

institutions and programmes in place that would support or impede NHA

institutionalization including the monitoring and evaluation infrastructure and the

human and financial resources This guide proposes steps to understand the gaps

and suggests approaches that would move countries towards successful and

sustainable NHA institutionalization

bull NHA hosting is a crucial factor for its sustainability ndash Different countries will take different

pathways to achieve the full institutionalization of NHA In general however NHA will be

housed where the most investment in data collection and analysis already exists NHA

should not be viewed as a project that will always require targeted vertical funding but

Page | xii

rather as a data reporting mechanism to be mainstreamed in existing routine data

collection systems Multiple institutions can house parts or all of the NHA processes if they

have the capacity to synchronize data collection management and analysis

Page | 1

1 BACKGROUND

All countries are committed to the 17 Sustainable Development Goals (SDGs)3 the third of

which aims at ensuring the provision of good health and well-being for all at all ages in all

countries Just like other States African countries are working towards achieving the Goal 3

through increased health spending and investments in cost-effective interventions The

investment process cannot be conducted blindly as both governments and donors are

increasing guided by data and becoming more efficient When it comes to health financing

understanding health expenditure indicators is indispensable in decision-making

demonstrating accountability and transparency for donor and taxpayer money making global

comparisons and sharing best practices Health expenditure indicators are internationally

standardized and tracked through the system of national health accounts (NHA)

Globally NHA has been used as a way for countries to monitor health spending regardless of

the entity financing and managing that spending NHA has the advantage of disaggregating

total health expenditure by end-user provider and population subgroups These breakdowns

are critical information in scaling up health care access and improving affordability in efforts

towards achieving universal health coverage (UHC) a strong contributor to SDG 3 Whereas

countries in America Asia and Europe have institutionalized NHA African countries are yet to

do so4 Some of the strong evidence coming from NHA is the understanding that most often

government subsidies benefit mostly richer groups living in major cities shrinking the

resources available for rural clinics contrary to the ethics of a well-designed health system5

Such evidence for decision-making becomes even more important in the context of the

COVID-19 pandemic with its contraction of countriesrsquo economic growth

2 RATIONALE SCOPE AND INTENDED AUDIENCE OF THIS GUIDE

21 Rationale

UHC means ldquothat all individuals and communities receive quality affordable and accessible

health services as close to them as possible It includes the full spectrum of essential health

services from health promotion to prevention treatment rehabilitation and palliative care

3 The Sustainable Development Goals or Global Goals are a collection of 17 interlinked global goals designed to be a

blueprint to achieve a better and more sustainable future for all The SDGs were set in 2015 by the United Nations General Assembly and are intended to be achieved by 2030 (httpswwwunorgdevelopmentdesadisabilitiesenvision2030html httpsenwikipediaorgwikiSustainable_Development_Goals)

4 The Status Update of National Health Institutionalization in the African Region WHO 2020 5 Maeda et al 2012 Creating Evidence for Better Health Financing Decisions A Strategic Guide for the

Institutionalization of NHA httpdocuments1worldbankorgcuratedar410301468323088938pdf689660PUB0publ07926B009780821394694pdf

Page | 2

across the life courserdquo6 UHC is a path towards achieving SDG 3 and a commitment that

countries are striving to honour In this journey the goal of a countryrsquos health financing

system is to protect its citizens from financial hardship and reduce inequalities in accessing

quality and cost-effective health care services NHA is an effective tool for providing evidence

on who is covered and who is not where the uncovered are which services have low coverage

and how much more money is needed to achieve agreed targets

NHA indicators support the monitoring of health spending and critically analyse health care

financing to ensure evidence-based resource mobilization and pooling purchasing of health

care services and benefit distribution They also provide the rationale for policy options This

guide provides a standardized yet flexible process to direct countries in undertaking

successful institutionalization of NHA and enhancing health system effectiveness efficiency

accountability and best practices

22 Scope and intended audience of this guide

This guide provides practical steps to strengthen the systems structures and institutions that

ensure the timely provision of quality NHA data It is intended for the WHO African Region

Member States to be used by their ministries of health and finance parliaments academia

civil society donor organizations regional bodies and the private sector in supporting the

institutionalization7 of NHA This guide will be adapted to each countryrsquos context

3 FRAMEWORK FOR THE INSTITUTIONALIZATION OF NHA

The 2012 World Bank guideline on the institutionalization of NHA proposes a framework for

the NHA cycle with four components (1) demand and use (2) production data management

and quality assurance (3) dissemination and (4) translation of NHA data into specific policies8

(see Fig 1)

6 httpswwwwhointnews-roomfact-sheetsdetailuniversal-health-coverage-(uhc) 7 The institutionalization of the National Health Accounts has been defined as routine government-led and



8 Maeda Akiko Harrit Margareta Mabuchi Shunsuke Siadat Banafsheh Nagpal Somil 2012 Creating Evidence for Better Health Financing Decisions A Strategic Guide for the Institutionalization of National Health Accounts Directions in Development ndash Human Development Washington DC World Bank (httpsopenknowledgeworldbankorghandle1098613141)

Page | 3

Figure 1 World Bank framework for the institutionalization of NHA

4 STEPS FOR THE INSTITUTIONALIZATION OF NHA

41 Governing ensuring capacity and financing NHA

The steps this guide proposes are based on the World Bank framework for the

institutionalization of NHA In terms of governance capacity and finance the report from the

assessment of the institutionalization of NHA in Africa showed that some countries were more

advanced than others in the NHA institutionalization journey A few general steps are

described here based on the challenges and recommendations identified during the recent

assessment of the current status of the institutionalization of NHA in Africa and best practices

The first step is to understand each countryrsquos context and thus the need to undertake a

situational analysis

For the situational analysis which is a customization process each country will have a unique

time frame based on the local environment specifically the political will and resources

including the available infrastructure human resources and NHA implementation culture A

careful understanding of the local context will yield sustainable results even though it may

seem to take considerable time and resources at the beginning Countries with an appropriate

legal or institutional framework will have an easy start because they will already have written

commitments

Page | 4

411 Country situational analysis

WHO defines a situational analysis as an assessment of the current situation fundamental in

designing and updating national policies strategies and plans9 The situational analysis should

be designed and conducted in a way to provide a systematic overview of the countryrsquos health

financing system with detailed evidence on challenges and gaps In the context of NHA

institutionalization the situational analysis will consider the following key elements

bull Stakeholders in the health sector ndash These include government branches (the executive

and the legislative) and nongovernment players such as civil society the private sector

academic institutions parliament etc Stakeholder analysis is critical to the understanding

of policy drivers and whether stakeholders are or are not potential NHA supporters The

purpose is either to capitalize on their support or design strategies to win them over to

the NHA cause This is also critical in understanding whether policies are designed in a

participatory process an important element for NHA to thrive

bull Previous efforts to produce or institutionalize NHA ndash It is important to be familiar with

the successes and failures of previous work on NHA in a given country to build on positive

experiences or to put strategies in place to mitigate previous failures In addition it is

important to assess the policy-making planning and budgeting processes including

monitoring and evaluation programmes and platforms within which NHA must be

mainstreamed

bull Major contextual factors ndash These include (1) the fiscal context of the governmentrsquos ability

to mobilize public revenues (2) public administration particularly the extent of

decentralization within the government and the decision-making responsibilities held at

different levels(3) public finance management and (4) the extent of private sector

involvement in health care

4111 Stakeholder analysis

Mapping of stakeholders

There are players inside and outside the government that based on their mission will

encourage the institutionalization of NHA First among these is the executive branch

constituting the ministry of health whose mission is to provide quality equitable and

affordable health care services Second is the ministry of finance whose goal is to improve

the populationrsquos living standards though it operates within an environment of competing

demands for resources Both these ministries have a core obligation to advocate for more

resources for health and to work at achieving the governmentrsquos health goals In some

countries the functions of finance economic development budget and planning are all rolled

into one ministry with different departments In other countries they are held by different

9 WHO AFR Status Update of the Institutionalization of NHA in Africa December 2020

Page | 5

ministries that work separately but in close collaboration In this document the term ministry

of finance embodies all the government functions of finance planning and budgeting

Whereas the ministry of health seeks adequate resources to implement health programmes

the ministry of finance faces budget constraints with multiple and competing demands for

resources from different sectors including education agriculture infrastructure defence etc

The ministry of finance will have a tendency to be conservative in allocating the limited

resources as it faces growing demands NHA generates triple benefits for the ministry of

health in particular and for the government as a whole by showing accountability for

government money at all levels supporting the ministry of health to advocate for increased

resources through linking expenditure to outcome indicators and (3) supporting the ministry

of finance in showing where and how much more funding is needed to achieve government

targets

Other government institutions with interest in NHA are the ministry of local government

which manages local services including health services and the office of the auditor-general

which has for instance the mandate to improve accounting and financial reporting and

promote effectiveness efficiency by holding to account all persons entrusted with

management of public funds and resources10 The auditor-generalrsquos annual audits

demonstrate the parliamentrsquos ultimate authority supervision and control over all aspects of

public finance In this context the legislative branch also is an important stakeholder because

it votes on laws and budgets Together with the ministry of local government the legislative

branch has the mandate to understand how much money is spent on the population under

its leadership who is covered and who is not covered and whether funding change will have

an impact on vulnerable populations under its responsibility

The national institute of statistics also is a key government institution in regard to NHA Its

mandate is to collect analyse archive and disseminate national statistical data with the

objective of aiding the government in making timely evidence-based national decisions This

institute can impact the production of NHA significantly by mainstreaming NHA data

requirements in existing tools such as population-based surveys The availability of data on

health expenditure patterns has the potential of enriching the recommendations from

analyses of demographic and health survey data

NHA generates benefits for nongovernment players such as civil society which is ldquothe

ecosystem that influences social change outside of the family market or government Often

referred to as the space where we act for the common good civil society aims to connect

10 Office of the Auditor General Michigan State USA (httpsaudgenmichigangovabout~text=The

20OAGs20overall20goal20isand20economy20in20State20government)

Page | 6

poor or marginalized people with groups that can mobilize support to helprdquo11 Civil society

can track the use of taxpayer money and advocate for underserved services or populations

NHA has benefits also for the private sector as it can use NHA data to make informed

decisions on where to allocate its investments for example in underserved wealthy

communities

The scientific and academic worlds need NHA to generate evidence on what works or does

not work through economic impact studies or efficiency and cost-effectiveness analyses of

health programmes This is critical in informing policy and programmes and in stimulating

innovation

For both government and nongovernment players NHA serves as an accountability tool to

show how available funding contributes to achieving key development goals In each country

stakeholder mapping will include a complete list of stakeholders contributing to the health

sector (see Table 1 for an example)

Table 1 Illustrative list of stakeholders in the health sector in African countries

Sector Branch Institution

Government Executive branch Ministry of health

Ministries of budget finance planning local government etc

National institute of statistics

Office of the auditor-general

Legislative branch Senate parliament

Academia

Schools of public health economics business

Stakeholder organizations

Multilateral agencies United Nations agencies (WHO UNAIDS UNFPA UNICEF UNDP) World Bank IMF Global Fund

Philanthropies Bill and Melinda Gates Foundation etc

Regional bodies African Union European Union East African Community East Central and Southern Africa Health Community etc

Bilateral agencies USAID Belgian Cooperation French Cooperation SIDA

Nongovernment institutions

Action Aid

Civil society Health Development Performance

Consulting organizations Abt Associates Management Sciences for Health

Note This list is illustrative and will be adapted based on countriesrsquo contexts

Assessment of stakeholder interest and influence for National Health Accounts

Once the list of stakeholders has been made it is important to undertake an analysis of their

interest and power to either positively or negatively impact the institutionalization of the NHA

process The interest or influence of stakeholders allows those entrusted with pushing

forward the NHA agenda to assess the next steps and take appropriate decisions Powerful

stakeholders are those with the interest and power to significantly impact NHA

institutionalization The most common among these on the government side are the

11 Mission Box Global Networks (httpswwwmissionboxcomarticle418social-change-whats-the-role-of-civil-society)

Page | 7

ministries of health and finance including the ministries of budget and planning in some

countries the parliamentary committee on health and the national institute of statistics

When leaders and technocrats from these key stakeholders support NHA institutionalization

the process can be smooth

The powerful nongovernment stakeholders are those capable of providing substantial

funding and technical support for NHA institutionalization These include United Nations

agencies and specifically WHO and the World Bank foundations such as the Bill and Melinda

Gates Foundation and civil society organizations Nongovernment stakeholders in support of

NHA institutionalization will be identified for engagement right away while awareness efforts

and training sessions will be undertaken for uninterested stakeholders to get them involved

because of their importance for funding resource mobilization and NHA data collection

analyses dissemination and interpretation

Semi-structured interviews can be useful to establish stakeholder awareness of and interest

in NHA institutionalization and specifically to understand

bull their knowledge on NHA demand and use production and dissemination and the

potential benefits for policy decisions

bull challenges and gaps related to NHA and factors that may impede its institutionalization

and

bull their suggestions for improving the demand and use production and dissemination of

NHA data and their translation into policies

The situational analysis results should lead to concrete actions in the form of

bull engagement with stakeholders who are unaware or unsupportive of NHA for example

through consultative meetings where their important role in the countryrsquos health and

development will be highlighted

bull assessment of each individual stakeholderrsquos organization and its potential benefits for

NHA

bull supporting the mainstreaming of NHA data in stakeholder routine activities through

involving the stakeholders in the collection sharing analysis interpretation and

dissemination of NHA data and their translation into specific policies

4112 Assessment of existing policies and programmes for National Health Accounts

NHA institutionalization requires the development of pertinent legal and institutional

frameworks Legal frameworks include ministerial orders policies laws memorandums of

understanding and collaboration instruments in support of NHA These frameworks should

be explicit and should provide specific institutions the mandate and resources for the

functions under their charge The goal is to move from the consultant-based approach that

Page | 8

has so far been the modus operandi for NHA production in all the countries Institutional

frameworks will encompass newly set up programmes and modifications or upgrades of

existing institutions or programmes to include NHA as a part of their deliverables Policies and

programmes supporting NHA already in existence are an important factor in charting the way

forward If an existing institution housing NHA is not delivering for some reason its policies

and institutional framework including its resources will need to be reviewed NHA

sustainability requires ownership and leadership and adequate policies programmes and

resources

412 Lead plan and finance National Health Accounts

4121 Leadership structure for National Health Accounts

There is need to create a country NHA leadership mechanism in coordination with the

stakeholders Three levels of leadership are proposed an NHA champion a role that will cease

with the successful institutionalization of NHA and steering and technical committees

Countries can contextualize the proposed leadership structure as needed including the

number of committee members Strategic selection of members will ensure that those in non-

technical roles will not exceed a dozen for efficiency in discussions (see Table 2 for an example

of the constitution of NHA institutionalization leadership teams)

National Health Accounts champion

The primary function of this role is advocacy for NHA institutionalization This role should be

entrusted to a person of influence who could be the prime minister minister of health or

finance or the chairperson of the health committee in parliament The champion will be the

face of NHA institutionalization efforts will ensure NHA gains political attention and will

support resource mobilization for NHA policy and programme implementation making sure

that there is evidence that resources are earmarked for NHA institutionalization This role has

a timeline and will end after the complete and successful NHA institutionalization has been

objectively demonstrated through an evaluation Being drawn from the existing leadership in

the country the champion will not earn an income for the role but will receive facilitation

support

Page | 9

Table 2 Country leadership for National Health Accounts in Africa

Leadership level Representation Institutions from which NHA team will be drawn

Champion High government level Minister of health finance and parliamentary health committee chairperson

Steering committee

Government

Secretary-general ministry of health

Secretary(ies) general ministries of financebudgetplanning

Director general institute of statistics

Head health committeeparliament

Academia Schools of finance public health or economics

Civil society

President of private health care providersrsquo federation

President of private health insurance federation

President of private pharmaciesrsquo federation

President of traditional healers and alternative medicine association

Representatives of NGOs working in health

Stakeholders Deputy directors at WHO

World Bank UNAIDS USAID UK Aid Belgian Technical Cooperation

Technical team

Coordinator National planning institute of statistics or IFMIS at the ministry of finance

Data collection and analysis teams

IFMIS 2 IT experts and 2 analysts EMR 2 IT experts and 2 analysts

4 staff (2 IT experts and analysts) from the institute of statistics

2 staff NHA focal person at MoH and ministry of finance

1 staff from MoH in charge of public hospitals

1 staff from private sector in charge of private hospitals

1 staff from the office in charge of traditional healers and alternative medicine

In countries where IFMIS teams do not exist any public finance team will work

Steering committee

This will be a political leadership structure giving legitimacy to the technical committee It will

provide political attention and resources for NHA institutionalization through its life cycle

from NHA demand and use to translation of the data analyses into policies It will contribute

to the interpretation of NHA results and validate own and translate them into actionable

policies that will be evaluated as part of the health sectorrsquos performance The steering

committee will be led by a chairperson who will be drawn from a government institution

and a co-chairperson who will come from a nongovernment institution

The steering committee should include permanent secretaries from the ministries of health

and the ministries of finance and their directors-general and the director in charge of health

financing and planning and equivalent in these ministries Additional members will be the

head of the institute of statistics leaders of the parliamentary health committee and

directors-general of the public social health protection schemes From outside the

government will be leaders of regional or provincial public hospitals the president of the

private health care providersrsquo federation heads of private pharmacies and health insurance

associations local nongovernmental organizations in health and the presidents of traditional

healers and alternative medicine associations

Page | 10

Technical committee

This committee will comprise technical teams working towards NHA institutionalization The

technical staff will be located in the different institutions collecting and analysing data and

whenever needed will be brought on board to focus on NHA or to support the overall

institution in which specific NHA data will be collected

The technical committee will be made up of a coordinator and staff working on a daily basis

in existing institutions and handling data Technical teams will not be located in the same

institution to avoid the NHA institutionalization becoming a vertical programme the goal

being to mainstream NHA in existing data systems The coordinator may be housed at any of

the key institutions handling data such as planning departments IFMIS or the institute of

statistics or she or he may be from academia The technical committee will include IT experts

health economists and data analysts from IFMIS electronic medical records or the institute

of statistics and the institution responsible for the integrated household living conditions

surveys and demographic and health surveys Other members will come from the directorate

in charge of public hospitals staff in charge of accounting in the private health insurance

federation technicalfinance staff from the office of traditional healersalternative medicine

etc The technical committee will include senior technical officers and directors at WHO the

World Bank UNAIDS USAID UK Aid Belgian Technical Cooperation etc

Steering and technical committee members will be drawn from the government civil society

academia the private sector and development partners The leaders from these institutions

who join the NHA team will be part of the steering committee whereas the technical staff

will be in the technical committee The technical committee will be the implementing team

in charge of institutionalizing data collection and analysis but in data interpretation they will

work in conjunction with the steering committee

413 Planning for National Health Accounts

The planning strategies and activities for institutionalizing NHA presented in this guide are

based on the World Bank NHA institutionalization framework They will need to be adapted

to countriesrsquo contexts Table 3 focuses on governance capacity and financing strategies and

activities while Table 4 deals with aspects relating to NHA demand and use and dissemination

and translation of data into policies

Page | 11

Table 3 Planning for National Health Accounts governance capacity and financing

Steps Activities

Step 1 Define governance of National Health Accounts capacity and financing

Step 11 Identify leadership and stakeholders

Step 111 Identify the NHA champion

Step 112 Appoint the steering committee

Step 113 Appoint the technical committee

Step 12 Conduct a situational analysis identify gaps and provide recommendations

Step 121 Agree on initial budget and source of funds for early work (meetings consultants etc)

Step 122 Hire consultant(s)

Step 123 Produce the situational analysis draft report circulate and revise it and share the final draft

Step 124 Organize report dissemination and validation

Step 125 Use the validation meeting to define the next steps objectives and priorities

Step 13 Develop a national strategy for the institutionalization of NHA

Step 131 Develop a national strategy for institutionalizing NHA (preferably as part of the health financing strategy MampE framework) including key indicators of progress

Step 132 In the process of setting up the strategy assign roles responsibilities and funding sources

Step 133 Produce the draft and circulate it

Step 134 Launch the costed national strategy with indicators roles and resources

Step 14 Mobilize resources

Step 141 Organize a stakeholder meeting for resource mobilization

Step 142 Agree on short-term mid-term and long-term funding and its integration in existing institutionsrsquo budget lines

Step 143 Develop MOUs and written commitments

Step 15 Implement and monitor

Step 151 Raise institutional and public awareness on NHA (through television radio print media)

Step 152 Ensure teams working on the demand and use production dissemination and translation of data into policies are doing their job or getting ready to do it

Step 153 Coordinator to organize monthly meetings of technical committee members

Step 154 Hold quarterly meetings of the steering committee to monitor the set milestones

Step 155 Integrate reviews of NHA institutionalization within the health financing reviews and annual health sector reviews

Step 156 Include the budget for the institutionalization of NHA in the budget of relevant institutions

These are drawn from existing identified stakeholder institutions

Page | 12

Table 4 Meeting National Health Accounts needs in terms of institutionalization

Steps Activities

Step 2 Improve the demand use and dissemination of NHA

Step 21 Ensure that all funding (initial short-term medium-term and long-term) is committedagreed upon

Step 22 Ensure that NHA data demand use and dissemination strategies and activities are included in the health sector strategic plan aligned with the evidence from the initial countryrsquos own needs assessment

Step 23 Map stakeholders understand their mandate and data needs and tailor the dissemination strategy accordingly

Step 24 Identify opportunities and best timing to share NHA data (eg national policy dialogues or retreats etc)

Step 25 Work with academia and designers to provide expertise in designing templates for short user-friendly regular reports on available data on spending Templates should be targeted at different audiences and revised regularly to include new knowledge and stakeholders

Step 27 Develop different dissemination products (formal and informal dissemination of NHA findings)

Focus on policy-makers hospitals and high-level leaders and publish articles policy briefs cost-effective analyses for the ministry of finance parliament etc

Step 28 Focus on civil society ndash organize radio and television shows on health financing and get inputs

Step 29 Focus on regional learning ndash encourage scientific studies innovative improvements in policy and programmes

Step 210 Use social media to highlight indicators needing public attention

Step 211 Integrate NHA dissemination in national MampE systems surveys reports government reviews etc

Step 212 Organize quarterly meetings of government institutions on NHA and define the needed policy improvements

Step 213 Organize quarterly meetings of private sector institutions on NHA and define needed policy improvements

Step 214 Organize quarterly meetings of the steering committee to agree on policy improvements

Step 215 Design a scoring system to motivate public and private sectors to publish NHA data Reward best performers with additional grants to support further research

Step 3 Improve the production and translation of specific analyses into policies

Step 31 IT tools

Step 311 List IT gaps and design or re-design tools and pathways for harmonized and interoperable systems for data collection sharing and analysis

Step 312 Create a national health financing dashboard located at the ministry of health

Step 313 Design a scaling plan and implement it (training installing new solutions in decentralized structures) Evaluate these as you go and create new solutions

Step 32 Enforce data submission and collection

Step 321 Train public and private sector entities in understanding the NHA data required

Step 322 Include submission of NHA data as part of government unitsrsquo performance assessments

Step 323 Bind renewal of licenses for private sector entities and tax submission to NHA data submission

Step 324 Design a scoring system for the public and private sectors to submit data Reward best performers through grants for research in support of data submission improvements

Step 33 Data production solutions

Step 331 List train and sustain human resource capacity (training of existing human resources mainstreaming data production in curricula in schools and public health economics public policy journalism institutions etc)

Step 332 Produce detailed and targeted analyses for all stakeholders (including subregional equity allocative and technical efficiency analyses etc)

Step 333 Monitor technologies to improve data production based on current science

Step 34 Translate specific analyses into policies

Step 341 Identify the list of policies and strategies concerned with NHA findings and monitor them

Step 342 Incorporate NHA in health financing working groups to inform policies after implementation

Step 343 Design a scoring system to motivate the public and private sectors to use data and inform programme and implementation Reward best performers eg with grants for improvements in data processes

Page | 13

414 Financing National Health Accounts Planning and budgeting for NHA institutionalization will be based on the overall country

situational analysis and will be part of the health sectorrsquos strategic plansrsquo costing exercises Some

countries will need more resources than others based on their local human resources and existing

IT infrastructure The steps below are proposed as guidelines for planning and budgeting purposes

and will need to be adapted to each countryrsquos context We categorize the funding for the

institutionalization of NHA into four types

bull The initial budget will start the functioning of the championrsquos role It is limited funding meant

to support the early stages of NHA institutionalization

bull The short-term budget will support the steering and technical committees and enable the

undertaking of a situational analysis and the subsequent development of a costed strategic

plan to respond to the gaps identified by the situational analysis

bull The mid-term budget or investment fund will ensure the implementation of the strategic plan

through for example building the governmentrsquos or the private sectorrsquos information

technology recruiting technical consultants in IT health financing or economics and

acquiring digital solutions servers and internet capability etc When NHA institutionalization

is complete the investment fund will cover the first two years of its monitoring and

evaluation

bull The long-term or routine budget will be disbursed as part of the regular budgets of the

institutions involved in collecting analysing and disseminating data and translating data into

policies The long-term budgetrsquos disbursement will not be vertical but will be mainstreamed

in existing budgets

Country teams will need to develop financial estimates and time frames for their activities

and Table 5 can serve as a template they can fill to capture the values for their budgets

Table 5 Situation analysis results and resources needed

Resources Funders Amount Time

1 Initial budget support NHA champion with initial discussions Activities will involve

meetings and travel to engage with stakeholders and potential supporters

2 Short-term budget The steering committee chairpersons (representing the

government) and co-chairpersons (representing nongovernment stakeholders) will

designate members of the steering and the technical committees This budget will

support these committees but not the salaries of members as they will be staff of

existing institutions The technical team will be covered by this budget including

recruitment of new IT staff to support existing institutions if required

3 Mid-term budget or investment fund This will cover infrastructure and technical

consultancy resources needed to upgrade IT systems and databases The consultants

may be existing staff of government or nongovernment institutions but working

outside their regular hours

4 Long-term budget or routine fund This budget will be dedicated to finalizing NHA

institutionalization once everything has been put in place and to ensure the system is

functioning well before exiting NHA efforts are implemented vertically

The money and time needed column will be filled by each country based on local needs

Page | 14

415 Hosting National Health Accounts for sustainability NHA institutionalization activities will be best hosted in an institution with a strong capacity

for data production for their maximum routinization in existing data systems The institution

should also have authority over the data to enforce data submission NHA would also benefit

from being accommodated by a host with the highest IT capabilities The situational analysis

report will propose the primary NHA host institution Several other institutions can be

considered secondary hosts based on the data they produce Ideally the coordinator should

be located in the primary host institution The host institution will be confirmed and

designated during the reportrsquos validation Below are the proposals for potential NHA host

institutions

4151 Ministry of health

The ministry of health is the first beneficiary of NHA data However it is mainly a political

institution and may not have the internal capacity to undertake the institutionalization of NHA

owing to funding and expertise limitations but also in terms of scope because NHA involves

data beyond those generated within this ministry The 2020 assessment of institutionalization

of NHA showed that most ministries of health in Africa were short of staff in general and IT

experts and economists in particular to coordinate data collection and analyses processes

It is expected that under the overall leadership of the minister of Health the process will be

accelerated

4152 Ministry of finance

In all countries the ministries of finance are the hosts of IFMIS In countries where IFMIS is

decentralized it becomes a precious tool to provide key government data for NHA IFMIS

teams are composed of economists finance officers and IT programmers and are a unique

resource to tap into to advance NHA as part of a regular report submission process such as

the reports submitted to the International Monetary Fund the World Bank UNDP National

AIDS Spending Assessment (NASA) etc Each countryrsquos ministry of finance has a set of

indicators that it generates monthly quarterly semi-annually or yearly Within the ministry

of finance NHA has the potential to thrive and benefit from the resources allocated to other

data systems The downside is that IFMIS focuses exclusively on public funds missing data

from the private sector However as part of a government institution IFMIS can find ways to

enforce submission of data from that sector Considering it require coordination between two

ministries the leadership of minister of finance along with minister of health will be vital for

success of this endeavour

4153 National institute of statistics

According to the UNstats national statistical agencies compile official statistics to provide

information to the general public governments business and research communities on the

Page | 15

economic demographic social and environmental fields12 Their mission include the

production and dissemination official statistics to support evidence-based decision making

and planning processes and to coordinate the statistical activities of the National Statistical

System including statistical capacity building initiatives helliprdquo13 They generate health non-

health financial non-financial and household demographic and health survey data etc There

are multiple advantages in housing NHA at the institutes of statistics (1) they are mandated

to produce data and are staffed and equipped to deliver on their mission (2) there are

economies of scale in entrusting them to mainstream NHA in the general data collection

systems and (3) they have a culture of enforcing data submission by both public and private

agencies The national institute of statistics should collaborate with the ministries of health

and finance on the one hand and academia on another hand to ensure the translation of data

analyses into policies As the National Institutes of Statistics have role in collection and

coordination of the data their leadership will ensure availability of health and financing data

in timely manner which meets the quality standards This would be essential for

institutionalization of the process and development of high quality NHA reports

4154 Academia

Universities and institutes of higher learning have the skills and mission to provide human

resources The schools of economics public health and public policy are mandated to train

and equip students with critical and independent analysis skills They provide the best setting

to sustain NHA human resources Students could major in health financing and use datasets

from the national statistics institute for training and research However academic institutions

do not have a mandate to generate data and hence may not serve as the primary but a

secondary host for NHA focusing on human resources The academia may be involved in the

capacity building of human resources who can be trained in working on development of

NHAs The selected academic institutions may be designated to conducti regular trainings in

NHA and related tools This would ensure that even if some of the staff responsible in various

concerned departments are transferred out there would be sufficient availability of

additional workforce to continue such activities This would strengthen the

institutionalization process

Table 6 shows the NHA hosting options available to the countries and their advantages and

disadvantages Each country will decide which among them best suits its setting

12 httpsunstatsunorgunsddnssgpImplementation_Guidelines_FINAL_without_editpdf 13 Institute of Statistics Rwanda httpswwwstatisticsgovrwpresspress-releasepress-release-nisr-signs-partnership-

aims

Page | 16

Table 6 Analysis of potential National Health Accounts hosts for sustainability

Potential host Advantages Inconveniences

Ministry of health

1 Health policy is a priority here and advocacy for more funding is a permanent activity

2 A clear advantage is the rapidity of translating the data into policies if NHA was hosted in this ministry

1 May not be equipped with enough personnel and skills to delve into data analyses and interpretation

Ministry of finance

1 The strong oversight and close monitoring of the performance of the health sector can serve to improve the efficiency of the health ministry This ministry can enforce the requirement for adequate improvement of NHA

2 NHA sustainability is guaranteed as this ministry is the budget holder

3 NHA will benefit from building on IFMIS infrastructure and human resources

4 It can easily enforce data submission from the private sector

1 Data activities are not a primary function

2 As the funds holder this ministry might use NHA as a tool of pressure requiring submission of data as a precondition for disbursing of funds

Institute of statistics

1 NHA will benefit from the primarily data collection and analysis function

2 Building on other data resources will be an advantage 3 Sustainability will be guaranteed due to the

investments in all national data collection infrastructure and human resources

4 This institute serves as the best intermediary between ministries by focusing on its role of production and providing evidence

1 NHA estimation is not a primary function

2 No control over development partners implementing partners and private sector reporting especially by hospitals

Schools of economics public health

1 NHA will benefit from supervision from professors and senior lecturers close by who will motivate studies and deeper analysis of data and interpretation of findings

1 Does not have a function of continuous data collection so NHA would be a vertical project with targeted funding

42 Meeting the needs for the demand and use production and dissemination of

NHA and translation of data into policies

421 Assessing country status on the demand and use of National Health Accounts

To ensure that NHA is fully institutionalized the situational analysis will provide responses to

the questions presented in Table 7

Page | 17

Table 7 Assessing country status on the demand and use of National Health Accounts

Assessment area

Question Text

Assessing the demand and use of National Health Accounts data

Q11 Is there an established governance structure for undertaking and coordinating NHA work Where is it housed

Q12 Who predominantly finances NHA work-related activities Is there a long-term financing strategy for the production of NHA

Q13

Who demands NHA data in the country What triggers the demand Who has direct interest in its demand and use Please present the context related to the expression of the need for NHA data from government (was it from the ministry of health or finance) the private sector and donor perspectives

Q14 Who are the stakeholders interested in the documentation and use of NHA data This would enrich the understanding of the willingness and readiness to use NHA data

Q15 What is the extent to which reference is made to NHA data in policy dialogues (joint annual reviews health sector assessments) in which decision-makers discuss and express the need for the availability of health expenditure data for planning and implementation

Q16 Is there any reference to NHA data in making resource allocations negotiations with the ministry of finance or monitoring of implementation equity or efficiency

Q17

Are there future plans to further improve the demand for and use of NHA data Documentation of the challenges and suggestions for the improvement of the demand and use of NHA data will be undertaken including best practices that have pushed the country forward in demanding and using NHA data

Q18 Is there additional information we may have forgotten on the demand and use of NHA data Please add as much information as needed to clarify this topic within your country context

The country-level assessment will provide details on data production including a description

of the policies and programmes related to data collection the human and financial resources

involved and the methods and tools used A clear understanding of data analyses the

discussions around the findings and data validation processes before their dissemination will

be assessed The challenges to achieving real-time submission of indicators using current

technologies will be described and potential solutions proposed Table 8 gives more details

on the minimum descriptions expected However more information is always better

422 Assessing country status on data production

If NHA reports are produced it is key to understand the level at which they are shared

whether the ministry of healthrsquos policy-makers and government stakeholders and especially

the ministry of finance are informed and whether public and private hospitals health

insurance partners academia and development partners have all been engaged Table 8

provides guidance on the questions to be asked to find out more about data production but

each country can customize this guide

Page | 18

Table 8 Assessing country status on data production

Assessment area Questions

Production data management and quality assurance of National Health Accounts data

Q21 Are policy priorities to be addressed by NHA determined before the exercise Who decides on them

Q22 Is there a team or institution with appropriate knowledge and skills charged with undertaking and coordinating NHA in the country

Q23 Who funds the production data management and quality assurance for NHA data Is there sustainable financing for these activities

Q24

To what extent are NHA data requirements incorporated into routine information systems Is there routinization of NHA indicators in the national financial and health information systems and population-based surveys (income and expenditure surveys) through adequate adjustments of the systems or inclusion of relevant questions in surveys to provide the data required to produce NHA

Q25 Is the undertaking of NHA included in the monitoring and evaluation plans with planned or existing data collection tools Please provide details

Q26 What are the existing tools and national data systems to sustainably produce NHA data These will include all IT tools such as the health management information systems (HMIS) and the integrated financial management information system (IFMIS)

Q27

What are the challenges in NHA reporting What is the degree of annualization of NHA and the degree of institutionalization in terms of the scope of NHA dimensions including existing roadmaps in the countries for effective NHA institutionalization An identification of the gaps and limitations will be provided with a view to identifying existing opportunities for integration of NHA indicators into existing data collection systems

Q28 What are the areas for potential upgrade or customization of existing tools to align with the System of Health Accounts (SHA) 2011 requirements and achieve NHA institutionalization The processes of quality assurance should be clearly described to show that the criterion of reliability is met for NHA data at the country level

Q29 Are there future plans to further improve the production data management and quality assurance of NHA data

Q210 What best practices can be applied in the context of synchronizing data tools and systems in the production and management of NHA data

Q211 Is there any additional information in relation to the production data management and quality assurance for NHA data Please add as much information as needed to clarify this topic

423 Assessing country NHA dissemination and data translation into policies

Table 9 provides a set of questions to help in gathering material for the production of a report on the status of NHA dissemination and data translation into policies

Page | 19

Table 9 Assessment of country National Health Accounts dissemination data translation

Assessment area Question

Dissemination

Q31 What are the different forums or meetings in which NHA data are presented in the country Which institutions are involved How often are NHA data dissemination forums or meetings organized

Q32 Are NHA results disseminated using soft and hard copies Are national websites publishing NHA data Are there printed summary reports of NHA data and their interpretation into policies and decisions

Q33 How are the NHA results disseminated to the different audiences Are there tailored approaches to reach different audiences

Q34 Who funds the dissemination activities for NHA results Is there any sustainable financing for the dissemination of NHA results

Q35 Are there future plans to further improve the dissemination of NHA data

Q36 What are the challenges and possible solutions to improve the dissemination of NHA results This applies to national subnational and local levels in addition to regional and international levels

Q37 What best practices have improved NHA data or results dissemination in your country that can be used by other countries

Q38 Is there additional information we may have forgotten on the dissemination of NHA data Please add as much information as needed to clarify this topic

Translation of data and dissemination of specific analyses

Q41 Ownership in data production and analysis

Q411 Who are the stakeholders involved in the translation of data and specific analyses These may be the ministries of health or finance members of parliament civil society or the donor community

Q412 Who are the funding organizations taking part in the activities related to the translation of data and specific analyses

Q42 Ownership of the processes of translating data into concrete decisions and actions that follow

Q421 Is the health sector leadership aware of and taking action based on the NHA analyses results

Q422 Who leads the translation of data into concrete decisions and the implementation of those decisions Who is involved government ministries donor organizations civil society List any other

Q423 How is the translation of data and specific analyses done Describe the processes involved

Q43 Are there future plans to further improve the translation of data and dissemination of specific analyses of NHA data

Q44 What are the challenges and suggestions in translating NHA data into specific policies NHA data interpretation and country ownership of their processes

Q45 What best practices did the country use in improving data and translating NHA data into specific policy decisions and its assumption of the ownership of the overall processes

Q46 Is there additional information we may have forgotten on the translation of NHA data and dissemination of specific analyses Please explain to clarify this topic

43 Monitoring National Health Accounts institutionalization progress

It is necessary to monitor progress through a set of indicators that can trigger adjustments for

success Based on the World Bank framework on the institutionalization of NHA a dozen

indicators are proposed in Table 10 The time frame will be considered from the time the

decision to institutionalize NHA will be made

Page | 20

Table 10 Progress indicators towards National Health Accounts institutionalization

Activities Numbered indicators

Governance capacity and funding

Identify leadership stakeholders and organizationsrsquo focal persons

1 Leadership and members of committees designated

Agree on initial budget to support early meetings as needed and consultants

2 A budget for institutionalization secured and disbursement conditions defined

Conduct a situational analysis identify gaps and provide recommendations

3 A situational analysis report

Cost the national plan of action 4 A costed NHA institutionalization strategy produced

Mobilize resources for the short medium and long terms

5 MOUs and written commitments from stakeholders

Demand and use and dissemination

Sustainably improve NHA demand disseminate findings and translate specific analyses into policies

6 NHA working group (government and partners) for the first year Locate it in the health financing working group after institutionalization is secured

7 Health sector reviews include NHA data

8 Annual NHA impact assessments on national policies

Production of NHA and translation of data into specific policies

Sustainably improve NHA production and translation of data into specific policies

9 Redesigned tools and pathways for data collection sharing and analysis

10 Health financing dashboard at the ministry of health

11 IT tools are scaled in public and private sectors

12 NHA curriculum accepted as part of existing health financing curriculum in the schools of public health economics and journalism

13 Reward mechanisms designed for timely submission of data and NHA data used for policy and programme reform

Full institutionalization 14 Funding and personnel for NHA are mainstreamed in relevant sector budget

44 Gantt Chart for National Health Accounts institutionalization

To ensure timely implementation of the NHA institutionalization strategic plan establishing

and agreeing on a time frame are critical to keep up the momentum and for the efficient use

of political capital and the resources available All stakeholders will need to keep track of time

and the champion will monitor the progress The work of both the steering and technical

committees will be time bound In the scenario where the budget appears to be insufficiently

planned and more resources are needed the steering committee and the champion should

be proactive in securing new funding to successfully institutionalize NHA in the country

Page | 21

Table 11 Gantt chart for National Health Accounts institutionalization

5 CONCLUSION

NHA is a powerful tool in understanding the health expenditure breakdown in a given country

It helps to comprehend the health expenditure trends and what influences them to inform

resource allocation Africa lags behind in institutionalizing NHA A few countries have made

steps that require support to keep up the momentum but more is needed to initiate the full

institutionalization of NHA in most countries For this to happen there is need for a well-

designed leadership structure for NHA with the functions clearly defined The most highly

recommended leadership structure includes political and technical teams Sufficient

resources also are necessary to build solid information technology infrastructure and recruit

capable human resources for the timely submission of NHA data and generation of real-time

dashboard information on performance indicators to report on health expenditure With the

current technologies and internet capabilities along with the provision of the necessary

technical and financial support and time African countries can potentially effectively

institutionalize NHA This guide is a step forward in inspiring the countries expectation is that

its customization will be necessary to fit individual country contexts

Indicators Time frame (months)

1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48


Leadership designated

Budget secured

Situational analysis report

Costed NHA institutionalization strategy

Funding MOUs signed


NHA working group

NHA mainstreamed in health sector reviews

Annual NHA impact assessments

2 publications on health expenditure every semester


Redesigned IT tools

Health financing dashboard

IT tools scaled in public and private sectors

NHA mainstreamed in schools

Rewards mechanisms designed

Full institutionalization

Funding and personnel are mainstreamed

Page | 22

RECOMMENDED LITERATURE

1 WHO AFR Status update of the institutionalization of NHA in Africa December 2020

2 Xu Ke Soucat A amp Kutzin J et al Public spending on health a closer look at global trends Geneva World Health Organization 2018

3 Nkhoma D Institutionalization of the national health accounts (NHA) production in Malawi 2018

4 Rwiyereka KA Improvement of Rwandarsquos health expenditure information systems Report to PHCPI amp WHO 2019

5 WHO Health accounts (httpswwwwhointhealth-topicshealth-accountstab=tab_1)

6 WHO What are national health accounts (httpappswhointnhawhatenindexhtml)

7 USAID National health accounts Global Policy Brief (httppdfusaidgovpdf_docs Pnacs960pdf)

8 PHRplus Project Using NHA to inform the policy process NHA Regional Policy Brief Eastern Central and Southern Africa

9 Fetter B Origins and elaboration of the national health accounts 1926-2006 Health Care Financing Review 2006 28(1)53ndash67 (wwwncbinlmnihgovpmcarticlesPMC4194972)

10 A system of health accounts Version of 2011 (httpswwwoecdorghealthhealth-systems 21160591pdf)

11 A system of health accounts Version of 2011 (httpswwwwhointhealth-accounts methodologysha2011pdfua=1)

12 Global Health Expenditure Database (GHED)

13 Organization for Economic Co-operation and Development (OECD) Creating an evidence base for better health financing and greater accountability - A Strategic Guide for the Institutionalization of National Health Accounts

14 WHO National health accounts (httpappswhointnhaen)


16 WHO National health accounts in policy formulation (httpappswhointnhauseen)

17 African Union African Heads of State and Government define the future direction for AIDS TB and malaria responses (httpwwwauint)

18 Robert Yin Case studies design and methods 2013

19 Vaismoradi et al Theme development in qualitative content analysis and thematic analysis Journal of Nursing Education and Practice 2016 (httpscoreacukdownloadpdf52132811pdf)

20 Maeda et al Creating evidence for better health financing decisions a strategic guide for the institutionalization of national health accounts 2012 (httpdocuments1worldbankorg curatedar410301468323088938pdf689660PUB0publ07926B009780821394694pdf )

21 httpswwwwhointhealthsystemspublicationsabuja_declarationen

22 World Bank (httpswwwworldbankorgentopicgovernancebrieffinancial-management-information-systems-fmis)



THE AFRICAN REGION

NOVEMBER 2021

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR AFRICA

BRAZZAVILLE bull 2021


ISBN 978-929023461-6













Page | iii

CONTENTS

ACRONYMS iv

FOREWORD v




EXECUTIVE SUMMARY x



1 BACKGROUND 1


21 Rationale 1



Accounts 2






5 CONCLUSION 21


LIST OF TABLES












Page | iv

ACRONYMS
















Page | v

FOREWORD





































Page | vi








Dr Kasonde Mwinga


Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22

























ISBN 978-929023461-6













Page | iii

CONTENTS

ACRONYMS iv

FOREWORD v




EXECUTIVE SUMMARY x



1 BACKGROUND 1


21 Rationale 1



Accounts 2






5 CONCLUSION 21


LIST OF TABLES












Page | iv

ACRONYMS
















Page | v

FOREWORD





































Page | vi








Dr Kasonde Mwinga


Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | iii

CONTENTS

ACRONYMS iv

FOREWORD v




EXECUTIVE SUMMARY x



1 BACKGROUND 1


21 Rationale 1



Accounts 2






5 CONCLUSION 21


LIST OF TABLES












Page | iv

ACRONYMS
















Page | v

FOREWORD





































Page | vi








Dr Kasonde Mwinga


Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | iv

ACRONYMS
















Page | v

FOREWORD





































Page | vi








Dr Kasonde Mwinga


Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | v

FOREWORD





































Page | vi








Dr Kasonde Mwinga


Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | vi








Dr Kasonde Mwinga


Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | vii












marching
















policy

Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | viii

ACKNOWLEDGEMENTS








Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | ix







main definitions
















Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | x

EXECUTIVE SUMMARY








to-read reports























human resources




Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | xi













sustainability


























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | xii




Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 1

1 BACKGROUND























21 Rationale








Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 2























(see Fig 1)





Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 3


















commitments

Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 4



















mainstreamed


















Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 5












targets
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 6





communities




innovation












Academia








Action Aid












Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 7


















and








NHA










Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 8








resources




















support

Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 9




Steering committee

Government






Civil society








Technical team










Steering committee

















Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 10

Technical committee






























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 11


Steps Activities





























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 12


Steps Activities


















Step 31 IT tools

















Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 13

















evaluation




in existing budgets





















Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 14









institutions









accelerated


















Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 15
















4154 Academia

















aims

Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 16



Ministry of health




Ministry of finance






















Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 17


Assessment area

Question Text




Q13





Q17

















Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 18







Q24




Q27








Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 19



Dissemination


























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 20


































Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 21


5 CONCLUSION
















1 2 3 4 5 6 7 8 9 10 11 12 18 24 30 36 42 48



Budget secured



Funding MOUs signed


NHA working group





Redesigned IT tools







Page | 22
























Page | 22
























Documents

guide for the institutionalization of national health accounts in