Table 2 Comparative analysis of institutionalisation indicators in the two policy units studied

1. Existence of an institutional framework (the unit’s mandate from government)

1.1. Law/regulation providing a mandate for the unit

➢ There is an inter-ministerial decree signed by the ministers of health and economy and finance; this identifies the stakeholders and their role in the production of health accounts

➢ An integrated organisation chart is aligned with the organisation chart for the overarching directorate

➢ There is an institutional framework that allows the implementation of the program

➢ There is an integrated organisation chart aligned with the organisation chart of the service for the fight against non-communicable diseases

1.2. Institutional home identified for the policy units

➢ There is a dedicated working space for this unit but it is insufficient for all staff

➢ There is working space available in an office, but shared with four other policy units

1.3. Protocols/public norms set out for data or information production

➢ WHO’s system of health accounts framework (currently SHA-2011) is the main guideline for health accounts

➢ There are protocols for medical care amongst those with these diseases

2. Consistent production of data and preparation of reports

2.1. Explicit process designed for data gathering, compilation and transmission for decision-making

➢ There is no system for routine gathering of health expenditure in the health information system

➢ The service uses a database of health expenditure developed in 2008 and integrated into the health system

➢ A survey is carried out each year, funded by donors, to provide additional data

➢ There is no data collection system, unlike other policy units for other diseases, although the unit has a data collection guideline

➢ No routine data are collected and no indicator from the unit is included in the statistical yearbook, the reference for data gathering and use in policymaking

2.2. Policy unit activities are regular and ongoing

➢ Ten sets of health accounts, including sub-accounts, have been produced since 2005

➢ Health accounts are poorly used in decision-making processes

➢ No policy unit activity was documented

2.3. Protocol exists for validating reports

➢ Data collection is not integrated into routine data collection processes, but the policy unit uses a standard health expenditure database

➢ There is a lack of coordination among stakeholders, which hinders data production

➢ There is a lack of involvement of stakeholders (NGOs, municipalities, social services) in caring for patients with these diseases

2.4. Minimum set of globally agreed data is produced

➢ Health system expenditure data are available every year

➢ Data are processed using the health accounts production tool and the health account analysis tool provided by the WHO and US Agency for International Development

➢ No administrative reports, evaluation reports or other publications have been developed and published

3. Adequate financial and human resources, and infrastructure capacity to routinely produce and make use of data in policymaking

3.1. The policy unit has an annual action plan

➢ There is an action plan for the health information and statistics department which includes the NHAU’s activities

➢ There is an action plan for the overarching Ministry of Health department, which should include PFNCD activities, but little is planned

3.2. Government budget is earmarked for the policy unit’s activities

➢ There is no budget line from the Ministry of Health

➢ The state budget contribution is mainly for salaries

➢ The unit’s activities are typically funded by donors; there is usually no difficulty obtaining the money but there may be delays in releasing funds

➢ There is a state budget line covering four health programs; the portion allocated to the policy unit is insufficient

➢ There are no donor funds available; the last such support was in 2006

3.3. Sufficient material and human resources are available for the policy unit’s activities

➢ The policy unit obtained computer equipment in 2010; it uses hardware from the health information and statistics unit

➢ There are sufficient multidisciplinary resources from several departments; however, staff must be regularly trained and financially motivated to retain them

➢ The PFNCD does not have enough equipment; it lacks computers and office furniture

➢ The PFNCD has just one member of staff, the policy unit coordinator, who is rarely available and mostly absent during planning, which hinders the mobilisation of resources

3.4. The policy unit’s annual action plan is at least half funded

➢ The history of the policy unit’s annual action plan shows that, since 2009, at least more than 90% of the activities were funded

➢ The records of the policy unit action plans from 2005 to 2012 shows that the unit activities funding rate are between 10% and 16%