Meghalaya Health Systems Strengthening Project

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Internal Performance Agreements

Internal Performance Agreements (IPAs)

Internal Performance Agreements (IPAs) are a type of Results-Based Financing mechanism designed to improve healthcare service quality, management, and accountability. The practice of result-based financing in healthcare services involves providing financial support/funding based on achieving specified and agreed health outcomes or outputs.

IPA Framework: Enhancing performance, accountability, and management in the healthcare system

IPAs are agreements made between the MHSSP project management unit (PMU) and various facilities/administrators under the health department with the aim of enhancing the performance of all relevant players in the health system. Individual IPA Frameworks have been drawn up for different level of health facilities and entities, i.e., PHCs, CHCs, DHs (with and without MCH), DMHOs, Directorates and MHIS. These IPA frameworks consist of key performance indicators which aims to foster a more accountable governance and contribute to improvements in the management of the system and the delivery of quality health services. Regular assessments, governed by the IPA frameworks will ensure internal verification mechanisms that will further strengthen the management, governance, and accountability relationships between the state and sub-state-level implementing units.

The IPA frameworks has also been designed, taking into account the ground realities and specific challenges, enabling the framework to be adaptable and flexible.

Funding and Performance Verification through IPA

Facilities and Entities within the health system are allocated maximum funding that can be earned based on their level of performance in an IPA. These funds are disbursed to institutions on a quarterly basis, subject to verification of their performance. The IPA's goal is to improve the performance of all relevant players in the health system simultaneously, in a coordinated manner, including health facilities and administrative units at the district and state levels.


Benefits of IPAs: Accountability, quality improvement and collaboration

IPAs offer several benefits for the healthcare system. Firstly, they promote accountability and transparency in the management of the system. Secondly, they incentivize healthcare facilities and staff to achieve high and better performance, leading to an improvement in the quality of services. Thirdly, they foster a more coordinated and collaborative approach towards enhancing the performance of the healthcare system.


The Pilot program started in January 2023 and included two assessment periods: Quarter 1 (Jan-March) and Quarter-2 (April-June). In the Pilot phase implementation, it was observed that since IPA was a new concept it took facilities some time to follow the processes that are part of these agreements, however, improvement in scores in almost all entities was observed by the second quarter verification. During this period, investments made by entities towards infrastructural capacity, patient satisfaction and quality service delivery has stood out and serves as a learning to all other facilities as well. In terms of implementation guidelines, various feedback was collected from entities, which has led the PMU to understand the gaps and work towards the required changes before the statewide IPA rollout.


Beginning in the Quarter of Oct-Dec 2023, the IPA statewide implementation encompasses 122 facilities, which include 3 Directorates, 1 Procurement Agency (MMDSL), 11 District & Medical Health Offices, 14 District Hospitals, 3 Specialty Hospitals, 20 CHC and 70 PHC. All these entities sign individual agreements with the PMU–MHSSP, based on which the entities earn their quarterly funds as per their performance. The statewide implementation takes from the feedback and observations of the Pilot Program which has enabled the MHSPP – PMU to plug the gaps and improve the frameworks and guidelines that govern the IPA Program. The IPA statewide implementation is planned to continue till March 2027. This pay-for-performance model promotes the spirit of autonomy amongst the participating stakeholders.

Statewide IPA Entities

Sl.No. District District Hospital Name
1 East Garo Hills Williamnagar Civil Hospital
2 East Jaintia Hills Khliehriat Civil Hospital
3 East Khasi Hills Ganesh Govt MC&H Hospital Shillong
4 East Khasi Hills Shillong Civil Hospital
5 Eastern West Khasi Hills Tirot Singh Memorial Civil Hospital Mairang
6 Ri Bhoi Nongpoh Civil Hospital
7 South Garo Hills Baghmara Civil Hospital
8 South West Garo Hills Ampati Civil Hospital
9 South West Khasi Hills Mawkyrwat Civil Hospital
10 West Garo Hills Tura Civil Hospital
11 West Garo Hills Tura Maternity and Child Hospital
12 West Garo Hills Jengjal Sub-Divisional Hospital
13 West Jaintia Hills Jowai Civil Hospital
14 West Khasi Hills Nongstoin Civil Hospital
15 West Garo Hills Tura TB Hospital
16 East Khasi Hills RP Chest Hospital
17 East Khasi Hills MIMHANS

Sl.No. District CHC
1 East Khasi Hills Mawsynram CHC
2 East Khasi Hills Mawryngkneng CHC
3 East Khasi Hills Ichamati CHC
4 East Khasi Hills Pynursla CHC

Sl.No. District CHC
1 West Jaintia Hills Nongtalang CHC
2 West Jaintia Hills Ummulong CHC

Sl.No. District CHC
1 Eastern West Khasi Hills Nongkhlaw CHC

Sl.No. District CHC
1 West Khasi Hills Riangdo CHC

Sl.No. District CHC
1 North Garo Hills Resubelpara CHC

Sl.No. District CHC
1 South West Khasi Hills Ranikor CHC

1 Ri Bhoi District Patharkhmah CHC
2 Ri Bhoi District Bhoirymbong CHC
3 Ri Bhoi District Umsning CHC
1 North Garo Hills Resubelpara CHC

Sl.No. District CHC
1 South Garo Hills Chokpot CHC

Sl.No. District CHC
1 East Jaintia Hills Sutnga CHC

Sl.No. District CHC
1 South West Garo Hills Mahendraganj CHC

Sl.No. District CHC
1 West Garo Hills Dalu CHC
2 West Garo Hills Phulbari CHC
3 West Garo Hills Alagre CHC

Sl.No. District CHC
1 East Garo Hills Rongjeng CHC

Sl.No. District PHC
1 East Khasi Hills Jongksha PHC
2 East Khasi Hills Pomlum PHC
3 East Khasi Hills Mawroh PHC
4 East Khasi Hills Laitkynsew PHC
5 East Khasi Hills Wahsherkhmut PHC
6 East Khasi Hills Smit PHC
7 East Khasi Hills Diengiei PHC
8 East Khasi Hills Laitlyngkot PHC
9 East Khasi Hills Mawkliaw PHC
10 East Khasi Hills Jatah PHC
11 East Khasi Hills Mawkynrew PHC
12 East Khasi Hills Khatarshnong Khrang PHC
13 East Khasi Hills Mawsiat Khnam PHC
14 East Khasi Hills Nongspung PHC
15 East Khasi Hills Diengpasoh PHC

Sl.No. District PHC
1 West Jaintia Hills Dawki PHC
2 West Jaintia Hills Mynso PHC
3 West Jaintia Hills Khliehtyrshi PHC
4 West Jaintia Hills Nangbah PHC
5 West Jaintia Hills Namdong PHC
6 West Jaintia Hills Iooksi PHC
7 West Jaintia Hills Pdengshakap PHC

Sl.No. District PHC
1 Eastern West Khasi Hills Pariong PHC
2 Eastern West Khasi Hills Madan Maroid PHC
3 Eastern West Khasi Hills Kynshi PHC
4 Eastern West Khasi Hills Markasa PHC
5 Eastern West Khasi Hills Laitdom PHC
6 Eastern West Khasi Hills Nongthliew PHC
7 Eastern West Khasi Hills Dongki Ingding PHC

Sl.No. District PHC
1 West Khasi Hills Rambrai PHC
2 West Khasi Hills Maweit PHC
3 West Khasi Hills Nonglang PHC

Sl.No. District PHC
1 North Garo Hills Mendipathar PHC
2 North Garo Hills Bajengdoba PHC
3 North Garo Hills Sualmari PHC
4 North Garo Hills Damas PHC
5 North Garo Hills Wageasi PHC
6 North Garo Hills Gabil PHC
7 North Garo Hills Kharkutta PHC

Sl.No. District PHC
1 South West Khasi Hills Mawthawpdah PHC
2 South West Khasi Hills Rangthong PHC

Sl.No. District PHC
48 Ri Bhoi District Byrnihat PHC
49 Ri Bhoi District Kyrdem PHC
50 Ri Bhoi District Mawhati PHC
51 Ri Bhoi District Marngar PHC
52 Ri Bhoi District Mawlasnai PHC

Sl.No. District PHC
1 South Garo Hills Sibbari PHC
2 South Garo Hills Rongara PHC
3 South Garo Hills Nongalbibra PHC
4 South Garo Hills Siju PHC

Sl.No. District PHC
1 East Jaintia Hills Lumshnong PHC
2 East Jaintia Hills Pamra Paithlu PHC
3 East Jaintia Hills Rymbai PHC
4 East Jaintia Hills Bataw PHC

Sl.No. District PHC
1 South West Garo Hills Rangsakona PHC
2 South West Garo Hills Betasing PHC
3 South West Garo Hills Zikzak PHC

Sl.No. District PHC
1 West Garo Hills Kherapara PHC
2 West Garo Hills Asananggre PHC
3 West Garo Hills Babadam PHC
4 West Garo Hills Bhaitbari PHC
5 West Garo Hills Tikrikilla PHC
6 West Garo Hills Tikrikilla PHC

Sl.No. District PHC
1 East Garo Hills Garobadha PHC
2 East Garo Hills Belbari PHC
3 East Garo Hills Nogorpara PHC
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