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.

IPA IMPLEMENTATION – PILOT PHASE (January – June 2023):

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.

IPA IMPLEMENTATION – STATEWIDE ROLL OUT (November 2023 – March 2027):

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

Important IPA Link

• Dashboard IPA

Glimpses of Statewide Workshop/Training on IPA

 

 

 

 

• Investments by IPA Funds

IPA Implementation