The Meghalaya Health Systems Strengthening Project combines results-based financing (RBF) and input-based financing approaches to achieve enhanced performance management in the public sector. It uses a system’s approach and is broken down into three individual components which need to be appreciated as forming part of a whole system’s approach complimenting each other – the first component strives for results, while the second and third components are designed for input-based financing and are critical for achieving the project objectives. In addition, strengthening the management and organization of the health insurance program is expected to boost health insurance utilization and a swiffer reimbursement to providers. A rigorous performance management approach will align incentives to support planning from top to bottom to move incrementally toward the national accreditation standards for district hospitals, CHCs, and PHCs. Inputs required to assist health facilities to reach national accreditation standards will be sourced not only from planning and followed through using performance-based instruments but also from resources put upfront through decentralized health facility grants and income through results-based quality achievements

Component 1

Improving accountability, management and strengthening governance (cost US$18 million). This component provides performance incentive grants to health agencies and health facilities with an overarching aim to improve governance and management structures and delivery of quality health services. The project envisages the IPA as a tool to introduce new ways of operations by moving from input-based financing to RBF. An RBF approach is expected to strengthen the management, governance, and accountability relationships between the state- and the sub-state-level implementing units. Grants to health agencies and health facilities would be made available based on the achievement of results, as measured by performance indicators specified in the IPA. The IPA aims to foster a spirit of more accountable government, along with RBF, contributing to improvements in the management of the system and delivery of quality health services.

Component 2

Strengthening systems to improve the quality of health services (cost US$16.90 million). The investment under this component will improve the quality of health services through the:

• Development and implementation of QA programs including training, certification, and quality-tracking tools and investments in the functionality of health services infrastructure for DHs, CHCs and PHCs.

• Provision of support for infection prevention and control, environmental and energy efficiency measures, and management of resources and biomedical waste at the health facility level;

• Development of tools and provision of technical assistance including training and outsourcing to improve:

  • (i) human resources supply, planning and management,
  • (ii) in-service capacity-building, and
  • (iii) pre-service education;

• Strengthening of DoHFW’s procurement of medicines and consumables and supply chain management at state and sub-state levels;

• provision of support for the design, development and piloting of innovative models for outreach and in service delivery, which may include use of telemedicine to connect primary health centres for referral and tertiary care and use of drones for emergency supplies;
• development of systems for, and provision of training and technical assistance to, the administrative structures responsible for health system management in planning, management and monitoring; and
• provision of support for the management of the Project, including on its technical, fiduciary, safeguards management, monitoring and evaluation aspects.

Component 3

Increasing coverage and utilization of health services (cost US$5 million). This component will invest in increasing the coverage of the state health insurance program, strengthen primary care through Health and Wellness Centers, and strengthen community-level interventions and engagement.

This will be achieved through:

• Assessment and strengthening of the MHIS, including its organization and operation systems to improve coverage.

• support for innovation pilots in health and wellness centers; and

• support for innovation pilots in community-led interventions to assess and improve gender equity in health services .

Component 4

Contingent Emergency Response (cost US$0 million). This component provides a mechanism for provision of immediate response to an Eligible Crisis or Emergency, as needed.