The World Bank has approved a $40 million project for Meghalaya to improve the quality of health services and strengthen the State’s capacity to handle future health emergencies, including the Covid-19 pandemic.
Approved by the World Bank board of executive directors on September 30, the $40 million loan from the International Bank for Reconstruction and Development (IBRD) has a maturity of 14.5 years, including a grace period of five years.
The Meghalaya Health Systems Strengthening Project will enhance the management and governance capabilities of the State and its health facilities; expand the design and coverage of the State’s health insurance program; improve the quality of health services through certification and better human resource systems; and enable efficient access to medicines and diagnostics.
The project will benefit all 11 districts of the State. It will also benefit health sector staff at the primary and secondary levels by strengthening their planning and management capabilities and building their clinical skills. The project will enable women to better utilise healthcare services at the community level.
According to the World Bank, under-five mortality in Meghalaya was 40 deaths per 1,000 live births in 2019–20. Stunting among under-fives was 47 per cent – a marginal increase from the previous survey (2015-16).
“A few districts perform better than others and rural-urban differences exist, with urban areas performing better in most health indicators. Meanwhile, NCDs (including hypertension, diabetes, heart disease, and cancer) account for more than half of the disease burden in the State,” the World Bank said.
The project will help strengthen the effectiveness of Meghalaya’s health insurance program known as the Megha Health Insurance Scheme (MHIS) – which currently covers only 56 per cent of the households. With its merger into the national Pradhan Mantri Jan Arogya Yojna (PMJAY), MHIS now plans to offer a more comprehensive package and cover 100 per cent of the households. This will reduce barriers to accessing hospital services and preventing catastrophic out-of-pocket costs for poor families.
“Meghalaya has the distinction of performing better than the national average on many key health indicators. Access to quality health services, however, remains a challenge, particularly in rural areas. The COVID-19 pandemic has further strained the state’s health systems, impacting the delivery of essential services,” said Junaid Ahmad, World Bank Country Director in India.
“This project will support the State government’s efforts to deliver quality healthcare for the poor and vulnerable, for women, and to those located in remote areas,” he added.
As a key strategy, the project will move towards a performance-based financing system where Internal Performance Agreements (IPAs) between the State Health Department and its subsidiaries would foster more accountability at all levels. This is expected to go a long way in improving the management of the system to deliver quality health services. The project will also focus on promoting synergy between various schemes and augment the capacity of the state insurance agency.
The project will invest in infection prevention and control for a more resilient response to future outbreaks, pandemics, and health emergencies.
Improved health services may also lead to an incremental increase in bio-medical waste. Any improper management of wastes including bio-medical waste and other hazardous wastes such as plastic waste and e-waste poses environmental risks. The project will invest in improving the overall ecosystem for bio-medical waste management (both solid and liquid waste). It will include segregation, disinfection, and collection while safeguarding the environment and improving the quality of health service and patient safety.
“Weak management capacity is leading to a range of gaps affecting the quality and utilisation of health services in Meghalaya,” said Amith Nagaraj Bathula, Senior Operations Officer, and World Bank’s Task Team Leader for the project.
“This project will help the state to improve management capacity, quality certification at health facilities, enhance human resources, and strengthen health insurance and other innovations,” he added.
