The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Meghalaya Health Systems Strengthening Project (P173589) SOUTH ASIA | India | IBRD/IDA | Investment Project Financing (IPF) | FY 2022 | Seq No: 8 | Archived on 03-Mar-2025 | ISR03248 Implementing Agencies: Department of Health and Family Welfare, Government of Meghalaya 1. OBJECTIVE 1.1 Development Objective Original Development Objective (Approved as part of Approval package on 30-Sep-2021) The project development objective (PDO) is to improve management capacity, quality and utilization of health services in Meghalaya. Has the Development Objective been changed since Board Approval of the Project Objective? No 2. COMPONENTS Name Improving accountability, management and strengthening governance:(Cost 18,000,000.00) Strengthening systems to improve the quality of health services:(Cost 16,900,000.00) Increasing coverage and utilization of health services:(Cost 5,000,000.00) Contingent Emergency Response Component:(Cost 0.00) 3. OVERALL RATINGS Name Previous Current Progress towards achievement of PDO Moderately Satisfactory Moderately Satisfactory Overall Implementation Progress (IP) Moderately Satisfactory Satisfactory Overall Risk Rating Substantial Substantial 4. KEY ISSUES & STATUS Mar 03, 2025 Page 1 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) 4.1 Implementation Status and Key Decisions Overall project is on track to met project development objectives. the component wise progress is provided below. Component 1: Improving Accountability, Management, and Strengthening Governance Over the past three years, the Meghalaya Health Systems Strengthening Project has expanded statewide, signing 123 IPAs with all planned institutions to enhance quality and management capacity. Approximately 70 percent of staff in IPA facilities have participated in Clinical Vignettes, although a mechanism to measure knowledge improvement is still needed. Third-Party Verification and Quality Assessment have faced some delays. The Project Management Unit (PMU) is conducting joint meetings with assessors and IPA entities to address inconsistencies and establish a common understanding. Component 2: Strengthening Systems to Improve the Quality of Health Services Significant progress has been made in the last three years, including renovating 115 healthcare facilities, enhancing human resource for health (HRH) reforms, and implementing key policies. Capacity-building efforts have focused on training health staff using evidence-based approaches, improving service delivery and infrastructure, and contributing substantially to the project's objectives of enhancing service quality and utilization of health services. Component 3: Increasing Coverage and Utilization of Health Services This component focuses on health insurance and social behavior change communication to augment service utilization. Significant progress has been made, with most TA activities for health insurance completed in the first year and recommendations embedded into the program design. The PMU has strengthened in-house teams to develop creative communication programs targeting health needs like teenage pregnancy and women's health. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 07 - 07 Nov Proposed Rating 30 Sep 2021 2024 Political and Governance Moderate Moderate Moderate Macroeconomic Substantial Moderate Moderate Sector Strategies and Policies Moderate Moderate Moderate Technical Design of Project or Program Substantial Moderate Moderate Institutional Capacity for Implementation and Substantial Substantial Substantial Sustainability Fiduciary Substantial Moderate Moderate Environment and Social Moderate Moderate Moderate Mar 03, 2025 Page 2 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Stakeholders Moderate Moderate Moderate Overall Substantial Substantial Substantial Mar 03, 2025 Page 3 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) 6. RESULTS 6.1 PDO Indicators by PDO Outcomes To improve Management capacity, quality, and utilization of health services in Meghalaya. Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year The percentage point 0.00 Apr/2021 31.44 30-Sep-2024 31.44 31-Jan-2025 20.00 Mar/2026 increase in average Comments on performance score in achieving targets targeted administrative units as per internal performance agreement from baseline. (Percentage) Cumulative number of 1.00 Apr/2021 0.00 30-Sep-2024 0.00 31-Jan-2025 9.00 Mar/2026 districts hospitals which are NQAS certified. (Number) 0.00 Apr/2021 74.38 30-Sep-2024 74.38 31-Jan-2025 20.00 Mar/2026 The percentage point Comments on increase in average quality achieving targets index score for CHCs and PHC from baseline. (Percentage) Increase in number of 1,650,932.00 Apr/2021 1,100,409 30-Sep-2024 1,403,441 31-Jan-2025 1,800,000.00 Mar/2026 patients utilizing government health services OPD in targeted facilities. (Number) Mar 03, 2025 Page 4 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Percentage of claims settled 50.00 Apr/2021 64.60 30-Sep-2024 64.60 31-Jan-2025 90.00 Mar/2026 within agreed turnaround time. (Percentage) 6.2 Intermediate Results Indicators by Components Improving accountability, management and strengthening governance Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Percentage of internal 0.00 Apr/2021 99.19 30-Sep-2024 99.19 31-Jan-2025 100.00 Mar/2026 performance agreements reviewed as per the operational manual. (Percentage) Percentage of targeted 0.00 Apr/2021 0.00 30-Sep-2024 0.00 31-Jan-2025 100.00 Mar/2026 facilities and administrative Comments on units that receive achieving targets performance payment, as per operations manual . (Percentage) 0.00 Apr/2021 72.50 30-Sep-2024 72.50 31-Jan-2025 25.00 Mar/2026 Percentage point increase in Comments on average patient satisfaction achieving targets score in targeted health facilities. (Percentage) People who have received 26,040.00 Apr/2021 92,924 30-Sep-2024 111,109 31-Jan-2025 137,500.00 Mar/2026 essential health, nutrition, Mar 03, 2025 Page 5 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) and population (HNP) services (Number) Number of deliveries 26,040.00 Apr/2021 92,924 30-Sep-2024 111,109 31-Jan-2025 137,500.00 Mar/2026 attended by skilled health personnel (Number) Percentage point decrease of 0.00 Apr/2021 0.00 30-Sep-2024 0.00 31-Jan-2025 10.00 Mar/2026 targeted health facilities Comments on Data not available reported stock-out of achieving targets essential drugs. (Percentage) Strengthening systems to improve the quality of health services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year 0.00 Apr/2021 0.00 30-Sep-2024 0.00 31-Jan-2025 25.00 Mar/2026 Comments on Numerator: average clinical vignette score core in targeted health units – baseline average The percentage point achieving targets clinical vignette score *100 Target= Doctors and Nurses in Target Health facilities Target= increase in score among those who participated in 11DH+18CHC+66 PHC clinical vignettes. (Percentage) 0.00 Apr/2021 40 30-Sep-2024 40 31-Jan-2025 90.00 Mar/2026 Percentage of medical Comments on Target= Doctors and Nurses in Target Health facilities Target= 11DH+18CHC+66 PHC doctors and nurses from achieving targets targeted facilities participated in clinical vignettes. (Percentage) 0.00 Apr/2021 75.36 30-Sep-2024 73 31-Jan-2025 30.00 Mar/2026 Mar 03, 2025 Page 6 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Comments on Numerator: Biomedical waste score* under Quality Index in targeted health facility achieving targets Denominator: Number of Targeted Health Facilities; Target= 11DH+18CHC+66 PHC * Bio medical waste management: Color coded bins with cover [one each in OPD, each Ward, OT, Average score for bio medical Dressing, Injection room, emergency, labor room and lab], Needle cutter, Hypochlorite waste management in solution in laboratory. Mops with bucket and disinfectant. [separate for each OT, labor room] and general patient care including ward. Daily Collection of waste and mopping [schedule]. targeted health facilities at Treatment of infectious waste: [hypochlorite for sharps], microwave/autoclave. Functional district, PHC and CHC level. sharps pit and deep burial pit with cover [no spillage outside] (All or None). (Percentage) 0.00 Apr/2021 100.00 30-Sep-2024 100.00 31-Jan-2025 95.00 Mar/2026 Percentage of targeted Comments on facilities where quality achieving targets scoring was done by higher level in last quarter. (Percentage) Increasing coverage and utilization of health services Baseline Actual (Previous) Actual (Current) Closing Period Indicator Name Value Month/Year Value Date Value Date Value Month/Year Increase in percentage 56.00 Apr/2021 88 30-Sep-2024 88 31-Jan-2025 80.00 Mar/2026 coverage of households under health insurance scheme. (Percentage) Increase in number of 84,055.00 Apr/2021 60,093 30-Sep-2024 81,116 31-Jan-2025 123,064.00 Mar/2026 women patients utilizing government health services IPD in targeted facilities. (Number) Mar 03, 2025 Page 7 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Percentage of local fund 0.00 Apr/2021 56.19 30-Sep-2024 56.19 31-Jan-2025 80.00 Mar/2026 utilization (including performance grants and Insurance reimbursements) in targeted hospitals. (Percentage) Mar 03, 2025 Page 8 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) 7. DATA ON FINANCIAL PERFORMANCE 7.1 Cumulative Disbursements 7.2 Disbursements (by loan) Loan/Credit/TF Status Original Revised Cancelled Disbursed Undisbursed % Disbursed IBRD-92910 Effective 40.00 40.00 0.00 18.19 21.81 45.47% 7.3 Key Dates (by loan) Loan/Credit/TF Status Approval Signing Effectiveness Orig. Closing Rev. Closing IBRD-92910 Effective 30-Sep-2021 28-Oct-2021 26-Nov-2021 31-Mar-2027 31-Mar-2027 8. KEY DATES Mar 03, 2025 Page 9 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Key Events Planned Actual Approval 30-Sep-2021 30-Sep-2021 Effectiveness 26-Nov-2021 26-Nov-2021 Mid-Term Review No. 01 31-Jan-2025 23-Jan-2025 Operation Closing/Cancellation 31-Mar-2027 9. RESTRUCTURING HISTORY 10. ASSOCIATED OPERATION(S) There are no associated operations Mar 03, 2025 Page 10 of 10