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: 7 | Archived on 07-Nov-2024 | ISR02177 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 29-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 Moderately Satisfactory Overall Risk Rating Substantial Substantial 4. KEY ISSUES & STATUS Nov 07, 2024 Page 1 of 9 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) 4.1 Implementation Status and Key Decisions The project is on track, meeting year three targets for four out of five Project Development Objectives (PDO) indicators. Of 13 intermediate indicators, eight have met their targets, one is delayed, and four are either delayed or yet to start reporting progress. Component 1: Improving Accountability, Management, and Strengthening Governance: Significant progress has been made, with 122 IPA entities participating, including state-level entities, secondary care health facilities, district-level administrative entities, and lower-level health facilities. Disbursement and expenditure under the IPA have improved, with overall disbursement at 35% and 55% of that spent. The implementation of Clinical Vignettes has gradually improved, with 40% staff participation. Component 2: Strengthening Systems to Improve the Quality of Health Services. Infrastructure development is progressing, with 110 out of 149 health facilities completed and financial progress at 73%. Nursing schools at Nongpoh, Nongstoin, and William Nagar are proposed for repairs, with assessments being underway. Significant progress has been made in Human Resources for Health (HRH), with a draft report on the functional review of health directorates and institutions to be submitted. The e-HRMIS (Manav Sampada) is progressing well and will be adopted. Capacity building is in its second year, with 55% of doctors and 30% of nurses trained. Component 3: Increasing Coverage and Utilization of Health Services. Community Interventions - Early Childhood Development (ECD) Intervention: Out of 10 deliverables, five are completed, one is in progress, and four are pending. Close monitoring is essential to ensure timely completion. Social Behavior Change Communication: PMU engaged the Society for Action in Community Health (SACH) to develop a comprehensive SBCC strategy. PMU has initiated the development of relevant IEC materials for display at health facilities. 5. SYSTEMATIC OPERATIONS RISK-RATING TOOL Rating at Approval Last Approved Rating Risk Category Approval Package - ISR Seq. 06 - 09 May 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 Substantial Moderate Environment and Social Moderate Moderate Moderate Nov 07, 2024 Page 2 of 9 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) Stakeholders Moderate Moderate Moderate Overall Substantial Substantial Substantial Nov 07, 2024 Page 3 of 9 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 Increase in number of 1,650,932.00 Apr/2021 1,817,210.00 31-Mar-2024 1,100,409 30-Sep-2024 1,800,000.00 Mar/2026 patients utilizing government health services OPD in targeted facilities. (Number) 0.00 Apr/2021 28.47 31-Mar-2024 31.44 30-Sep-2024 20.00 Mar/2026 The percentage point increase Comments on in average performance score achieving targets in targeted administrative units as per internal performance agreement from baseline. (Percentage) Cumulative number of 1.00 Apr/2021 0.00 31-Mar-2024 0.00 30-Sep-2024 9.00 Mar/2026 districts hospitals which are NQAS certified. (Number) 0.00 Apr/2021 27.25 31-Mar-2024 74.38 30-Sep-2024 20.00 Mar/2026 The percentage point increase in average quality index score Comments on for CHCs and PHC from achieving targets baseline. (Percentage) 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 31-Mar-2024 64.60 30-Sep-2024 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 People who have received 26,040.00 Apr/2021 57,296.00 31-Mar-2024 92,924 30-Sep-2024 137,500.00 Mar/2026 essential health, nutrition, and population (HNP) services (Number) Number of deliveries 26,040.00 Apr/2021 57,296.00 31-Mar-2024 92,924 30-Sep-2024 137,500.00 Mar/2026 attended by skilled health personnel (Number) Percentage of internal 0.00 Apr/2021 99.19 31-Mar-2024 99.19 30-Sep-2024 100.00 Mar/2026 performance agreements reviewed as per the operational manual. (Percentage) Percentage of targeted 0.00 Apr/2021 0.00 31-Mar-2024 0.00 30-Sep-2024 100.00 Mar/2026 Page 5 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) facilities and administrative Comments on units that receive achieving targets performance payment, as per operations manual . (Percentage) 0.00 Apr/2021 40.70 31-Mar-2024 72.50 30-Sep-2024 25.00 Mar/2026 Comments on Percentage point increase in achieving targets average patient satisfaction score in targeted health facilities. (Percentage) Percentage point decrease of 0.00 Apr/2021 0.00 31-Mar-2024 0.00 30-Sep-2024 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 31-Mar-2024 0.00 30-Sep-2024 25.00 Mar/2026 Comments on Numerator: average clinical vignette score core in targeted health units – baseline average The percentage point increase achieving targets clinical vignette score *100 Target= Doctors and Nurses in Target Health facilities Target= in score among those who 11DH+18CHC+66 PHC participated in clinical vignettes. (Percentage) Page 6 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) 0.00 Apr/2021 0.00 31-Mar-2024 40 30-Sep-2024 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 0.00 31-Mar-2024 75.36 30-Sep-2024 30.00 Mar/2026 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, Dressing, Average score for bio medical Injection room, emergency, labor room and lab], Needle cutter, Hypochlorite solution in waste management in laboratory. Mops with bucket and disinfectant. [separate for each OT, labor room] and general targeted health facilities at patient care including ward. Daily Collection of waste and mopping [schedule]. Treatment of district, PHC and CHC level. infectious waste: [hypochlorite for sharps], microwave/autoclave. Functional sharps pit and (Percentage) deep burial pit with cover [no spillage outside] (All or None). 0.00 Apr/2021 100.00 31-Mar-2024 100.00 30-Sep-2024 95.00 Mar/2026 Percentage of targeted Comments on facilities where quality scoring achieving targets was done by higher level in last quarter. (Percentage) Page 7 of 10 The World Bank Implementation Status & Results Report Meghalaya Health Systems Strengthening Project (P173589) 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 77.00 31-Mar-2024 88 30-Sep-2024 80.00 Mar/2026 coverage of households under health insurance scheme. (Percentage) Increase in number of women 84,055.00 Apr/2021 100,353.00 31-Mar-2024 60,093 30-Sep-2024 123,064.00 Mar/2026 patients utilizing government health services IPD in targeted facilities. (Number) Percentage of local fund 0.00 Apr/2021 30.00 31-Mar-2024 56.19 30-Sep-2024 80.00 Mar/2026 utilization (including performance grants and Insurance reimbursements) in targeted hospitals. (Percentage) 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 Historical Disbursed IBRD-92910 Effective 40.00 40.00 0.00 15.81 24.19 39.52% 40.00 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 Nov 07, 2024 Page 8 of 9 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 Operation Closing/Cancellation 31-Mar-2027 9. RESTRUCTURING HISTORY 10. ASSOCIATED OPERATION(S) There are no associated operations Nov 07, 2024 Page 9 of 9