Government of India, the Government of Meghalaya and the World Bank signed a $40 million health project for the state of Meghalaya on 28^th October 2021. project will improve the quality of health services and strengthen the state’s capacity to handle future health emergencies, including the COVID-19 pandemic.

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.

All 11 districts of the state will benefit from the project. 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 utilize healthcare services at the community level.

The Department of Economic Affairs, Ministry of Finance stated that “Strengthening and expanding health care systems is a priority for the Government of India. The Project will enhance the management and quality of health services in the state. It will also help expand the coverage of health services and make it accessible and affordable to the poor and vulnerable in the state.”

The agreement was signed by Shri Rajat Kumar Mishra, Additional Secretary, Department of Economic Affairs, Ministry of Finance on behalf of the Government of India; Shri Ramkumar S, Joint Secretary, Department of Health and Family Welfare on behalf of the Government of Meghalaya; and Mr Junaid Ahmad, Country Director, India on behalf of the World Bank.

The project will help strengthen the effectiveness of Meghalaya’s health insurance program known as the Megha Health Insurance Scheme (MHIS) – which currently covers 56% 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% of the households. This will reduce barriers to accessing hospital services and preventing catastrophic out-of-pocket costs for poor families.

As a key strategy, the project will move towards a performance-based financing system where Internal Performance Agreements (IPAs) between the DoHFW 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.

Health system strengthening boosts governance, expands insurance coverage and adds performance-based financing to improve access and preparedness. The agreement establishes a project to enhance governance, management and quality of health services in Meghalaya through capacity building, facility certification and expanded insurance coverage. It integrates the state insurance scheme into the national programme to pursue universal household coverage, introduces performance-based financing via Internal Performance Agreements to improve accountability, invests in infection prevention and control for emergency preparedness, and funds comprehensive biomedical waste management including segregation, disinfection and collection to mitigate environmental risks.