Supplemental Letter STATE OF MEGHALAYA October 28, 2021 International Bank for Reconstruction and Development 1818 H Street, N.W. Washington, D.C. 20433 United States of America INDIA: Loan No. 9291-IN (Meghalaya Health Systems Strengthening Project) Performance Monitoring Indicators Dear Sirs and Mesdames: We refer to Section II of Schedule 2 to the Loan Agreement of even date between India and the International Bank for Reconstruction and Development (Bank) and Section II.A of the Schedule to the Project Agreement. Unless otherwise agreed with the Bank, we shall monitor and evaluate implementation of the Project in accordance with the Performance Monitoring Indicators attached to this letter. Very truly yours, STATE OF MEGHALAYA s¢Fr. Authorized Representative Attachment- Performance Monitoring Indicators Results Fram ew ork COUNTRY: India M eghalaya Health System s Strengthening Project Project Developm ent Objectives(s) The project development objective (PDQ) is to improve management capacity, quality and utilization of health services in Meghalaya. Project Development Objective Indicators Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 To improve Management capacity, quality, and utilization of health services in Meghalaya. The percentage point increase in average performance score in targeted administrative 0.00 5.00 10.00 15.00 15.00 20.00 units as per internal performance agreement from baseline. (Percentage) Cumulative number of districts hospitals which 1.00 2.00 3.00 5.00 7.00 9.00 are NQAS certified. (Number) The percentage point increase in average quality index score for 0.00 5.00 10.00 15.00 15.00 20.00 CHCs and PHC from baseline. (Percentage) Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Increase in number of patients utilizing government health 1,650,932.00 1,670,000.00 1,700,000.00 1,730,000.00 1,750,000.00 1,800,000.00 services OPD in targeted facilities. (Number) Percentage of claims settled within agreed 50.00 55.00 60.00 70.00 80.00 90.00 turnaround time. (Percentage) Intermediate Results Indicators by Components Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 Improving accountability, management and strengthening governance. Percentage of internal performance agreements reviewed as per the 0.00 80.00 90.00 95.00 100.00 100.00 operational manual. (Percentage) Percentage of targeted facilities and administrative units that receive performance 0.00 80.00 90.00 95.00 100.00 100.00 payment, as per operations manual . (Percentage) Percentage point increase in average 0.00 5.00 15.00 20.00 20.00 25.00 Indicator Name PBC Baseline Intermediate Targets End Target 1 2 3 4 patient satisfaction score in targeted health facilities. (Percentage) People who have received essential health, nutrition, and population 26,040.00 26,500.00 53,500.00 81,000.00 109,000.00 137,500.00 (HNP) services (CRI, Number) Number of deliveries attended by skilled 26,040.00 26,500.00 53,500.00 81,000.00 109,000.00 137,500.00 health personnel (CRI, Number) Percentage point decrease of targeted health facilities reported 0.00 20.00 20.00 15.00 10.00 10.00 stock-out of essential drugs. {Percentage) Strengthening systems to improve the quality of health services. The percentage point increase in score among those who participated in 0.00 5.00 10.00 15.00 20.00 25.00 clinical vignettes. (Percentage) Percentage of medical doctors and nurses from targeted facilities 0.00 20.00 50.00 80.00 90.00 90.00 participated in clinical vignettes. (Percentage) Average score for bio 0.00 10.00 15.00 20.00 25.00 30.00 Indic ator Nam e PBC Baseline Interm ediate Targets End Target 1 2 3 4 medical waste management in targeted health facilities at district, PHC and CHC level. (Percentage) Percentage of targeted facilities where quality scoring was done by 0.00 80.00 80.00 85.00 90.00 95.00 higher level in last quarter. (Percentage) Increasing coverage and utilization of health services. Increase in percentage coverage of households 56.00 60.00 65.00 70.00 75.00 80.00 under health insurance scheme. (Percentage) Increase in number of women patients utilizing government health 84,055.00 84,055.00 92,460.00 101,707.00 111,877.00 123,064.00 services IPD in targeted facilities. (Number) Percentage of local fund utilization (including performance grants and Insurance 0.00 20.00 40.00 60.00 80.00 80.00 reimbursements) in targeted hospitals. (Percentage) Monitoring & Evaluation Plan: PDQ Indicators . . . . . . Methodology for Data Responsibility for Data Indicator Name Definition/Description Frequency Datasource Collection Collection Numerator: average . . . performance score in The percentage point increase in ed ·+b? sl» Internal Quarterly internal :. targete units- iaseline Project Management average performance score in f contract Project review by . . f :: : . average performance I Quarterly.: · Unit, Directorate o targeted administrative units as per 100 tracking project management +[th ±hal . score Heat Meg a aya internal performance agreement from T d . . . system unit. . arget= 1 6 a ministrative b ase I me. . units [5 State level and 11 district level] Numerator: Number of Targeted Health Facilities Quality C 'f' . d b · d . . · .ertiicates issue y h h ave receive who Division: · . · . • •· . MinistryofHealth Directorate of Health, Cumulative number of districts unconditional national Quarterly Directorate 4dF: ·ih Welf;> M zhal . I whict h ospitals 'f' d h' h are NQAS certitiea. quality assurance I h ot f h ealtti, an G am, y eflndi are, eg a aya ·· overnmento n ia certificate. Meghalaya Target: 11 District Hospitals Numerator: average P . Quality Index score in ~oject Quarterly Internal The percentage point increase in targeted health units , {[ 'tanager? project review by Finance Division and I. .index average quality d C score ffor C HCs 1· average quality b aseline 1· uarter y nt unit: J, ] . project management MHIS and PHc from baseline. indexscore100 ,""" amit -new Target= 11DH+18CHC+66 PHC Number of outpatients Health Project management Increase in number of patients registered (Male and Q Manageme unit from HMIS D' f H Ith uarterly I ...4 irectorateot leal ., utilizing government health services Female) in comparison to nt division, Monthly, Mezhalava OPD in targeted facilities. same months previous Information routine g y year in allopathic OPD system Numerator: Number of claims for which the Project Quarterly Internal money has been Manageme Project review by Finance Division and Percentage of claims settled within transferred to beneficiary Quarterly nt unit: project management MHIS. agreed turnaround time. Denominator: Number of Internal unit. Claims submitted MIS-new Turnaround time= 30 days. Monitoring & Evaluation Plan: Intermediate Results Indicators . . . /D . . F Methodology for Data Responsibility for Data Indicator Name f Definition] )escription Frequency O )atasource colection oll . Coll olection Numerator: Number of administrative units and targeted health facilities which have internal performance contract reviewed Denominator: Number of Project Quarterly Internal administrative units and Manageme Percentage of internal performance Project review by Directorate of Health, targeted health facilities Quarterly nt Unit: agreements reviewed as per the project management Meghalaya that has signed the Internal operational manual. unit. internal performance MIS-new contract Denominator: state level- s Units (HR, Health Insurance, Bio Medical waste, Quality Assurance, Community mobilisation) 11 Districts, 11DH,18CHC,66 PHC Numerator: Number of targeted administrative units and facilities having Project Quarterly Internal Percentage of targeted facilities and quality assessments done Manageme Project review by administrative units that receive through Quality Index Quarterly nt unit: Finance Division project management performance payment, as per tool and paid within 60 Internal unit. operations manual . days of the end of the MIS-new quarter Denominator: Number of Targeted Health Facilities Numerator: average Review of patient satisfaction score- minute of Percentage point increase in average Community Directorate of Health, patient satisfaction score Quarterly last patient satisfaction score in targeted mobilisation division Meghalaya in baseline 100 quarterly health facilities. Target= 11DH+18CHC+66 meeting PHC People who have received essential Directorate of Health, Quarterly HMIS HMIS health, nutrition, and population Meghalaya (HNP) services Directorate of Health, Number of deliveries attended by Quarterly HMIS HMIS Meghalaya skilled health personnel Numerator: Number of Existing- targeted health facilities Health Quarterly Internal having stockout essential Percentage point decrease of targeted Manageme Project review by Directorate of Health, medicines, as reported in Quarterly health facilities reported stock-out of nt project management Meghalaya the HMIS (none reporting essential drugs. Information unit. to be considered as System stockout) Denominator: Number of Targeted Health Facilities Numerator: average clinical vignette score core in targeted health Project Quarterly Internal The percentage point increase in score units- baseline average Manageme Project review by Directorate of Health, among those who participated in clinical vignette score Quarterly nt unit: project management Meghalaya clinical vignettes. 100 Internal MIS unit. Target= Doctors and Nurses in Target Health facilities Target= 1 1DH+18CHC+66 PHC Project Quarterly Internal Target= Doctors and Percentage of medical doctors and Manageme Project review by Directorate of Health, Nurses in Target Health Quarterly nurses from targeted facilities nt unit: project management Meghalaya facilities Target= participated in clinical vignettes. Internal MIS unit. 11DH+18CHC+66 PHC Numerator: Biomedical waste score* under Quality Index in targeted health facility Denominator: Number of Targeted Health Facilities; Project Quarterly Internal Average score for bio medical waste Target= 11DH+18CHC+66 Manageme Project review by Directorate of Health, Quarterly management in targeted health PHC nt unit: project management Meghalaya facilities at district, PHC and CHC level. Internal MIS unit. Bio medical waste management: Color coded bins with cover [one each in OPD, each Ward, OT, Dressing, Injection room, emergency, labor room and lab], Needle cutter, Hypochlorite 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]. Treatment of infectious waste: [hypochlorite for sharps], microwave/autoclave. Functional sharps pit and deep burial pit with cover [no spillage outside] (All or None). Numerator: Number of targeted health facilities which are visited and Project Percentage of targeted facilities where scored using Quality Index Manageme Quarterly Internal Directorate of Health, quality scoring was done by higher tool by district quality Quarterly nt unit: Project review by projedleghalaya management team and Internal level in last quarter. management unit. showing at least 10% MIS-new point improvement from the previous quarter performance Increase in percentage coverage of Numerator: Number of Every six Manageme Combinations of all Meghalaya Health households under health insurance Families enrolled and months nt the Government run scheme. given smart card for Information insurance schemes Insurance Scheme health insurance system: under Directorate of Denominator: Estimated Meghalaya Health Number of families in the Health state at the beginning of Insurance the project Number of inpatients Project management Increase in number of women patients registered (only Female) Every Six unit from HMIS Directorate of Health, HMIS utilizing government health services in comparison to same Months division, Monthly, Meghalaya IPD in targeted facilities. months previous year in routine IPD. Numerator: Total booked expenditure Project Denominator: Total funds Quarterly Internal Percentage of local fund utilization Manageme received* by the targeted Project review by Finance Division and (including performance grants and Quarterly nt unit: facility during last quarter project management MHIS Insurance reimbursements) in Internal Funds received from unit. targeted hospitals. MIS-new NHM, State, Insurance, world bank project and user fee, if any