Strengthening Public Health Systems in Meghalaya

Significant Achievements in Our Partnership with the State

As a strategic partner to the Government of Meghalaya for strengthening its health system, HSTP conducts research and shares evidence-based recommendations to bridge gaps and enhance public health services. This month, a draft policy for Specialist and Public Health Cadres developed based on a comprehensive assessment by HSTP has been opened for public input. Additionally, the state-wide rollout of Internal Performance Agreements where HSTP provides technical assistance to the Department of Health, has marked a significant stride toward a more robust healthcare system. 

HSTP’s support areas in the state of Meghalaya include health financing, resource planning for health, Human Resources for Health (HRH), and digital health. The team undertakes research to facilitate evidence-based decision-making in policy and program implementation. The goal is to address current gaps within the health system, enhance the delivery of public health services, and ultimately improve health outcomes within the state.

HRH Policy – Specialist and Public Health Cadre

The healthcare workforce, or Human Resources for Health (HRH) is a critical component of healthcare delivery. Policies governing HRH directly impact the availability, distribution, competency, and satisfaction of the healthcare workforce, which, in turn, influences healthcare quality, accessibility, and availability across the country. Despite their importance, however, the evaluation of HRH policies in states remains an underexplored area in India. Recognizing the pivotal role of HRH policies in achieving universal health coverage and addressing emerging health challenges, HSTP is dedicated to assessing and addressing critical gaps in HRH policies across states.

On invitation from the state government, HSTP conducted a comprehensive health system assessment in Meghalaya, revealing a shortage of Specialists with Medical Officers functioning from a common pool in the public health system. This imbalance in the availability of HRH posed a unique challenge for the state, not just from the perspective of the citizens but also the Specialists and Medical Officers for their career opportunities, aspirations, progression, and retention. Thus, it necessitated a thorough examination of HRH policies to ensure an optimal healthcare workforce.

To tackle these challenges, team HSTP conducted an in-depth analysis of the state-specific HRH policies against the need to provide specialised and general health services. This analysis identified gaps that limited the absorption and progression of Specialists and Doctors within the state public health system. In response to these findings, HSTP formulated a set of recommendations, emphasising the creation of specialist and public health cadres as a crucial step toward enhancing the availability of specialised health services in the state. Aiming to capture contextual issues and gaps in the implementation of HRH policies, the team actively participated in multiple rounds of expert committee consultations, collaborating with representatives from the Directorate of Health Services, District Level Officers, Meghalaya Health Systems Strengthening Project (MHSSP), and practising Specialists and Doctors within the health system. 

As a key milestone in this process of working with the state’s HRH policies, HSTP provided technical support to the State Health Department in developing a state-specific Policy for the Creation of Specialist, Public Health, and Teaching Sub-Cadres governing their caderisation, service rules, recruitment, posting, transfer, and career progression. We are pleased to announce that on November 9, 2023, the draft policy document was made available on the State Health Department's website for comments from experts and the public at large. This marks a significant step towards a more robust and responsive healthcare system in Meghalaya. 

Implementation of the Internal Performance Agreement

HSTP also provides technical assistance to the Department of Health, Meghalaya, in implementing the Internal Performance Agreements (IPAs) in the state. IPAs can be used as a mechanism to appropriately plan, allocate, and spend resources based on needs to improve service delivery in the state. 

In the process of supporting the state in identifying priority areas, HSTP conducted a situational assessment. Health interventions that require strengthening in Meghalaya were identified through stakeholder consultations facilitated by the team, which included meetings with the Directorate of Health Services, District Health Officials, members from the Program Management Unit of the Meghalaya Health Systems Strengthening Project (MHSSP), practising Specialists, and different categories of healthcare providers. 

The readiness of existing health facilities to implement the IPAs identified was also assessed by HSTP. This led to frameworks and activities being developed for the different IPAs implementing units along with indicators to measure performance. A pilot test of the IPA frameworks across selected health facilities was conducted by the team to check the feasibility of the proposed activities and outcome indicators. The indicators were revisited and finalised based on the pilot. 

The intent of this exercise has been to develop IPAs that align with the nuances of the state’s requirements, with the flexibility to adapt to consequent findings and challenges revealed in the process of implementation. This prioritisation of health care needs, strengthening of the quality of care, and optimisation in resource utilisation aims to bolster the delivery of health care services in the state.

HSTP takes great pleasure to announce that the state-wide roll-out of IPAs in Meghalaya was launched on 1st November 2023.