Mizoram Health System Strengthening Project (MHSSP)

WORLD BANK - MIZORAM HEALTH SYSTEMS STRENGTHENING PROJECT (MHSSP)

https://projects.worldbank.org/en/projects-operations/project-detail/P173958

The Department of Health and Family Welfare (DoHFW), Government of Mizoram with technical and financial support from the World Bank, is implementing ‘Mizoram Health Systems Strengthening Project’ (MHSSP) in the State for improving the health status of its citizens. The MHSSP intends to strengthen the management capacity and quality of health services in Mizoram. The activities under the project are structured under the following four broad components: 

Component 1: Strengthen management and accountability through Internal Performance Agreements: This will support the creation of an enabling environment for reforms at each level (state, district and sub-district), enhance performance of the DoHFW and its subsidiaries, and improve efficiency of the public health administration. 

Component 2: Improve the design and management of the government-sponsored health insurance programs in the state:  This will focus primarily on improving the overall design, management and the effectiveness of the health insurance schemes including the community interventions to increase enrollment in the program. 

Component  3:  Enhance  the  quality  of  health  services  and  support  innovations:  The  activities  will  support  the  development of the state health system, structural quality improvements and also pilot health innovations. Developing a comprehensive quality assurance system, improving  biomedical  waste  management,  enhancing  human  resource  management  are critical sub-components.   

Component 4: Contingent Emergency Response Component: A mechanism for provision of immediate response to an Eligible Crisis or Emergency, as needed. 

To  ensure  the  effective  implementation  of  various  components  and  to  achieve  the  desired  outcomes  of  MHSSP,  agencies  have  been  engaged  to  support  and  assist  us.  The  agencies  are  -  IQVIA  for  Project  Management  and  Technical  Support (PMTA); IQVIA for strengthening Human Resources for Health (HRH), and SUTRA for third-party evaluation.  While  there  are  several  components  under  the  Mizoram  Health  Systems  Strengthening  Project,  in  this  issue  we  have focused on IPA and HRH. All components of the project will be covered in the coming issues

WORLD BANK - MIZORAM HEALTH SYSTEMS STRENGTHENING PROJECT (MHSSP)

            World Bank leh Mizoram sawrkar tangkawpin Mizoram health system tihchak nana project - Mizoram Health Systems Strengthening Project chu June ni 17, 2021 khan sign fel ani ta a. He project, US $ 40 million hi 80%, i.e., $32 million hi World Bank atanga loan hmanga thawh tur ani a. $8 million hi state sawrkar tum tur ani a. A rulhlet lamah chuan $32 million rulh leh tur hi 90% Department of Economic Affairs (DEA) in min rulhsak anga, 10% erawh Mizoram sawrkarin a tum ve a ngai dawn ani. He Project in a tum ber chu Mizoram a Health System kalphung tih changtlun leh tih hmasawn a ni. (to improve management capacity and quality of health services in Mizoram). 

MHSSP hian Component 4 a nei a, chungte chu:

Component 1: Strengthen Management and Accountability through Internal Performance Agreements (cost US$13.5 million):

Internal Performance Agreement hi State, District leh health facilities level a kalpui tur niin, agreement siam a ni ang a, Result based incentives (an hnathawh dan azira sum hmuh) hmuh theihna tur a ni a, indicators tur te hi duan mek a ni. Hemi in a tum ber chu Health facilities  zawng zawng NQAS (National Quality Assurance Schme) certification hmu thei khawpa tih changtlun a ni.  

Component 2: Improve Design and Management of the State Health Insurance Programs (US$2.5 million) :

Mizoram Health Insurance Programme kan neih leh PMJAY te tun aia tha zawk leh mipuite te tana hlawk zawka kalpui dan tur te ngaihtuaha duan ani ang a. Mipui tam zawkin Insurance Scheme a an tel ve theih nana hmalakpui a tel bawk.

Component 3: Enhance Quality of Health Services and Support Innovations (US$15.92 million):

Kan damdawiin leh thawktute hnen atanga enkawlna kan dawn te hi tun aia tha leh zuala tihchangtlun leh tihhmasawn tum  a ni a. Heta ngaih pawimawh ber chu ‘quality’ a ni. Hei hian a tul dan a zirin infrastructure tih changtlun pawh a keng tel ang.

Component 4: Contingent Emergency Response Component (US$0 million): 

Engemaw tul bik thil Emergency ah a chunga mite khi pawh pen theih an ni ang.

Achievement during 2023-24

Component 1 

Internal Performance Agreement (IPA)

Performance-based financial support is being provided to Administrative Facilities and Health Care Facilities under Internal Performance Agreement (IPA) . At present , 89 facilities comprising of 1 State Health Team( DHS and DHME), 1 Mizoram State Health Insurance Team (MSHCS), 9District Health Teams/CMO Office, 9 District Hospitals, 2 Sub-District Hospitals, 9 Community Health Centres and 58Primary Health Centres across 11 districts have signed Internal Performance Agreement and are called as IPA Units. Total Rs. 47.68 crore (Including CI)have been released to the IPA units to enhance their quality of health service delivery. The un-tied performance-based financial support provides autonomy to IPA units to plan service quality improvement measures based on localized need.

Fund Released to IPA (Including CI):         Rs. 47.68 Crore (OTG: Rs. 9.49 Cr + Rs. 38.19 Cr)

Support to Achieve National Quality Assurance Standards (NQAS)

MHSSP is supporting Quality Assurance team of Health & Family Welfare Department and Healthcare Facilities to achieve NQAS certification. MHSSP deploy District Quality Managers (DQMs) and District Hospital Quality Managers (DHQMs) at targeted Healthcare Facilities to support efforts in achieving NQAS certificate.

Facilities achieving NQAS Certification :

1. Aibawk PHC
2. Thingsulthliah PHC

Civil Hospital Aizawl, Civil Hospital Lunglei and Champhai District Hospital, 2 UPHCs (ITI &Chawlhhmun) and Haulawng PHC have faced external NQAS assessment and are currently waiting for the report.

Further, to strengthen monitoring progress of IPA units towards NQAS, MHSSP is developing NQAS Dashboard to facilitate monitoring at health facility level, district level and state level.

Clinical Knowledge and Skills Improvement (CKSI)

Continuous knowledge and skill update of medical and para-medical staff is essential to improve quality of health service delivery. 

CKSI is implemented by a systematic, quality-driven, easily accessible, and cost effective with low dose high frequency approach trainings through a series of targeted clinical vignettes adopted by Mizoram Health Systems Strengthening Project for improvement of Clinical skills and competencies of healthcare professionals of Mizoram.

CKSI App was launch on 24^th November, 2022 and is designed to accommodate 1500 users. CKSI test (Provider knowledge) via App is one of the IPA indicators to assess the performance of the Health care Providers on Clinical Knowledge & Skills Improvement (CKSI) learning conducted on quarterly basis. CKSI test was piloted for Oct – Dec, 2022 quarter and roll out from Jan – March, 2023 Quarter.It can be accessed through Web and Mobile Phones (Android and IOS version). 

Release of CKSI IOS app - 5th May 2023.

Release of revised app version 2.0 - 23rd Dec 2023

Component 2

Household Enumeration for Insurance Schemes and Beneficiary Identification Drive

To strengthen insurance schemes in the state, MHSSP is supporting Mizoram State Health Care Society (MSHCS) to undertake household enumeration to identify existing beneficiaries and potential beneficiaries under different health insurances in Mizoram. With plans being devised to improve the health insurance system as a whole, the importance of data on eligible or potential beneficiaries on all health insurance schemes under the Govt. of Mizoram is evident. Hence, Household Enumeration was planned to enumerate the total number of households within the state as well as validating their eligibility to the existing health insurance scheme under the Government of Mizoram. 

Status of Household Enumeration in Mizoram under MHSSP:

The Household Enumeration commenced on February, 2023 across all over Mizoram and is completed in all District except Mamit.

AB-PMJAY Beneficiary Identification Drive :

91.22% (197589 out of 216584 target) families and 110.61% (561973 out of 508090 target) individuals have been provided Golden Card with the support from MHSSP in conducting BIS Drive.

Photos :State BIS Team covers hard/difficult areas that health facilities are unable to cater.

Community Intervention – Non-communicable Diseases

As non-communicable diseases (NCDs) are emerging as major health issues among community of Mizoram where awareness and health seeking behavior among community is low. 

MHSSP has rolled-out pilot phase of community intervention in three districts i.e. Kolasib, Lawngtlai and Mamit Districts targeting increase uptake of healthy lifestyle, awareness about NCDs and uptake of NCD health services. Total 54 community level functionaries, primarily VHSNC, SHG and MHIP members weretrained by the trainers to carry out Social Behaviour Change Communication (SBCC) for NCDs among their own community members.

Encouraging results of pilot phase led to scale-up community intervention in 2024 as Damna Kawl Eng to six districts – Aizawl East, Kolasib, Mamit, Lawngtlai, Lunglei and Serchhip, covering more than 430 villages.  The scale-up will also cover urban population. First batch of scale-up has already trained 71 Trainers to Train 167 community level functionaries.

Under community intervention we are implementing:

• Social Behaviour Change Communication Startegy
• Training Strategy
• Training Manual
• Facilitator Guide
• IEC Materials: Leaflets, Story Cards, Prosters, Community Flex, Miking Scripts

Audio-visual IEC materials is also planned.

Community intervention initiative is in-progress to include Lung Cancer, Stomach Cancer and Esophagus Cancer into its SBCC activities

 Component 3

Infrastructure Development

Poor infrastructure issues of key institutions of H&FW department causes unconducive work place environment to its human resources. With the aim to introduce Post Basic BSc Nursing and MSc Nursing course in Mizoram College of  Nursing (MCON)  major renovation and upgradation of MCON is ongoing.Repair and renovation of Civil Hospital Aizawl, Civil Hospital Lunglei, Lawngtlai DH, Siaha DH and Champhai DH are undertaken by the MHSSP and is ecpected to be completed within 2024 .

MHSSP has also undertaken construction of three Chief Medical Officer’s offices at Khawzawl, Hnahthial, and Saitual respectively.

Completed Civil Works under MHSSP is highlighted below :

1. CMO Building Construction – Khawzawl:

 CMO Building Construction –Hnahthial:

Completed and Handover toPrincipal Director, H&FW Dept.

4. CMO Building Construction –Saitual:

Completed and Handover to Principal Director, H&FW Dept.

5. MSHCS office renovation

Completed and Handover to MSHCS

Nursing

In order to - have a quality of education, enhance student satisfaction, strengthen institutional reputation, promotes continuous improvement, ensure compliance with standards, improves operational efficiency and encourage faculty development in the Mizoram College of Nursing. MHSSP is supporting the institute in achieving ISO certification.

Achievements of Mizoram Health Systems Strengthening Project During 2022-23

The Health & Family Welfare Department, Government of Mizoram has started a five-year Mizoram Health Systems Strengthening Project with support from the World Bank. The Project was declared effective from 13^th July, 2021 with objective ‘to improve management capacity and quality of health services in Mizoram’. 

IQVIA, HISP, TVASAN, and SUTRA have been contracted for technical support at different areas of the project. The endeavor to strengthen health systems have achieved various milestones in past two years since inception and few more achievements will be added to the list in near future. Few of the achievements of MHSSP till 31^st March, 2023 are mentioned as below:

Internal Performance Agreement (IPA)

Performance-based financial support is being provided to Administrative Facilities and Health Care Facilities under Internal Performance Agreement (IPA) . At present , 89 facilities comprising of 1 State Health Team( DHS and DHME), 1 Mizoram State Health Insurance Team (MSHCS), 9District Health Teams/CMO Office, 9 District Hospitals, 2 Sub-District Hospitals, 9 Community Health Centres and 58Primary Health Centres across 11 districts have signed Internal Performance Agreement and are called as IPA Units. Total Rs. 22.77 crore have been released to the IPA units to enhance their quality of health service delivery. The un-tied performance-based financial support provides autonomy to IPA units to plan service quality improvement measures based on localized need.

Fund Released to IPA:         Rs. 22.77 Crore (OTG: Rs. 8.61 Cr + Rs. 14.16 Cr)

Support to Achieve National Quality Assurance Standards (NQAS)

MHSSP is supporting Quality Assurance team of Health & Family Welfare Department and Healthcare Facilities to achieve NQAS certification. MHSSP deploy District Quality Managers (DQMs) and District Hospital Quality Managers (DHQMs) at targeted Healthcare Facilities to support efforts in achieving NQAS certificate.

Four facilities namely Civil Hospital Aizawl, State Referral Hospital Falkawn, Civil Hospital Lunglei and Champhai District Hospital are targeted for NQAS certification by July, 2023.

Full NQAS score of the targeted facilities :

1. Civil Hospital Aizawl - 92%

2. State Referral Hospital Falkawn – 83%

3. Lunglei DH - 86%

4. Champhai DH - 78%

Further, to strengthen monitoring progress of IPA units towards NQAS, MHSSP is developing NQAS Dashboard to facilitate monitoring at health facility level, district level and state level.

Clinical Knowledge and Skills Improvement (CKSI)

Continuous knowledge and skill update of medical and para-medical staff is essential to improve quality of health service delivery. 

CKSI is implemented by a systematic, quality-driven, easily accessible, and cost effective with low dose high frequency approach trainings through a series of targeted clinical vignettes adopted by Mizoram Health Systems Strengthening Project for improvement of Clinical skills and competencies of healthcare professionals of Mizoram.

CKSI App was launch on 24^th November, 2022 and is designed to accommodate 1500 users. CKSI test (Provider knowledge) via App is one of the IPA indicators to assess the performance of the Health care Providers on Clinical Knowledge & Skills Improvement (CKSI) learning conducted on quarterly basis. CKSI test was piloted for Oct – Dec, 2022 quarter and roll out from Jan – March, 2023 Quarter.It can be accessed through Web and Mobile Phones (Android and IOS version). 

• Android version was released on 15^th Sept, 2022
• Web version was released on 10^th Mar, 2023

Household Enumeration for Insurance Schemes

To strengthen insurance schemes in the state, MHSSP is supporting Mizoram State Health Care Society (MSHCS) to undertake household enumeration to identify existing beneficiaries and potential beneficiaries under different health insurances in Mizoram. With plans being devised to improve the health insurance system as a whole, the importance of data on eligible or potential beneficiaries on all health insurance schemes under the Govt. of Mizoram is evident. Hence, Household Enumeration was planned to enumerate the total number of households within the state as well as validating their eligibility to the existing health insurance scheme under the Government of Mizoram. 

Objectives of Household Enumeration :

1. The primary objective of Household Enumeration is to quantify the total number of households within the state who are eligible under the existing health insurance schemes implemented by the Govt. of Mizoram so as to quantify scheme uptake.

2. Taking advantage of the household enumeration being undertaken, secondary goals emerge wherein; house to house awareness of health insurance schemes, segregation of households based on their eligibility on health insurance and data on issues encountered by beneficiaries in accessing health insurance were later included.

3. Furthermore, to maximize the effectiveness of the activity being undertaken; name, age, gender and marital status of all family members were also included for use in different programs of H&FW Department.

The Household Enumeration commenced on February, 2023 across all over Mizoram and is expected to be completed by September, 2023. 

Community Intervention – Non-communicable Diseases

As non-communicable diseases are emerging as major health issues among community of Mizoram where awareness and health seeking behavior is among community is low. 

MHSSP has rolled-out pilot phase of community intervention in three districts i.e. Kolasib, Lawngtlai and Mamit Districts targeting increase uptake of healthy lifestyle, awareness about NCDs and uptake of NCD health services. Approximately pool of 6 master trainers and 39 trainers have been created. Total 56 community level functionaries, primarily VHSNC, SHG and MHIP members will be trained by the trainers to carry out Social Behaviour Change Communication for NCDs among their own community members.

The Community Intervention activity for pilot Districts will be rolled out soon and is expected to be completed by September, 2023. 

Human Resources for Health

The Human Resources for Health (HRH) component has been undertaken by the H&FW Dept., Government of Mizoram to develop a robust strategy and management framework for the health department.

1. HR Enumeration: Information of over 5550 staff across 561 facilities & establishments have been captured:  

•           Information pertaining to staff/employee life cycle (education, qualification, entry into the department, promotion, transfer, training, pay and benefits, etc.)

•           Operational and infrastructure details of health facilities and establishments including geotagging and photographs

2. Training Needs Assessment (TNA) : Adapting Hennessy-hicks model for TNA of 27 cadres selected in 5 districts to understand the perceived importance of core responsibilities and competencies to perform the job effectively, to understand current training needs and develop comprehensive training calendar for techno managerial skill sets.

Infrastructure Development

Poor infrastructure issues of key institutions of H&FW department causes unconducive work place environment to its human resources. With this regard, major renovation work for Mizoram College of Nursing, Civil Hospital Aizawl, Civil Hospital Lunglei, Lawngtlai DH, Siaha DH and Champhai DH is being planned under MHSSP. Repair and renovation works is expected to be executed by July, 2023.

MHSSP has also undertaken construction of three Chief Medical Officer’s offices at Khawzawl, Hnahthial, and Saitual respectively. All the three construction work is expected to be completed before December, 2023 . 

Ongoing Civil Works under MHSSP is highlighted below :

 1. CMO Building Construction – Khawzawl:

Expected Completion Date : 12.07.2023

Physical Progress : 67.00%

2. CMO Building Construction – Hnahthial :

Expected Completion Date : 13.12.2023

Physical Progress : 54.22%

4. CMO Building Construction – Saitual:

Expected Completion Date : 02.10.2023 

Physical Progress : 50.50%

5. MSHCS office renovation

Expected Completion Date : 09.08.2023

Physical Progress : 30.00%

Major renovation work for Mizoram College of Nursing, Civil Hospital Aizawl, Civil Hospital Lunglei , Lawngtlai DH, Siaha DH and Champhai DH is also being planned.