Component 1

Strengthen management and accountability through Internal Performance Agreements

This component focuses on reforms in governance and management structures through IPAs between the DoHFW and its subsidiaries at the state and substate levels. An RBF approach is expected to strengthen the management and accountability relationships between the state- and the substate-level implementing units. Fund transfers to institutions and health facilities would be made against the achievement of performance indicators specified in IPAs.

The IPAs aim to foster a spirit of more accountable government, along with results-based monitoring, contributing to improvements in management of the system and delivery of quality health services. At the health facility level, this approach will provide flexible resources, strengthening management autonomy of decentralized structures. A system of geographic equity adjustments will be put in place to ensure that the most destitute health facility will have relatively the largest performance budget. Measures that will govern these geographic equity adjustments will include travel time to the state capital, human resources density, poverty scores, and immunization coverage.

At the health facility level, the IPA will be focused on key structural quality elements such as planning, budgeting, and coordination; user experience targeting women patients; and core metrics for content of care quality such as knowledge and competency tests of providers. These quarterly metrics, carried out timely and diligently by certified assessors from district and state levels (responsible to their departments, governed by IPAs), will be carefully designed in close collaboration with the client and adjusted incrementally once a year.

The IPAs will be designed to align the objectives of the participating entities. Internal verification mechanisms, governed by IPAs, will ensure regular assessments. An external counter-verification mechanism will be established to validate internal verification results.