By Our Reporter
SHILLONG, Jan 3: Meghalaya has met most of its fourth-year health reform targets under a World Bank-supported programme, but gaps in construction quality, biomedical waste management and contractor payments could threaten the gains, a recent assessment has warned.
The findings are based on an Implementation Support Mission conducted from December 15 to 17, 2025, under the $40-million Meghalaya Health Systems Strengthening Project.
According to the World Bank, the state’s implementation performance has improved significantly over the past six months, with four of the five key development indicators meeting or exceeding Year-4 benchmarks. The lone remaining indicator—quality certification—is progressing, with five of seven district hospitals certified so far.
Of the 13 intermediate indicators tracked, 12 have achieved or surpassed targets. These include improvements in management efficiency, service delivery, fund utilisation, timely payments to performance-linked units, clinical assessments and health insurance coverage.
Quality certification has expanded across the public health system, with 19 facilities, including four district hospitals, securing National Quality Assurance Standards accreditation. The state expects the number of certified facilities to rise to about 50 by March 2026.
The report noted that performance-linked financing through Internal Performance Agreements has driven improvements, with average facility scores rising from 70 per cent to 79 per cent. Meghalaya plans to scale up this results-based approach to all health facilities through an Output-Based Budgeting framework from April 2026.
Health outcomes have also improved. Maternal mortality fell from 172 in 2022 to 96 in 2025, while neonatal mortality declined from 7.2 to 2.7 during the same period. Use of referral services increased, and access gaps in remote areas narrowed.
The mission also highlighted workforce development, noting that over 3,000 doctors, nurses and instructors were trained over the past three years, with nearly 200 nurses trained and placed overseas in the last year alone.
However, site inspections flagged concerns over renovation work at some of the 147 facilities nearing completion, citing poor workmanship and safety lapses, particularly at the Nongpoh nursing school. The World Bank also flagged unpaid differential GST dues to contractors following the 2022 tax hike.
Biomedical waste management was identified as a key risk area. Around 100 facilities continue to use effluent treatment plants and burial pits that fail to meet safety norms due to high groundwater levels. The Bank urged the state to phase out such systems and fast-track common biomedical waste treatment facilities through public-private partnerships.
