Nagaland Health Project (NHP) with support from World Bank aims to
improve management and delivery of health services and increase their
utilization by communities in targeted locations in Nagaland without duplicating
existing government programs. The project will target 177 health facilities and
500 villages across the state over the six-year project duration. The project
will accomplish these objectives through implementation of two components:
·
Component
1: Community action for health and nutrition
·
Component
2: Health system development
·
Community Action for Health and
Nutrition: Under this component, activities to
support community engagement and management of health services will intend to
contribute to improved delivery of local health services. This component will
also aim to increase community awareness and knowledge to increase utilization
of health services and engage in positive health behaviors. Capacity-building
activities for the Village Health committees will also be undertaken. This
component will also support increased representation by women and foster the
involvement of women's self-help groups. Around 500 Village Health Committees
are potentially for support on Component 1
This component is designed to empower communities to
oversee, manage, and improve HNP services and their utilization. An incentive
strategy will be used whereby funding will be provided to communities on the
basis of progress on defined indicators of improved health and nutrition-related
services and practices. In turn, communities will use the incentives for
activities and investments that are important to them and have potential
impacts on health and nutrition.
Committees will be empowered to use these incentives
for health and nutrition-related activities that are priorities to them,
including investments designed to improve performance in future rounds.
Examples could include improving health facility infrastructure; incentivizing
health staff; contracting additional staff; filling gaps in supplies and
equipment; and encouraging behavior change in areas of health, nutrition, and
hygiene. These activities will be consistent with existing policies and systems
of Government of India.
·
Health System Development: Under the second component, support will be provided for
improvements in the management and delivery of health services, which includes
targeted and system-wide investments. This will include investments in off-grid
electricity solutions and water supply and sanitation in targeted health
facilities and consultancy service for Nagaland Medical College, Kohima.
·
The target list includes all 11 District Hospitals and
21 Community Health Centers in the state, as well as 55 Primary Health Centers,
90 Sub-Centers.
·
The
project will support development of key state-level components of the health
system intended to improve the management and effectiveness of government
health services in Nagaland.
·
Development
of the health supply chain management system will include improving planning
and ordering, procurement, quality assurance, stock management, distribution,
storage, and reporting and information systems. Along with required policy and
process improvements, including adoption of standard operating procedures, investments
will encompass training, equipment and warehouse improvements.
·
The
project will also support investment in information and communications
technology (ICT) systems to improve management and delivery of health services.
The project will also contribute to addressing health human resource
constraints, including improving human resource management and supporting
implementation of a health human resource strategy for the state that is
currently under development.
·
Reliable electricity supply. The project will invest
in off-grid electrical power solutions that will be adapted to the needs of
each targeted health facility to ensure a basic level of functioning (that is,
for lighting and high-priority equipment), acting as a backup when grid power
is not available. In larger facilities, solar energy technology will be
installed, while smaller facilities will require battery and inverter systems
that can be charged by the grid when it is available. Sunlight, altitude, and
temperature conditions in Nagaland make solar energy a cost effective option.
The project will also support installation of solar water pumps and water
heaters in targeted health facilities.
·
Improved water supply and sanitation. Investment in improved
water supply in targeted health facilities will entail repair and upgrading of
piping and storage facilities linked to existing water supplies, as well as
installation of roof water harvesting systems. This work will include ensuring
water supply to washbasins and toilets. Sanitation improvements will include
upgrading septic tanks, including anaerobic filter installations. The first
phase of implementation will involve water supply and sanitation investments in
27 health facilities for which technical requirements have been assessed. The
second phase will cover the approximately 150 remaining targeted facilities. It
is well understood that investment in infrastructure is not enough to ensure
better hygienic conditions. The project will support behavior change
communication to encourage effective maintenance and cleaning.
Other
investment requirements. Flexibility
will be retained for the project to support other priority investments to
improve health service delivery that cannot be met from other sources,
including at the level of District Hospitals. Technical assessment and World
Bank concurrence will be required for such activities to be included in the
project's annual budget and work plan. During initial implementation, detailed
technical assessments of health facilities to define bills of quantities for
procurement of energy and water and sanitation investments under Sub-component
2.1 will also identify other gaps in health service capacity. These will
include minor repairs and rehabilitation and medical equipment and supplies
necessary for effective delivery of health services necessary for achievement
of the PDO. The state government's parallel funding in support of the project
will be used to fill such gaps.
Bio Medical Waste Management: It was emphasized that the project needs to follow safe
handling, segregation, storage, transportation, treatment and disposal as under the Bio-Medical Waste
(Management and Handling) Rules (2016), and adapt Infection
Management and Environment Plan
(IMEP) Guidelines to new provisions
under those Bio rules and as per local situation and quantity of waste
generation. Bio-Medical Waste Management
(BMWM) Expert to undertake a study on the existing bio-medical waste management
system across different level of health care facilities in the state and design
an action plan for improvements. The NHP
advised to consult Nagaland Pollution Control Board in the process of
developing appropriate measures and get it verified by them before
implementing. NHP supporting all the Govt. health facilities in the state for
implementation of BMWM.
The project was declared effective on March 20,
2017, and formally launched by the state government on June 2, 2017
