RFP - Comparative Study of IPA-implementing vis-à-vis Non-implementing Facilities in Meghalaya

Request for Proposals

Comparative Study of IPA-implementing vis-à-vis Non-implementing Facilities in Meghalaya

Terms of Reference

Issued by the Forum for Health Systems Design and Transformation Health Systems Transformation Platform (HSTP)

Study focus: Assessment of current Outcome-Based Budgeting implementation, patient experience and community outreach in Meghalaya.

1 About HSTP

The Forum for Health Systems Design and Transformation, popularly known as the Health Systems Transformation Platform (HSTP), is a not-for-profit company registered under Section 8 of the Indian Companies Act, 2013, and established under the aegis of Tata Trusts. HSTP works with governments and other partners to generate and apply evidence for stronger, more equitable and responsive health systems through research, technical assistance and implementation support.

HSTP invites proposals from qualified research organisations, academic institutions and consulting agencies to assess the implementation of Internal Performance Agreement (IPA) now known as Outcome-Based Budgeting (OBB) in Meghalaya guided by the principle of results-based financing, with patient exit interviews and community outreach assessment as the principal components.

2 Background and rationale

Meghalaya’s experience with Internal Performance Agreements (IPA) in selected health facilities informed the introduction of OBB in December 2025 and the subsequent transition of facilities across the state. OBB links financing with performance and seeks to strengthen local decision-making, accountability, service quality and responsiveness to community needs.

With facilities now operating under OBB, an IPA versus non-IPA comparison is no longer appropriate. Asking patients or community members to reconstruct their experiences from the earlier IPA period would also introduce substantial recall bias. The study will therefore assess current OBB implementation and service performance, without a historical comparison of a control group.

Patient exit interviews will capture the care received during the current visit. Community assessment will examine recent outreach, access barriers and unmet need, including the experiences of people who do not attend facilities. Facility and financial records will help explain how resources and implementation practices relate to these experiences and identify priorities for improvement.

3 Study objectives

3.1 Overall objective

To assess current OBB implementation in Meghalaya and how funded activities address patient and community needs, with particular emphasis on patient experience, affordability, effective outreach and equitable access to care.

3.2 Specific objectives

• Assess patients’ experiences of access, respectful care, communication, medicine and diagnostic availability, out-of-pocket expenditure, and advice on referral and follow-up during their current facility visit.
• Assess the reach, regularity and responsiveness of community outreach, its links to service uptake and continuity of care, and barriers affecting underserved populations and non-users.
• Examine current OBB fund flows, resource utilisation, facility autonomy, accountability and implementation constraints in relation to patient services and outreach.
• Document community participation, provider and manager experiences, operational practices and service gaps that require attention.
• Develop actionable recommendations to strengthen OBB implementation, monitoring and sustainable health financing in Meghalaya, with lessons relevant to other states.

Proposal submission

Submit separate technical and financial proposals electronically in Word format by the deadline notified by HSTP. The technical proposal shall include:

• Organisation and investigator details; executive summary; understanding of the assignment; design, sampling justification, tools and analysis plan.
• Quality assurance, ethics and data-management arrangements; work plan; deliverables; team CVs and responsibilities; relevant assignments and conflict-of-interest declaration.

The financial proposal shall follow Section 11. HSTP may seek clarifications, discuss the proposed approach and verify relevant experience before selection. Late or incomplete proposals may not be considered.

Designated contact

Dr. Nishikant Singh

Lead Health Financing & Planning

Health Systems Transformation Platform, New Delhi

Email: nishikant.singh@hstp.org.in

All proposals must be submitted @ hstp@hstp.org.in by 20^th November 2026. Late submissions will not be considered.

For detailed information, please check the complete version of the RFP attached below.

Job Email ID: hstp(at)hstp.org.in

Download Attachment: HSTP_Revised_RFP_IPA_Meghalaya.pdf