Nagaland Deputy Chief Minister, TR Zeliang on Tuesday called for stronger collaboration among Northeastern States to reform health financing systems and strengthen healthcare delivery, emphasizing that “cross-state learning can transform individual experiments into collective progress.”
He was speaking at the workshop on “Health Financing Reform for Cross-State Learning in the Northeast Region” held at Niathu Resort, attended by senior officials from the World Bank, Ministry of Health and Family Welfare, Department of Economic Affairs, Government of Gujarat, and representatives from academia, civil society etc.
Addressing the gathering, Zeliang said it was a privilege for Nagaland to host an event that brings together policymakers, practitioners, and partners “committed to building health systems that are equitable, efficient, and resilient.”
He highlighted that the Northeast, home to more than 52 million people, continues to face “structural challenges” that constrain growth and equitable development. “The predominance of rural livelihoods, difficult terrain, and limited connectivity make service delivery uniquely complex. These challenges are compounded by climate change, a reality that is already altering disease patterns, food systems, and disaster risk across the region,” he added.
“The health of our people is both a reflection of, and a determinant of, the region’s social and economic well-being,” Zeliang said, noting that maternal mortality and untreated childhood illnesses remain critical concerns, while non-communicable diseases such as cancer and cardiovascular conditions are emerging as major cause of death.
However, he also underscored that the region has not stood still in the face of these challenges. “The Northeast has not stood still, it has innovated,” he remarked, recalling that the Nagaland Health Project, supported by the World Bank in 2017, broke new ground by introducing Results-Based Financing (RBF) for the first time in the region — a model that linked funds to performance rather than inputs.
Following Nagaland’s example, neighboring states like Meghalaya, Mizoram, and Assam adopted similar approaches through Internal Performance Agreements (IPAs) tailored to their specific needs. “At the same time, Nagaland and Mizoram have expanded social health insurance beyond targeted groups, moving toward universal health protection — a bold and progressive step that aligns squarely with India’s vision for Universal Health Coverage (UHC),” he said.
The Deputy Chief Minister further noted that several states, including Nagaland, have also undertaken Public Financial Management (PFM) assessments to identify bottlenecks in planning, budgeting, and expenditure. “These reforms may not grab headlines,” he said, “but they are essential for the long-term sustainability of health systems.”
Reflecting on the workshop, he said each state in the Northeast has taken different paths toward improving health financing and service delivery. Some have focused on insurance coverage and equity; others on accountability and performance; and yet others on strengthening governance and public financial systems.
Zeliang lauded the participation of representatives from the Government of Gujarat, whose pioneering work in public financial management and health governance offers valuable lessons for the Northeast. “Their participation underscores the spirit of cross-state learning, where insights flow not only within the region but across regions, enriching India’s collective journey toward better health financing and service delivery,” he added.
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“By bringing these stories together, we not only celebrate what has worked, but also candidly examine what has not — the challenges of sustaining RBF, aligning incentives, or building institutional capacity to manage performance-based funds,” Zeliang stated.
He expressed hope that the deliberations, panel discussions, and field visits during the workshop would help chart a shared roadmap for strengthening collaboration between health, finance, and planning departments across the region.
“This workshop is not the end of a project cycle; it is the beginning of a new phase of cooperation — one where data, evidence, and dialogue drive policy,” Zeliang said. “The road to Universal Health Coverage in the Northeast may be long, but it is within reach if we continue to innovate, learn from one another, and invest in systems that place people, especially the most vulnerable, at the center.”
Commending the Department of Health and Family Welfare, Nagaland, the World Bank, and all participating states for making the event possible, Zeliang concluded with a call for unity and shared purpose. “Let this forum be remembered as a moment when the Northeast came together, not just to discuss reforms, but to build a shared vision for a healthier, more resilient future.”
Marion Cros, Senior, Health Specialist, World Bank, in her address said over the past, World Bank has worked closely with Nagaland and other Northeastern states to enhance health reforms. She said this region has faced tough challenges—difficult terrain, extreme weather, and historically low health spending.
Despite these hurdles, Marion said, the Northeast has shown strong resilience and community spirit, which have been key drivers of reform success.
The Senior Health Specialist said Nagaland and Mizoram have introduced universal health insurance, which ensures access to hospital care without financial hardship. On the supply side, states like Assam, Mizoram, Meghalaya and Nagaland are testing results-based payment systems in primary health care, she added.
Stating that Northeast offers important lessons, Marion said these are not widely known but can help guide other states, especially those expanding PM-JAY towards universal coverage. “Sharing what’s worked—and what hasn’t—can save time, money, effort and lives,” she added.
Junko Onishi, Lead Social Protection Specialist and Program Leader for Human Development at the World Bank, on Tuesday urged Northeastern States to strengthen collaboration, share lessons, and improve the efficiency of health financing to advance India’s goal of Universal Health Coverage (UHC).
Onishi lauded the Government of Nagaland for hosting the two-day event and for bringing together senior officials from the World Bank, the Department of Economic Affairs (DEA), and representatives from the Governments of Tripura, Mizoram, Assam, Meghalaya, Sikkim, and Manipur.
“It is an opportune time to take stock, learn from each other’s experiences, and have frank conversations about what has worked — but more importantly, how we can do things better,” she said. “We must ensure that we use the valuable resources we have most effectively and efficiently towards Universal Health Care.”
Onishi noted that the World Bank has worked across all Northeastern States through federal and state-level engagements, particularly supporting health sector reforms in Nagaland, Assam, Mizoram, and Meghalaya. “All of these four projects are known for their innovations and our counterparts’ openness to implementing new ideas and using cutting-edge technology,” she said, adding that the event would provide a platform to discuss these innovations and the lessons derived from them.
Earlier, in his welcome address, Commissioner & Secretary, Department of Health and Family Welfare, Anoop Khinchi, IAS, stated that the forum marked a significant milestone in Nagaland’s efforts to strengthen its health systems, improve healthcare outcomes, and build resilient communities.
He said the event aimed to encourage cross-learning and the exchange of ideas among states, emphasizing the importance of adopting evidence-based policies to make health financing more responsive and efficient.
Elaborating on the Result-Based Financing (RBF) model being implemented in the state, Khinchi explained that it directly links financial resources to performance indicators and measurable outcomes. He noted that this approach has enhanced financial discipline and accountability, ensuring that public funds are utilized more effectively to deliver tangible improvements in the health sector.
