Guwahati: Meghalaya has just 23.8 allopathic doctors for every 100,000 people, or roughly one doctor for every 4,200 residents, according to a new study published in Health Policy and Planning. The figure is significantly below the national average of 61.5 doctors per 100,000 people, which is equivalent to about one doctor for every 1,600 residents.
The shortage is even more pronounced among specialists. Less than half of the 320 sanctioned specialist positions in the state are currently occupied, with most of the available specialists concentrated in East Khasi Hills. Several other districts have no specialists at all.
The study, titled “Prospective policy analysis of healthcare workforce policies for effective non-communicable disease prevention and management in Meghalaya, India,” was authored by Ankur Nair, Pratheeba John, and Rajeev Sadanandan of the Health Systems Transformation Platform-India.
It assesses whether Meghalaya’s proposed healthcare workforce reforms can address two growing concerns: the rising prevalence of non-communicable diseases (NCDs) and longstanding disparities in access to medical services.
NCDs now contribute 56% of the state’s total disability-adjusted life years (DALYs), compared with 28% in 1990. Conditions such as diabetes, hypertension, cardiovascular diseases and cancer require regular diagnosis, treatment, medication and follow-up, increasing the demand for a stable and adequately distributed healthcare workforce.
However, the study found that Meghalaya’s existing workforce is not sufficiently aligned with these changing healthcare needs. Patients with chronic illnesses in remote and underserved areas face particular difficulties in accessing continuous care and specialist services.
The researchers caution that creating additional posts or changing service regulations alone will not resolve the workforce shortage, particularly in tribal and geographically isolated communities.
Among the proposed reforms under the 2024 Human Resources for Health framework are the creation of a dedicated Public Health cadre, restructuring of clinical cadres to address specialist shortages, rationalisation of postings, incentives for rural service, greater transparency in transfers and postings, and improved systems for collecting and managing workforce data.
The reforms represent one of Meghalaya’s most significant efforts to improve healthcare workforce planning and administration. However, the study notes that implementation and retention will determine whether these measures produce meaningful changes on the ground.
A sanctioned position does not necessarily mean that a doctor is available at a health facility, while recruitment alone cannot guarantee that specialists will remain in remote districts.
The unequal distribution of specialists has created what researchers describe as “horizontal inequity”, where people with similar healthcare needs receive different levels of treatment depending on their location.
Geography further compounds the problem. A specialist posted in Shillong or East Khasi Hills may contribute to the state’s overall workforce numbers, but patients living in distant districts may still have to travel considerable distances to access specialist care.
The study also highlights a gender disparity within the medical workforce. Although women make up the majority of Meghalaya’s health workforce, they account for only 5% of specialists, indicating potential barriers to career advancement and leadership opportunities.
The authors argue that the proposed reforms will need sustained political commitment, sufficient funding and a clear focus on equity to benefit communities that currently face the greatest barriers to healthcare.
They also emphasise the importance of involving local communities and strengthening locally relevant training so that workforce policies respond to conditions on the ground rather than remaining limited to administrative reforms.
Ultimately, the study suggests that the success of Meghalaya’s healthcare reforms should not be judged simply by the number of posts created or policies changed. The key measure will be whether people in remote areas can access qualified healthcare professionals when they need them.
With only 23.8 allopathic doctors per 100,000 people and less than half of specialist posts occupied, the study highlights a substantial gap between Meghalaya’s healthcare policy ambitions and the availability of services on the ground.