SHILLONG, Nov 12: Meghalaya has witnessed progress in reducing Maternal Mortality Rate (MMR), as per the Health Management Information System. As of January this year, the state recorded 107 maternal deaths, down from 243 per 100,000 live births in 2020-2021 and 155 in 2022-2023. To date, there have been 98 maternal deaths this year, with 36 per cent occurring during delivery, 33 per cent post-delivery, and 32 per cent pre-delivery.
In view of the challenges that the Health Department faces from several quarters, The Shillong Times caught up with Principal Secretary of Health, Sampath Kumar to get some clarity not just on problems faced but strategies adopted by the department to alleviate the problems faced by women in particular in rural Meghalaya. Here are the excerpts:
Q: It’s good to know that MMR & IMR in Meghalaya are down. By how many percentile and what were the strategies adopted? Were those strategies locally developed or adapted from elsewhere?
A: Since launching the Rescue Mission in November 2020, Meghalaya has made notable strides in reducing maternal and infant mortality. By FY 2023-2024, maternal deaths dropped by nearly 50%, and infant deaths by around 30%. Previously, Meghalaya faced high rates of maternal and infant mortality; the 2019 National Family Health Survey highlighted poor health and nutrition indicators, including low child immunisation rates and the highest child stunting rate in India at 46.5%. To address these challenges, the state launched a collaborative framework, MOTHER (Measurable Outcomes for Transforming Health, Education, Social Welfare, and Rural Development), involving key departments—Health, Social Welfare, Education, and Community & Rural Development—to focus on maternal and child health. During the COVID-19 pandemic, the need for action became even more urgent as health-seeking behaviour declined due to fear of the virus. The Rescue Mission was thus initiated to address maternal and child health directly and urgently, beginning with a root-cause analysis of maternal and infant mortality factors.
The Rescue Mission adopted a ‘Problem-Driven Iterative Adaptation’ (PDIA) strategy to find localised solutions for reducing mortality rates. This approach empowered district leaders to exercise ‘Adaptive Leadership’ and implement context-specific innovations. Through extensive review meetings and field interactions, the mission identified three primary root causes:
1. Geographical barriers: Approximately 1,700 villages in Meghalaya are difficult to access, with about 400 reachable only on foot. Recognizing this as a major obstacle for maternal care, the state introduced transit homes under the Chief Minister’s Safe Motherhood Scheme. These homes enable mothers from remote areas to stay near health facilities a week before their due date, ensuring timely access to safe deliveries.
2. Poverty-related barriers: Economic hardships hindered many mothers’ access to healthcare. The Self-Help Group (SHG) saturation program, now covering about 90% of households, supports approximately 50,000 SHGs, helping families afford childbirth care and address child malnutrition through the Vulnerability Reduction Fund.
3. Gender-related barriers: Weekly analyses highlighted insufficient birth spacing as a major risk factor. Many maternal deaths were linked to complications from inadequate spacing between pregnancies. The mission worked to increase community awareness on birth spacing and maternal health, aiming to empower women and encourage healthier practices.
By implementing adaptive, locally developed strategies, the Rescue Mission has established a strong foundation for continued progress in maternal and child health. Additionally, the state has established a Government Innovation Lab to support further development initiatives, ensuring continued focus on health and other complex challenges through strategic and locally tailored solutions.
Q: Is the Health Department concerned with the burgeoning number of teenage pregnancies which is the reason for our poor economic indices and poor health of women and the children they deliver unthinkingly? Which departments are working together on this issue? Also from research conducted by the Health Department what are the deep-seated reasons for teenage pregnancies and what is the way forward?
A: The Health Department in Meghalaya has identified multiple root causes of teenage pregnancy, including socio-cultural norms, lack of adolescent health education, high school dropout rates due to distance, economic challenges, stigma surrounding reproductive services, and gender-based caregiving roles. Addressing this issue requires coordinated efforts across government departments, communities, and faith institutions to shift mindsets and encourage behavioural change around birth spacing and health education.
The state has established the State Human Development Council to oversee the Multisectoral Programme for Adolescent Wellbeing, Empowerment, and Resilience (MPOWER). Funded by the World Bank, MPOWER aims to equip adolescents (ages 9-19) with life skills and career guidance to empower them and address systemic causes of teenage pregnancy.
Additionally, Meghalaya has launched the Early Childhood Development (ECD) Mission, supported by the Asian Development Bank, to provide high-quality early interventions that can break generational cycles of poverty. Based on evidence from studies like the Perry School Study in the U.S., the ECD mission seeks to enhance long-term health and productivity outcomes by investing in early childhood services.
The State’s Human Development Leadership Programme (HDLP) complements these initiatives through weekly joint field visits by district, block and frontline workers from Health, Social Welfare, Education, and Rural Development departments, targeting vulnerable households to raise awareness and provide support.
Q: There’s a general complaint from doctors that they are too busy implementing programmes at the cost of not having time to attend to patients and make field visits. Is there a time ratio allocated for adequate patient-doctor interface?
A: The health department in Meghalaya focuses on two main areas: clinical support for hospital patients and public health services like immunisation, antenatal care, disease surveillance, and programs addressing communicable diseases (e.g., TB, malaria) and non-communicable diseases (e.g., cancer). Efforts are under way to strengthen these functions, especially by training doctors in remote Primary Health Centres (PHCs) and Community Health Centres (CHCs) in specialised skills such as ultrasonography, anaesthesia, and emergency obstetric care through a partnership with Tamil Nadu. Trained doctors are now able to manage emergency units in remote regions.
The state has built a healthcare structure that extends from village-level health workers to district and state-level teams to implement health programs. Medical Officers (MOs) are encouraged to focus on comprehensive healthcare and spend quality time with patients, in line with the goal to improve life expectancy by 10 years. Additionally, the government aims to instil a sense of responsibility and public service motivation in MOs, and is studying successful healthcare models from Kerala and Thailand to bring further reforms for better healthcare delivery across the state.
Q: Many are unable to understand the reason for creation of the State Health Mission and State Health Society. Why are these two verticals needed and what outcomes are expected from them? What happens to the Health Directorate then?
A: The State Health Mission (SHM) and the State Health Society (SHS) were formed as a mandate of the National Health Mission.
The SHM is a high-level body headed by the Chief Minister or Health Minister of the state that oversees and provides guidance on implementing health policies, programmes, and services in the state whereas the SHS is an operational and administrative body headed by the State Mission Director, responsible for implementing and managing various health programmes in the state. It is created to execute the directives and plans formulated by the National Health Mission.
The SHM and SHS are not two verticals but two distinct entities within the state’s healthcare administration, each with different roles, functions, and responsibilities.
As for the Directorate of Health Services, its role is also different from the SHS. The DHS administers public health services, oversees hospitals and health centres, ensures overall healthcare delivery whereas, the SHS execute programs (e.g., immunisation, TB control, maternal health).
We have been successful in bringing good synergy between DHS and NHM, and we can see the results of this in the improvement of healthcare services in the state.
Q: What is the reason for creation of the MMDSL? Some doctors have said that they are not consulted as to what medicines to procure and that medicines are procured by non-medical people and that could be a problem.
A: Meghalayan Medical Drugs and Services Limited (MMDSL) was established by the Government of Meghalaya to enhance healthcare accessibility across the state. Its mandate is to ensure a steady supply of essential drugs & medical supplies through efficient logistics and rigorous quality controls, directly benefiting healthcare facilities and patients state wide. It provides an online monitoring system to ensure a timely supply of medicines across the state.
A fresh essential drug list is prepared and approved by a committee headed by the C&S, Health, with members including DHS and young doctors posted in remote PHC/CHCs, through a comprehensive consultative process.
This has also reduced the cost of procuring medicines by 40%, thus bringing more efficiency into the system. Regarding procurement processes, MMDSL follows a structured and transparent approach. The selection of medicines is strictly guided by the Essential Drugs List (EDL), meticulously developed by a committee of senior doctors and healthcare experts. This ensures that all drugs procured align with established medical standards and local health needs.
To further emphasise our commitment to professional oversight, the procurement process involves a Procurement Committee, comprising the Managing Director, DHS (MI), DHS (MCH), a Senior Pharmacologist, as well as representatives from the finance and procurement team. Every procurement decision is thoroughly reviewed and approved through consultation with this multidisciplinary team, ensuring that medical, financial, and logistical expertise are all considered.