To hear of healthcare facilities not being available for people in Dawki area is an unpardonable lapse. Dawki is a border area and is supposed to be better served because of the distance involved in reaching the nearest health care centre. Sadly, last mile health care facilities are sorely wanting in Meghalaya. Meghalaya’s healthcare crisis is not only about infrastructure it is about the lack of medical professionals where they are most needed. More so their absence at the last mile. In a state where roughly 80 percent of the population lives in rural areas, access to a health centre with a doctor present depends on so many factors like geography, the weather and luck. For many villages in the Garo Hills, Jaintia Hills and even remote pockets of East Khasi Hills, the nearest government doctor may be several hours away. Primary Health Centres (PHCs) and Community Health Centres (CHCs) frequently function without full-time medical officers, and some operate with skeletal staff or contractual doctors who do not stay long.
Let’s face it – most doctors are unwilling to serve in remote areas. Official data over the years has consistently shown vacancies in sanctioned posts for doctors and specialists. Even when recruitment drives are announced, postings in remote blocks such as those in South Garo Hills or East Jaintia Hills remain unattractive. Poor road connectivity, limited housing, lack of educational facilities for children, and minimal professional growth opportunities discourage young doctors from serving in rural Meghalaya. Most medical graduates from the state prefer to work in urban centres like Shillong or move outside the state for better pay and exposure. Without adequate incentives, compulsory rural service becomes a paper mandate rather than a lived reality. The health system in rural Meghalaya rests heavily on Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), and nurses. They are the first responders for maternal health, immunisation drives, tuberculosis monitoring and even mental health referrals. But they are not doctors. They cannot diagnose complex conditions, manage emergencies, or handle complications during childbirth.
In medical emergencies families often have to transport patients to district hospitals in Tura or Shillong. Critical cases are referral to facilities outside the state, further increasing cost and delay. The shortage is even more acute in specialist care. District hospitals struggle to retain surgeons, paediatricians, anaesthetists and gynaecologists. This leads to irregular surgeries, postponed procedures and preventable complications. In a geographically challenging state like Meghalaya, where monsoons can cut off entire regions, the absence of specialists at district level can be life-threatening. Over the years, buildings have been constructed and schemes announced under national programmes. However, infrastructure without human resources is a mockery. A well-equipped PHC without a doctor is merely a structure. Telemedicine has been introduced in some areas, but digital consultations cannot replace physical examination, especially, where internet connectivity is unreliable. The Government has to prioritise health care which is a right and not a privilege. If the last mile citizen cannot access a doctor, the state has failed in its constitutional duty. The health of a state is not measured by the number of hospitals in its capital, but by whether a mother in a remote village can see a qualified doctor when she needs one most. The ASHA and nurses are no substitute for a doctor.
