Meghalaya is a hilly state in the north-east of India. Its links to the mainland of the country, whether by road or air, run largely through Assam, which is its neighbour to the north. The state had an estimated mid-year population in 2021 of 33 lakhs, almost 80% of which is rural. The population density is about a third that of India as a whole, at 147 per square kilometre. This too is unevenly distributed with the majority in the East Khasi Hills district, where the capital Shillong is located, and the West Garo Hills, where the second largest city of Tura is located, while most other districts have large sparsely populated and poorly connected rural tracts.

The social and health indicators of the state present a mixed picture. The average life expectancy has improved in the last decade to 72.4 years in females and 66.8 years in males. The literacy rate is also above the national average with higher female than male literacy; 88% of women and 83% of men are literate (NFHS 5). On the other hand, infant mortality rate is close to the national average at 32.3, while percentage of children fully vaccinated is much lower at 63.8 % and only 58.1% of births in the state are institutional. The state has also seen a marked shift in its burden of disease. A recent situational analysis conducted by NHSRC reported that while communicable, maternal and new-born diseases continue to be significant sources of morbidity and mortality, non-communicable diseases now form the bulk of the disease burden in the state (56%). Meghalaya also has a very high incidence of substance abuse, and HIV incidence is almost five times the national average.

The public health system in Meghalaya faces several challenges. Despite the state spending a significant percentage of its total expenditure on health (15.8%), there is major shortfall in the available infrastructure and human resources when compared to IPHS 2022 norms. The largest shortfall in infrastructure is at the peripheral subcentre level but three of the eleven districts also do not have a district hospital. Shortages in health workforce range from 35% in Multi-Purpose Health Worker cadres (MPWs), to 66% in Staff Nurses, 26% at Medical Officer level and 46% for Specialists. Marked geographical mal-distribution of the available HRH with skewed rural under servicing, absent or malfunctioning equipment, lack of consumables and drugs, and questionable quality of services compound the problems. Lack of any production capacity for doctors is also a major challenge; the state does not have any state level medical college. Only 9 MBBS seats in the central government medical college at Shillong (NEIGRIHMS) are reserved for Meghalaya students while another 47 seats are allocated in other central colleges across the country. These shortfalls are reflected in the poor utilization rates for various services. Majority of the rural population visit indigenous healthcare providers for their needs and child immunization rates are amongst the lowest in the country, as are institutional births. The state has a long distance to go for achieving the SDGs.