With increasing specialisation in health sector, it is important to set up specialty units in secondary and tertiary hospitals and to establish forward and backward linkages to them from primary care settings. The crucial component of such units are qualified specialists. Creation of a separate cadre is essential to attract, retain and build the competence of specialists to ensure delivery of quality specialist health care services in the public health facilities. The specialist cadre requires an institutionalized process and structure which enables separate and direct entry for post graduate doctors into the health system1. To achieve this the Government of Meghalaya proposes to organise the doctors in the Government Health Services into various cadres.

The state of Meghalaya has no specialist cadre in the state. The specialists enter the regular cadre at the Grade-III post of Medical and Health Officer, where they conduct duties similar to the MBBS graduate. As per the Meghalaya Health Service Rules 1982-1990, the following clinical specialists may be hired under the regular cadre - General cum Plastic Surgery, Surgery, Medicine, Obstetrics and Gynaecology, Ophthalmology, Radiology, Psychiatry, E.N.T. and Pathology2. The list of speciality cadres in the health service rules need to be modified as per the list of speciality cadres deemed essential in the IPHS norms 2022. This will give more flexibility to the state to recruit and absorb other specialities within the regular cadres. As per the HRH- Situational Analysis report, state is yet to utilize the flexibility of ‘You Quote, We Pay’ to attract specialists from other states. At present state is utilizing the flexibilities under NHM to absorb retired clinical specialists from regular cadre under NHM.

In order to facilitate the encaderisation of doctors, data on available and required number of specialists was analysed. The requirement for the specialists was calculated based on the following facility level data that was shared by the state as a part of their Program Implementation Plan proposal for 2022 24. It is to be noted that the state has a total of 28 Community Health Centres (CHCs) in rural areas of which 1 CHC has been upgraded to function as First Referral Units (FRUs). CHCs act as the initial point of contact for the patients referred from the primary health care facilities, if these CHCs are upgraded, it would bring quality secondary care services closer to the community. The requirement of specialists in the state would increase if more CHCs are upgraded as FRUs