Shillong: Meghalaya can be a confusing state at times, especially for outsiders. The state is a tourist magnet, to say the least: from festivals that draw in lakhs of tourists to concerts of global artists like Akon and Bryan Adams, Meghalaya and tourism are almost inseparable. Yet, beyond all the glitter and glamour of festivals, the breathtaking views of caves, jungles, waterfalls and root bridges, there is a Meghalaya that unfortunately is witnessed almost exclusively by locals. And this is the Meghalaya where hundreds of schools do not have teachers, where landlessness is shockingly high, and where public health remains a far-fetched dream. This explains, perhaps, why when the Health Dynamics of India report was released, it showed that Meghalaya has a shortfall of 108 specialists, needing 112 but having sanctioned and posted only four so far.
And Jongksha is a perfect example of how bad things are when it comes to public health in Meghalaya.
In September 2022, the foundation stone was laid to upgrade the Jongksha Public Health Centre (PHC) in Meghalaya’s East Khasi Hills District into a Community Health Centre (CHC). This milestone was celebrated by Banteidor Lyngdoh, the constituency’s MLA, as a significant achievement. However, two years later, in September 2024, the PHC made news for a different reason — residents of Jongksha village shut it down due to the lack of doctors.
Located 28 kilometers from Shillong in the Mawkynrew Block, Jongksha PHC serves a vast population of 47,000 across 51 villages and six sub-centres, including Thangsning, Mawlyngngot, Pingwait, Kharang, Thynroit, and Mawpyrshong. Despite its critical role in the region, the PHC is staffed by only two Medical Officers (MOs) and one AYUSH doctor. With three additional sub-centres set to open soon, the burden on the current medical staff will grow, requiring them to manage nine sub-centres.
Given the vast and challenging terrain, including hard-to-reach and non-motorable areas, the PHC is grappling with a severe shortage of medical professionals. This has left the existing doctors overburdened and struggling to meet the growing healthcare demands, underscoring the urgent need for more resources and manpower.
A CHC upgrade is the need of the hour
An official ceremony marked the announcement of upgrading Jongksha Public Health Centre (PHC) to a Community Health Centre (CHC), and many reports have since referred to it as Jongksha CHC. However, despite receiving Administrative Approval (AA), no tangible progress has been made on the upgradation project.
Mawkynrew MLA Banteidor Lyngdoh, who was at the PHC during EastMojo’s visit, stated that the facility is functioning normally, with doctors available even after the September shutdown incident. Lyngdoh also inspected ongoing construction work at the PHC and assured that efforts to upgrade it to a CHC are underway.
“The upgrade is in process. After receiving Administrative Approval, we laid the foundation stone, and we hope the government will expedite this project,” said Lyngdoh. As a member of the ruling party, he acknowledged the delays but pledged to press the government to prioritize the work. “This Block urgently needs a CHC. The PHC is overwhelmed by the population it serves, and I will apprise the Chief Minister of the necessity for swift action,” he added.
Jongksha’s headman, Olet Kharsahnoh, who has held the position for over a decade, echoed these sentiments. While noting improvements in the healthcare system over the years, he expressed concern over the ongoing challenges faced by the largely indigenous population. Kharsahnoh highlighted the overburdened state of the three doctors at the PHC, who not only serve a vast population but also travel to remote areas, leaving them stretched thin.
Both leaders emphasized the pressing need for the CHC to meet the healthcare demands of the region and improve accessibility for the community.
Overworked and under-appreciated
A doctor at the Jongksha PHC, speaking anonymously, highlighted the immense challenges of serving a population of 47,000 across 51 villages and six sub-centres. Despite meeting the standard staffing norm of two Medical Officers and one AYUSH doctor for a PHC, the doctor stressed the need for the government to adopt a more practical approach, given the scale and unique challenges of the region.
“Three doctors are insufficient to handle the demands of this area and population. Beyond patient care, we frequently conduct tours for immunizations and antenatal care (ANC), often requiring house visits. The terrain adds to the difficulty, with many areas being far-flung and hard to reach,” the doctor told EastMojo.
The PHC primarily acts as a First Response Unit, stabilizing critical cases before referring them to higher facilities in Shillong. However, financial constraints often deter residents, many of whom come from economically disadvantaged backgrounds, from seeking care outside the village. “Referrals to higher facilities burden patients with transportation and hospital costs. While we counsel them, some patients request treatment here, and we do our best to manage,” the doctor explained.
The PHC is relatively well-equipped compared to others in the state, offering services under Meghalayan Medical Drugs & Services Ltd (MMDSL) and undergoing lab expansion. Still, the doctor emphasized the need for improvement to meet the heavy reliance of the population on PHCs.
The doctor also underscored the urgent necessity of establishing a CHC in the region. Even if a CHC were built at Smit, closer to Shillong and the highway, it would significantly ease the burden. Currently, the nearest CHC is located in Shillong, far from the communities relying on the Jongksha PHC for care.
Lack of Specialists in Meghalaya
Meghalaya, with 7,097 villages spread across 12 districts, has a network of 463 sub-centres, 122 rural PHCs, 25 urban PHCs, 28 rural CHCs, one urban CHC, and 11 district hospitals. However, the state’s healthcare infrastructure faces significant challenges, particularly the acute shortage of specialists in CHCs.
In rural CHCs, there are no surgeons, only two obstetricians and gynecologists, and one physician and pediatrician each, falling far short of the government-mandated requirement of four specialists per CHC. Overall, Meghalaya has a shortfall of 108 specialists, needing 112 but having sanctioned and posted only four so far.
The government has repeatedly acknowledged this gap and the reluctance of specialists to relocate to Meghalaya. Health Minister Ampareen Lyngdoh highlighted the issue during the Meghalaya Cancer Conclave 2024, stating, “We are having a hard time finding specialists willing to come to Meghalaya. Even when we find candidates, they must navigate the scrutiny of the reservation policy, raising concerns about whether positions can be filled outside its purview.”
To address the shortage, the state government has begun reviewing its bond policy to retain more doctors. Additionally, it is considering a comprehensive transfer and posting policy to encourage equitable distribution of doctors and nurses, particularly in remote areas.
Local residents share similar concerns about the inadequacies of healthcare facilities. Many rural PHCs lack the capacity to treat common ailments, forcing residents to travel to cities for basic healthcare services. “We need proper government health facilities in the village or nearby towns with basic amenities like X-rays and CT scans,” lamented a local resident. “We can’t afford to hire cars to travel to the city for minor ailments and often have to take loans just to access healthcare. It’s frustrating to hear announcements of PHC upgrades to CHCs when no actual work has begun.”
The growing dissatisfaction among residents and the persistent manpower shortages highlight the urgent need for meaningful reforms and timely implementation of healthcare infrastructure projects in the state.
Also Read: This story has been published as part of the AIPP-EastMojo Fellowship 2024
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