Shillong, Sept 6: Meghalaya’s maternal deaths have fallen by 56% and infant deaths by 40% since the launch of the Rescue Mission in November 2020, with the state’s five-year effort showing how data-driven reviews, stronger health services and community action can help prevent deaths once considered difficult to avoid.
A new Implementation Learning Note by the State Health Systems Resource Centre (SHSRC), Meghalaya, titled “From Inevitable to Preventable: How Meghalaya Reduced Maternal & Infant Deaths,” documents the journey and examines how the Rescue Mission changed not only health outcomes but also the way the state health system identifies problems, responds to them and learns from failures.
The Rescue Mission was launched in November 2020 after weekly reviews during the COVID-19 pandemic brought the high number of maternal deaths to the attention of senior political and administrative leadership. In 2020-21, Meghalaya recorded 244 maternal deaths, corresponding to a Maternal Mortality Ratio (MMR) of 295.
The challenge was compounded by Meghalaya’s geography. Around 25% of the state’s nearly 7,000 villages were classified as hard-to-reach, while residents of 49% of villages could not reach a health facility within 30 minutes by vehicle.
But the assessment that followed pointed to problems beyond geography and infrastructure. The SHSRC note says maternal and infant mortality had often been viewed as an unfortunate or inevitable outcome rather than as a problem that the health system could collectively solve.
The Rescue Mission sought to change that mindset while building the capacity to act on it.
Rather than relying on a single programme, Meghalaya worked simultaneously on several parts of the health system, including human resources, emergency care, health information, financing and community participation.
Putting data in the hands of frontline workers
One of the key interventions was the MOTHER App, which enabled the health system to track every pregnant woman and lactating mother, with individual-level information made available in real time to Medical Officers and frontline workers.
The system allowed health workers to identify high-risk women, follow up on their care and anticipate potential barriers before they resulted in adverse outcomes.
The significance of the app, however, went beyond digitising records. District and block teams began using the information during regular reviews to jointly identify problems and follow up on corrective action. Data, the SHSRC note says, increasingly became a tool for learning and action rather than merely reporting.
Tackling the last-mile barriers
Geographical access emerged as another major obstacle.
Women were sometimes unable to reach health facilities for institutional delivery because transport was unavailable, there was nobody to look after their children, or family members dependent on daily wages could not afford to accompany them.
The state responded with the Chief Minister’s Safe Motherhood Scheme (CM-SMS), launched in July 2022.
Instead of creating another narrowly defined entitlement, the scheme provided resources directly to health facilities, giving Medical Officers flexibility to address practical barriers faced particularly by high-risk pregnant women and those living in hard-to-reach areas.
The scheme provides transport support and transit homes where women and their attendants can stay for several weeks before delivery. The transit homes are managed by Self-Help Groups, while traditional birth attendants are incentivised to refer high-risk pregnant women to health facilities.
The intervention has also evolved in response to problems identified on the ground.
Field visits found that some women were still unable to travel for delivery because they had nobody to care for their children. CM-SMS is therefore being expanded to provide childcare support through Village Organisations and Self-Help Groups.
More doctors, nurses and emergency facilities
Meghalaya also moved to address shortages in its health workforce.
The Meghalaya Medical Services Recruitment Board (MMSRB), established in October 2022, was created to streamline recruitment and reduce the time required to fill vacancies in the public health system.
According to the SHSRC note, the board has completed three recruitment drives and recruited 380 Medical and Health Officers, 108 Junior Specialists, 163 Staff Nurses, 110 ANMs and eight Dental Surgeons. Recruitment cycles are now being completed within 20–40 days.
The state has also invested in specialised training. Through a partnership with the Tamil Nadu government, Medical Officers have undergone six-month competency-based training in Comprehensive Emergency Maternal Obstetric Care, Life Saving Anaesthetic Skills and ultrasonography.
Four batches have completed the training so far, covering 20 doctors in CEmOC, 25 in LSAS and 45 in ultrasonography, while a fifth batch is undergoing training.
Infrastructure has been strengthened alongside the workforce. Five Community Health Centres are currently functioning as First Referral Units capable of providing emergency obstetric services, with six more planned.
The aim is to bring emergency and specialist services closer to communities and reduce delays in referrals, which are particularly important in a state characterised by difficult terrain and dispersed settlements.
The death reviews that changed the approach
One of the more distinctive features of the Rescue Mission has been what happens after a maternal or infant death.
Every month, health officials, Medical Officers, doctors from tertiary facilities and district leadership from the Health, ICDS and Community & Rural Development departments examine individual cases and ask a fundamental question: what could have been done differently to prevent the death?
The reviews are explicitly designed not to assign blame. Instead, they provide a space for frontline workers to discuss the challenges they faced, including gaps in the care pathway, while state and district leadership identify how they can support them to prevent similar deaths.
The process has since become institutionalised.
A defined monthly reporting calendar requires maternal and infant deaths from the preceding month to be reported and reviewed at the state level by the second week of every month.
The SHSRC describes the process as a regular learning loop: a death occurs, data is collected, the case is analysed, gaps are identified, actions are agreed upon and those actions are followed up.
The approach, according to the note, has helped shift the culture from reactive programme management towards prevention, accountability and continuous problem-solving.
From reviewing deaths to mentoring health workers
The reviews also revealed that identifying what went wrong did not always mean that Medical Officers and frontline workers had the knowledge, skills or confidence to address the problem.
This led to the Rescue Mission Staff Mentorship programme, developed by the Regional Health & Family Welfare Training Centre, the state’s nodal agency for capacity-building of healthcare providers.
Instead of relying solely on classroom training, the programme uses personalised mentoring, case discussions and tailored learning sessions based on gaps identified through death reviews.
The objective is problem resolution rather than blame, with continued mentoring where further support is required.
Regular field visits have similarly been used to connect senior leadership with the realities faced by communities and health workers.
The state is now seeking to institutionalise this approach through the Human Development Leadership Program (HDLP), which extends the principles of the Rescue Mission beyond maternal and infant health to areas including nutrition, education and livelihoods.
A wider model for running government
The SHSRC note argues that the deeper outcome of the Rescue Mission may be the creation of greater state capability to solve complex health problems.
The experience brought political and administrative leadership, frontline providers, communities and multiple departments together around a shared problem. Data increasingly became a tool for identifying risks and solving problems, while regular reviews, mentorship and field engagement helped build ownership among frontline workers.
The state is now considering whether the same approach can be applied to other health challenges, particularly non-communicable diseases.
The model is based on identifying problems through data and local knowledge, bringing together the actors who can influence them, empowering those closest to the problem and continuously reviewing and adapting the response.
There is also an effort to give frontline teams greater autonomy while linking that autonomy to accountability.
Under Outcome-Based Budgeting, Meghalaya plans to provide funds directly to directorates, districts and health facilities, with financing linked to outcomes. The stated population-level goals include reducing maternal and infant mortality and increasing life expectancy.
Towards a “learning health system”
The longer-term ambition is to move from a successful mission to what the SHSRC describes as a learning health system.
The state is building institutional mechanisms around research, concurrent evaluation, community feedback and knowledge generation, with the aim of treating implementation itself as a source of learning.
Successful innovations are to be identified and adapted, failures examined rather than hidden, and community feedback connected to decisions made by frontline teams and policymakers.
The results so far are significant. The SHSRC note records a 56% reduction in maternal deaths since the launch of the Rescue Mission in November 2020, while infant deaths have declined by 40%. It also notes that the rise in maternal deaths in 2020-21 reflected both the impact of COVID-19 and better reporting following the launch of the Mission.
For Meghalaya, however, the numbers are only part of the story.
The more enduring change, the learning note suggests, is whether the state can institutionalise the habits developed through the Rescue Mission—using data to identify problems, giving frontline workers the authority and resources to respond, involving communities and other departments, and learning systematically from what goes wrong.
The immediate goal remains to move towards zero preventable maternal and infant deaths, while applying the capabilities built through the Rescue Mission to the next generation of health challenges.
In that sense, what began in 2020 as a mission to prevent mothers and infants from dying is now being positioned as something broader: a new way for Meghalaya’s health system to identify problems, act, learn and adapt.
