Prospective policy analysis of healthcare workforce policies for effective non-communicable disease prevention and management in Meghalaya, India.

Abstract

This study presents a prospective policy analysis of healthcare workforce (human resources for health, HRH) reforms in Meghalaya, India, a state facing dual challenges of a rising burden of non-communicable diseases (NCDs) and persistent inequities in access to medical and public health specialists. Grounded in a health systems and social justice perspective, this study examines current HRH needs and proposed reforms, evaluating their potential to address the evolving health demands of the population, particularly among poor and marginalized groups vulnerable to NCDs. Using secondary evidence, including national surveys, epidemiological data, and government reports, the study maps workforce gaps, especially in rural and tribal regions, and highlights the physician-centric nature of HRH governance in India. The Walt and Gilson policy triangle, combined with adapted HRH evaluation frameworks, guided the analysis of policy context, content, processes, and actors. This approach identified key gaps in recruitment, rural retention, cadre structures, and specialist training for effective NCD prevention and management. A scenario analysis, using the Intuitive Logic method, developed a best-case trajectory of reform achievable through equity-oriented design, strong political will, and institutional capacity, while recognizing risks of policy stagnation. Findings indicate that achieving a socially accountable HRH system characterized by equitable distribution, transparent governance, and meaningful community engagement is critical for improving NCD outcomes and reducing health inequities, particularly by preventing financial distress among the poor. The study contributes to health policy and systems research by linking institutional design to future health system resilience, underscoring the need to embed justice, participation, and adaptability within HRH governance to effectively address present and future health challenges in low-resource contexts such as Meghalaya.