Building Purpose and Leadership Among Government & Citizens to Transform Health

Meghalaya, a state in northeast India, has long faced high maternal mortality due to its hilly terrain and dispersed population across 6,000 villages. Recognizing the limits of top-down strategies, the state government adopted two key practices to build local leadership and purpose. First, cross-sector teams were established at every level, and village health councils were empowered to identify and solve local challenges. 

This sparked grassroots innovation and strengthened community ownership. Second, regular reviews and field visits reconnected citizens with state systems. These helped align goals, raise issues, and build trust. These practices led to impactful local solutions. In one district, medical officers noticed women struggled to reach facilities in time, so they arranged stays near health centers before delivery. The state scaled this into citizen-run transit homes. As a result of these and other innovations, maternal deaths dropped by nearly 50% between 2021 and 2023.