Public Private Partnership in Meghalaya: delivering healthcare in difficult to access tribal areas

Introduction Meghalaya, a hilly tribal state in northeast India, has many inaccessible areas with little or no access to good quality health services. With an infant mortality rate (IMR) of 58 infant deaths per 1000 live births, an institutional delivery proportion of 29.7 % of all deliveries, a full immunization coverage rate of 32.8 %, and a total fertility rate of 3.8, Meghalaya has some of the poorest health indicators in the country. Faced with challenges of attracting and retaining skilled health workers in these remote settings, the state adopted a Public Private Partnership (PPP) approach in 2008. The approach involves handing over the management and operations of 29 poorly performing community health centres (CHC), primary health centres (PHC) and subcentres located in difficult areas to nongovernmental organisations (NGO), through a memorandum of understanding. We conducted this study to assess the effectiveness of this approach with respect to increasing access to essential healthcare services.