It is said that Conrad K. Sangma remembers a time when he first became Chief Minister of Meghalaya in 2018. Someone asked him what he was going to do better. He didn’t promise a big change in policy. In the words of author Shiv Khera, he said he wouldn’t change anything, but he would change how he did things. It sounds like something from a business class. In real life, it seems to be shaping something more important.
In June, a three-day Early Childhood Development Implementation Science Workshop was held in Shillong. During that time, Sangma talked about this philosophy in a very open way. Policymakers, researchers, and practitioners from all over the country came to the workshop, which was put together by the Meghalaya Early Childhood Development Mission with help from the Van Leer Foundation, the Asian Development Bank, and the State Capability Enhancement Project. “From Science to State Action” was the theme, which said it all: the goal was high. Sangma’s speech seemed more grounded than that.
His main point was so simple that it scared people: most governments already have the plans they need. Almost always, the gap is in how things are done. He used MGNREGA as an example of how better implementation in Meghalaya greatly increased the program’s ability to absorb new funds. The state now oversees projects worth nearly ₹12 billion that were helped by outside sources. This is as much as or more than the portfolios of many states with many times as many people and a lot more land.
The way this way of thinking has been used in maternal and child health is harder to ignore. At the start of Sangma’s administration, it was thought that getting more women to give birth in hospitals would lower the death rate for mothers. One that makes sense and is often put forward. But a closer look showed something else. For women living in remote areas, the biggest problems weren’t lack of knowledge or general access to facilities. Instead, they were the cost of getting there, the distance, and the lack of someone to be there with them. So, the government set up a model for community transportation and paid local car owners to take pregnant women to health facilities. After that came Safe Motherhood Homes, where women from faraway villages could stay, eat, and rest in the days before they gave birth. Used-full, adapted to local conditions, and not too expensive.
It’s easy to wonder why more states haven’t done the same thing. No one ever hid the answers. They only needed someone who could focus on the issue for a while and fully grasp it.
This way of thinking led to the creation of MOTHER, an initiative for health, education, rural development, and social benefit in Meghalaya. Even though the name is a bit awkward, the idea behind it is hard to argue with: instead of seeing government departments as separate, they should be organized around the life cycle of a person. The health of a mother. The early years of a child. What does the family really need, and when do they need it? “We are no longer looking at departments or schemes in isolation,” Sangma said in a clear way at the workshop. We are seeing a person’s life.”
The number of self-help groups is one concrete sign of what that unified focus has led to. Meghalaya had about 4,500 of these groups when Sangma took office. There are almost 60,000 now. It is not a coincidence that economic empowerment for women is linked to better health outcomes for children. It is built into the system.
A representative from the Van Leer Foundation named Patricia Núñez Zamora used Chile’s “Chile Crece Contigo” program as an example. She said that the problem in most countries was never a lack of services. There wasn’t enough communication between the services, so they didn’t have the same picture of the child and family. The same lesson seems to have been learned in Meghalaya in its own way.
Since then, Meghalaya’s governance model has been written up as a case study on adaptive leadership by the Harvard Kennedy School. This could be a sign of support or caution, depending on how skeptical you are about these kinds of things. It’s not so easy to ignore the fact that the National Family Health Survey data shows that in the state, maternal and child health, nutrition, and stunting have all gotten better, even though officials say there are still real problems.
It seems like what Sangma is trying to do in Meghalaya isn’t going to be easy to do on a large scale. Each state has its own history, politics, and way of running its government. But it’s harder to argue with the idea behind it—that good governance is mostly about being honest about problems and always following through—than with most of the things that are said at policy workshops in Shillong or anywhere else.
