Are village health councils advancing health equity? A case from the northeastern region of India

Despite global commitments to Universal Health Coverage (UHC), nearly 4.5 billion people remain without adequate health coverage. India’s UHC index stands at 43.9% with significant disparities across districts. Policy commitments alone cannot ensure positive health outcomes without community engagement. In Meghalaya, Village Health Councils (VHCs) serve as critical links between the state health system and community members to promote positive health outcomes. This study explores how and under what conditions community engagement through VHCs contribute to health equity. This qualitative study involved 13 in-depth interviews and 9 focus group discussions with 85 participants. The participants included VHC members, community members and frontline health workers from nine villages and seven health centres, across three blocks in West Garo Hills District, Meghalaya, purposively selected by the district health team. Data was audio recorded and transcribed. Thematic analysis was used to identify codes, subcategories and emerging themes. Additionally, the data were analysed through the lens of the Assessing Community Engagement (ACE) Conceptual Model. The findings revealed that VHCs have potential to advance health equity through community mobilization and trust, strong linkages with frontline health workers, a shared sense of responsibility towards community members and active involvement in community health education. However, their effectiveness remains constrained by unclear member roles, capacity gaps, weak coordination between VHC and AAMs and unmet expectations at health facilities. Most VHCs cannot yet function independently and heavily rely on the ASHA worker for its functioning. VHCs have potential to contribute to health equity in rural Meghalaya if supported by role clarity, capacity building and sustained handholding.