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Aim: This study aims to evaluate surgical care systems across tertiary, secondary, and primary health institutions in the state of Meghalaya, India. Materials and methods: The government of Meghalaya conducted the first comprehensive assessment of surgical capacity at three levels of care: Tertiary hospitals, community health centers (CHCs), and primary health centers (PHCs). This cross-sectional survey utilized World Health Organization (WHO) tool for situational analysis to assess emergency and essential surgical care (EESC) to capture health facilities’ capacity to perform life-saving and disabilitypreventing surgical interventions, such as resuscitation, surgical, trauma, obstetric, and anesthetic care. Data were collected across four categories: Infrastructure, human resources, surgical procedures, and equipment. Results: The 55 facilities surveyed comprised 8 tertiary hospitals, 26 CHCs, and 21 PHCs. A total of 107,962 surgical presentations were reported across all facilities per year, with the greatest number presenting to PHC. No specialist doctors worked at PHC level; there were 1 anesthesiologist and 2 obstetricians at the CHC level. All of the PHCs or CHCs referred do not provide key emergency and essential surgical procedures, including resuscitation, cesarean section, general anesthesia, laparotomy, and closed and open treatment of fractures. At the tertiary level, only 50% provide cesarean section and laparotomy procedures. Conclusion: The results of this WHO state survey demonstrate significant gaps, notably in resuscitation, at all lower level health ORiginAl ARticle 1Resident Physician, 2Member and Secretary, 3Associate Conjoint Lecturer, 4Lead, 5Member, 6Team Lead, 7Representative 1Department of Orthopaedic Surgery, Harvard Medical School Boston, Massachusetts, USA 2Government of Meghalaya Technical Working Group for EESC, Rajiv Ghandi Indian Institute of Management, Shillong Meghalaya, India 3Prince of Wales Hospital, The University of New South Wales Sydney, New South Wales, Australia 4Emergency and Essential Surgical Care Program, Department of Health Services and Delivery, World Health Organization Geneva, Switzerland 5WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) Program, VPS HealthCare, Abu Dhabi, United Arab Emirates 6,7WHO Country Office for India, WHO, New Delhi, India Corresponding Author: Bonnie Y Chien, Resident Physician Department of Orthopaedic Surgery, Harvard Medical School Boston, Massachusetts, USA, Phone: +16507148048, e-mail: mannil10@gmail.com 10.5005/jp-j urnals-10035-1058 Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study 1Bonnie Y Chien, 2Khumukcham I Singh, 3Laksmi S Hashimoto-Govindasamy, 4Meena N Cherian, 5Manish Mehrotra 6Paul P Francis, 7Natela Menabde facilities and the absence of obstetric procedures at some tertiary hospitals, in essential and emergency surgical capacity, including human resources, equipment, and infrastructure, across all levels of health institutions in Meghalaya. Clinical significance: This study is an effort to identify the strengths and limitations of surgical capacity in the state of Meghalaya. The method of the study are simple and results can be extrapolated to other states of the country or any third world state which can translate into enhancement and redirection of resources for an optimum outcome. Strengths of the study • This study is driven by the motivation of the government of Meghalaya to address the issue of surgical care capacity. • The study identifies concrete areas of need in surgical care capacity in a collaborative effort with the government of Meghalaya. • Given the wealth of information on different levels of care centers provided by the government, specific recommendations for improvement can be made. Limitations of the study • Although detailed, the situation analysis survey tool is not fully comprehensive and cannot be used exclusively for program planning. • Not all care centers were able to be surveyed; thus, the results may be representative of only those surveyed.