Performance audit of National Rural Health Mission in Meghalaya for the period 2011-2016 disclosed shortages in availability of required healthcare facilities such as Public Health Centres and Sub Centres, unavailability of essential drugs, lack of infrastructure in the health facilities, equipment lying unutilised etc. Required infrastructural facilities viz. operation theatres, blood bank facility, water supply, telephone connections, etc. were not found available in selected healthcare facilities. In other cases, infrastructure was created but were lying unutilised for want of required personnel to operate them. Shortages in availability of required manpower, especially medical specialists was a serious impediment in the proper delivery of healthcare services. A large number of pregnant women did not show up for antenatal care while a number of them did not receive the full dose of Iron Folic Acid tablets. 47 per cent to 51 per cent of registered pregnant women preferred delivery at home rather than at health facilities. There was shortfall in achievement of immunisation as well as sterilisations. There was shortfall in payment of Janani Suraksha Yojana incentive despite availability of funds. All these indicated that the State Government had failed to connect the scheme with the people who are the stakeholders. The Quality Assurance Committees at various levels did not meet at the prescribed intervals to assess the quality of the services being delivered. Mismatch of data as per Health Management Information System and data as per original records maintained at the healthcare facilities was noticed. Monitoring of the Mission by State Health Mission headed by the Chief Minister was absent while monitoring by State Health Society headed by the Chief Secretary was minimal thus indicating that adequate priority was not being accorded to the health sector in the State. Considering that there is a strong correlation between facilities created and health outcomes (infant mortality rate, maternal mortality ratio and total fertility rate), the deficiencies were responsible in preventing the State from achieving the targets set by GoI.