Introduction: Meghalaya is a state in northeast India that has a predominantly indigenous population and an age-old system of tribal medicine. There are practitioners of this system in most villages, who use medicinal plants sourced from the state’s vast forest bio-resources. This project studied the tribal medicine of Meghalaya from three perspectives, the healer, the community and the policy maker. It locates tribal medicine within the government’s policy on medical pluralism and seeks to understand how tribal medicine of a local context fits into the national policy of the Government of India. Methods: A mixed methods study design was employed. Estimates of awareness and use of traditional medicine in the community were obtained from the analysis of a household survey. For the qualitative component tribal healers, policy makers, and influential members of the community were interviewed. A combination of in-depth interviews, observations and focus group discussions was employed in the field with healers, while in-depth interviews were the main source of data from policy actors. Qualitative data was analysed using a thematic content analysis approach that incorporated elements of the grounded theory approach. Results: The community - tribal medicine has wide acceptance across the state, 87% believed it to be efficacious and 46 % reported using it in the 3 months prior to the survey. In comparison only 31% had heard of any of the AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) systems that are being promoted by the state and only 10.5% had ever used it in their lifetime. Healers - tribal healers are a heterogeneous group who treat a wide variety of ailments. Their expertise is well regarded in the community for certain ailments such as musculoskeletal disorders, but often their services were sought when patients were dissatisfied with biomedicine. For physical ailments that are culturally understood their services are often the preferred option. Their expertise niches have evolved through their interactions with, and the perceived needs of the community. Policy actors – although there were some appreciative voices, several biomedical doctors and policy makers in the government department of health derided tribal medicine’s unscientific nature. In comparison other systems like Ayurveda and homeopathy were assumed to have scientific merit mainly because of institutionalisation and government recognition of these systems. The comparison with homeopathy is pertinent as its scientific credentials are being increasingly questioned in scientific literature. In contrast those outside the health department, academics, biomedical doctors and other influential members of the community favoured tribal medicine because of its widely regarded efficacy and its cultural value. Neglect of tribal medicine while promoting the imported AYUSH systems was seen as illogical and disrespectful to their culture by the latter group. Conclusions: the current policy in Meghalaya of mainstreaming AYUSH medicine is not supported by locally relevant evidence. It has led to a disproportionate increase in AYUSH doctors in the public sector. It represents a top down approach to policy formulation that ignores local realities. This study demonstrates the importance of contextualising policy to cultural milieus. It emphasises the importance of research in health system development and questions the generalising of policy in a country as diverse as India. The study illustrates the complexities, but points to the potential benefits of supporting tribal medicine in Meghalaya