The present study attempts to examine the role of specialist services in rural public health system of India in the areas of maternal and child healthcare. The study uses primary data collected through a survey of doctors and paramedical staff working at public health facilities regarding availability and quality of the specialist services in gynaecology, paediatrics and anaesthesia. The study discusses in detail the aspects of infrastructure, manpower and operational challenges faced in effective provisioning of specialist services through the rural health facilities of four largest states-Bihar, Madhya Pradesh (MP), Rajasthan and Uttar Pradesh (UP). The findings of the survey reveal significant dearth of specialist doctors with their concentration at the district level. Moreover, there are severe misallocations of the specialist doctors and, lack of manpower support, equipment and basic infrastructure within the public health system causing serious challenges in effective provisioning of specialist services for maternal and child healthcare. Lastly, the efforts made by the government for providing additional manpower support for these services are also not giving desired results.