The 2030 global agenda deadline intensifies the urgency to achieve Sustainable Development Goals (SDGs), with SDG 15.3 aiming for land degradation neutrality (LDN). Aligned with the Rio Declaration’s seventh principle on ecohealth restoration, the LDN paradigm emphasizes balancing degradation and improvement for a neutral outcome. While studies have supported various ecohealth restoration programs in Asian drylands (ADs), comprehensive monitoring of ecohealth progress, interplaying the Rio principle and LDN paradigm, remains critical yet underexplored. Using remote sensing datasets, we developed an integrated framework combining the LDN paradigm and the regional ecohealth assessment model simulated with land use, landscape metrics, and biophysical indicators (e.g., soil moisture, slope, and vegetation dynamics) to monitor ecohealth progress and quantify the equilibrium state of change across ADs (2000 to 2020). Analysis revealed that regional ecohealth declined until 2012 and then improved thereafter. Within the LDN paradigm, we estimated that 22% (196 Mha) of ADs experienced ecohealth-induced degradation, while 13% (119 Mha) improved (2000 to 2020). This resulted in a land debt of about 8% of ADs (76.9 Mha) that needs to be addressed for an equilibrium outcome. Notably, Dryland East Asia showed greater ecohealth improvement than Central Asia, where degradation prevailed, particularly in Kazakhstan. Here, we show that these changes are driven by land use activities (i.e., agriculture, desertification, forestation, and urbanization), impacting 9.1% (79.3 Mha) of ADs, and climate-affected areas with above-average anomalies. While LDN is still within reach, we emphasize protecting intact ecosystems while restoring degraded areas through region-specific strategies tailored to the root causes and local conditions for dryland sustainability.