Bihar is the third-largest state in India, with a population of over 110 million. Despite recent gains, Bihar has some of the country’s highest rates of maternal, neonatal, and infant mortality, as well as a high prevalence of malnutrition, stunted growth, and high fertility rates. Extreme poverty, social inequality, low literacy rates, and early marriage further compound Bihar’s poor health outcomes.
The Bihar Technical Support Program is a partnership between CARE, the Bill & Melinda Gates Foundation and the Government of Bihar, focused on reducing rates of maternal, newborn, and child mortality and malnutrition, and of improving immunization rates and reproductive health services statewide. The program covers all 534 blocks in 38 districts of Bihar and involves at least 400 public sector hospitals and 200,000 frontline workers. Through this partnership, CARE has contributed to significant improvements in the health system.
Today, CARE and the government continue to invest in sustaining improvements made through scale-up as well as addressing systematic issues by transforming institutions, organizational structure, regulations, and governance.
The Bihar Technical Support Program is working to reduce rates of maternal, newborn, and child mortality and malnutrition, and to improve immunization rates and the quality of reproductive health services statewide
Since 2011, CARE and the Government of Bihar have made great strides in testing and implementing innovations to improve health outcomes and strengthen the health system.
The Bihar Technical Support Program has also contributed to state-level impact in the areas of maternal and infant mortality:
Improvements made to the health system have also increased use. In 2005, public health facilities had a client load of 39 people per facility per month. In 2018, that figure was about 10,000 people per facility per month.
Frontline health workers form the backbone of the public health system in India, like they do in many low-income countries. With long distances between health centers, poor road conditions, and limited transportation options, people living in rural and remote areas of Bihar have little access to facility-based health services. Frontline workers work hard and walk miles each day to provide in-home counseling, health and hygiene education along with basic maternal, newborn and child health and nutrition services to families in need. Properly trained, supported, and valued, they have the potential to save millions of lives.
Manju is an ASHA – a frontline health worker working in Bihar. She goes door-to-door, walking miles each day, to provide counseling and basic health services to people in rural communities who would otherwise have no access to care.
CARE is working as an integrated unit within the Government of Bihar to strengthen community- and state-level systems to accelerate progress toward maternal and child health goals and to promote sustainability. CARE has successfully tested and scaled health innovations across the entire state.
