Bihar Technical Support Program - CARE
FIGHT COVID-19: Families already in crisis are now threatened by COVID-19. Donate now to provide hand washing stations and hygiene kits to help save lives >>

Bihar Technical Support Program

The Bihar Technical Support Program supports the Health and Social Welfare Departments of the Government of Bihar, India, to reduce rates of maternal, newborn, and child mortality and malnutrition, and to improve immunization rates and the quality of reproductive health services (including family planning).


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, gender and social inequality, low literacy rates, and early marriage further compound Bihar’s poor health outcomes.


CARE is supporting the Government of Bihar to strengthen and improve population health and nutrition outcomes. The Bihar Technical Support 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.

Program achievements

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:


165 per 100,000 maternal mortality ratio compared to 312 per 100,000 in 2005.

38 per 1,000 infant mortality rate compared to 61 per 1,000 in 2005.

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.

The importance of the Bihar Technical Support Program

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.


Bihar Technical Support Program Learning Brief

A program brief on the Bihar Technical Support Program, which CARE began in Bihar, India, in 2011 with funding from the Bill & Melinda Gates Foundation.

Read More

Building Skills, Saving Lives – Bihar Innovation Brief #1

Innovation brief covering the incremental learning approach, in which CARE partnered with the Government of Bihar to plan and facilitate training sessions for frontline health workers at health subcenters.

Read More

Working Better Together – Bihar Innovation Brief #2

Using team-based goals and incentives to leverage the power of incentives, teamwork, and goal-setting to improve the motivation and job performance of frontline health workers.

Read More

Making Magic in Health Facilities – Bihar Innovation Brief #3

This approach tackles several elements of high quality care by upgrading infrastructure and equipment, improving staff morale, sharpening clinical skills, and updating a range of standards at primary health centers.

Read More

A Model for Mentorship – Bihar Innovation Brief #4

Using mobile nurse mentoring teams to unlock the potential of nursing staff in public facilities.

Read More

The Littlest Lives – Bihar Innovation Brief #5

Innovating to identify, track, and care for very low birth weight newborns to ensure newborns survive and thrive.

Read More