Speaker A
When you come and work in Bihar, you realize that it's quite different here.
CARE and the Gates Foundation support Bihar's public health system, improving maternal and child health through quality care and community outreach.
Key Takeaways
- Improving quality of care and community outreach are key to enhancing public health in rural Bihar.
- Frontline health workers are essential in bridging the gap between communities and health services.
- Sustained institutional memory and government collaboration are vital for long-term health system improvements.
- Data-driven approaches and scalable solutions lead to measurable improvements in maternal and child health.
- Large-scale change in public health is achievable even in resource-constrained settings through coordinated efforts.
Summary
- Bihar is the third largest Indian state with over 110 million people, 89% of whom live in rural areas, impacting healthcare delivery.
- CARE focuses on improving facility-level quality of care, especially intrapartum care, to build trust in the public health system.
- Frontline workers like ASHA and Anganwadi workers play a crucial role in community outreach and service delivery.
- CARE supports the state government in strengthening health systems, with primary health centers acting as hubs for care and outreach.
- Significant improvements have been made: public health facility visits increased from 39 to 10,000 per month.
- Immunization rates for 1-year-olds rose from 12% to 84%, maternal mortality decreased from 312 to 208, and infant mortality dropped from 61 to 38.
- The program emphasizes collaborative problem analysis, solution development, and scalable implementation.
- Building institutional memory is critical to sustaining healthcare improvements despite personnel changes.
- The experience in Bihar demonstrates that large-scale government programs can achieve substantial health outcomes under challenging conditions.
- The initiative aligns with the vision of a healthier and more prosperous Bihar, contributing to a healthier India.
Full Transcript — Download SRT & Markdown
Speaker A
It's the third largest state in India.
Speaker A
More than 110 million people.
Speaker A
But about 89% of Bihar is rural and that is a very important factor for the implications on healthcare.
Speaker B
Health is a very complex sector in India.
Speaker B
To a very large extent, your cultural practices leads to health outcomes.
Speaker A
It became very obvious we had to do something to improve the quality of care in Bihar.
Speaker B
The challenge before us was to augment the trust in the public health system.
Speaker A
We think of the priorities of the program as three components.
Speaker A
One is the facility-level quality of care, particularly intrapartum care.
Speaker C
Hum jo labor room mein delivery karwane mein duty karte hain, kaam karte hain.
Speaker C
Season mein toh 300-350 pahunch jaati hai.
Speaker D
aapki hai na? Aapke yahan chicken pox hai.
Speaker D
Gaye the na? Pura likh ke layenge detail.
Speaker D
Copy mein nahi banana hai.
Speaker E
Aa gaya, aa gaya, aa gaya, aa gaya.
Speaker E
Aa gaya, aa gaya.
Speaker E
Aa gaya.
Speaker E
Pado niche aaiye, pado niche aaiye.
Speaker C
Amanat training ke baad jankari jo hume mila, uske anusaar se bacche ko kisi tarah se problem hota hai, punarjeevan karna padta hai.
Speaker A
Another component is the frontline workers and outreach.
Speaker F
Idhar nikal rahe hain.
Speaker F
Jaldi jaldi.
Speaker F
The ASHA (Accredited Social Health Activist) is the representative of her community and helps the community get services from the health system.
Speaker A
The Anganwadi worker runs an Anganwadi Center, which is where children come down for pre-school education as well as meals.
Speaker A
They can practically do away with paperwork.
Speaker F
Bache se.
Speaker A
And in order to support these two arms, CARE has helped the state government improve the set of health systems.
Speaker A
The primary health center becomes the hub of both facility level care as well as outreach.
Speaker G
Hum awareness phaila rahe hain, health education ka kaam hum pura kar rahe hain, ki taaki public ko jankari ho ki sarkar unko kya de rahi hai.
Speaker A
These arms of work together constitutes the work of CARE in supporting the Government of Bihar.
Speaker H
I am Mangal Pandey, Minister of Department of Health, Government of Bihar.
Speaker H
Hum swasth Bihar se samriddh Bihar ki aur badh rahe hain.
Speaker B
In 2005, 39 people were going to a public health facility in a month. Just a little over one per day.
Speaker B
Today that figure is about 10,000 people.
Speaker B
1-year-olds with completed immunization used to be 12%. Now it's about 84%.
Speaker B
Our maternal mortality rate was 312 at that time. It's down to 208.
Speaker B
The infant mortality rate used to be 61. It's 38 now.
Speaker B
I think the challenge is, how do you come together and work at the edges of government departments.
Speaker B
It's more than simply saying we have a few technological solutions, some magic bullets.
Speaker B
The model is more about, can we together learn to analyze our health situation, define our problems better, find new solutions, apply them at scale and get results.
Speaker H
Ki jaise swasth Bihar samriddh Bihar banayega.
Speaker H
Usi prakar se swasth Bharat hi samriddh Bharat bana sakta hai.
Speaker B
To be able to build systems, so even if people come in and go out, the institutional memory remains.
Speaker B
That is extremely important.
Speaker A
The experience in Bihar has taught us that, under difficult circumstances, it is possible for government programs to bring about substantial change at very large scale.
Topics:Bihar healthcareCARE IndiaGates Foundationpublic health systemmaternal healthchild immunizationASHA workersAnganwadi centershealthcare qualityrural health India
