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Women Lead: Ten Years of Health System Change in Bihar, India

Through a powerful 10-year partnership in Bihar, India, positive maternal and child health outcomes were achieved via working with frontline health workers, especially women. See the impact a decade partnership can lead to in this flagship report.

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What a Difference a Decade Makes

More than 10 years ago, CARE formed a groundbreaking partnership with the government of one of India’s most resource-challenged states to help turn around its public health system. Bihar, with a socioeconomic profile not unlike those of the poorest African nations, lags in most development and health indicators, including those pertaining to maternal, neonatal and child health. To address these critical issues, the Bill & Melinda Gates Foundation (BMGF) supported CARE in forging a collaboration, under state leadership and eventually encompassing more than 100 partners, bringing a wide array of skills and ideas.

Today the state has achieved historic milestones – transforming health systems and outcomes, reducing maternal and child mortality to the lowest among India’s large northern states, and registering the country’s steepest declines in childhood stunting and fertility rates. Visceral leishmaniasis stands almost eliminated as a public health problem, and efforts toward elimination of tuberculosis and lymphatic filariasis have gained momentum. The state was one of the least damaged by the COVID-19 pandemic, with among the highest vaccine coverage. All these achievements were accompanied by economic growth, improved infrastructure and communications, and rising levels of women’s education and empowerment – reflecting the CARE-Bihar partnership’s central strategy of working with women for the benefit of women and children.

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