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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.

Photo credit: Richard Bright


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.


A powerful partnership

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

Bihar Technical Support 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.

Bringing health services to “the last mile”

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.


Meet Manju

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.

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.

Since the program began, more than 16,700 weak newborns have been saved and more than 85,000 accredited social health activists have been trained.
"In the old times there was nothing like this," says Manju Devi, a frontline health care worker working in Bihar.

Highlighted Resources

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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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.

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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.

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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.

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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.

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A Model for Mentorship – Bihar Innovation Brief #4

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

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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.

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Technology for Transformation – Bihar Innovation Brief #6

Using digital job aids to transform health systems and improve the lives and work of frontline health workers in India.

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Transforming A Healthcare System Through Integrated Support — Bihar Innovation Brief #7

Catalyzing multi-level change in the Bihar, India healthcare system through the Technical Support Unit Model.

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Driving Data-based Decisions Through User-Friendly ICT Platforms — Bihar Innovation Brief #8

Innovating and leveraging digital tools and platforms to make data-driven decisions to achieve Bihar’s health goals.

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Weak Newborn Tracking Program Brief

A program brief on the weak newborn tracking model implemented and evaluated in the Bihar Technical Support Program.

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