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We Are

Bringing health services to "the last mile"

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 & 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.

Bringing health services to Women, Young People and Childrens

We Do

  • A group of women gathered to understand the benefits about Maternal Care

    Maternal Care

    Under the Bihar Technical Support Programme (BTSP) implemented by CARE India, we have been providing direct technical assistance to frontline workers, sustainable change is required in improving public health leadership and managerial skills, sharpening focus on outcomes, gaining the ability to use data and be driven by evidence.

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  • A mother vaccinates her child under the Newborn Care program

    Newborn Care

    About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal period—the first 28 days of life—carries the highest risk of mortality per day than any other period during the childhood. The daily risk of mortality in the first 4 weeks of life is ~30-fold higher than the post-neonatal period, that is, from 1 month to 59 months of age.

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  • A mother giving nutrition to her child by a female colleague


    With 1 in every 3 children malnourished in the country, India has the maximum number of malnourished children in the world. The effects of malnourishment is dangerous and irreversible if it occurs at a young age leading to permanent disabilities which will render the child ill for the rest of their lives. The Integrated Child Development Scheme

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  • A husband and wife taking steps of family planning after birth of a child

    Family Planning

    There is an unmet need among married women in Bihar, between the ages of 15 to 24 years, for family planning, especially for spacing births. Our approach in Family Planning initiatives is to ensure that all persons in the reproductive age group has access to a basket of choices regarding spacing and conception to choose from.

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  • A crowd gathered to check-up of Kala Azar Elimination

    Kala Azar Elimination

    CARE India is providing strategic leadership and implementing the scale up of VL control activities across multiple states, backed by a highly-skilled programme support team at the state and divisional levels with experience in finance, human resources, and administration management.

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Over 9 Years
of Commitment

To better lives and transform destinies

Strong, Vibrant

With global and national associates

Trusted Partner
of the Government

Together, driving change by supporting policy

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Key Events

It's more than simply saying that we have a few technological solutions, some magic bullets. 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.

The experience in Bihar has taught us that, under difficult circumstances, it is possible for government programs, to bring about substantial change, at a very large scale.

~ Dr. Sridhar Srikantiah
(Technical Director, BTSP)

- Our Key Innovations -

Key Innovations

Nurse Mentoring Program

Detailed plans were proposed by the TSU to help the GoB build robust internal mechanisms for ongoing mentoring and quality assurance, with a scope that includes intranatal and postnatal care as in the nurse/doctor mentoring interventions so far, but also expands to include other specialized areas such as Institutional care of sick newborns. proposed for the TSU to help the GoB build robust internal mechanisms for ongoing mentoring and quality assurance, with a scope that includes intranatal and postnatal care as in the nurse/doctor mentoring interventions so far, but also expands to include other specialized areas such as SNCU care.

Key Innovations

Incremental Learning Approach

CARE India is supporting GoI to design and implement an innovative capacity building, supervision and system strengthening approach called, Incremental Learning Approach (ILA) as part of the World Bank supported NNM. ILA is aimed to strengthen the knowledge and skills of field functionaries and enhance quality and content of supervision in Health program.

Key Innovations

Quality Improvement at Health Facilities

It focuses on clinical outcomes with oversight mechanisms, robust clinical documentation, ongoing clinical skilling/mentoring and the efficient management of available human resource, infrastructure, supplies. It aims to improve basic infection control and clinical care practices. It also deals with prevention as well as identification, stabilization, referral and management of maternal and neonatal complications, as well as family planning procedures.

Key Innovations

Weak New Born Tracking

A digital scale improves the accuracy of identifying very low birth weight babies. Frontline workers provide immediate and systematic post-natal care and follow up with families to improve neonatal outcomes. Including mechanisms of mentoring, supervising and supporting FLWs to focus on delivering services and support equitably to all families, robust name based tracking systems, logistics for ensuring supplies at the last mile.

Key Innovations

Team-based goals and incentives

Front-line workers (ASHAs, ANMs and AWW for Health) are key for last-mile delivery of Health and Nutrition outcomes in Bihar. It is important to ensure high degree of coordination between FLWs and keep them motivated due to the direct impact they have at a community level. Team-Based Goals and Incentives (TBGI) was introduced to promote culture of collective accountability, problem solving and teamwork. The program aims to make teams of FLWs who work in the same catchment area jointly responsible for delivering results and provide non-monetary incentives to teams of FLWs for reaching pre-defined targets for multiple services.

Our Reach





2.7 M

Pregnant Women




Grade 'A' Nurses


Asha / AWW