In the Indian context the milieu of maternal health has always been a great public health concern. A great degree of variation is observed in maternal health indicators in India among different states, rural-urban distribution patterns, rich and poor socio-economic status and level of education and availability of health services. U.P and Bihar are the least performing states in the health front according to NITI Ayog report.
Bihar is home to millions of people living on or below the poverty line – estimates vary depending on the criteria used – however, in rural parts, it can be up to 60%. Maternal and child mortality rates are higher than the national average – equating to approximately 2 mothers out of 1,000 dying in childbirth, and 4 child deaths out of every 100 born.
Scale of Intervention on the ground
The mandate during 2010- 2013 was to engage with Health programs of the GoB to improve the coverage of a range of RMNCHN interventions at a scale of eight districts (~28 m population), using creative yet replicable ways of improving frontline worker performance, appropriate to the challenging context: sharply defined intervention priorities, better tools and job aids, skill-building, improved last-mile supervision.
It became equally clear by 2013 that the responsiveness of the FLWs and nurses to our interventions were not matched by more than a lukewarm response from the program leadership itself. Thus, the scale-up technical assistance plans evolved into a Technical Support Unit, with work under a fresh grant kicking in effectively in mid-2014 and spreading across all 38 districts of Bihar.