CARE's work in Bihar began in eight high-risk districts, focusing on the facility level, particularly quality of care, and the community level, through frontline health workers and outreach. As a result of successful implementation of key interventions at these levels and much learning, CARE began providing state-wide technical support to the government in 2013 to scale up outreach and facility-centered interventions to all 38 districts in the state.

Through this partnership, CARE has contributed to significant improvements in the health system. For example, in 2005, public health facilities had a client load of 39 people per facility per month. In 2018, that figure is about 10,000 people per facility per month. 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.