Improving the Reproductive, Maternal, Newborn-Child and Adolescent Health among marginalised communities

Maternal and neonatal mortality ratios are indicators of a state’s health status. In Bihar, these numbers were a challenge since the maternal and neonatal complication identification and management rates were poor. Often, complications like obstructed labour, prolonged labour with fetal distress failed to get timely and emergency cesarean sections. Records of patients with complications were not adequately recorded and the practice of post-facto and retrospective documentation of patient records prevailed.

Our approach has been to use systems-thinking and evidence to strengthen the health systems and influence the microsystems at facility and outreach levels. Dedicated verticals/technical teams were formed to advocate and facilitate the usher of reformative and renovative transformation in the existing way of work.

Our Activities

  • High level advocacy with the government was done to come up with policy reforms in drug regulatory mechanisms, and supply chain systems strengthening.
  • Worked towards improving the quality of clinical processes and reporting of reliable data, form Quality Improvement (QI) teams and facilitate data-driven discussions.
  • Helped identify and manage maternal and neonatal complications in district hospitals which led to an overall reduction in maternal and neonatal mortality.
  • CARE supported the government of Bihar in making advances in addressing the health system gaps and strengthening it at many levels to influence the outcomes at maternal and child health levels.
  • A finance team was provided to support the bottom-up finance planning, drive uniform accounting practices, and increase the capacity of accounts personnel in the state through skill-based training, to counter issues like high and unorganised patient flow, inadequate human resources, stock out of drugs and supplies, unavailability of blood, etc.
  • It has also helped establish monthly review and monitoring of program financials, and ASHA payments, targeted expenditure trend, quarter by quarter, to augment the pattern and quality of fund utilisation.

Our Approach

  • District Mentoring Team
  • Weak Newborn Tracking
  • Audit of Maternal & Child Deaths
  • Adolescent Health


  • Decreasing trend of Maternal Mortality Ratio from 165 in 2014 to 149 in 2018 (SRS)
  • Institutional delivery at 86% in the community
  • Increasing trends of referral services in terms of availability of Ambulance services from 12% to 24% (2014-2020)
  • Decreasing trends of home delivery from 28% to 20% (2014-2020)
  • Increasing trends of Antenatal Care (ANC) registration in first trimester from 39% to 42% (2014-2020)
  • Increasing trends of 4 ANC services from 8% to 29% (2014-2020)

Connect with Us

Corporate and Registered Office

Module No. 411, 4th Floor, NSIC-MDBP Building
Okhla Industrial Estate, New Delhi – 110020 (INDIA)