Chief Development Partner for improving the quality of care in Bihar

In 2014, CARE India established the Bihar Technical Support Unit, scaling up its IFHI interventions across all 38 districts, along with Ananya partnership, an initiative of Gates Foundation. CARE India is the chief development partner for improving the quality of care provided at Bihar’s defunct healthcare facilities and creating demand and improving the health-seeking behaviours of its population who had distanced from the system. CARE India started its Integrated Family health initiative (IFHI) pilot in 137 blocks of eight districts in 2011. The program implemented many core interventions and innovations across the care continuum, covering maternal and neonatal health, family planning, nutrition, and immunisation.

Our Activities

  • During this period mobile mentoring teams of nurses and doctors (MNMT, MDMT) provided the much-needed clinical training through skill labs that CARE had helped set up at the facilities for the frontline healthcare staff. Facilitators helped strengthen the health sub-centre review platform where all the outreach frontline staff converged.
  • Through its innovative incremental learning approach, the frontline staff was imparted basic knowledge on understanding health issues and planning services to address those. Focus on conducting Village Health sanitation and nutrition day (VHSND) to address the last-mile delivery of services was also done.
  • An enabling environment was required to be created that would allow for collaboration, trust, and contextual problem solving with the stakeholders.
  • A systemic approach to solving problems was required, wherein collaboration with technical partners to get to the roots will be necessary.
  • Interventions should be designed on global evidence-based best practices, as pilots with contextualised learnings.
  • A flexible and adaptable platform design would be required upon which interventions and innovations can be built.
  • It is necessary to intervene at the neglected and mismanaged frontline with a focus on the most vulnerable, which will help enhance the trust of the communities that will not only boost coverage and delivery but also pay dividends in larger system improvement efforts in the future.
  • The system shows scope for embedding technology at various levels, but this needs a careful design to ensure scalability and enhanced user experience.
  • Developing the system’s HR capabilities was found to be key to sustainable practices.

Impact

  • The results of the three-year pilot were promising with demonstrated improvement in-home visits by Front line workers from 6 percent to 29 percent.
  • Mothers receiving advice on weak new-born increased from 37 percent to 82 percent.
  • Early initiation of breastfeeding improved from 39 to 59 percent.
  • Complimentary feeding improving from 30 to 77 percent.
  • The use of oxytocin for active management of the third stage of labour increasing from 9 percent to 78 percent, and family planning counselling improving from 10 percent to 29 percent.

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