Bihar Technical Support Programme
Bihar Technical Support Programme

Bihar Technical Support Programme

Bihar Technical Support Programme

Bihar Technical Support Programme finds roots in CARE India’s Integrated Family Health Initiative (IFHI) project that was first launched in 2011, as part of the Ananya program, with support from the Bill and Melinda Gates Foundation (BMGF) . The goal was to increase the coverage and quality of life-saving interventions and improve the health, survival and nutrition of women, newborns and children during the first 1,000 days – from conception to the child’s second birthday. CARE India interventions focused on better counseling and emergency preparedness for the mother and newborn, building Basic Emergency Obstetric and Newborn Care (BEmONC) capabilities, improved management of neonatal infections, early initiation and exclusive breastfeeding, complimentary feeding, increased immunization, and expanded access to quality family planning services and birth spacing methods. These solutions were implemented universally across 137 blocks of eight focus districts over 3 years, to potentially reach a population of over 25 million.

To tackle the menace of Kala Azar disease, a separate program was launched in 2012 as a special effort to eliminate the disease from Bihar by 2015. The elimination of Kala Azar follows a two-pronged approach – Indoor Residual Spraying (IRS) and Case Identification & Treatment. Intensive support and supervision of IRS, joint monitoring of spraying including case detection and tracking was initially provided in 8 districts and then scaled up to all 33 endemic districts since 2013. The efforts have shown positive results with a steady decline in the no. of reported cases over the years.

Of late, the confluence of five key factors – (1) launch of Manav Vikas Mission under the chairmanship of Chief Minister of Bihar (2) launch of the GoIs RMNCH+A strategy in February 2013 (3) success of the Ananya program in identifying strategies and solutions that support these goals (4) the World Bank assisted ICDS Systems Strengthening and Nutrition Improvement (ISSNIP) initiative with half of Bihar’s districts falling under the project, and (5) the request to the Foundation from GoB for support in the areas of nutrition and family planning, created a pivotal opportunity to accelerate progress toward achieving Government of Bihar’s (GoB) 2017 targets for reductions in rates of mortality, fertility and malnutrition, and increased immunization coverage.

To strengthen this endeavour, CARE India established a Technical Support Unit (TSU) constituted with major development partners – DFID/BTAST, UNICEF, UNFPA, NIPI, WHO/NPSP, Emory, AMDD, Janani, BBC Media Action, EngenderHealth and Abt Associates, to provide catalytic support to the Health & Social Welfare and ICDS Departments of the GoB. The Technical Support Unit aims to overcome system and policy level barriers to bring about the requisite systemic changes, develop government leadership with focus on outcomes, promote the use of data and accountability mechanisms, and build technical and managerial skills at both outreach and facility levels.

The Bihar Technical Support Programme, supported by Bill & Melinda Gates Foundation, provides catalytic support to the Health and Social Welfare Departments of the Government of Bihar in achieving their goals of reducing rates of maternal, newborn and infant mortality, total fertility, anemia and malnutrition, improving family planning services, and increasing immunization coverage in the state.

The programme helps the two departments in transforming capabilities and behaviors, build ownership towards health programmes, and unlock the potential of both public and private sector providers to effectively improve the quality and coverage of maternal and child health, family planning and nutrition interventions.

The scale and scope of this CARE India intervention is enormous- covering all 534 blocks in 38 districts of Bihar and involves at least 400 public sector hospitals and 200,000 frontline workers – to cater consistently and reliably to over 10 million mothers and their babies till 2017.

Health Innovations 

  1. Mobile nurse mentoring
  2. ICT
  3. Team Based Goals and Incentives/ Health Sub-center platform
  4. Tracking of weak newborn babies





Solutions under IFHI were implemented universally across 137 blocks of eight focus districts over 3 years, to potentially reach a population of over 25 million. This effort involved the engagement of 40,000 frontline workers in nearly 2,300 health sub-centers, along with the nursing, administrative and medical staff of about 119 Public, State and District Health Centers. In addition, about 50 private sector providers at district levels were engaged for improved quality of clinical care for deliveries.

The work in these eight districts resulted in significant improvements in the intervention areas.

  • Three home visits by Frontline Workers (FLWs) in the first week after delivery going up from 6 to 29 percent
  • Mothers with preterm/Low Birth Weight babies receiving advice for extra care increased from 37 to 82 percent
  • Early Initiation of Breastfeeding improving from 39 to 59 percent
  • Complementary feeding practices increasing from 30 to 77 percent
  • Oxytocin correctly administered for Active management of Third stage of Labor, rising from 9 to 78 percent
  • Counselling for Family Planning services increased from 10 to 29 percent