This post is part of our series, Global Conversations on Newborn Health in India. Join the conversation on Impatient Optimists and Healthy Newborn Network as we explore the pressing need – and what our partners are doing to address the need – to save the lives of newborns in India.
Mamda Devi, with her newborn child, Sandeep, shows her and her children’s health cards outside of her home in Patna District, in Bihar. Photo: the Bill & Melinda Gates Foundation.
For decades, Bihar has been known as one of India’s poorest and most backward states. It has struggled with low literacy rates, high crime, terrible infrastructure, and far worse health outcomes than sub-Saharan Africa.
About six years ago, things began to change when a new, reforming government was elected.
Led by the dynamic Chief Minister Nitish Kumar, this administration set to turn Bihar around by committing to improve roads, fight crime and — especially — provide better health services for those who need it most.
Within a few years, routine immunization rates doubled. This helped inspire donors, including the Bill & Melinda Gates Foundation, who in 2010 joined the Government of Bihar in a five-year partnership aimed at reducing maternal, newborn, and child mortality by 40 percent by 2015.
Addressing critical gaps in care during the most vulnerable time of life, the partnership focuses on a thousand-day window of opportunity: from conception, through pregnancy, to the birth of a newborn baby, and to the child’s second birthday.
The emphasis is on family planning, pre and post-delivery care for mothers and their newly born infants, immediate and exclusive breastfeeding, care and nutrition for children up to 2-years old, and routine immunization. Coverage for treatment of diarrhea and pneumonia as well as some neglected diseases and sanitation, is also a part of the plan.
To deliver this package of services and life-saving changes to tens of millions of Biharis, the Government of Bihar along with the Bill & Melinda Gates Foundation reached out to an experienced and capable group of organizations to join as implementing partners. We gave our alliance a name symbolizing uniqueness and boundlessness: “Ananya”.
Improving delivery of government-provided health services is a first challenge to address. In partnership with CARE, the Ananya program will focus on village health workers such as nurse-midwives, child care workers and trained village level health activists (ASHAs), as well as health care service providers at various facility levels. This will happen in eight districts at first, and then expand to the entire state.
Despite having a right to publically funded health care, Biharis mostly seek treatment in the private sector, often from untrained practitioners in makeshift village clinics. An important part of the Ananya partnership, World Health Partners (WHP) is focusing on improving private delivery of quality care at all levels.
Using innovative approaches, WHP will train, improve and encourage private providers to offer safe, sound services, and to focus on four deadly diseases – tuberculosis, diarrhea, pneumonia and visceral leishmaniasis. WHP’s effort will cover 70 percent of Bihar’s population.
Looking at the supply side of delivering care presents great opportunities for improved survival; however it is not the full picture. Patients have a crucial role in their own, and their children’s, health care.
For a variety of reasons including illiteracy, traditional social barriers, or traumatic past experiences, many Biharis don’t go to doctors or hospitals even if seriously ill. To help shape demand for quality health services and improve key household level practices, our partnership with BBC World Service Trust will focus on using mass media, radio, television, newspapers and cell phones, as well as uniquely tailored outreach platforms.
This includes involving the entire community in the health of mothers and newborns, aiming to not only improve survival outcomes, but also to enhance accountability and equity of services across Bihar.
India is at a crucial moment. These partners are already on the ground in Bihar, setting up their networks and forging crucial relationships. They have the crucial support of the Government of Bihar and its committed officials and leaders. Bihari families have a right to high quality health care. Ananya will ensure that they get it.