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Strengthening health, nutrition, water and sanitation services, Bihar


Bihar is the third largest state in India with a population of more than 100 million. Key health indicators are worse than the national average with high maternal and child mortality, and low levels of institutional delivery and antenatal care. More than one-third of all children under five years old are reported to be underweight. The Bihar government is working to increase the availability of high quality essential services such as health, nutrition, water and sanitation. The aim is to improve the ability of the poorest people, those living in rural areas, and women and children to access the services they need.

We supported the government to strengthen health services in Bihar as part of a sector-wide approach. The UKAid-funded Bihar Technical Assistance Support Team provided timely and focused technical expertise in strategic planning, and design of health, nutrition, water, sanitation and hygiene services. We ensured that services reached excluded or marginalised groups, and monitored progress towards better health services.

We supported in:

  • Increasing the scale and quality of nutrition, health and water and sanitation services.
  • Strengthening systems for improving efficiency and effectiveness.
  • Enhancing joint working between the government and non-government health care providers.
  • Improving quality and use of monitoring and evaluation systems.
  • Working with communities to ensure that people are aware of services, and able to access them when they need them.
Project achievements:
  • We supported the development of a comprehensive health sector strategy, a quality improvement strategy for public health facilities, and a nutrition policy and implementation plan. We also reviewed the organisational structure for the three departments to ensure that they would have the resources to deliver plans as intended.
  • We supported the development of a human resource for health strategy and strengthened the information system needed to manage the deployment of health staff across the state.
  • We provided technical support to the Family Friendly Hospital Initiative to improve quality of care in 93 health facilities in 25 districts of Bihar. This initiative set the standards for the current National Quality Assurance Scheme now being implemented in 69 facilities across these 25 districts.
  • We supported the Gram Varta Plus initiative to mobilise women’s self-help groups and communities around health issues. We reached around 60,000 groups, enabling women to demand and gain improved access to health, nutrition, water and sanitation services across nine priority districts.
  • Bihar is the first state in India to carry out blanket testing and GIS mapping of the public water supply source across the entire state.

Impressive improvements in women and children’s health have been achieved in Bihar. Between 2010 and 2013, the number of deaths amongst children under five years old fell by nearly 10%. In the last 10 years, the proportion of underweight children (0–5 years) has reduced from 56% to 37%.

Focus areas
Maternal and Newborn Health
Monitoring, Evaluation, Research and Learning Quality Improvement
South Asia and Asia Pacific

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