The eastern state in Hindi-heartland continues to outperform peers in one of the most effective indicators of the overall health system’s performance.
Bihar is probably one of the most underestimated and often derided state in India. looking deeper into the number of bad and bizarre news emerging from the state so frequently, the derision may not be always baseless. Generally, any bad news from other parts of the country entices a deeper analysis of the issue but not in the case of Bihar, which is almost always a target of speculative generalizability. Most widely accepted good news from Bihar generally appear when results of competitive exams, especially the tougher ones like; civil services, IIT-ZEE and medical entrance exams declared. This is probably the most widely accepted good news about the state.
The health care system in Bihar is very complex and challenging. According to the latest round of National Family Health Survey (NFHS), the indicators of health status, access and quality of care in the state is probably one among the worst performing state. Women health-related indicators such as; maternal undernutrition, anaemia and full ante-natal care coverage are also very worrying in the state. Besides this, the indicators for maternal and child health care services are also better as compared to other better performing states. For these reasons, Bihar is clubbed in the group of states called ‘Empowered Action Group’ (EAG), earlier known as BIMARU states. Other than Bihar, the other states in the group are Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha and Rajasthan.
Considering the abovementioned contextual factors, the report by the Registrar General of India (RGI) on Maternal Mortality Ratio (MMR) published in 2018 offers a reason to rejoice to the state of Bihar. Although miles are yet to go. Since the year 2003, the RGI is bringing out the special bulletin on MMR at a regular interval, mostly every three years. The MMR in Bihar for the period of 2001-03 was 371 per 100,000 live births. In the next round, which was 2004-06, the MMR declined by nearly 16% to end up at 312. During next two rounds of estimation of MMR, which was for the period of 2007-09 and 2010-12, again a decline of around 16% was observed during each round, bringing MMR down to 261 in 2009 and 219 in 2012. In 2012, the MMR in Bihar came down to be the lowest among all EAG states. The next round of SRS report was published just after a year only, so the data during this period was overlapping for two years 2011 and 2012. Due to overlapping two years, the actual reduction in MMR during 2011-13 as compared to the previous period of 2010-12 was low. During this period the MMR reduction rate in all EAG state ranged from 2.4% to 8.5% and decline at the national level was 6.2%. The MMR figure for Bihar also reduced up to 208. According to the latest report, which covers a period of three years from 2014-16, the MMR in Bihar reduced to 165, which is again the lowest among all peer states in the EAG group.
As mentioned earlier too, the health system in the state faces multiple challenges. The infrastructure for health systems, both in public as well private are very limited. The access to comprehensive primary health care, as well as secondary and tertiary care for the rural population, is still a challenge. But despite, all these general limitations, often compounded by the shortage of human resources, the public health system in the state has performed quite well in delivering maternal and child health services. Many initiatives taken by the state health department has paid a great dividend to improve the MCH services in public health care facilities. The quality of care around birth has improved a lot due to several steps are taken to improve childbirth care and new-born services, and also by introducing the on-site competency-based training and mentoring of the nursing cadre. Notable to mention here is the role of nursing cadre working in public health systems, they are really the backbone of maternal health care, and real champions behind this success story. Other evidence supporting this argument in low Infant Mortality Rate (IMR) in the state. The maternal health indicators are often termed as a direct proxy of the overall status of women in society. Many decisive policy actions by the state government in recent years have played important role in improving the overall status of women.
*views are personal.
Swasthya Chaupal 