Inspiring films tell the story of frontline health workers in Bihar

We’re excited to see new resources from the Bihar team!

A collaborative storytelling project from Bihar

Two  short and powerful films document the  Bihar Technical Support Program,   a  partnership between CARE the Bill & Melinda Gates Foundation, and the Government of Bihar to improve the quality of care and health system in Bihar, India. Through two films you will be inspired by the story of Manju Devi,  a frontline health worker in Bihar, working to save lives by delivering maternal and child health care in her village; and  in  the  second film you will be transported to  Bihar to  learn how CARE and the Government of Bihar are reducing rates of maternal, newborn, and child mortality and malnutrition, and improving reproductive health  services statewide. Watch the films here: bihar.care.org

Innovation  Briefs: Bihar Innovations

New briefs highlight five innovations being taken to scale in Bihar, India and beyond, Including Team-based Goals and Incentives. CARE has developed and implemented a package of evidence-based, quality innovations that seek to address the various issues which impede access to high-quality services in Bihar. The implementation of these innovations have resulted in successful outcomes and improvement in the health system – so significant that the Government of Bihar began to scale several of the innovations to all 38 districts in the state,  and some of the innovations are scaling nationally.  Find all five briefs at bihar.care.org.

Click here to read the Team-Based Goals and Incentives brief

Innovation, Partnership, and Self-Reliance: Health Policy Lessons from India’s Bihar State

We’re excited that our team from Bihar (Cohort 1) will be at the CSIS Global Health Policy Center for a half-day conference examining the lessons learned from the Bihar Technical Support Program and its implications for U.S. foreign policy and assistance programs.

Wednesday, December 19, 2018 9:00 am – 1:30 pm
CSIS Headquarters

Click here to register for the online webcast 

Bihar State is the third largest in India with a population of 110 million, which would make it the 12th largest in the world if it was its own country.  Bihar has some of the highest rates of maternal, neonatal, and infant mortality in India, as well as malnutrition, stunting, and high fertility.  These issues are exacerbated by extreme poverty, early marriage, gender and social inequality, and low literacy rates.  The Bihar Technical Support Program, funded by the Bill & Melinda Gates Foundation and implemented by CARE, was founded to address these challenges with the goal of boosting capacity and self-reliance.  The program covers all 534 blocks in 38 districts of Bihar and involves at least 400 public sector hospitals and 200,000 frontline workers.

The Bihar Technical Support Program offers many lessons learned about innovative program design to meet a variety of critical health challenges in a large population, as well as for purposefully building capacity with the intent to transition support at a designated end date.  With self-reliance and country ownership on the Washington foreign policy community’s minds with USAID Administrator Mark Green’s strategic transitions agenda and proposals for significant reductions in U.S. foreign assistance spending, the Bihar program offers important lessons for broader health and development programs.

The conference runs from 9am – 1:30pm.  Conference Agenda:

Welcome Remarks
Sara M. Allinder
Executive Director and Senior Fellow
CSIS Global Health Policy Center

Introductory Remarks
Sushil Kumar Modi
Deputy Chief Minister, Government of Bihar

Panel I: Overview of the Bihar Technical Support Program and Achievements from the Partnership

Panelists:
Usha Kiran
India Country Lead, State Health and Community Systems
Bill & Melinda Gates Foundation

Mangal Pandey
Health Minister, Government of Bihar

Hemant Shah
Chief of Party
Bihar Technical Support Program

Moderator:
Heather Higginbottom
Chief Operating Officer
CARE

Panel II: The Role of Data and Innovation

Panelists:
Sanjay Kumar
Principal Health Secretary, Government of Bihar

Kenney Ng
Manager, Health Analytics Research Group
IBM

Macon Phillips
Chief Digital Officer
CARE

Moderator:
Sara M. Allinder
Executive Director and Senior Fellow
CSIS Global Health Policy Center

Panel III: Policy Implications of BTSP

Panelists:
Gary Darmstadt
Associate Dean for Maternal and Child Health
Stanford University School of Medicine

Kerry Pelzman
Deputy Assistant Administrator, Bureau for Global Health
USAID

Moderator:
J. Stephen Morrison
Senior Vice President and Director
CSIS Global Health Policy Center

This event is made possible through generous support from CARE.

Innovation + Systems Strengthening in Bihar

Our Team-Based Goals and Incentives team from our Cohort 1 alums are part of a broader team dedicated to scaling innovation with the government of Bihar, India. In his annual letter, the Gates Foundation Director of the India Country Office highlight’s CARE’s work in Bihar, addressing the real-world challenges of making innovation effective in the midst of fragile and broken systems.  Way to go team!

The public health system in Bihar consists of hundreds of thousands of health workers, from doctors and auxiliary nurse midwives in primary health facilities to ASHA and Anganwadi workers who provide basic advice and care to women in communities. We began by helping the government test new techniques and technologies to improve the quality of these providers’ services in eight pilot districts. For example, to help frontline workers advise women about healthy practices like breastfeeding, we developed next-generation teaching aids based on digital technology. In facilities, we established a nurse-mentoring program that has, among other successes, doubled the number of nurses who wash their hands and wear gloves before and during procedures.

Though these interventions have led to successful outcomes, a careful review of the data revealed that by themselves they were unlikely to have enough impact on maternal, newborn, and child survival, which was the ultimate goal of the work. Therefore, the Government of Bihar, our foundation, and our grantee CARE India agreed to expand these investments in innovative methods and tools that solve specific problems to more districts and to augment them with investments in basic best practices that strengthen the underlying health system in general.

The partners are now working to bolster everything about Bihar’s health system, from budgeting and procurement to management practices and data collection. This two-pronged approach that layers technical solutions on top of a stronger health delivery platform promises to help Bihar meet its goals while generating lessons that will benefit other partners, especially other state governments interested in investing in the health and the human capital potential of their people.”

Read the full letter here

Dr. Hemant Shah Profiled as a Global Leader in Maternal and Newborn Health

Dr. Hemant Shah, a member of the Team Based Goals and Incentives Scale X Design Accelerator team, was recently profiled as a global leader in maternal and newborn health on the Maternal Health Task Force blog. He has extensive experience with reproductive, maternal, newborn, child and adolescent health in the Bihar state in India. He has served as a maternal health expert in the Integrated Family Health Initiative project and has successfully led quality improvement activities in health facilities in Bihar state.

With funding from the Bill & Melinda Gates Foundation, Dr. Shah is providing technical support to the government of Bihar, one of India’s poorest states, affected with high maternal and infant mortality rates. Despite the difficult challenges within the context of the Bihar state, Dr. Shah and team are focused on three categories: improving quality of care in the facilities; building the capacity of frontline workers to improve services at community level; and working on health system issues like supply chain management, human resources, and more.

Dr. Shah can attribute his success to several factors. First, his technical knowledge but also being able to bring stakeholders together and taking responsibility for failure instead of blaming team members. When a leader himself or herself takes responsibility it builds the confidence of the team that their leader is also ready to try his or her best.

Thanks to Dr. Shah and team for not only the knowledge and skills improvement they have achieved, but also for inspiring behavior and cultural change.

“From the SDG point of view, one of the qualities required in a leader is perseverance, because achieving the goals is not going to happen in the next one or two years. If you consistently pursue the things with your all, honest efforts, sooner or later, you will get the results.” -Dr. Hemant Shah

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Meet the Teams: Team Based Goals and Incentives (TBGI)

Bihar is one of India’s largest states, home to almost 100 million people. It is also one of its poorest states, affected with high maternal and infant mortality rates, malnutrition, anemia, poor family planning services and a plethora of diseases claiming lives. The lack of motivation in Community Health Workers (CHWs) is a critical barrier in the delivery of relevant health services and messages to clients. This lack of motivation is compounded by the fact that a CHW has to solely survive on incentives for services provided, or is paid a nominal honorarium. Amplifying the problem is the absence of functional integration of health programs. In Bihar, there are three cadres of CHWs – Auxiliary Nurse & Midwifes,  Accredited Social Health Activists from Department of Health, and Anganwadi Workers from Department of Integrated Child Health Services under the Social Welfare ministry – who are supposed to be serving the same clients. Yet these three groups function disparately and do not coordinate or collaborate with each other since they belong to different departments.

Drawing from the business world, CARE developed an innovation that aimed to strengthen the teamwork and motivation of the CHWs, called Team-Based Goals and Incentives (TBGI). It integrated both the motivational power of incentives and the virtues of teamwork. We facilitated the formation of a ‘team’ that brings all three cadres of CHWs together on a single platform. We let the team mutually decide and set goals for the provision of services in their catchment area with specific numeric targets on predetermined health indicators for each quarter. The team then worked together to meet the targets. All operational challenges were alleviated through mutual support and leveraging of individual competencies.

TBGI was piloted in 76 Health Sub Centers (38 treatment + 38 control) in the Begusarai district of Bihar. An independent randomized controlled trial showed encouraging results after just one year of implementation in exclusive breastfeeding (71 percent in treatment area versus 61 percent in control) and use of modern contraceptives (26 percent in treatment area versus 15 percent in control), among other areas.

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Meet the Team

HEMANTKUMAR G. SHAH | Chief of Party, Bihar Technical Support Project | CARE India

Dr. Hemant Shah was the Director of the State RMNCH+A Unit, Bihar, prior to being promoted to the COP position. He has successfully established the biggest State RMNCH+A Unit in India and has helped the Government of Bihar develop various policies/ revise existing policies on public health for the state, rationalize deployment of specialist doctors, assisted the government in gap analysis of procurement systems, helped prepare specifications for equipment and provided guidance in the preparation of state PIPs etc. Being the main interface with the government, Dr. Shah’s role is critical in establishing buy-ins, planning and implementing the scale-up.

AMITAVA BANERJEE| Communications Specialist | CARE India

Amitava Banerjee heads all communications for the program and is an expert on IEC/BCC strategies and advocacy communications. He is responsible for positioning, branding and dissemination of all program initiatives to different national and global stakeholders, and the media by translating complex implementation and impact data into comprehensible creative outputs for diverse audiences. Amitava joined the social sector after spending close to 17 years heading marketing and communications for multi-million dollar businesses in the Indian sub-continental and APMEA markets. He has been supporting advocacy efforts for scale up of TBGI since last 1 year through the strategic use of the media. His communication skills will prove invaluable when advocating the need of addressing the “motivation” barrier and the potential of TBGI to impact lives and transform the health landscape.

SUNIL MOHANTY | Program Manager, Gaya | CARE India

Sunil Mohanty has more than 14 years of experience in managing large scale health programs and implementing them at scale through the government. Sunil has been associated with Team Based Goals and Incentive Pilot Program (TBGI) right since conceptualization and design of the innovation. He was involved in preparing the concept notes, tools and sharing of the concept with government counterparts and securing the necessary approvals. Also, Sunil was the Manager of the pilot district of Begusarai and led project implementation and assisted the CML team in conducting the baselines assessments for Begusarai.

MOHAMMED AFTAB ALAM | Program Manager, Saharsa | CARE India

Aftab has been working in the project since inception and has more than 7 years of experience working with the government health system. He is skilled at mentoring and managing teams, collaborating with the government, implementation on ground and anticipating barriers to implementation. He brings in the experience of implementing the pilot for the first year and having supported the formative phase with development of indicators, identifying factors driving motivation of FLWs, designing and testing of tools, budgeting costs and identifying possible barriers to implementation and finding ways around them. During implementation, Aftab had built the capacity of other team members involved in the pilot.

AMARJEET PRABHAKAR | District Manager, Begusarai | CARE India

Amarjeet Prabhakar has more than 12 years of experience in managing health and ICDS programs. His skills lie around mentoring and managing teams, collaborating with government counterparts and program implementation. Amarjeet has been working with this innovation since last two years in Begusarai. He is responsible for inclusion of TBGI in the government PIP. He has been involved in many research and evaluations for the innovation including supporting the end line assessment by Mathematica.