Health Sector in Bihar | BPSC Preparation: All subjects - BPSC (Bihar) PDF Download

HealthCare Sector

• Based on the indicators primarily related to primary health care infrastructure and reproductive and child health care, the State ranks 35th in the country. On a similar basis, the districts in Bihar have also been ranked. Amongst the districts that are lagging behind in the State are-Sheohar, Samastipur, Kishangaj, Jahanabad, Nalanda, Khagaria, Araria, Sitamarhi, and Pashchim Champaran.
• The Maternal Mortality Ratio (MMR) in Bihar has shown significant improvement over recent years. According to the Sample Registration System (SRS) 2018-20 report, Bihar's MMR was 118 per 100,000 live births, a decrease from 130 in the 2017-19 period. This places Bihar sixth among Indian states with the highest MMR, following Assam (195), Madhya Pradesh (173), Uttar Pradesh (167), Chhattisgarh (137), and Odisha (119).   While this reflects progress, Bihar's MMR remains above the national average of 97 per 100,000 live births.
•  The high level of MMR can be attributed to low level of institutional / supervised deliveries, high level of anaemia among women, and low level of full ante-natal coverage etc.
•  Bihar's infant mortality rate (IMR) is close to the national average, though slightly higher, with recent estimates showing Bihar's IMR lower than 61 per 1,000 live births while the national average is closer to 28-30 per 1,000. The state's total fertility rate (TFR) remains one of the highest in India, around 3.0, compared to the national average of 2.0-2.2.  Although Bihar's mean age of marriage for women has risen to about 18.9 years, which is near the legal age of 18, it is still below the legal marriage age for men (21).  Additionally, Bihar’s birth rate is around 26-28 per 1,000 population, and its death rate is 6-8 per 1,000, both of which exceed the national averages of around 20-22 and 6-7, respectively. 
• The coverage under routine immunization and pulse polio is also very low compared to the national figure. As per the 2001 census, full immunization in the State was only 11% against the national average of 54%. As a result, a large number of cases of vaccine-preventable diseases are still reported in the State. Undernutrition among children and women is also much higher than the national level with 54.4% of children being underweight and 81% anaemic. The percentage of women with chronic energy deficiency (39.3%) is also higher than the national figure of 35.8%.
• However, the recent National Family Health Survey (NFHS-3, 2005-06) indicates some improvement since NFHS-2(1998-99). It has shown an increase in immunization coverage from 12% to 33%; contraceptive use from 24% to 34%; institutional deliveries from 15% to 22%; and the proportion of women who have heard of AIDS from 11% to 35%. But the figures are still far off from the national averages. Malnutrition continues to be very high. In fact, malnutrition among children has increased from 54% to 58%. Number of children showing wasting (weight for age) has gone up by 8%. Anaemia has gone up from 81% to 88% amongst children of 6-35 months and from 46% to 60% amongst pregnant women.
• The State has the largest number of Kala-azar cases. The prevalence of other vector-borne diseases like malaria, filariasis and communicable diseases like tuberculosis is quite high. The occurrence of waterborne diseases is also high. In 2006-07, the second highest number of polio cases in the country was from Bihar.
• Available data on rural primary health care infrastructure indicate that, in Bihar, there are substantial gaps in sub-centres, primary health centres and, community health centres, and also in essential requirements in terms of manpower, equipment, drugs and consumables in primary health care institutions. The State has a shortage of 1210 sub-centres, 13 primary health centres, and 389 community health centres. As per the 11^th Plan approach paper of the Government of Bihar, there is only one sub-centre for the 10,000 population. However, according to the national norms, there should be at least one sub-centre for 5000 population. Moreover, Bihar has one Primary Health Centre for one lakh population where ideally there should be one PHC for every 30,000 population.
• Shortage of human resources in the health sector is another major problem with 5648 female health workers and 9786 male health workers being deficient. There is also a lack of specialists at the Community Health Centres.
• NSSO-60^th Round reflected a drastic decline in the share of public health facilities in the treatment of non-hospitalized ailments in both rural and urban areas. In rural areas, the share declined from 13%  to 5%. In urban areas, it declined from 33% to 11% during the corresponding period. The survey also showed that the number of hospitalized cases treated (per 1000) in public hospitals in rural areas is only 144 as compared to the all-India average of 417. In urban areas, the figure is 215 as compared to the all-India average of 382.
• At the end of one year of implementation of the NRHM, based on a survey conducted in 17 districts of the State, the Centre for Health and Social Justice reported that half the Anganwadi Workers (AWW) had not heard about the NRHM. Most of the Auxiliary Nurse Midwives (ANMs) and AWWs felt that ASHA was meant to assist them in immunization and listing of pregnant women. A few districts did not even receive the money to disburse as untied funds and District Action Plans had not been prepared. Neither the women got any money under the Janani Evam Bal Suraksha Yojana, nor did the ones who were sterilized know about the family planning insurance schemes. However, now the official figures at the end of the second year of NRHM reflect a better picture.
• The State has 11 Ayurvedic, 5 Unani and, 11 Homoeopathic hospitals. It also has 311 Ayurvedic, 143 Unani and, 179 homoeopathic dispensaries (Department. of AYUSH, Ministry of Health & Family Welfare). By placing AYUSH practitioners in the PHCs alongside the MBBS doctors, it will be possible to mainstream this system into the general health care system and also enable the patients to avail the care in the system or their choice. Training and reorientation of AYUSH practitioners in Family Welfare and National Disease Control Programmes will help in improving the coverage under these programmes.

The important issues concerning Health in Bihar are

• Substantial gaps in sub-centres, primary health centres, and a very large gap in community health centres.
• Substantial gaps in essential requirements in terms of manpower, equipment, drugs and consumables in primary health care institutions.
• Skewed sex ratio (919).
• Very low Couple protection rate (34%).
• Very high fertility rate (4.2).
• A very high percentage of girls marrying below 18 years of age (51.5%).
• Very low coverage of Full Immunization (33%).
• Very low Awareness of HIV/AIDS (25.6%).
• Low level of institutional delivery (23.2%) and high level of maternal deaths (3.71 per 1000).
• High level of malnutrition among children of age 0-6 years (55.9% children are moderately and 24.5% are severely malnourished).
• Very high levels of anaemia among children (81%), adolescent girls (40.9%) and pregnant women (63.4%).
• Very low coverage for Vitamin A (10%) and salt Iodisation 25.2% (15 ppm & above).