Significant reductions in both maternal and infant mortality rates – While figures vary among the districts covered through this Initiative, both MMR and IMR were reduced. The results were achieved through increases in antenatal and postnatal care, immunisations, training of rural health providers, and increases in institutional deliveries. These improvements are in contrast to state-wide statistics, which remain static or are only marginally improved.
Increased immunisation rates – Education on child vaccinations and child health had a large impact on immunisation coverage, reduced IMR, and improved overall health of children under the age of five.
Advocacy efforts improving health infrastructure – Grassroots, district and state level advocacy efforts are bearing fruit as health infrastructure is improving in the project areas of the implementers. Communities have begun to demand government health services that were not previously being provided.
Improved perception of women’s value – During the three years of the Initiative, we have seen the development of many rural Indian women from hesitant and shy to confident and determined to move to the next level in terms of health, social and economic status.
Health personnel shortage – There has been a shortage of skilled frontline health personnel (auxiliary nurse midwives, rural health care providers) to provide timely and quality antenatal and postnatal care services and to assist in home-based deliveries.
Inadequate public health facilities and medicines – The public health facilities providing obstetric and gynecological care at district and sub-district levels are inadequate. Likewise, vaccines and medicines remain in short supply.
Cultural barriers – Deeply rooted divides in terms of caste, religion, gender and economic status still exist in the rural areas. Transformation of the mindset and behaviour of the rural population influenced by long-held superstitions and traditions is very difficult, but not impossible.
Quality partner CBOs and CBO staff retention – A lack of law and order and an abundance of environmental disasters and economic hardship make rural Bihar an undesirable place to work. Identifying quality CBO partners in some areas is a challenge. For CBOs, identifying and retaining quality staff is a challenge.
Government corruption – Corruption at all levels of government remains a significant barrier to effecting lasting change.