In the NITI Aayog Health Index, 2021, Bihar ranked 18th out of 19 large states in India, reflecting a poor health performance when compared to other states. This ranking highlights the serious challenges the state faces in terms of health infrastructure, accessibility, and outcomes. Despite some improvements, Bihar continues to lag behind in several health-related indicators.

Factors Responsible for Bihar’s Poor Health Ranking

Several factors contribute to Bihar’s low ranking in the NITI Aayog Health Index. These include:

1. Weak Healthcare Infrastructure

• Insufficient Medical Facilities: Bihar suffers from a lack of adequate healthcare infrastructure, including hospitals, primary health centers, and skilled healthcare workers. This leads to overcrowded hospitals and inadequate treatment facilities.
• Limited Rural Healthcare Services: A significant portion of Bihar’s population lives in rural areas, where healthcare services are not only sparse but also poorly equipped.

Example: Many areas in Bihar are underserved, leading to long travel times for patients seeking specialized care.

2. High Infant and Maternal Mortality Rates

• Bihar has one of the highest maternal mortality ratios (MMR) and infant mortality rates (IMR) in India. Poor nutrition, lack of prenatal care, and inadequate delivery facilities contribute to these alarming figures.

Fact: According to NITI Aayog’s report, Bihar’s MMR is significantly higher than the national average, which indicates a weak healthcare system for women and children.

3. Malnutrition and Poverty

• High levels of poverty and malnutrition are major contributors to the poor health conditions in Bihar. Malnutrition, especially among children, increases susceptibility to various diseases and stunts physical and cognitive development.
• Poor economic conditions make it difficult for many families to afford adequate healthcare or nutritional food.

Illustration: Bihar has one of the highest rates of underweight children in India, leading to chronic health issues that persist into adulthood.

4. Low Healthcare Spending

• The state’s budget allocation for healthcare is low compared to other states, making it difficult to improve healthcare infrastructure or provide quality care.
• Public health spending remains underfunded, which hampers efforts to build new health facilities or hire sufficient healthcare workers.

5. Lack of Awareness and Education

• A significant portion of the population in Bihar lacks awareness about preventive healthcare, hygiene, and nutrition. This leads to the spread of preventable diseases such as diarrhea, tuberculosis, and vector-borne diseases.

Example: The lack of health education, especially in rural areas, has contributed to the continued spread of diseases like malaria and dengue.

Steps Taken to Improve Health in Bihar

Despite these challenges, the state government, with the support of the central government, has taken several steps to improve the healthcare situation in Bihar.

1. Bihar Health Sector Reforms

• Bihar State Health Society: The state has undertaken various reforms to improve healthcare delivery, focusing on strengthening primary healthcare services, especially in rural areas.
• Free Medicines Scheme: The state has introduced schemes like free medicines and diagnostic services to improve accessibility and affordability of healthcare services.

2. National Health Mission (NHM)

• The National Health Mission, launched by the central government, aims to improve maternal and child health, increase immunization rates, and reduce mortality. Bihar has benefited from the NHM’s outreach programs.

Fact: The state has seen improvements in immunization rates and institutional deliveries under the NHM program.

3. Improvement in Health Indicators

• Bihar has recorded gradual improvements in health indicators such as life expectancy, infant mortality rates, and immunization coverage. However, the overall progress remains slow.

Example: The introduction of Janani Suraksha Yojana (JSY) has encouraged institutional deliveries, helping reduce maternal mortality.

4. COVID-19 Response

• Bihar’s healthcare infrastructure faced significant challenges during the COVID-19 pandemic, but efforts were made to improve testing, treatment, and vaccination rates. The state has ramped up efforts in vaccination drives and providing COVID-specific care.

Fact: During the pandemic, Bihar became one of the states with the highest vaccination coverage, with over 90% of the eligible population receiving the vaccine by the end of 2021.

Are the Steps Taken Sufficient?

While the steps taken by the Bihar government and the central government have shown some positive effects, they are still not enough to address the state’s deep-rooted healthcare challenges.

Challenges to Effective Implementation

• Budget Constraints: Bihar still allocates a smaller portion of its budget to healthcare compared to other states, limiting the scope for comprehensive reforms.
• Inadequate Healthcare Workforce: There is a persistent shortage of healthcare workers, particularly doctors, nurses, and technicians, which hinders the effective delivery of services.
• Infrastructure Deficiencies: Much of Bihar’s healthcare infrastructure, especially in rural areas, remains underdeveloped. Even with reforms, the state continues to face issues like overcrowded hospitals and insufficient beds.

Need for Long-Term Solutions

• Bihar needs a more systematic approach to healthcare, focusing on long-term sustainability. This includes improving infrastructure, increasing public health expenditure, and enhancing healthcare awareness among the population.
• Collaboration with Private Sector: To improve healthcare access, the state can explore partnerships with private healthcare providers to establish new medical facilities in underserved areas.

Conclusion

Bihar’s low ranking in the NITI Aayog Health Index, 2021, is primarily due to factors such as poor healthcare infrastructure, high maternal and infant mortality rates, malnutrition, and insufficient government spending. While several steps have been taken to improve the situation, such as the introduction of health missions and schemes, these measures have not been sufficient to address the underlying challenges.

A more sustained and coordinated effort is required to uplift the healthcare sector in Bihar. The state needs to increase its budget allocation for healthcare, build better infrastructure, and ensure adequate training for healthcare workers to achieve meaningful improvements in public health outcomes.