The major health and demographic indicators of the State like infant mortality rate (IMR), maternal mortality ratio (MMR), total fertility rate (TFR), etc. are much higher than the all-India level and reflect a poor health status in the State. The Human Development Index (HDI), a composite of literacy, life expectancy and per capita income, has increased for Bihar like the rest of India. But the State still lags at 0.367 compared to the Indian average of 0.472. Amongst the major States, the HDI of Bihar has been the lowest for the last three decades. In view of the large population size, high poverty ratio, and high decadal growth indices in the State, Bihar is one of the States covered by the National Rural Health Mission.
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 which are lagging behind in the State are-Seohar, Samastipur, Kishangaj, Jahanabad, Nalanda, Khagaria, Araria, Sitamarhi, and Pashchim Champaran.
The MMR in Bihar is 371 per 100,000 live births, which is fourth highest in the country. 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.
Though the infant and child mortality rates in Bihar are nearer the national figures, yet the State is amongst the States with high mortality rates. The Infant Mortality Rate (IMR) in the State is 61 per 1000 live births, which is close to the national average of 58.0. The Total Fertility Rate in the State is second highest in the country. However, the mean age of marriage in Bihar is relatively high at 18.9 years. Figures for Birth Rate and Death Rate in the State are still higher than the national average with Birth Rate being 30.4 and Death Rate as 8.1 per thousand population.
The coverage under routine immunization and pulse polio is also very low as compared to the national figure. As per 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. Under-nutrition among children and women is also much higher than the national level with 54.4% 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 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 water borne diseases is also high. In 2006-07, the second highest number of polio cases in the country is 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 11th Plan approach paper of Government of Bihar, there is only one sub-centre for 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-60th Round reflected a drastic decline in the share of public health facilities in 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 all-India average of 417. In urban areas, the figure is 215 as compared to 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 Anganwadis 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 fund 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 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 along side 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:
(i) Substantial gaps in sub-centres, primary health centres, and a very large gap in community health centres.
(ii) Substantial gaps in essential requirements in terms of manpower, equipment, drugs and consumables in the primary health care institutions.
(iii) Skewed sex ratio (919).
(iv) Very low Couple protection rate (34%).
(v) Very high fertility rate (4.2).
(vi) Very high percentage of girls marrying below 18 years of age (51.5%).
(vii) Very low coverage of Full Immunization (33%).
(viii) Very low Awareness of HIV/AIDS (25.6%).
(ix) Low level of institutional delivery (23.2%) and high level of maternal deaths (3.71 per 1000).
(x) High level of malnutrition among children of age 0-6 years (55.9% children are moderately and 24.5% are severely malnourished).
(xi) Very high levels of anaemia among children (81%), adolescent girls (40.9%) and pregnant women (63.4%).
(xii) Very low coverage for Vitamin A (10%) and salt Iodisation 25.2% (15 ppm & above).