Bihar, India’s third most populous and most densely populated state is also one of the most resource constrained. But what it can strengthen is human capital, which depends on a healthy and skilled population across all socio-economic groups and across all regions within the state. For more than a decade now, commendable political commitment by the Government of Bihar to improve health and nutrition care delivery system is showing results. Bottlenecks still exist for last mile service delivery either due to inadequate policy guidance or due to inherent challenges in health system design. In addition, it is evident from available literature that policy making in the state is constrained largely due to lack of high quality evidence-based research, resulting in some anomalies in health systems design.

The Centre for Health Policy (CHP) at the Asian Development Research Institute (ADRI) has been set up with support from the Bill & Melinda Gates Foundation to strengthen the health sector in Bihar with a multi-dimensional and multi-disciplinary approach. Its aim is to engage in rigorous analysis of the health system and inform policy makers to fine-tune interventions for even stronger outcomes. CHP has started functioning at a time when the Sustainable Development Goals (SDGs) are being implemented globally. The driving principle of the SDGs is to ‘leave no one behind’. Thus, health outcomes are expected to be as uniform as possible across income groups, social groups. SDG3 (Health) is closely linked to several other goals related to poverty, nutrition, gender, infrastructure, technology and the environment including effects of climate change.

CHP is not an isolated unit. It will build on the larger technical and implementation work that is ongoing through several partners in Bihar for several years. Primarily, CHP will act as a knowledge hub to support such ongoing work. It will follow an inter-disciplinary approach, because health outcomes, as mentioned above, depend on other development policies including education, urbanization, disaster risk reduction, gender equality and women’s empowerment, livelihoods, sustainable agriculture and the environment. These inter-linkages are crucial for a holistic health policy. CHP will uncover these interlinkages.

The status of women in the family and in society in general have a strong bearing on health outcomes for the family, particularly their children. Women’s access to - and control over – resources, their education, work status, health status, age at marriage and the birth of the first child, the prevalence of gender-based domestic violence are known to be crucial variables which have a bearing on the efficacy of direct interventions. These are very much contextual and therefore require a broad set of appropriate qualitative and quantitative data to derive evidence-based policy messages. Men are an important linkage for the support and advancement of the health of women and children. Lack of male involvement in such areas often results in major initiatives failing to achieve their desired objectives. Thus, men’s interest and full participation in the programs, canaddress gapsin ‘partnership’towards the future strengthening of Bihar’s health system.

CHP will remain forward looking. It will anticipate the challenges of the future, through statistical projections of important demographic variables related to health, both directly and indirectly, and suggest policies which may be implemented today to cope with those challenges. It will engage in research which is needs-driven, i.e., required by the state government, as also other stakeholders, to fill any existing evidence gaps. At the same time, it will also bring to the table new recommendations by conducting primary surveys as needed,carefully analysing local data, and drawing on global best practices, which the concerned stakeholders may consider implementing.

To the extent possible, CHP will aim at providing a ‘costing’ of new policies, keeping in mind the resource constraints, both on the supply as well as demand sides.On the supply side, new, or refinement of existing policies have implications for requirements of health infrastructure and availability of human resources, both of which require financial resources.This brings in the role of the private sector as health care providers. CHP will inform policy makers ways in which the private sector can be regulated so that it complements the government’s responsibility in the public space. On the demand side, ‘out of pocket’ expenses for health care is a burden that the poor can ill-afford, beyond a level. CHP, in close partnership with the widest possible range of similar think tanks, multilateral agencies, civil society and the people in general will analyse these issues.

Focus areas of CHP:

Research and analytical studies:

It will constitute the core of CHP’s activities. The areas of research will include health infrastructure and delivery with emphasis on equity, health outcomes such as IMR, MMR, TFR and its predictors, health financing, private-public partnerships, regulatory frameworkand its implementation, and other issues which might emerge. Flagship knowledge products under consideration include a roadmap for health and nutrition, and periodic state health development reports.

Informing policymakers on strengthening the existing health system:

CHP aims to be the trusted partner of the state Government in providing evidence-based inputs in making the health system stronger, resilient and equitable.

Broader dissemination and outreach:

CHP will liaise with all other stakeholders in health and human capital – the latter being a more holistic concept combining health, education and livelihoods - about its own research findings, and those of others which are relevant to Bihar’s context, in several ways including conferences, workshops, formal and informal interactions and through its website.

Sustainable health solutions:

CHP recognizes the need for establishing a strong health system which will be self-sustaining. It means immunity to natural disasters/calamities, financial uncertainties and possibly political instability. These three pillars are interrelated; CHP will provide a framework of synergy among actors working on these pillars.

Collaboration:

CHP will engage in collaboration with an extensive network of academic and policy research institutions both in India and abroad in health and the broader social sciences.

Overall, CHP’s role is to provide continuous evidence to finetune policies and interventions starting from the grassroots level and moving on to the state, national level and international levels, to make them even more effective.The Centre willhear from and reach out to stakeholders at all these levels on how to make Bihar’s health outcomes stronger for a brighter future. Through research, capacity building and networking with relevant partners both locally and otherwise, CHP aspires to emerge as a widely recognized centre for research on health policy. Hosted at ADRI, CHP, will be guided by an Executive Board of experts and eminent scholars, soon to be formed.