Given our focus on improving conditions for the India’s poorest people, we are making significant investments in two states in particular: Bihar and Uttar Pradesh. With a combined population of more than 300 million and a high burden of disease, these states have disproportionate needs that their governments are working with partners to address.


Bihar, India’s most densely populated state, has experienced rapid economic growth in recent years. But it remains one of the country’s poorest states, with acute challenges that include the healthcare needs of its 104 million people, 90 percent of whom live in rural areas.

The state’s leaders are committed to addressing these needs, with a focus on improving healthcare for women and children. In 2010, we formed a partnership with the state government called Ananya (Hindi for “unique”) to work with the private sector and community organizations on several health-related issues. They include family planning, nutrition, childhood immunization, sanitation, and infectious disease control. This partnership was recently extended for another five-year period.

Ananya’s goals are aligned with those of the state government on key health indicators. The program thus aims to help meet national health targets and in turn contribute to India’s progress toward the relevant Millennium Development Goals.

Ananya focuses on four key aspects of the health system in Bihar:

  • Improving the skills and knowledge of community health workers
  • Strengthening the ability of primary care facilities to provide services to women and children
  • Improving the quality of services provided by private clinics and hospitals
  • Expanding the role of women’s self-help groups and community organizations in encouraging good health practices

The program also supports rigorous monitoring and measurement in the health sector. It conducts twice-yearly surveys to measure progress in areas such as contraceptive use and exclusive breastfeeding and uses the findings to identify best practices and refine strategies.

Ananya has expanded from eight pilot districts to all 38 districts in Bihar. Ultimately, successful approaches in Bihar could provide a model for other parts of the country.

Uttar Pradesh

In 2012, two years after the launch of our partnership in Bihar to improve maternal and child health, we launched a similar partnership in Uttar Pradesh, which has a maternal mortality rate 50 percent higher than the national average. The state also fares poorly in child mortality, disease burden, malnutrition, immunization rates, and access to family planning.

Our work in Uttar Pradesh aims to reach mothers in places where they already receive care, either through the public health system or private providers. We collaborate with government and nonprofit partners to test and refine approaches to improving facility care, training community health workers, expanding delivery of proven interventions, improving healthcare management and oversight, and expanding private-sector delivery of primary care. We are also working to develop a monitoring and evaluation system for public health, with the goal of improving healthcare delivery.