By Ryan Derni Ryan.Derni@care.org

Over the last seven years, CARE has partnered with the Government of Bihar, India with the support from the Bill and Melinda Gates Foundation to dramatically change health outcomes for women, children and families. In 2011, we began testing various innovations across 8 districts, and today we continue to support health system innovation across the entire state through the Technical Support Unit to the Government of Bihar. The scale and scope of the CARE program is enormous – covering all 534 blocks in 38 districts of Bihar and involving at least 400 public sector hospitals and over 200,000 frontline workers to cater consistently and reliably to over 10 million mothers and their babies. The core innovations currently being scaled in Bihar span the facility, community and systems level, aiming to improve quality of care and strengthen the health workforce. Our partnership with the Government of Bihar and statewide scale up of our core innovations has yielded impressive results, such as a drop in the infant mortality rate from 61 to 38 per 1,000 live births between 2005 and 2018, and a drop in the maternal mortality ratio from 312 to 165 per 100,000 live births between 2005 and 2018. More information about our work in Bihar is found on our website.

As our work continues in Bihar and other parts of India, we also aim to support many more countries that face the same challenge of overcoming poor maternal, child and reproductive health outcomes and have an immense need to build a better health- care system. CARE will share, adapt and scale proven innovations from Bihar through our Learning Exchange for Adaptation and Diffusion (LEAD) program. LEAD is an innovative approach to adaptation and diffusion supported by CARE’s Sexual and Reproductive Health and Rights (SRHR) team and CARE India. This program started in December 2017 and has already experienced small wins such as the adaptation and replication of Bihar innovations in two northeast provinces in Cambodia and plans for adaptation and replication of innovations in Bangladesh and Nepal. LEAD has also helped facilitate cross-learning and experience sharing among our various country offices. Last month a CARE team from the Sunamganj district in Bangladesh and local government officials visited Bihar to better under- stand the referral system and mHealth tool innovation used by frontline health workers. As we look towards the future, we envision LEAD becoming a multi-stake- holder platform within and outside of CARE that sup- ports the diffusion and adaption of SRHR innovations.