Bihar Elections: Beyond jobs and industry, the state needs to address its health

Bihar, which is scheduled to go for polls on November 6 and 11, is witnessing an intense campaign around issues of unemployment, education, migration, and industrial growth. In a state where nearly half of young children face malnutrition, health isn’t a “soft” sector—it is Bihar’s growth plan. The next government will succeed only if it treats primary health centres (PHCs), anaemia reduction, and climate-proof care as hard infrastructure for productivity and dignity. Fix health first; the economy follows.

Bihar has shown it can move fast—immunisation up, maternal and infant mortality down—when programs are well designed. The mandate now is to scale that urgency into an economy-wide strategy: health as growth infrastructure, measured, time-bound, and climate-resilient.

A weak health system

Bihar faces inadequate health infrastructure. On average, every PHC is supposed to have a minimum of four beds. Only 41 per cent of Bihar’s PHCs fulfill this criterion against the national average of 74 per cent. This is a hard bottleneck for inpatient stabilisation. According to the Good Health and Well-Being score by NITI Aayog’s Sustainable Development Goal India Index, Bihar scores 67 and is among the lowest-performing states. The national average score for the same is 77.

Bihar is witnessing high rates of malnutrition. Forty-three per cent of children under the age of five are stunted, 9.2 per cent are wasted and 23 per cent are underweight. Although stunting has declined from 48.3 per cent, the numbers remain high. Sixty-three percent of women aged between 15-49 years are anaemic in Bihar. It is among the top five states with the highest number of anaemic women. Undernourished and anaemic women give birth to low-weight children, which only deepens the crisis of stunting and wasting.

Bihar’s doctor-to-population ratio is 1:2600, which is much lower than the World Health Organization (WHO)-recommended 1:1000 and the national average of 1:811. The practical shortage shows up in vacancy lists and service gaps.

According to a Comptroller and Auditor General report, there are 49 per cent vacant posts under various departments such as the Directorate of Health Services, State Drug Controller, Food Safety Wing, AYUSH, and Medical Colleges and Hospitals (MCHs) of the Health Department. Operation theatres were not available in the four sub-district hospitals that were checked, although the Indian Public Health Standards make it mandatory. Of 132 available ventilators in the checked facilities, only 71 were functional. The rest remained idle because of the unavailability of technicians and functional ICUs.

Although in 2025-26, Bihar has allocated 6.6 per cent of its expenditure to health, which is higher than the average allocation for health by states in 2024-25 (6.2 per cent), but below the eight per cent target envisaged in National Health Policy 2017, a realistic three-year glide path can close the gap. Though the existing efforts signal intent, they require systematic reforms in staffing and infrastructural development. Bihar also witnesses intense spells of heatwaves and floods, which affect medical availability and impact the day-to-day lives of people, turning weather into a health-system variable.

But the picture is not entirely gloomy. Bihar has ensured large scale immunisation coverage, which has increased to 84 per cent in 2025 from 12 per cent in 2005. As per the Special Bulletin on Maternal Mortality Ratio (MMR) released by the Sample Registration System (SRS) 2018-20, the MMR of Bihar has reduced from 165 per lakh live births in 2014-16 to 118 per lakh live births in 2018-20. Similarly, as per the Sample Registration System (SRS) 2020, the Infant Mortality Rate (IMR) of Bihar has been reduced from 42 per 1,000 live births in 2014 to 27 per 1,000 live births in 2020. Despite chronic deficits, Bihar has shown it can achieve rapid improvements when programs are well designed and supported.

What Bihar needs to do is to create a robust mechanism of healthcare infrastructure that can address these issues. Bihar needs to heavily invest in the expansion and upgradation of its PHCs, especially in flood-prone areas and districts that fare poorly on various indicators. It needs to go on a war footing in recruiting professionally equipped employees and ensuring reliable medicine supply chains. More technological interventions are needed to ease the burden on Anganwadi and National Health Mission workers so that they can focus on providing better preventive healthcare rather than paperwork.

As per National Family Health Survey-5, 39 per cent of Bihar’s households still lack toilets. Safe sanitation, clean water, and waste management infrastructure are essential defences against climate-driven disease. Train ASHA and Anganwadi workers on climate-health risks, from managing heat stress to preventing waterborne diseases. Their local presence can bridge the gap between policy and community action. Create mechanisms linking health, agriculture, disaster management, and urban planning departments for integrated climate-health responses. Development planning must incorporate health risk assessments from the outset.

Health is hard infrastructure: Five measurable pledges to power Bihar’s growth

Over the next 24 months, Bihar can treat health as growth infrastructure by turning floods into service corridors—pre-positioning solar-powered mobile/boat clinics across the Kosi-Ganga belts before the monsoon and linking them to district specialists via tele-ECHO—building on Assam’s proven boat-clinic model that delivers immunisation, ANC/PNC and vector testing to riverine communities (feasible throughput ≈3 lakh contacts/year and a ~20 per cent lift in RI sessions in covered blocks), as documented by the Assam NHM and WHO features on C-NES clinics, which demonstrate operational viability in similar geographies (National Health Mission, Assam).

By making the Heat Index a scheduling tool with state-wide rules that shift school/work hours by heat bands, mandate hydration/rest breaks, and require every school to publish a heat calendar by April—directly operationalising NDMA’s heat-action guidance and recent state/UT plans—so on-duty heat-stroke deaths are driven to zero (National Disaster Management Authority).

By building an “Iron Ring” against anaemia: weekly IFA and deworming per Anaemia Mukt Bharat, full roll-out of iron-fortified rice through PDS/PM-POSHAN with FRK quality controls, and eggs/fruit thrice weekly with opt-outs, aiming to reduce women’s anaemia by 10 percentage points from Bihar’s NFHS-5 baseline (≈63-64 per cent) and lift school attendance by ~5 per cent, acknowledging evidence that fortified staples work best as part of a package and are now backed by ICMR-NIN’s white paper and programme standards, (National Health Mission Guidelines).

By guaranteeing cashless emergency stabilisation across public and empanelled private facilities while enforcing a hard 45-day claim-payment SLA with a public dashboard, learning from Rajasthan’s Right-to-Health rollout and the recurrent cashless suspensions under RGHS that underscore why timely reimbursement is pivotal to provider participation—so 95 per cent of claims are paid on time. No patient is refused stabilisation (Indian Journal of Medical Ethics).

And by executing a PHC Upgrade Blitz in the 100 worst-performing blocks to meet IPHS bed norms (≥4 beds), run live drug-stock dashboards, and fill 2,000 CHO/ANM vacancies—moving Bihar from ~41per cent PHCs meeting the 4-bed norm toward ≥85 per cent within 24 months—using IPHS/RHS/PRS benchmarks to track progress and cut essential-drug stock-out days below 5 per cent/quarter, (PRS Legislative Research).It is high time that the election campaigns also focus on the healthcare crisis. Bihar’s past successes, from polio eradication to improved maternal health, demonstrate that transformation is possible with the right combination of political will, resources, and partnerships. The state has demonstrated its ability to implement large-scale programs effectively. But sustaining these gains and adapting them to new challenges will define Bihar’s next decade. Health is not a soft issue; it is an economic imperative. A young workforce burdened by disease and malnutrition cannot drive industrial growth.

Anish Bari and Pranjal Pandey co-founded Health Spark, a public initiative aimed at promoting awareness and dialogue around health and climate.

Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth