Who CAREs?

How does my assignment fit into the bigger picture? Well, let me first give you a brief intro about my NGO – CARE India

CARE now stands for ‘Cooperative for Assistance and Relief Everywhere‘, it has been working in India for over 60 years, focusing on ending poverty through improvement in the lives and livelihoods of women from poor and marginalised communities. CARE India is part of the CARE International confederation working in 84 countries.

CARE India’s Mission is to fight poverty and exclusion by empowering women and girls from the poor and marginalised communities. Its goal is to help 5 million women and girls from the most marginalised communities in India to have the power to realise choices in personal and public spheres to advance their positions.

Curiously you may ask why women and girls? From the NGO’s experience – when equipped with the proper resources, women and girls have the power to help the whole families and entire communities escape poverty.

Pictures & poster around the office showing the goals & mission of the NGO
Pictures & poster around the office showing the goals & mission of the NGO

CARE is focusing on 4 programme areas: health, education, livelihoods, and disaster preparedness & response. I am glad to be working on a health project on Kala Azar as my PULSE assignment, it is under the umbrella of IFHI (Integrated Family Health Initiative). Health programmes in general aim to provide comprehensive solutions to address public health problems of the most vulnerable communities such as the Dalits, Tribals, urban poor migrants, minorities and women-headed household. CARE staff work hard to promote essential new born care & immunisation, reduce malnutrition in children, prevent infant and maternal deaths, and protect those at risk of HIV, AIDS and TB.

As part of IFHI, the SKAEP (Strengthening Kala Azar Elimination Project) is funded by the Gates Foundation; the funding will cover a period of 4 years. The program is to support the Govt of Bihar to reduce morbidity and mortality due to Kala Azar in 8 districts of Bihar and accelerates progress towards eliminating the disease. With the IFHI project, CARE India is supporting the Govt of Bihar in achieving Millennium Development Goal 5 (improve maternal health) and Goal 6 (combat HIV/AIDS, Malaria and other diseases).

So, have you heard of Kala Azar (KA, visceral leishmaniasis) before? It is the second-deadliest parasitic disease in the world after malaria; but unfortunately it is not very well known, it is one of the Neglected Tropical Diseases. KA is endemic in India, Nepal, Bangladesh, Brazil, Sudan and an estimated 500,000 new cases, around 50,000 deaths each year worldwide; it’s greatly under-reported as it is a disease of the rural poor. In India >80% of the incidence is in Bihar, that’s why the SKAEP is targeting Bihar.

Here are photos of the sand-fly and some of the patients we spoke to during the field trip.

Sand fly is the vector for Leishmania donovani
Sand fly is the vector for Leishmania donovani
Cow sheds are sandfly heaven
Cow sheds are sandfly heaven
A young KA patient
A young KA patient
Patients are waiting for better access to KA diagnosis and treatment
Patients are waiting for better access to KA diagnosis and treatment

Because of the healthcare-seeking behaviour of patients (i.e. majority seek help in the private sector) and a data gap on the private sector’s contribution to the diagnosis and treatment of KA, the Elimination Program is faced with multiple challenges, such as:

  • How can we understand the extent of KA?  How can we measure progress?
  • How can patients get diagnosed quickly and properly?  How can they get proper treatment?
  • How do we eliminate KA?  How can we sustain this effort?

My assignment is to design a study to answer some of these key questions.  The evidence generated by the study will help CARE India to facilitate change to public policy regarding the private sector.

This work is on-going…..   because we care.


  1. Wonderful blog, Clara! And powerful images. Thanks for sharing the broader context of your PULSE assignment – and thank you so much for the great work you’re doing for communities in Bihar. Best wishes for continued success & learning!

  2. Excelelnt project. I would be interested if there is a high incidence of topical leishmaniasis, as I found on my Pulse assignment in Ethiopia 2 years ago.

  3. Hello! I am a student from Singapore and am doing a project regarding the provision of maternal healthcare in rural Bihar, India. As such, if it is possible, I would like to carry out an online interview with you. I would be asking you a few questions regarding your experience in Bihar, and how you think NGOs could play a part in alleviating the situation. If that is fine with you, please drop me an email. Thank you!

    p.s Your cause is really something worth fighting for! All the best for your project!

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