Acute encephalitis syndrome and Bihar health profile: Urgent need to revitalize primary health care.

Acute encephalitis syndrome(AES) represents long term public health challenge with recurrent seasonal outbreak in many districts of Bihar for the past two decades. Multiple hypothesis has been postulated linking it as cause of acute encephalitis syndrome. Agrochemicals, lychee toxins, heat stroke, infectious causes and environmental factors have been postulated as AES cause. Although association have been found but no definite causation ascertained yet. Bihar heath performance on various indicators have been poor for past many years. Health index 2019 released by Niti Ayog with ministry of health and family welfare ranked Bihar on 20th place out of 21 large states based on various health indicators. Early access to nearest PHC may significantly improve outcome. As most of the children are from rural areas it's imperative to strengthen rural health care. Rural urban disparity and inequitable distribution of resources, lack of well-trained health workforce has been widely reported. Primary healthcare is the essential foundation of emergencies outbreaks. PHC is the best strategy and most cost-effective investment to provide high quality care ensuring equitable access to all. PHC reduces morbidity and makes public health system resilient to absorb sudden increase in number of cases, rising health demands putting health workforce at stress and strain to available resources.