Rashtriya Bal Swasthya Karyakram (RBSK) is a new initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability.
It is important to note that the 0 - 6 years age group will be specifically managed at District Early Intervention Center ( DEIC ) level while for 6 -18 years age group, management of conditions will be done through existing public health facilities. DEIC will act as referral linkages for both the age groups.
First level of screening is to be done at all delivery points through existing Medical Officers, Staff Nurses and ANMs. After 48 hours till 6 weeks the screening of newborns will be done by ASHA at home as a part of HBNC package. Outreach screening will be done by dedicated mobile block level teams for 6 weeks to 6 years at anganwadis centres and 6 - 18 years children at school.
Once the child is screened and referred from any of these points of identification, it would be ensured that the necessary treatment/intervention is delivered at zero cost to the family.
The services aim to cover children of 0 -6 years of age in rural areas and urban slums in addition to children enrolled in classes I to XII in Government and Government aided Schools. It is expected that these services will reach to about 27 crores children in a phased manner. The broad category of age group and estimated beneficiary is as shown below in the table. The children have been grouped in to three categories owing to the fact that different sets of tools would be used and also different set of conditions could be prioritized.
|Target group under Child Health Screening and Intervention Service Categorie|
|Categories||Age Group||Estimated Coverage|
|Babies born at public health
facilities and home
|Birth to 6 weeks||2 crores|
|Preschool children in rural areas and urban slum||6weeks to 6 years||8 crores|
|School children enrolled in class 1st and 12th in government and
government aided schools
|6yrs to 18 yrs||17 crores|
Child Health Screening and Early Intervention Services under RBSK envisages to cover 30 selected health conditions for Screening, early detection and free management. States and UTs may also include diseases namely hypothyroidism, Sickle cell anaemia and Beta Thalassemia based on epidemiological situation and availability of testing and specialized support facilities within State and UTs.
|Selected Health Conditions for Child Health Screening & Early Intervention Services|
|Defects at Birth||Deficiencies|
|1. Neural tube defect
2. Down's Syndrome
3. Cleft Lip & Palate / Cleft palate alone
4. Talipes (club foot)
5. Developmental dysplasia of the hip
6. Congenital cataract
7. Congenital deafness
8. Congenital heart diseases
9. Retinopathy of Prematurity
|10. Anaemia especially Severe anaemia
11. Vitamin A deficiency (Bitot spot)
12. Vitamin D Deficiency, (Rickets)
13. Severe Acute Malnutrition
|Diseases of Childhood||Developmental delays and Disabilities|
|15. Skin conditions (Scabies, fungal infection and Eczema)
16. Otitis Media
17. Rheumatic heart disease
18. Reactive airway disease
20. Convulsive disorders
|21. Vision Impairment
22. Hearing Impairment
23. Neuro-motor Impairment
24. Motor delay
25. Cognitive delay
26. Language delay
27. Behavior disorder (Autism)
28. Learning disorder
29. Attention deficit hyperactivity disorder
|30. Congenital Hypothyroidism, Sickle cell anemia, Beta thalassemia (Optional)|
Child screening under RBSK is at two levels community level and facility level. While facility based new born screening at public health facilities like PHCs / CHCs/ DH, will be by existing health manpower like Medical Officers, Staff Nurses & ANMs, the community level screening will be conducted by the Mobile health teams at Anganwadi Centres and Government and Government aided Schools.
All pre-school children below 6 years of age would be screened by Mobile Block Health teams for deficiencies, diseases, developmental delays including disability at the Anganwadi centre at least twice a year. Tool for screening for 0-6 years is supported by pictorial, job aids specifically for developmental delays. For developmental delays children would be screened using age specific tools specific and those suspected would be referred to DEIC for further management.
School children age 6 to 18 years would be screened by Mobile Health teams for deficiencies, diseases, developmental delays including disability, adolescent health at the local schools at least once a year. The too used is questionnaire (preferably translated to local or regional language) and clinical examination.
The mobile health team will consist of four members- two Doctors (AYUSH) one male and one female, at least with a bachelor degree from an approved institution, one ANM/Staff Nurse and one Pharmacist with proficiency in computer for data management
|Suggested Composition of Mobile Health Team.|
|1||Medical officers (AYUSH) -1male and 1 female at least with a bachelor degree from an approved institution||2|
|3||Pharmacist with proficiency in computer for data management||1|
|*In case a Pharmacist is not available, other paramedics –Lab Technician or Ophthalmic Assistant|
Source: National Health Mission