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Rashtriya Bal Swasthya Karyakram (RBSK)

Introduction

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.

Target age group

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

Health conditions to be screened

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
14. Goiter
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
19.Dental conditions
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)

Mechanisms for screening at Community & Facility level:

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.

Screening at Anganwadi Centre

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.

Screening at Schools - Government and Government aided

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.

Composition of mobile health team

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.
S.No Member Number
1 Medical officers (AYUSH) -1male and 1 female at least with a bachelor degree from an approved institution 2
2 ANM/Staff Nurse 1
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



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