Rbsk

Rashtriya Bal Swasthya
Karyakram (RBSK)
Child Health Screening and
Early Intervention Services under NRHM
Feb 2013

Introduction
 Under National Rural Health Mission, significant progress
has been made in reducing mortality in children over
the last seven years (2005-12).
 Whereas there is an escalation of reducing child
mortality there is a dire need to improve survival
outcome
 This would be reached by early detection and
management of conditions that were not addressed
comprehensively in the past.
1911/14
OPERATIONAL GUIDELINES: Rashtriya Bal Swasthya Karyakram (RBSK)
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Child health
screening
Early
Intervention
services
Early detection &
Management of 4 D
Defects
Diseases Deficiency
Developmen
tal
delay
1911/14

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Historical perspective
• First School medical inspection -
Baroda city in 1909.
• Every provinces in British India
then introduced school health
program in middle and high
school.
• After independence at
government level, Renuka Ray
school health committee was set
up in 1961 to review program at
national level.
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 Committee recommends
 Phase I (1962-66) – PHC area cover
40 nearby schools & in urban cover
all primary schools
 Phase II ( 1966-71) - Should be
extended to primary schools in both
rural and urban areas.
 National policy on Health (1983) and on education
(1986) strongly supports school health programs .
 Responsibility of state – different states have their
own schemes.
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School Health Programs
 These promotes health through schools.
 Includes all school based activities that
contribute to understanding, maintenance and
improvement of the health of the school
population including
 Health services,
 Health education and
 Healthful school environment.
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Components of school health services
• School Health care services
– Regular periodic medical examination
– Daily inspection
– A health record card
• School health education
• School health environment (physical and
psychosocial)
• Health promotion for school personnel
• Nutrition and food safety
• Physical education and recreation
• Mental health counseling and social
support.

Benefits
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Halt the condition from furthur deterioration
Reduce economic burden
Country wide epidemiological data for planning
Creating a developed society, agile
and able to compete with the rest
of the world
1911/14

Target group
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0-6 years of age group in
rural areas and urban
slums
Older children upto 18 years of
age enrolled in classes 1st to
12th in Government and
Government aided schools.
27 crore
children
1911/14

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1911/14

Magnitude of the problem –
Defects at birth
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1911/14
Serious birth defects may be fatal .
In survivors without intervention it can cause irreversible life-long mental,
physical, auditory or visual disability.
At least 3.3 million children die from birth defects every
year and another 3.2 million of those who survive may
be disabled for life.
64.3 infants per thousand live births are born annually
with birth defects.
7.9 have cardiovascular defects
4.7 have neural tube defects
1.2 have hemoglobinopathy
1.6 have Down’s Syndrome
2.4 have G6PD deficiency

1911/14
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1 in 1000 live births
1in 1000 live
births
1-17 %
Defects at birth

Magnitude of the problem
Deficiency
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> 50 % of under 5 year children are chronically
malnourished
43 % underweight 20 % wasted
6 % SAM
> 70 % of children are iron deficient

Magnitude of the problem-
Diseases
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Dental caries
( 40 -60 %)
Rheumatic heart
disease
(1.5/1000)
Reactive airway
disease
( 4.75%)

developmental delay
1911/14
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200 million children do not reach their developmental potential
in the first five years
Poverty
Lack
Of
Early
stimulation
Poor
Health&
Nutrition
20 % of children discharged from SNCU
have poor developmental outcome

Health Conditions Identified for
Screening
 Child Health Screening and Early Intervention
Services cover 30 identified health conditions
for early detection and free treatment and
management.
 Based on the high prevalence of some diseases,
States and UTs may incorporate them as part of
this initiative which may include
 Hypothyroidism,
 Sickle cell anaemia
 Beta thalassemia
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Health conditions identified for
screening
1911/14
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Rashtriya Bal
Swasthya
Karyakram
(RBSK)
Defects
Neural Tube Defect
Down’s Syndrome
Cleft Lip & Palate
Cleft Palate alone
Talipes (club foot)
Developmental Dysplasia of the
Hip
Congenital Cataract
Congenital Deafness
Congenital Heart Diseases
Retinopathy of Prematurity
Deficiencies
Anaemia.
Vitamin A Deficiency
Vitamin D Deficiency
Severe Acute
Malnutrition
Goiter
Childhood diseases
Skin conditions
Otitis Media
Rheumatic Heart Disease
Reactive Airway Disease
Dental Caries
Convulsive Disorders
Devptl delay &
disability
Vision Impairment
Hearing Impairment
Neuro-Motor Impairment
Motor Delay
Cognitive Delay
Language Delay
Behaviour Disorder
Learning Disorder
ADHD
Congenital
Hypothyroidism, Sickle
Cell Anaemia, Beta
Thalassemia (Optional)

Implementation Strategies
1911/14
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Implementation strategies
1911/14
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Facility based newborn screening
at public health facilities, by
existing health manpower.
Community based newborn
screening at home through ASHAs
for newborn till 6 weeks of age
during home visitation.
Anganwadi Center based
screening by the dedicated
Mobile Health Teams
Government and Government
aided school based screening
by dedicated Mobile Health
Teams.
Newborn 6 weeks – 6 years
6 – 18 years

ASHA - role
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She would be equipped with a tool kit consisting of a pictorial reference book
having self-explanatory pictures for identification of birth defects. Suitable
performance based incentive may also be provided to ASHAs.

Mobile health team
1911/14
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At least three dedicated Mobile Health Teams in each Block will be
engaged to conduct screening of children

1911/14
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Composition of Tool Kit for Mobile Health Team
6 weeks – 6 years 6 – 18 years
1. Equipments for Screening including Developmental Delays
Bell, rattle, torch, one inch cubes,
small bottle with raisins, squeaky
toys, coloured wool
Vision charts, reference charts
BP apparatus with age appropriate cuff size
Manual and a card specific to each age with age appropriate developmental check
list to record milestones to identify developmental delays
(6 weeks -9 years)
2. Equipments for Anthropometry
Age appropriate-
• Weighing scale (mechanical newborn weighing scale , standing weighing scale)
• Height measuring – Stadiometers/Infantometers
• Mid arm circumference tape/ bangle
• Non stretchable measuring tape for head circumference

Screening of children aged 6 weeks till
6 years attending Anganwadi Centers
 Children in the age groups 6 weeks to 6 years of age will
be examined in the Anganwadi Centers by the dedicated
Mobile Health Teams.
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Screening of children enrolled in Govt. and
Govt. aided schools
 Children in the age groups 6 to 18 years will be
screened in Government and Government aided
schools.
 At least three dedicated Mobile Health Teams in each
Block.
 Screening frequency at least
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School
Anganwadi
Once in
year
Twice a
year

Logistic support , screening &
monitoring
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Block programme
manager
Block
teams
Medical officer, school,
anganwadi centre

District Early intervention centre
1911/14
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An Early Intervention Center will be established at the District Hospital
The purpose of Early Intervention Center is to provide referral support to children
detected with health conditions during health screening.

Role of DEIC
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Children and students presumptively diagnosed to have a disease/
deficiency/disability/ defect and who require confirmatory tests or further
examination will be referred to the designated tertiary level public sector health
facilities through the DEICs.

Screening & referral by the DEIC
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1911/14
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Training & Institutional
collaboration
 Training of the personnel involved in Child Health Screening
and Early Intervention Services is an essential component of
the programme
 Collaborative centres are identified to co-ordinate, mentor,
provide supportive supervision and train health workers of
various cadres, review data from Blocks and health facilities
to estimate the incidence/prevalence of various health
conditions in the States .
 They also support them in establishing data base of children
screened and diagnosed with specific disease, disorders, and
disabilities that require long term follow up and treatment.
1911/14
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Collaborating institutes
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Role of State level committee
 The States/UTs would conduct mapping for provision of
specialized tests and services.
 Private sector partnership/ NGOs If tertiary public
health institutions are not available.
 Accredited health institutions  will be reimbursed as
per the agreed cost.
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 Contract rates as per existing norms at the District
Hospitals, Medical Colleges and any insurance
schemes or CGHS approved rates can be used as a
reference guideline.
 Process costs required for management of ailment is
to be budgeted under NRHM.
 Convergence with ongoing schemes of the Ministry of
 Woman and Child Development,
 Human Resource Development
 School Education and
 Social Justice and Empowerment.
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Reporting and monitoring
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ANodal Office at the State, District and Block level will be
identified for programme monitoring.
The Block will be the hub of activity for all Child Health Screening
and Early Intervention Services activities.
The ‘Child Health Screening Card’
is to be filled up by the Block
Health Teams for every child
screened during the visit
A ‘Health Camp Register’ is to be
maintained by the Mobile Block Health
Teams. The Early Intervention Center
at the District level would also
conduct screenings, manage the cases
and maintain a ‘DEIC Register
The State Nodal Officer will send this report on a monthly
basis to the Child Health Division of the Ministry of Health
and Family Welfare.

Screening and Referral Card
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Mobile Health Team Register
(>6 weeks to 18 years, to be maintained by Mobile Health Team)
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District Early Intervention Center (DEIC)Register
(To be maintained by DEIC)
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RBSK MONTHLY REPORTING FORMAT
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Roll-Out Steps
 Identification of State Nodal Persons
 Dissemination of ‘Operational Guidelines’ to all
Districts.
 Estimation of the State/ District magnitude of various
diseases, defects, deficiencies, disabilities as per
available national estimates.
 State level orientation meeting.
 Recruitment of District Nodal Persons.
 Estimation & recruitment of the total requirement of
dedicated Mobile Health teams.
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Roll-Out Steps cont…
 Mapping of facilities/institutions (public and private
for treatment of specific health conditions).
 Establishment of DEIC at the District Hospital.
 Procurement of equipment for the Block Mobile Team
and District Hospital.
 Translation of tools, training packages, printing of
formats, training material.
 Training of Master Trainers.
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 Block micro-plan for school and community visits
 Communication to the school, Anganwadi Centers,
ASHAs, relevant authorities.
 Anganwadi Centers and school authorities should
arrange for prior communication with parents and
motivate them to participate in the process.
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Roll-Out Steps cont…

1911/14
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Child health
screening
Early
Intervention
services
Early detection &
Management of 4 D
Creating a developed society, agile and
able to compete with the rest of the
world

1911/14
Newborn week 2014
42
Thank You

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