it is coming under the National ruler health mission. every year various guidelines are published by CENTRAL GOVERNMENT to improve the condition of children.

1. Good morning

2. Rashtriya Bal Swasthya
KaryakraM

3. 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 advance in
reducing child mortality there is a dire need to
improving survival outcome. This would be
reached by early detection and management of
conditions that were not addressed
comprehensively in the past.

4. CONt…..
Rashtriya Bal Swasthya
Karyakram (RBSK) is an important
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.

5. CONt…..
It aims at providing continuum of care from
birth to throughout childhood period. It is a step
towards ‘Health for All’ or ‘Universal Health
Care’ wherein children would get free assured
services under NHM.
The task is gigantic but quite possible, through
the systematic approach that RBSK. Implemented
in right earnest, it would yield rich dividends in
protecting and promoting the health of our
children.

6. aim
Rashtriya Bal Swasthya Karyakram (RBSK)
is an important 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

7. Vision
 The strategy envisions that all adolescents in India are
able to realise their full potential by making informed
and responsible decisions related to their health and
well-being, and by accessing the services and support
they need to do so.
 The implementation of this vision requires support
from the government and other institutions, including
the health, education and labour sectors as well as
adolescents’ own families and communities.

8.  Building an agenda for adolescent health
requires an escalation in the visibility of young
people and an understanding of the challenges
to their health and development.
 It needs implementation of approaches that
will health needs and special concerns of
adolescents are understood and addressed in
national policies and a range of programmes at
different levels.

9. Objective
Improve nutrition
Reduce the prevalence of malnutrition among adolescent
girls and boys
Reduce the prevalence of iron-deficiency anaemia (IDA)
among adolescent girls and boys
Improve sexual and reproductive health
Improve knowledge, attitudes and behaviour, in relation
to SRH
Reduce teenage pregnancies
Improve birth preparedness, complication readiness and
provide early parenting support for adolescent parents

10. Cont…..
Enhance mental health
Address mental health concerns of adolescents
Prevent injuries and violence
Promote favourable attitudes for preventing injuries and
violence (including GBV) among adolescents
Prevent substance misuse
Increase adolescents’ awareness of the adverse effects
and consequences of substance misuse
Address NCDs
Promote behaviour change in adolescents to prevent
NCDs such as hypertension, stroke, cardio-vascular
diseases and diabetes.

11. The Rationale for the RBSK Program
The National Child Protection Program has been
launched to provide super-specialty level health facilities
free of cost to poor children. Under this, various diseases of
the heart of the children (including holes in the heart),
severed lips, crooked teeth, congenital white glaucoma,
crooked legs (club feet), vitamin D deficiency, hearing
problems, respiratory diseases About 30 diseases, including
etc. For this, RBSK centers have also been opened in
district level government hospitals.

12. Implementation Mechanism
Facility based newborn screening at public
health facilities by existing health service
providers
Community based newborn screening at
home through ASHA workers (0-6 months)
Community based screening at Angawadi
centres for children 6 weeks to 6 years by
block level Dedicated Mobile Health Teams

13. School based screening for children (6 to 18
years) in Government and Government aided
schools by block level Dedicated Mobile
Medical Health Team
District Early Intervention Centre at
District hospital to facilitate and support
management of specific conditions and to act
as referral linkage

14. HEALTH CONDITION OF CHILDREN IN INDIA
• As per available estimates, 6% of children are born with
birth defects, 10% children are affected with development
delays leading to disabilities. This translates into more than
15 lakh new-borns with birth defects annually.
• Further, 4% of under- five mortality and 10% of neonatal
mortality is attributed to birth defects.
• Out of every 100 babies born in this country annually, 6 to 7
have a birth defect translating to 1.7 million birth defects
annually and would account for 9.6 per cent of all newborn
deaths (March of Dimes, 2006).
• Various nutritional deficiencies affecting the preschool
children range from 4 percent to 70 percent

15. Selected Health Conditions for Child Health
Screening & Defects at Birth
Defects at Birth
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
Deficiencies
10. Anaemia especially
Severe anaemia
11. Vitamin A deficiency
12. Vitamin D Deficiency,
13. Severe Acute
Malnutrition
14. Goiter

16. Diseases of Childhood
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
Developmental delays
and Disabilities
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

17. Target group
Categories
• Babies born at public health facilities and
home
• Preschool children in rural areas and urban
slums
• Children enrolled in classes 1
st
to 12
th
in
Government and Government aided schools

18. Mobile Health Team
Composition of Mobile Health Team
• Medical officers (AYUSH) - 1 male and 1
female at least with a bachelor degree from an
approved institution-2
• ANM/Staff Nurse- 1
• Pharmacist* with proficiency in computer for
data management- 1

19. District Early Intervention Centre
Professionals
 Medical Professionals (Paediatrician -1, Medical
Officer 1, Dental Doctor -1)
 Physiotherapist
 Audiologist & Speech Therapist
 Psychologist
 Optometrist
 Early Interventionist cum Special Educator cum
Social Worker
 Lab Technician
 Dental Technician
 Manager
 Data Entry Operator
Numbers
 3
 1
 1
 1
 1
 2
 1
 1
 1

20. ROLE OF DEIC
• Providing referral services to referred children for
confirmation of diagnosis and treatment
• Screening children at the “District Early
Intervention Centre”
• Visit all newborns delivered at the District
Hospital, including those admitted in SNCU,
postnatal and children wards for screening all
newborns irrespective of their sickness for
hearing, vision, congenital heart disease before
discharge

21. • Ensure that every child born sick or preterm or with
low birth weight or any birth defect is followed up at
the DEIC.
• All the referrals for developmental delay are followed
and records maintained
• The Lab Technician of the DEIC would screen the
children or inborn error of metabolism and other
disorders at the District level depending upon the
logistics and local epidemiological situations
• Ensure linkage with tertiary care facilities through
agreed MOU.

22. DEIC operational strategies
1. Identification of site
2. Estimation, layout and BOQ
3. Infrastructure development by renovation/ repair
4. Procurement of equipment and furniture
5. Printing of guidelines, training manual and standard forms
6. Recruitment of Human resources
7. Capacity building
8. Linkage of screening of developmental milestones through
ASHA

23. 1. Inauguration of DEIC services (medical services, preventive
health and immunization),
2. general women and child services: nutritional and related to
feeding of babies, neurological assessment, physiotherapy,
occupational therapy, psychological services, cognitive
development including play and socialization, testing for
speech and language, vision and hearing.
3. Monitoring and supportive supervision
4. Linkage with tertiary centre in a public sector
5. Roll out of quality medical and surgical treatment
6. Linkage and convergence with departments of Social Justice
and Empowerment and Women and Child Development.
7. Strong advocacy on Prevention of 4 Ds and Traditional good
practices of child rearing.

24. • Pillar 1: Human Resource & Capacity building –
Recruitment of staff for MBHTs and DEIC along with
required trainings
• Pillar 2: Supply of logistics, manuals, formats etc –
Regular and timely supply of essential logistics,
equipments, manuals, formats
• Pillar 3: Information Education and Communication &
Behaviour Change Communication – Posters, Banners,
Media (Radio, TV), Mid Media.
The above pillars need to be supported by supportive
supervision, mentoring, along with regular feed back from
the collected data

25. • Bringing Prevention of 4 Ds to the centre of
the agenda
• Draft documents presently being developed
viz. Technical guidelines, Training Manual
and Guidelines-DEIC incorporates the
deliberations from report of this conference.
• Launch of these documents along with
National and State/UT dissemination
• Strengthening the three pillars

26. Bibliography
Net references:-
Operational guidelines, Rashtriya Bal
Suraksha Karyakram, MOHFW, Govt. of India