RBSK is a government of india launched programme.

1. RASHTRIYA BAL SWASTHYA
KARYAKRAM
Child Health Screening and
Early intervention Services
Presented By : DR.PREETAM KUMAR KAR
1st Yr P.G STUDENT
Facilitators : DR.MINAKSHI MOHANTY
DR.ALPANA MISHRA
Dept. of COMMUNITY MEDICINE
S.C.B MEDICAL COLLEGE , CUTTACK

2. LAYOUT OF PRESENTATION
• History
• Rationale
• Introduction
• Target Group
• Implementation Mechanism
• Methodology of Screening
• Health Conditions Identified for Screening
• Training and Institutional Collaboration
• Reporting and Monitoring
• Challenges
• References
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3. HISTORY
• We are committed to the UN Declaration of the Rights of
the Child ,1959 .
• 1960 the Ministry of Health, Government of India, set up
a School Health Committee under the chairmanship of
Smt. Renuka Ray.
• ICDS was launched in 1975.
• CSSM launched in 1992.
• RCH launched in 1997.
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4. RATIONALE
IN INDIA
• Defects at birth - 1.7 million accounting for
10% of total new born deaths.
4% of under 5 mortality rate.
• Deficiencies and Diseases
Malnourished- 47%
Underweight-43%
Wasted-20%
Severely acute malnourished- 8 million
Anemia in under 5 - 70%
Dental caries - 50% to 60%
• Developmental delays – 10% of child population .
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5. ODISHA STATEMENT
• In Odisha, Child mortality (under five) rate is 82, As
perAnnual Health Survey, 2010-12.
• Infant mortality rate is 57, SRS-2012 .It envisages that
health problems starts from early age, is a burden for the
family as well as the State.
• About 65% children (0-5) years are anemic, NFHS-III.
• 1.23 lakhs students are identified as disabled/ physically
challenged OPEPA, 12-13.
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6. INTRODUCTION
• Rashtriya Bal Swasthya Karyakram,a Child Health
Screening and Early Intervention Services Programme
aims to roll out to over 27 crore children from 0-18 years
of age.
• The key feature of the Services is the continuum of care
extending over different phases of the life of a child over
the first 18 years.
• The guidelines made on basis of identification and
management of select prevalent conditions of huge
public health significance in India.
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7. Intro contd….
• In the long run, the programme would bring social and
economic gains, particularly for the poor and
marginalized.
• All those children who may be diagnosed for any of the
30 illnesses would receive follow-up referral support and
treatment & management of four D’s.
• Efficient implementation of this programme is the joint
responsibility of the Centre and State Governments.
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10. IMPLEMENTATION MECHANISM OF RBSK
BENEFICIARIES
SITE OF SCREENING
PERSON / TEAM
RESPONSBILE
New Born Children of age 6
week to 6 years
Children of 6
years to 18 years
Facility
based
Community
based
Anganwadi
centre
Government
&
Government
aided school
Existing
Health
Manpower
ASHA
Dedicated
Mobile Health
Team
Dedicated
Mobile Health
team
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11. ROLE OF ASHA
• ASHAs will be trained with simple tools for detecting
gross birth defects.
• ASHAs will mobilise caregivers of children to attend the
local Anganwadi Centers for screening.
• ASHA will be equipped with a tool kit and suitable
performance based incentive may also be provided to
ASHAs.
• ASHAs would particularly mobilise the children with low
birth weight, underweight and children from households
known to have any chronic illness.
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13. ROLE OF BLOCK PROGRAMME MANAGER
• Block Programme Manager for
Chalk out a detailed screening plan.
Providing logistic support.
Monitoring the health screening process.
Encourage referral support.
Manage compilation of the data.
• The Block teams will work under the overall guidance
and supervision of the CHC Medical Officer.
• Tour diary and logbook should be maintained by MHT.
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14. MICROPLANNING FOR MOBILE TEAM VISIT
1. Ensure all stake holders & team members are identified
(Education, ICDS, Local volunteers / Mobiliser , Local
NGO).
2. Ensure all villages & public /public aided schools are
covered for visit by mobile teams.
3. Prepare mobile team visit plan with route chart for day
wise visit.
4. Prepare a block plan / urban area plan to help logistics
management & reporting system.
5. Share micro plan with other departments to ensure co-
ordination & timely communication. 14

15. Mobile Health Team Register
(>6 weeks to 18 years, to be maintained by Mobile Health Team)
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16. DISTRICT EARLY INTERVENTION CENTER (DEIC)
• Provide referral support to children detected with health
conditions during health screening.
• The DEIC would promptly respond to and manage all
issues related to developmental delays, hearing defects,
vision impairment, neuro-motor disorders, speech and
language delay, autism and cognitive impairment.
• Screening of all newborns delivered at the District
Hospital irrespective of their sickness for hearing, vision,
congenital heart disease,neurological deficits before
discharge.
• Ensure linkage with tertiary care facilities through agreed
MOU.
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18. District Early Intervention Center (DEIC)Register
(To be maintained by DEIC)
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19. ROLE OF STATE LEVEL COMMITTEE
• The States/UTs would conduct mapping for provision of
specialized tests and services.
• If public health institutions providing tertiary care are not
available  Private sector partnership/ NGOs
• Accredited health institutions  will be reimbursed as per
the agreed cost of tests or treatment packages.
REFERRAL SERVICES
• A three-part referral card is to be provided to
parents/caregivers/students with clear instructions and
address of the specified facility to be visited in the District.
• Budget for referral transport  NRHM
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20. METHODOLOGY OF SCREENING PROCESS
LOOK- Pictorial job Aid-
A simple photograph of a new born/child with any visible
birth defects/abnormality is to be shown. Such tools will be used by MHT &
ASHA for easy identification of health conditions
ASK- Questionnaire tool in the form of checklist for 0-6 & 6-18 yrs age group-
A simple questionnaire tool is to be used for identification of
deficiency, Diseases, developmental delays including disability. These are age-
specified & disease appropriate, for easy identification of the selected health
conditions.
PERFORM:- Clinical Examination/ Simple tests to confirm the condition:-
Basics tests can be used for identification of deficiencies &
diseases e.g. - swelling in the neck for goitre etc.
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24. DEFICIENCY DISORDERS
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27. CHILDHOOD DISEASES
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30. DEVELOPMENTAL DELAYS
• Developmental delay is a descriptive term used, when a
young child’s development is delayed in one or more
areas, compared to other children. These different areas
of development may include:
I. Gross motor development
II. Fine motor development
III. Speech and language development
IV. Cognitive/intellectual development
V. Social and emotional development
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32. Screening and Referral Card
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33. TRAINING AND INSTITUTIONAL COLLABORATION
• A ‘cascading training approach’ would be adopted.
• Appropriate budgets will be included in the State’s
Annual Programme Implementation Plan (PIP).
• It is proposed to identify Collaborative Centers in different
regions of the country.
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34. REPORTING AND MONITORING
• A Nodal 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
& also to maintain ‘Health Camp Register’.
• These children should be issued unique identification
number from the Mother and Child Tracking System
(MCTS).
• The Monthly Reporting Form is to be filled by Mobile
Health Teams and DEIC.
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35. RBSK MONTHLY REPORTING FORMAT
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36. CHALLENGES
• Is it possible to cover 27 crore children (almost one 4th of
population ) of India for screening , detailed
examination proper referral , follow up at referral site &
their complete treatment ?
• Is it possible to check 100 children by two medical
officers to do all the examination including vision ,
hearing & cognitive development in one day ?
• No guideline is given for percentage to cover school in
specific time period.
• Is it ethical to permit AYUSH medical officers to treat the
common ailments in school children ?
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37. Challenges cont…
• Prevalence of dental disease is 50-60% , how can be one
single doctor per DEIC is able to cater the vast
population of one district .
• Incentive given to ASHA is not explained.
• Coordination with other health programme is not well
explained like RNTCP , UIP , NVBDCP , ARSH.
• No standard treatment guideline is attached to treat the
school children .
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38. REFERENCES
• Operational guidelines, Rashtriya Bal Swasthya
Karyakram, MoHFW, Govt of India, Feb-2013,
• J Kishore, National Health Programme of India, School
health program in India, 9th Edi 2011 Century
Publications,NewDelhi.
• K Park, Park’s Text book of Preventive and Social
Medicine,22nd Edition 2013, Bhanot Publications,
Jabalpur,India.pp 534-37
• Elementary Education in India, 2012, DISE 2010-11: Flash
Statistics, NUEPA & DSEL, MoHRD, GOI. and State
Report Cards: 2010-11 Secondary education in India,
NUEPA
• Technical reports on Operational Status of SNCUs in
India, 2012.
• Levinger B (1994). Nutrition, Health and Education for
all, United Nations Development Programme.
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