The Rastriya Bal Swasthya Karyakram (RBSK) or Child Health Screening and Early Intervention Services Programme was launched in 2013 under India's National Health Mission. It aims to screen children from birth to 18 years for defects, diseases, deficiencies, and developmental delays. Mobile health teams screen children at anganwadi centers and schools. Children identified through screening are referred to District Early Intervention Centers for confirmation of diagnosis and free treatment. The programme aims to improve children's quality of life and reduce mortality and morbidity through early identification and intervention.

1. RASHTRIYA BAL SWASTHYA
KARYAKRAM (RBSK)
CHILD HEALTH SCREENING AND EARLY INTERVENTION
SERVICES UNDER NRHM
Prof.Nagamani.T
Dept of Community Health Nursing
Quality Health Care College of Nursing

2. Introduction
• The Rashtriya Bal Swasthya Karyakram (RBSK) was launched in February 2013 by
Ministry of Health & Family Welfare, Government of India, under the National
Health Mission
• The ‘Child Health Screening and Early Intervention Services’ Programme or RBSK
is an innovative and ambitious initiative, which envisages Child Health Screening
and Early Intervention Services, a systemic approach of early identification and link
to care, support and treatment for children from birth to 18 years.
• Health screening of children is a known intervention under the School Health
Programme.

3. Need for RBSK
• Out of every 100 babies born in this country annually, 6 to 7 have a birth
defect. In Indian context, this would translate to 1.7 million birth defects
annually and would account for 9.6 per cent of all newborn deaths. Various
nutritional deficiencies affecting the preschool children range from 4 percent
to 70 percent. Developmental delays are common in early childhood
affecting at least 10 percent of the children.
• These delays, if not intervened timely, may lead to permanent disabilities
with regard to cognition, hearing and vision.

4. • There are also groups of diseases which are very common in children e.g., dental
caries, otitis media, rheumatic heart disease and reactive airways diseases which can
be cured if detected early.
• It is understood that early intervention and management can prevent these
conditions to progress into more severe and debilitating forms, thereby reducing
hospitalisation and resulting in improved school attendance.
• The ‘Child Health Screening and Early Intervention Services’ will also translate into
economic benefits in the long run. Timely intervention would not only halt the
condition to deteriorate but would also reduce the out-of-pocket (OOP)
expenditure of the poor and the marginalised population in the country.

5. RBSK -Aim
• To improve the overall quality of life of children
• To reduce mortality and morbidity rates among children
• Early identification and early intervention of childhood
prevalent diseases.

6. RBSK - Objective
• Early identification and early intervention for children
from birth to 18 years to cover 4 ‘D’s viz. Defects at
birth, Diseases in children, Deficiency conditions and
Developmental delays including Disabilities.

7. Objectives
RBSK
4 ‘D’s
Defects at
birth
Diseases in
children
Deficiency
conditions
Developm
ental
delays
Child Health
Screening
Early
Intervention
Services

8. Target age group/ Beneficiaries
• The services aim to cover children of 0 to 6 years of age in rural areas and urban
slums.
• In addition to children enrolled in class I to XII in Government and Government
aided Schools.

9. The broad category of age group and estimated beneficiary is as shown
below in the table .
Target group under Child Health Screening and Intervention Service
Category
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

10. Mechanisms for screening at Community & Facility level:
• Under RBSK 0-6 year’s age group will be specifically managed at District
Early Intervention Centre (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.

11. • Immediately after delivery first level of screening is 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 Home Based New-born Care (HBNC) package.
• Outreach screening will be done by dedicated Mobile Health teams for 6
weeks to 6 years at Anganwadi centres and 6-18 years children at school.

12. • 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.
• It is expected that these services will reach to about 27 crores children in a
phased manner.
• 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.

13. 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.

14. 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.

15. 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

16. Selected Health Conditions for Child Health Screening & Early Intervention
Services
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 (Bitot spot)
12. Vitamin D Deficiency, (Rickets)
13. Severe Acute Malnutrition
14. Goiter
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
30. Congenital Hypothyroidism, Sickle cell anemia,
Beta thalassemia (Optional)

17. Mobile Health Team
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

19. RBSK

20. Role of DEIC
• 1. Providing referral services to referred children for confirmation of diagnosis and treatment
• 2. Screening children at the “District Early Intervention Center”
• 3. 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
• 4. Ensure that every child born sick or preterm or with low birth weight or any birth defect is
followed up at the District Early Intervention Center
• 5. All the referrals for developmental delay are followed and records maintained
• 6. The Lab Technician of the DEIC would screen the children for inborn error of metabolism
and other disorders, at the District level depending upon the logistics and local epidemiological
situations
• 7. Ensure linkage with tertiary care facilities through agreed MOU.

21. Roll-Out Steps for Child Health Screening and Early
Intervention Services
• Identification of State Nodal Persons for the Child Health Screening and Early
Intervention Services.
• 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.
•

22. • Estimation of the total requirement of dedicated Mobile Health Teams &
recruitment of the Mobile Health Teams.
• 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
(as per the list provided in the ‘Operational Guidelines’).
• Translation of tools, training packages, printing of formats, training material.
• Training of Master Trainers.

23. • Block micro-plan for school and community visits monthly outreach plan based on
the mapping of educational institutions and Anganwadis and enrollment in them.
• The schedule of visits of the Block Mobile Teams should be communicated to the
school, Anganwadi Centers, ASHAs, relevant authorities, students, parents and
Local Government well in advance so that required preparations can be made.
• Anganwadi Centers and school authorities should arrange for prior communication
with parents and motivate them to participate in the process.

24. • References:
• http://cghealth.nic.in/nhmcg/Informations/RMNCH/7Rastriya_Bal_Swaasthya_k
aryakaram.
• Rbsk.gov.in
• Nhp.gov.in/rbsk
• (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)

25. THANK YOU