rbsk

Rashtriya Bal Swasthya

Karyakram (RBSK)Child Health Screening and

Early Intervention Services under NRHMFeb 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.

1911/14OPERATIONAL GUIDELINES: Rashtriya Bal Swasthya Karyakram (RBSK)

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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


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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


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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


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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


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Implementation strategies


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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


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At least three dedicated Mobile Health Teams in each Block will be

engaged to conduct screening of children


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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


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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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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.


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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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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


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Thank You

rbsk

Documents

school health programsthese

school personnelnutrition

high school

school population

healthful school environment

school based activities

birthoperational guidelines

benefitsoperational