Rbsk
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The Rastriya Bal Swasthya Karyakram (RBSK) program aims to screen over 27 crore children aged 0-18 years in India for various health conditions. It will implement screening at Anganwadi centers, schools, and through dedicated mobile health teams. Children will be screened for deficiencies, diseases, developmental delays, and disabilities. Those requiring treatment will be referred to District Early Intervention Centers. Implementation involves training community health workers, screening using questionnaires and basic exams, issuing referral slips, maintaining records, and monitoring through monthly reporting. Key challenges include the massive scale of screening all Indian children, capacity of doctors to screen many children per day, lack of treatment guidelines, and ensuring follow
Rbsk
- 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 2
- 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. 3
- 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 . 4
- 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. 5
- 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. 6
- 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. 7
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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 10
- 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. 11
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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. 13
- 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) 15
- 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. . 16
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- 18. District Early Intervention Center (DEIC)Register (To be maintained by DEIC) 18
- 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 19
- 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. 20
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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 30
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- 32. Screening and Referral Card 32
- 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. 33
- 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. 34
- 35. RBSK MONTHLY REPORTING FORMAT 35
- 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 ? 36
- 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 . 37
- 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. 38
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Editor's Notes
- #17: The purpose of Early Intervention Center at DEIC in District hospital is to provide referral support to children detected with health conditions during health screening. There is also a provision for engaging a manager who would carry out mapping of tertiary care facilities in Government institutions for ensuring adequate referral support. The funds will be provided under NRHM for management at the tertiary level at the rates fixed by the State Governments in consultation with the Ministry of Health and Family Welfare.
- #20: The States/UTs would conduct mapping to identify public health institutions through collaborative partners for provision of specialized tests and services. Private sector partnership/ NGOs providing specialised services can also be explored in case services at public health institutions providing tertiary care are not available. Accredited health institutions will be reimbursed for the specialized service provided as per the agreed cost of tests or treatment packages
- #34: Based on the number of Block level teams required for the programme, an estimate of the training load will be made for each year and appropriate budgets will be included in the State’s Annual Programme Implementation Plan (PIP) under the ‘trainings head’.