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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.
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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.
. 16
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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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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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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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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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.
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
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’.
