Rashtriya Bal Swasthya Karyakram (RBSK)

The RBSK is an initiative under the National Health Mission of the government of India for children between birth to 18 years of age. The RBSK full form stands for Rashtriya Bal Swasthya Karyakram, It aims at early identification and intervention to prevent the 4 D's, namely, Defects at birth, Deficiencies, Diseases and Developmental delays including disability. Children between 0-6 years of age are managed at the District Early Intervention Center (DEIC) level and children under the age group of 6-18 are managed in the already existing public healthcare facilities. The DEIC also functions as a referral linkage between the aforementioned age groups.

The early screening of a newborn starts at birth by the existing medical officers, nurses and ANMs (Auxiliary Nurse Midwives) followed by ASHAs (Accredited Social Health Activists) from 48 hours till the child is 6 weeks old. This is a part of the Home Based Newborn Care (HBNC) scheme (2011) that incentivizes ASHAs for making visits to the newborns and their mothers to reduce cases of neonatal mortality. After 6 weeks, the children are managed by dedicated mobile block level teams till 6 years and thereafter at schools.

Target Age Groups Covered

Children under 0-6 years of age along with those enrolled in classes I to XII in Government and Government-aided schools are covered under the RBSK scheme. The targeted groups are further subdivided into three categories owing to the fact that they necessitate the use of different sets of tools and might have different priorities. About 27 crore children are expected to be reached in a phased manner under the RBSK scheme. The subcategories are as follows:

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

Health conditions to be screened

30 selected health conditions are covered under the Child Health Screening and Early Intervention Services of the RBSK. Additionally, diseases like hypothyroidism, Sickle cell anaemia and Beta Thalassemia can also be included by States and UTs based on the epidemiological situation and the availability of necessary facilities for testing and support. The following table enlists the selected health conditions as classified under the 4 D’:

Selected Health Conditions for Child Health Screening & Early Intervention Services

Defects at Birth

Deficiencies

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

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

Developmental delays and Disabilities

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

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)

Screening process at Community & Facility level

The screening mechanism under the RBSK is divided into two types, one done at the facility level at Public Health Centres/ Community Health Centres/Digital Hospitals by medical practitioners, and the other done at the community level. Mobile health teams at Anganwadi centres and Government and Government-aided schools help in screening at the community level.

Screening at Anganwadi Centre

Children below the age of 6 are screened by the Mobile Health Teams for deficiencies, diseases, developmental delays including disability at the Anganwadi centres at least twice a year. Pictorial job aids are used for the screening of developmental delays including disability. Those suspected of a delay in development are referred to the DEIC for further management.

Screening at Government and Government aided Schools

Children between the ages of 6-18 years are screened for deficiencies, diseases, developmental delays including disability and adolescent health at the local schools at least once a year. The tools used here are mostly questionnaires (preferably translated to a local language) and clinical examinations.

Mobile health team composition

The mobile health team consists of four members as mentioned in the table below:

Suggested Composition of Mobile Health Team.

S.No

Member

Number

1

Medical officers (AYUSH) -1 male 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

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