According to the World Health Organization, in the year 2020, around 5 million children below the age of five lost their lives due to mostly preventable and treatable causes. Moreover, around half of those deaths, 2.4 million, occurred among newborns.
These alarming figures underscore the pressing need for innovative solutions to address child healthcare in India, like the Rashtriya Bal Swasthya Karyakram (RBSK). But what is RBSK, and how does it aim to tackle the critical health challenges faced by children in the country? In this article, we will learn more about this program and its potential to transform child healthcare in India.
Rashtriya Bal Swasthya Karyakram (RBSK):
Rashtriya Bal Swasthya Karyakram (RBSK) is an innovative program designed to identify and address health concerns in children from birth to 18 years of age, focusing on the “4 D’s” – Defects at birth, Deficiencies, Diseases, and Developmental delays, including disabilities.
Notably, children in the 0-6 age group will receive specialised care at the District Early Intervention Centre (DEIC) level. In contrast, those between the age group of 6 and 18 will have their conditions managed through the existing public health facilities. DEIC will serve as a vital link for referrals for both age groups.
The initial screening will occur at all delivery points and be conducted by existing Medical Officers, Staff Nurses, and ANMs. After the first 48 hours and up to 6 weeks of age, ASHA workers will conduct screenings for newborns in their homes as part of the HBNC package.
Outreach screening for children between the ages of 6 weeks and 6 years will be conducted at Anganwadis centres by specialised mobile teams operating at the block level. While children between 6 years and 18 years will be screened at schools.
Once a child is screened and referred from any of these identification points, it will ensure that the necessary treatment and intervention will be provided to the family at zero cost.
Target Age Group:
The services provided under Rashtriya Bal Swasthya Karyakram are intended to shield children aged 0 to 6 years residing in rural areas and urban slums.
Additionally, the program extends its coverage to children enrolled in classes I to XII in government and government-aided schools.
The implementation of these services is anticipated to benefit approximately 27 crores (270 million) children gradually.
To accommodate the diverse needs and conditions of these children, they have been divided into three distinct categories, each requiring specific tools and priorities.
The table below illustrates the age groups and their estimated beneficiaries:
| Beneficiary of Rashtriya Bal Swasthya Karyakram | Age Group | Cost Estimation |
| Infants born at home and at public health centres | 0-6 weeks | 2 crores |
| Young toddlers in rural and urban slums attending preschool | 6 weeks – 6 years | 8 crores |
| Students enrolled in government and government-aided schools in classes 1 through 12 | 6 years – 18 years | 17 crores |
Heath conditions to be screened:
Child health is a fundamental concern for any society, and early identification and treatment of ailments can have a major impact on a child’s life.
In India, the Rashtriya Bal Swasthya Karyakram (RBSK) is an initiative that aims to revolutionise child healthcare by offering comprehensive screening and early intervention services.
The Rashtriya Bal Swasthya Karyakram (RBSK) program is committed to addressing 30 identified health conditions in children, ensuring that early detection is followed by free, effective management.
Furthermore, the program empowers States and Union Territories (UTs) to adapt to their specific needs and concerns.
| 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. Behaviour disorder (Autism) 28. Learning disorder 29. Attention deficit hyperactivity disorder |
| 30. Congenital Hypothyroidism, Sickle cell anemia, Beta thalassemia (Optional) |
Let’s delve into the significance of this approach and its potential to transform child healthcare in India:
- The RBSK’s Mission:
At its core, the RBSK strives to ensure that no child is left behind when it comes to their health. By covering children from birth to 18 years, it casts a wide net, enabling the early detection of health conditions that might otherwise go unnoticed. Its primary goal is to address health concerns comprehensively, ensuring that every child receives the appropriate care and intervention without imposing financial burdens on their families.
- The 30 Selected Health Conditions:
The RBSK program sets out to tackle 30 selected health conditions through proactive screening and early detection. These conditions encompass a wide spectrum, ranging from congenital defects to deficiencies and developmental delays. By focusing on these conditions, RBSK endeavours to catch health issues in their nascent stages, enabling more effective treatment and management.
- Empowering States and UTs:
One of the unique strengths of the RBSK program is its flexibility. States and UTs are given the autonomy to include additional diseases based on the local epidemiological situation and the availability of testing and specialised support facilities. This approach recognises the diversity of health challenges that different regions face and empowers local authorities to tailor the program to their specific needs. It’s a recognition of the fact that healthcare is not one-size-fits-all, and this adaptability enhances the program’s effectiveness.
- Focus on Hypothyroidism, Skin Cell Anemia, and Beta Thalassemia:
Hypothyroidism, skin Cell Anemia, and Beta Thalassemia are three health conditions that can significantly impact a child’s well-being. Recognising their importance, RBSK allows states and UTs to include these conditions in their program. This is a crucial step, as it acknowledges the prevalence of these conditions in certain regions and ensures that affected children receive the care they require.
Rashtriya Bal Swasthya Karyakram Guidelines:
The Rashtriya Bal Swasthya Karyakram guidelines represent a comprehensive framework designed to ensure the effective implementation of this vital program. These guidelines delineate the core principles and objectives of RBSK, emphasising the early identification and intervention for children aged from birth to 18 years.
They provide a roadmap for health professionals and stakeholders, detailing the key components of the program, including the screening process, treatment, and follow-up procedures. Rashtriya Bal Swasthya Karyakram guidelines underscore the importance of integrating efforts across various healthcare sectors, emphasising the delivery of essential services at zero cost to families. These guidelines serve as a foundational document, guiding healthcare practitioners and administrators in their mission to safeguard the health and well-being of India’s youth.
Operational Guidelines – Rashtriya Bal Swasthya Karyakram:
The operational guidelines for Rashtriya Bal Swasthya Karyakram provide a practical and detailed roadmap for executing the program at the ground level. These guidelines offer step-by-step instructions on how to carry out the various aspects of RBSK, from the initial screening of children to the delivery of necessary interventions.
They specify the roles and responsibilities of different healthcare personnel, outline data management procedures, and provide protocols for referrals and linkages between different healthcare levels. Moreover, they offer valuable insights into monitoring and evaluation mechanisms to ensure the program’s effectiveness. These operational guidelines are indispensable tools for healthcare workers, enabling them to translate the broader objectives of RBSK into tangible actions that directly benefit the health of children across the nation.
Here are some of the operational guidelines – Rashtriya Bal Swasthya Karyakram:
Age Group Inclusion: The program covers children from 0 to 18 years of age, encompassing various age groups, including infants, school-going children, and adolescents.
Screening: The RBSK program involves systematic health screening of children to detect a range of health conditions, including congenital defects, deficiencies, diseases, and developmental delays.
District Early Intervention Centres (DEIC): DEICs are established at the district level and serve as referral support centres for children identified with health conditions during screening. These centres are staffed with a team of healthcare professionals, including Pediatricians, Medical Officers, Nurses, and Paramedics.
Tertiary Care Mapping: A dedicated manager is responsible for mapping tertiary care facilities within government institutions to ensure that children in need of specialised medical attention have access to adequate referral support.
Funding: Financial support for the program’s tertiary care level is provided under the National Rural Health Mission (NRHM), with charges decided after discussion with the Ministry of Health and Family Welfare and State Governments.
Flexibility: States and Union Territories (UTs) have the flexibility to include additional diseases in the program, such as hypothyroidism, Sickle Cell Anemia, and Beta Thalassemia, based on local epidemiological conditions and the availability of testing and support facilities.
Early Intervention: The program focuses on early intervention, ensuring that children with identified health concerns receive appropriate care and management in a timely manner.
Outreach Screening: Outreach screening activities are conducted in Anganwadis centres for children aged 6 weeks to 6 years and in schools for children aged 6 to 18 years.
Free Services: The Rashtriya Bal Swasthya Karyakram (RBSK) program ensures that the necessary treatment and intervention for identified health conditions are provided to children and their families at no cost.
Comprehensive Care: The program adopts a holistic approach to child healthcare, aiming to address a wide spectrum of health conditions, from birth defects to developmental delays.
Collaboration: Effective collaboration between healthcare professionals, government bodies, and local stakeholders is essential for the successful implementation of the RBSK program.
Screening at Community & Facility level: Screening is a fundamental component of the Rashtriya Bal Swasthya Karyakram (RBSK) program, and it occurs at both the community and facility levels. This dual-level screening approach is crucial for identifying and addressing various health conditions in children, ensuring early detection and timely intervention. Here’s an overview of screening at both the community and facility levels in the RBSK program:
Community Level Screening:
Community Health Workers: Accredited Social Health Activists (ASHAs) and other community health workers play a vital role in conducting screenings in local communities.
Home-Based Newborn Screening: ASHAs are responsible for conducting screenings for newborns at home, particularly during the first 48 hours to 6 weeks after birth. This is part of the Home-Based Newborn Care (HBNC) package.
Outreach Screening: Dedicated mobile teams are deployed to conduct screenings for children aged 6 weeks to 6 years at Anganwadi centres and for those aged 6 to 18 years at schools.
Wide Coverage: The community-level screening ensures that a significant portion of the child population is covered, even in remote or underserved areas.
Facility Level Screening:
District Early Intervention Centres (DEIC): These centres, established at the district level, are equipped to conduct more comprehensive screening. They serve as referral support centres for children identified with health conditions during screenings.
Multidisciplinary Team: The DEIC teams consist of healthcare professionals, including Pediatricians, Medical Officers, Nurses, and Paramedics. This ensures a thorough evaluation of children’s health.
Specialised Referrals: When children are identified with health concerns during community-level screenings or routine health check-ups at government facilities, they are referred to DEIC for further evaluation and specialised care.
Tertiary Care Mapping: A manager is designated to map tertiary care facilities within government institutions to ensure that children in need of specialised medical attention have access to appropriate referral support.
By combining community-level and facility-level screening, the RBSK program maximises its reach and effectiveness. Early identification of health conditions, whether at the grassroots level or through specialised facilities, is the cornerstone of the program’s success in providing timely and comprehensive healthcare services to children across India.
Conclusion:
In conclusion, the Rashtriya Bal Swasthya Karyakram (RBSK) is a pivotal initiative aimed at securing the well-being of our nation’s youth addressing their health needs from infancy to adolescence. This comprehensive program, with its emphasis on early detection and intervention, plays a crucial role in ensuring that every child receives the necessary care and support, regardless of their socio-economic background.
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