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

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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

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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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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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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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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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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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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

ASHADedicated

Mobile Health Team

Dedicated Mobile

Health team

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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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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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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.

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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)

• 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.

.

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District Early Intervention Center (DEIC)Register

(To be maintained by DEIC)

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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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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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DEFICIENCY DISORDERS

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CHILDHOOD DISEASES

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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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Screening and Referral Card

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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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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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RBSK MONTHLY REPORTING FORMAT

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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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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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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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