Friday 7 February 2014

Rashtriya Bal Swaasthya Karyakram A New Preventive Health Care Initiative

The newly launched Rashtriya Bal Swaasthya Karyakram of the Ministry of Health & Family Welfare assures a package of health services for children up to 18 years of age. The initiative, which is part of the National Rural Health Mission, was launched on February 6, in Palghar, a tribal dominated block of Thane district in Maharashtra, by UPA Chairperson Sonia Gandhi, in the presence of Union Health & Family Welfare Minister Ghulam Nabi Azad and Maharashtra Chief Minister Prithviraj Chavan. The programme will be extended to cover all districts of the country in a phased manner.
Early Detection; Early Intervention
Rashtriya Bal Swaasthya Karyakram, also known as Child Health Screening and Early Intervention Services aims at early detection and management of ‘4Ds’ prevalent in children. These are Defects at birth, Diseases in children, Deficiency conditions and Developmental delays including Disabilities. The health screening of children is a known intervention under School Health Programme. It is now being expanded to cover all children from birth to 18 years of age. The services aim to cover all children of 0-6 years of age group in rural areas and urban slums, in addition to children enrolled in classes 1st to 12th in Government and Government aided schools.  A set of 30 common ailments / health conditions have been identified for screening and early intervention.

Defects at Birth
Globally, about 7.9 million children are born annually with a serious birth defect of genetic or partially genetic origin which account for 6 percent of the total births. In India about 1.7 million babies are born with birth defects annually.  For those who do not receive specific and timely intervention and yet survive, these disorders can cause irreversible life-long mental, physical, auditory or visual disability.

Anaemia prevalence has been reported as high as 70% amongst under-five children largely due to iron deficiency. The situation has remained virtually unchanged over the past decade. Almost half of children under age five years (48 %) are chronically malnourished. During pre-school years, children continue to suffer from adverse effects of anaemia, malnutrition and developmental disabilities, which ultimately also impact their performance in school.
The prevalence of dental caries varies between 50-60 percent among Indian school children as reported in different surveys. Rheumatic heart disease is reported at 1.5 per thousand among school children in the age group of 5-9 years. The median prevalence of reactive air way disease including asthma among children is reported to be 4.75 percent.

Developmental Delays
Globally, 200 million children do not reach their developmental potential in the first five years because of poverty, poor health, nutrition and lack of early stimulation. The prevalence of early childhood stunting and the number of people living in absolute poverty could be used as proxy indicators of poor development in under five children. Both of these indicators are closely associated with poor cognitive and educational performance in children and failure to reach optimum developmental potential.

Defects at Birth
·         Neural tube defect
·         Down’s Syndrome
·         Cleft Lip & Palate / Cleft palate alone#
·         Talipes (club foot)
·         Developmental dysplasia of the hip
·         Congenital cataract
·         Congenital deafness
·         Congenital heart diseases
·         Retinopathy of Prematurity
·         Anaemia especially Severe anaemia
·         Vitamin A deficiency (Bitot spot)
·         Vitamin D Deficiency, (Rickets)
·         Severe Acute Malnutrition
·         Goitre

Child hood Diseases
·         Skin conditions (Scabies, fungal infection and Eczema)
·         Otitis Media
·         Rheumatic heart disease
·         Reactive airway disease
·         Dental caries
·         Convulsive disorders

Developmental delays and Disabilities
· Vision Impairment
· Hearing Impairment
· Neuro-motor Impairment
· Motor delay
· Cognitive delay
· Language delay
· Behaviour disorder (Autism)
· Learning disorder
· Attention deficit hyperactivity disorder
· Congenital Hypothyroidism, Sickle cell anaemia, Beta thalassemia (Optional)

Implementation mechanism
Facility Based Newborn Screening
This includes screening of birth defects in institutional deliveries at public health facilities, especially at the designated delivery points by nurses, medical officers/ gynaecologists.

Community Based Newborn Screening
Accredited Social Health Activists (ASHAs) during home visits for newborn care will use the opportunity to screen the babies born at home and the institutions till6 weeks of age. ASHAs will be trained with simple tools for detecting gross birth defects. For performing this task, ASHA would be provided with a tool kit consisting of a pictorial reference book with self-explanatory pictures for identification of birth defects.

Screening at Anganwadi Centres and Schools
The children in the age groups 6weeks to 6 years of age will be examined in the Anganwadi centres by the dedicated mobile health teams. The children in the age groups 6 to 18 years will be screened in Government and Government aided schools.  The screening of children in the anganwadi centres would be conducted at least twice a year and at least once a year for school children to begin with.

Block to be the Hub of Activity
The Block will be the hub of activity for the programme. At least three dedicated mobile health teams in each Block will be engaged to conduct screening of children. Villages within the jurisdiction of the Block would be distributed amongst the 3 teams. The number of teams may vary depending on the number of anganwadi centres, schools, difficult to reach areas and enrolments of children in the schools.  The mobile health team will consist of four members - two Doctors (AYUSH) one male and one female, one nurse and one pharmacist.  The Block Programme Manager will chalk out a detailed screening plan for all the three teams in consultation with schools, anganwadi centres and CHC Medical Officer. A tour diary will be maintained by block health teams.

Early Intervention Centre at District Level
An Early Intervention Centre will be established at the District Hospital. The purpose of Early Intervention Centre is to provide referral support to children detected with health conditions during health screening. A team consisting of paediatrician, medical officer, staff nurses, paramedics will be engaged to provide services. This centre would have the basic facilities to conduct tests for hearing, vision, neurological tests and behavioural assessment.

Training and Management
Training of the personnel involved in Child Health Screening and Early Intervention Services would be through a cascading training approach. Standardized training modules are to be developed in partnership with technical support agencies and collaborative centres. KEM Hospital, Mumbai and Pune and Ali Yavar Jung National Institute for Hearing Handicapped, have been identified as public sector collaborative centres in Maharashtra for imparting training.

Ministry of Health & Family Welfare has drawn up ‘Operational Guidelines’ for effective planning and systematic implementation of the programme. These guidelines explain the process of identification and management of select conditions of huge public health significance in India.

Impact of the Programme
By providing early intervention service, the new initiative is expected to bring economic benefits in the long run by directly reducing expenditure in terms of providing critical health care. “Extending preventive and promotive health care would impact the National Human Capital, reduce disease burden and also public health expenditure.” says Union Minister for Health & Family Welfare Ghulam Nabi Azad.

When fully implemented, the Rashtriya Bal Swasthya Karyakram is expected to benefit approximately 270 million (27 crore) children across the country.

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