Name of Programme: Rashtriya Bal Swasthya Karyakram (RBSK)

About the programme:

Rashtriya Bal Swasthya Karyakram (RBSK) is a health initiative aiming at early identification  and  early  intervention  for  children  from  birth  to  18  years to cover 30 plus health conditions termed as 4 ‘D’s viz. Defects at  birth,  Deficiencies,  Diseases,  Development  delays  including  disability. The programme was initiated in the state of Mizoram from July, 2013. As of April, 2023, there are 25 dedicated RBSK mobile Health Teams with each team comprising of 2 (two) medical officers (BDS/ AYUSH); 1 (one) pharmacist & 1 (one) health worker/ ANM.

Aims & Objectives:

RBSK aims to manage the 0 - 6 years age group mostly at  District  Early  Intervention  Center ( DEIC ) level, the first referral centre established under the programme while  for  6 -18  years  age  group,  management  of conditions  is presently done  through  both the DEIC(s) as well as existing  public  health facilities such as Sub Centres, Primary Health Centres, Urban Primary Health Centres, Community Health Centres, Health & Wellness Centres, Sub District Hospitals, District Hospitals, Civil Hospital, Aizawl and several faith-based and privately-run hospitals within and outside the state of Mizoram. Since its establishment in 2015, the two DEICs (located in Kulikawn, Aizawl West (near Kulikawn Sub-District Hospital) and Lunglei District Hospital) have been serving as the main referral linkages for all clients under the programme.

Target Group:

Categories	Age-group
Babies born in public facilities and at home	Birth to 6 weeks
Pre-school Children enrolled in Anganwadi Centers	6 weeks to 6 years
Children enrolled in classes 1st to 12th Standard in Govt. and Govt.Aided Schools	6 years to 18 years

 

Health Conditions Identified for Screening under RBSK:

 

Defects at Birth	Deficiencies	Childhood Diseases	Developmental Delays and Disabilities:
1. Neural Tube Defect	10. Anaemia especially Severe Anaemia	15. Skin conditions (Scabies, Fungal Infection and Eczema)	21. Vision Impairment
2. Down’s Syndrome	11. Vitamin A Deficiency (Bitot spot)	16. Otitis Media	22. Hearing Impairment
3. Cleft Lip & Palate / Cleft Palate alone	12. Vitamin D Deficiency (Rickets)	17. Rheumatic Heart Disease	23. Neuro-Motor Impairment
4. Talipes (club foot)	13. Severe Acute Malnutrition	18. Reactive Airway Disease	24. Motor Delay
5.Developmental Dysplasia of the Hip	14. Goiter	19. Dental Caries	25. Cognitive Delay
6. Congenital Cataract		20. Convulsive Disorders	26. Language Delay
7. Congenital Deafness			27. Behaviour Disorder (Autism)
8. Congenital Heart Diseases			28. Learning Disorder
9. Retinopathy of Prematurity			29. Attention Deficit Hyperactivity Disorder
30. Congenital Hypothyroidism, Sickle Cell Anaemia, Beta Thalassemia (Optional)

 

 

Implementation Mechanism:

The RBSK Operational Guidelines outline following mechanism to reach all the target groups of children for health screening-

·         For new born:

§  Facility based newborn screening at public health facilities, by existing health manpower.

§  Community based newborn screening at home through ASHAs for newborn till 6 weeks of age during home visitation.

·         For children 6 weeks to 6 years:

§  Anganwadi Center based screening by the dedicated District RBSK Mobile Health Teams.

 

·         For children 6 years to 18 years:

§  Government and Government aided school based screening by dedicated District RBSK Mobile Health Teams.

 

 

HR under the Programme:

 

1.      Engagement of 2 support staff i.e, State Coordinator (RBSK) and Consultant (DEIC cum Service Access) at the state level to assist the State Nodal Officer (RBSK).

2.      Engagement of 9 DEICs managers. All are posted across all 9 Health districts.

3.      Engagement of DEICs staffs posted in the 2 DEICs established in Aizawl West & Lunglei districts. Aizawl West DEIC is short of Audiologist while Lunglei DEIC is short of visiting Pediatrician & Audiologist.

4.      Engagement of 58 Medical Officers (DENTAL/ AYUSH) - engaged as Team Leaders of dedicated RBSK Mobile Health Teams across all 9 Health districts.

5.      Engagement of 20 Pharmacists- engaged as part of dedicated RBSK Mobile Health Teams across all 9 Health districts.

6.      Engagement of 11 ANM/Health Workers (regular & contractual)- engaged as part of dedicated RBSK Mobile Health Teams across all 9 Health districts.

 

 

Facilities under the Programme:

 

1.      Provision of RBSK Surgical Packages for 13 select conditions to help ease Out of Pocket Expenditure on the part of clients.

2.      Procurement of Essential Drugs/ Medical Supplies under RBSK Mobile Health Teams to needy clients during health screening to minimize Out of Pocket Expenditure on the part of clients.

3.      Establishment of 2 DEICs in Aizawl West & Lunglei districts respectively. Both centers act as hubs of all referrals under RBSK.

4.      Provision of Mobility Support for Hiring of Vehicle to existing 25 RBSK Mobile Health Teams.

5.      Provision of Daily Allowance for RBSK Mobile Health Teams for visits requiring Overnight Halt/ Overnight Stay.

 

 

List of affiliated Public & Private Health Institutions under RBSK (where Memoradum of Understanding (MoU) is signed):

Name of Health Institution	Institution Type	Conditions being treated
Shija Hospital & Research Centre, Imphal	Private	Congenital Heart Disease/ Rheumatic Heart Disease, Clubfoot, Strabismus; Congenital Cataract; Cleft Lip/ Cleft Palate
Anushka Foundation India	Non-governmental Organization	Clubfoot
Clubfoot Society of Mizoram	Society	Clubfoot
Synod Hospital, Durtlang	Faith-based	Strabismus; Congenital Cataract;
State Referral Hospital, Falkawn/ Zoram Medical College	Public	Cleft Lip/ Cleft Palate
Civil Hospital, Aizawl, all District Hospitals and other public health facilities under H&FW Department	Public	Other conditions treatable by each facility.

 

13 Surgical Conditions Identified under RBSK:

S.No	Name of Conditions
1	Rheumatic Heart Disease
2	Dental Conditions
3	Otitis Media
4	Neural Tube Defect
5	Down Syndrome
6	Cleft Lip+ Cleft Palate
7	Talipes (Club Foot)
8	Developmental dysplasia of the hip
9	Congenital Heart Disease
10	Congenital Cataract
11	Congenital Deafness
12	Retinopathy of Prematurity
13	Vision Impairment (Starbismus)

 

About District Early Intervention Center (DEIC):

The purpose of setting up Early Intervention Center is to provide referral support to children detected with health conditions during health screening. A team consisting of Paediatrician, Medical Officer, Staff Nurses and other Paramedics are involved and engaged to provide services at the DEIC. Each DEIC is manned by a Center manager who is responsible for carrying out mapping of tertiary care facilities in Government institutions for ensuring adequate referral support. Support Fund for 13 surgical conditions under RBSK is provided under NHM for management at the tertiary level, at the rates fixed by the State Governments in consultation with the Ministry of Health and Family Welfare.

Composition of Staff at Aizawl West DEIC:

Member	Number
Medical Officer	1
Dental Surgeon	1
Physiotherapist	1
Audiologist & Speech Therapist	nil
Early Interventionist cum Special Educator	1
Social Worker	1
Clinical Psychologist	1
Optometrist	1
Lab Technician (Graduate)	1

Composition of Staff at Lunglei DEIC:

Member	Number
Medical Officer	1
Dental Surgeon	1
Physiotherapist	1
Audiologist & Speech Therapist	nil
Early Interventionist cum Special Educator	1
Social Worker	1
Clinical Psychologist	1
Optometrist	nil
Lab Technician (Graduate)	1

Role of DEIC:

S.No	Role of the Center
1	Providing referral services to referred children for confirmation of diagnosis and treatment
2	Screening children at the “District Early Intervention Center”
3	Visit all newborns delivered at the District Hospital, including those admitted in SNCU, postnatal and children wards for screening all newborns irrespective of their sickness for hearing, vision, congenital heart disease before discharge
4	Ensure that every child born sick or preterm or with low birth weight or any birth defect is followed up at the District Early Intervention Center
5	All the referrals for developmental delay are followed and records maintained
6	The Lab Technician of the DEIC would screen the children for inborn error of metabolism and other disorders, at the District level depending upon the logistics and local epidemiological situations
7	Ensure linkage with tertiary care facilities through agreed MOU.