Rastriya Bal Swasthya KaryakaramMinistry of Health and Family Welfare under the flagship National Rural Health Mission

launched
Rashtriya Bal Swasthya Karyakram (RBSK) as structured health screening and management of
childhood health conditions in February 2013. An operational guideline outlines the programme.
Health screening of school going children is a continued intervention under the School Health
Programme, and it is now being expanded to cover all children from birth to 18 years of age.
RBSK aims at early detection and management of the prevalent health conditions in children
groups in 4 broad groups, 4Ds- Defects at birth, Diseases of childhood, Deficiency and
Developmental delays including disabilities. A total of 30 conditions have been identified for
screening and appropriate referral and management.
The services aim to cover all children of 0 to 6 years of age in rural areas and urban slums in
addition to children enrolled in classes 1st to 12th in Government and Government aided schools.
It is expected that these services will reach to about 270 million children in a phased manner.
The following mechanisms as per GOI Operational Guidelines will be used to reach children for
health screenings:

Community based newborn screening at home through ASHAs for newborn till 6 weeks
of age during home visitation.
Anganwadi Centre based screening by the dedicated mobile health teams for children 6
weeks to 6 years
Government and Government aided school based screening by dedicated mobile health
teams for children 6 years to 18 years.
Facility based newborn screening at public health facilities, by existing health
manpower.

In addition to the community screening through mobile teams, an Early Intervention Centre will
be established at the District Hospital. The purpose of Early Intervention Centre will be to provide
referral support to children detected with health conditions during health screening in addition
to establishing screening mechanism for detection of hearing, visual and other developmental
delays and birth defects. A multispecialty team consisting of Pediatrician, Medical officer, Dentist,
Physiotherapist, Psychologist, Staff Nurses, Paramedics etc will be engaged to provide services.
The complexities in rolling out of the RBSK scheme by the states, the various dimensions of its
management and the lack of experience in the states necessitates an intensified and systematic
efforts at diverse levels to achieve RBSK objectives for equitable child health towards universal
health coverage, as envisaged in the 12th five year plan

The rationale for the RBSK program

Out of every 100 babies born in this country annually, 6 to 7 have a birth defect. In Indian context,
this would translate to 1.7 million birth defects annually and would account for 9.6 per cent of all
newborn deaths1. Various nutritional deficiencies affecting the preschool children range from 4

percent to 70 percent. Developmental delays are common in early childhood affecting at least 10
percent of the children. These delays, if not intervened timely, may lead to permanent disabilities
with regard to cognition, hearing and vision.
There are also groups of diseases which are very common in children e.g., dental caries, otitis
media, rheumatic heart disease and reactive airways diseases which can be cured if detected
early. It is understood that early intervention and management can prevent these conditions to
progress into more severe and debilitating forms, thereby reducing hospitalization and resulting
in improved school attendance.
The Child Health Screening and Early Intervention Services will also translate into economic
benefits in the long run. Timely intervention would not only halt the condition to deteriorate but
would also reduce the out-of-pocket (OOP) expenditure of the poor and the marginalized
population in the country. Additionally, the Child Health Screening and Early Intervention Services
will also provide country-wide epidemiological data on the 4 Ds (i.e., Defects at birth, Diseases,
Deficiencies and Developmental Delays including Disabilities). Such a data is expected to hold
relevance for future planning of area specific services.

Key roles of the stakeholders

Government of India will facilitate the requisite programme management support structure at
the State, District and Block levels for programme implementation and monitoring. It will support
state plans through inclusion of RBSK activities in the district PIPs and their subsequent approval.
Government of India under NRHM will continue to bear the cost of nationwide implementation
of RBSK with NIPI as a technical Partner for assistance in development of guidelines, tools, training
packages, quality assurance, review mechanisms and implementation research. With support
from the RBSK National team It will also initiate Convergence meeting with RBSK Stakeholders
Department of School education and literacy, Women and Child development ICDS and
Department of Disability affairs under Ministry of Social justice and empowerment to understand
the available financial and human resources working or earmarked for the child population at
State and followed at district level.
UNDP NIPI-Newborn Project) will by establishing a National team (RBSK team) will provide
technical and facilitation support including support in establishing a robust monitoring system.
Towards these technical personnel will participate in the review processes at the National and
State level and participate in joint consultative meetings with RBSK unit along with periodic review
with GOI.
The 30 conditions across the defects (birth), deficiencies, diseases, developmental delays and
disabilities spectrum requires the domain experts in the country to be brought together to
develop various knowledge products including technical guidelines, training modules and job aids.
RBSK team headed by Senior Advisor (RBSK) will work in close coordination and guidance from JS
RCH and AS & MD, NRHM with technical guidance from DC (Child Health & Immunization). The

national team would seek technical and implementation support from domain experts. A
mechanism would be developed to utilize the knowledge pool of the best experts in the country
through creating a Technical Expert Group (TEG). Towards this direction a National level Advisory
Group (NAG) for the technical and implementation of RBSK has been constituted.

M&E Framework of support to RBSK

Outputs /Outcome

Fully functional office with

approved HR in place.

Major Activities

Indicators

Means of
Verification

Facilitate in setup office for

RBSK unit

No. of technical officer placed in RBSK

unit

RBSK MPR

Facilitate in placement of
technical officer
Skills transfer guidelines,
tools, capacity building
packages developed for
priority interventions
identified across 4 Ds.

National/ state trainers

trained in community
screening and skills transfer

M&E mechanism
established

Facilitate development of RBSK

training and other capacity
building tool (DEIC)

Facilitate National and state ToT

in community screening and
skills transfer
Placement of M&E expert in
RBSK unit
Facilitate in development of
online MIS for RBSK
Compilation of periodic report
of RBSK

Training material developed for mobile

health team

RBSK MPR,
RBSK training
material

Capacity building material developed

for DEIC staff
No. of national and state ToT on
community screening
No. of national & state ToT on DEIC
establishment

Training
report

M&E expert placed in RBSK unit

Online MIS developed and
implemented
Periodic report of RBSK

Periodic
report,
online MIS of
RBSK