Rashtriya Bal Swasthya Karyakram

The Rashtriya Bal Swasthya Karyakram (RBSK) is a flagship health initiative launched by the Government of India in February 2013 under the National Health Mission (NHM). Its primary aim is the early identification and management of health conditions in children and adolescents from birth to 18 years of age. The programme addresses the “4Ds” — Defects at birth, Diseases, Deficiencies, and Developmental delays including disabilities — with a focus on ensuring that every child achieves optimal physical and cognitive development.
RBSK represents a comprehensive approach to child health screening and early intervention, integrating preventive, promotive, curative, and rehabilitative care into a single continuum of service delivery.

Background and Rationale

India has one of the largest child populations in the world, and a significant proportion of morbidity and mortality among children arises from preventable and treatable conditions. Many congenital and developmental disorders go undetected in the early years, leading to lifelong disabilities and reduced productivity.
The RBSK was conceptualised to bridge this gap by ensuring early detection and timely treatment. It builds upon earlier initiatives such as the School Health Programme, expanding its scope beyond school-going children to include newborns and preschoolers as well.
The programme aligns with national commitments such as the National Policy for Children (2013), the National Rural Health Mission (NRHM) goals, and global objectives like the Sustainable Development Goals (SDGs), particularly those related to child health, nutrition, and disability inclusion.

Objectives of RBSK

1. Early Detection: To identify birth defects, deficiencies, diseases, and developmental delays in children as early as possible.
2. Early Intervention: To provide timely treatment, rehabilitation, and referral services to prevent progression or complications.
3. Comprehensive Coverage: To screen all children from birth to 18 years, covering newborns, preschoolers, and school-going children.
4. Continuum of Care: To integrate community-level health services with higher referral facilities for effective management.

Target Group and Coverage

The RBSK targets children in four distinct age groups across various platforms:

The programme aims to reach approximately 27 crore (270 million) children across India through regular and systematic health screening.

Conditions Covered: The 4Ds Approach

RBSK identifies and manages 30 common health conditions categorised under the 4Ds framework:
1. Defects at Birth (Congenital Anomalies): Examples include neural tube defects, cleft lip and palate, clubfoot, congenital cataract, congenital deafness, and congenital heart diseases.
2. Diseases: Focus on early detection of childhood illnesses such as rheumatic heart disease, tuberculosis, leukaemia, thalassaemia, and sickle cell anaemia.
3. Deficiencies: Conditions such as anaemia, malnutrition, vitamin A deficiency, vitamin D deficiency, and iodine deficiency disorders.
4. Developmental Delays and Disabilities: Autism, learning disorders, speech and language delay, cerebral palsy, vision and hearing impairment, and other neurodevelopmental issues.

Institutional Framework and Implementation

RBSK operates under the Ministry of Health and Family Welfare (MoHFW) as part of the National Health Mission (NHM) framework. Implementation occurs through a coordinated structure at national, state, and district levels.
1. Screening and Service Delivery:

• Mobile Health Teams (MHTs): Each block has two dedicated teams (one for boys and one for girls) comprising four members — a doctor (MBBS/AYUSH), a nurse, a pharmacist, and an ANM.
• ASHAs and Anganwadi Workers: Conduct home visits and community mobilisation for screening newborns and infants.
• School Teachers: Facilitate screening visits and referrals.

2. Early Intervention Centres (DEICs): Each district has a District Early Intervention Centre (DEIC) established at the District Hospital.

• Serve as the first referral unit for children detected with any of the 4Ds.
• Provide diagnostic, therapeutic, counselling, and rehabilitative services.
• Include specialists such as paediatricians, audiologists, speech therapists, psychologists, and physiotherapists.

3. Referral and Continuum of Care: Children needing specialised care beyond DEICs are referred to tertiary hospitals or medical colleges under a defined referral chain.

Integration with Other Programmes

RBSK is integrated with several national health and welfare programmes for better coordination and resource utilisation:

• Rashtriya Kishor Swasthya Karyakram (RKSK) – for adolescent health.
• Integrated Child Development Services (ICDS) – for preschool children.
• Janani Shishu Suraksha Karyakram (JSSK) – for free care of sick newborns.
• National Programme for Prevention and Control of Deafness (NPPCD) and National Programme for Control of Blindness (NPCB) – for sensory impairments.
• National AIDS Control Programme (NACP) and Immunisation Initiatives for disease prevention.

Achievements and Impact

Since its inception, RBSK has achieved significant progress in expanding access to early screening and intervention services:

• Over 27 crore children screened across the country.
• Establishment of more than 700 District Early Intervention Centres (DEICs).
• Identification of millions of children with health conditions requiring intervention.
• Enhanced coordination between health, education, and social welfare departments.
• Improved awareness among parents and communities regarding childhood health and development.

Challenges in Implementation

Despite its success, RBSK faces several operational and systemic challenges:

• Human Resource Shortage: Inadequate staffing of Mobile Health Teams and DEICs in several states.
• Infrastructure Gaps: Limited availability of specialised diagnostic and therapeutic facilities at the district level.
• Awareness and Community Participation: Many families remain unaware of screening schedules or referral pathways.
• Data Management Issues: Inconsistent record-keeping and lack of real-time digital monitoring systems.
• Interdepartmental Coordination: Effective collaboration between health, education, and social sectors needs further strengthening.

Recent Developments and Strengthening Measures

• Digital Platforms: Introduction of the RBSK Mobile App and digital health cards for efficient data capture and follow-up tracking.
• Telemedicine Integration: DEICs in some states have adopted telehealth consultations for remote screening and specialist access.
• Training and Capacity Building: Continuous skill enhancement for ASHAs, ANMs, and RBSK team members through state-level training modules.
• Special Focus on Disabilities: Enhanced linkage with schemes like Accessible India Campaign (Sugamya Bharat Abhiyan) and Samagra Shiksha Abhiyan.