1. District Early Intervention Centre (DEIC)
“Rashtriya Bal Swasthya Karyakram” – A Comprehensive Approach to Screen and Manage Children for 4 ‘D’s i.e. Defects at birth, Diseases, Deficiencies, Developmental Delays including disabilities in India
Manpreet Khurmi1, Ajay Khera1
1Ministry of Health and Family Welfare, Government of India
Abstract
Introduction. Defects at birth, Diseases, Deficiencies and Developmental delays including disabilities in children pose a significant challenge for the entire world and especially for a low and middle income country like India. Although, there is some data available for childhood diseases and deficiencies, but very little in-country data is available for defects at birth and developmental delays. It is estimated that India may account for the largest number of such children worldwide. Moreover, the social costs and epidemiological information on these 4 ‘D’s has huge potential benefits in terms of reducing incidence of these conditions and also by improving quality of life.  
Objective. “Rashtriya Bal Swasthya Karyakram (RBSK)” was launched in Feb 2013 by the Government of India to screen and manage children from birth to 18 years, as a step towards universal healthcare and eventually cover 270 million children in a phased manner. Hence, this programme has the potential to alleviate future suffering of affected children in the country, in general and those from rural areas, in particular, as equity linked approach focussed on the life cycle and continuum of care model.  
Methods. The screening process would be by health personnel at all health facilities in the public sector for institutional deliveries, by Accredited Social Health Activists (ASHAs) for home deliveries and dedicated Mobile Block Health Teams (MBHTs), each comprising of two Medical Officers [Indian System of Medicine i.e. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH)], a Staff Nurse or Auxiliary Nurse Midwife (ANM) and a Pharmacist. MBHTs would conduct twice yearly screening for pre-school children (up to six years of age) and once yearly screening for children from six years to 18 years in all government and government aided schools in the country. In order to link screening with management (surgical, medical or therapy), a District Early Intervention Centre (DEIC) would be made operational in all districts of the country to provide services related to this programme.  
Results and Conclusion. This programme would add to robust capturing of data of huge epidemiological significance and could be used by programme managers in setting aside funds to meet desired objectives through Programme Implementation Plans (PIPs), annual budgetary activity under National Rural Health Mission. Besides this, the programme could also be a model for the Post 2015 Global Development Agenda.
Defects at birth
Estimated 17 lakh babies are likely to be born with a birth defect
Account for 9.6% of all newborn deaths
Diseases
Dental caries affects 50-60% Indian school children
Rheumatic heart disease : estimated to affect 1.5 /1000 children
Deficiencies
Various deficiencies affect 4-70% preschool children
70% under five children anaemic,
43% underweight
Developmental delays & disabilities
10% children are affected with development delays leading to disabilities
20% of newborns discharged from SNCUs may have developmental delays
Magnitude of 4Ds in India
Early detection of medical conditions,
Early intervention,
Reduction in mortality, morbidity and lifelong disability
Human Capital, Invest in tomorrow
Implementation of RBSK
DEIC
(Hub of all activities)
Confirmatory diagnosis
Coordination
Convergence
Identification and establishing service linkages
Referral
Management
Reporting
New born screening
at Delivery points
Asha in HBNC visitation
Children (6 wks to 6 years) screening
at Anganwadis twice a year
Children (6 years to 18 years) screening
at Government and Government aided schools once a year
Specialized Care: Public & Private centers2
Screening and referral
System strengthening and sustainability
Training and capacity building
Tracking
2 CRORE
Estimated annual births in public system and home
8 CRORE
Preschool children registered with AWC
17 CRORE
School children in classes 1st to 12th in Government and Government aided schools
25% of all birth defects due to (MOD)
Congenital Heart Disease
Neural Tube Defects
Down Syndrome
Hemoglobin disorder
G6PD deficiencies
10% newborn
suffer from developmental delays may result in disability
Screening at Aganwadi in Pune
Integrating Silos
Too Complicated for Action ?
Screening
Reporting
Counseling
Treatment
Follow-up
Building Blocks…
Public delivery system,
aims to cover 27 crores and to reduce out of pocket expenses
Capacity building
District Early Intervention Centre (DEIC)
Screening at Community through ASHA and Aganwadi center from 0-5
Logistics 12 persons per block and 60 per district + Travel + Tools
Screening at
School for
6-18 years
District early intervention center
Logistics from 14 persons to developmental of space and Equipment's
Tertiary care hospital
Financial packages
Road mapping
Referral + Feed back
Capacity building of our system including government institutions
Howz
At the district Hospital
As screening, facilitation and management facility
Confirmation of the referred cases,
Linkages with appropriate secondary and tertiary facilities within District and/or State,
Provide management interventions for developmental delay and disability
Manpower for DEIC (13 member)
Medical professionals
Paediatrician -1, Dental doctor -1,
Specialist in paediatric ECHO -1*,
Ophthalmologist with experience/trained in ROP -1*, ENT with experience/trained in Paediatric ENT -1* on call
Paramedics
1 each - Audiologist & speech therapist, Psychologist, Optometrist, Dental assistant
2 Lab technicians
2 SNs
Support staffs
1 each - Early interventionist cum special educator, Social worker and Data entry operator
DIEC Manager
1 at each DEIC
Donald Silberberg
Rashtriya Bal Swasthya Karyakram
“ Social model - Medical model – Integrated model”
Existing School health programme under NRHM is expanded for children (below 18 years)
30 selected health conditions
Free management and treatment including surgical interventions under National Rural Health Mission.
Newborn screening at public health facilities by existing health service providers
Screening through ASHAs during home visits from birth – 6 weeks
Screening by Mobile Health Teams
Screening
Early Intervention Centre at District hospital
for further assessment and act as a referral linkage to appropriate health facility
Referral
Free -of-cost services including surgical interventions in District Early Intervention Centre or at pre-identified tertiary level institutions
Management
Implementation mechanism
DEIC Hoshangabad