Rashtriya Bal Swasthya Karyakram (RBSK)
RBSK, launched in February 2013, is a flagship child health initiative under the National Health Mission. It aims to screen all children from birth to 18 years for the '4 Ds': Defects at birth, Diseases in childhood, Deficiencies, and Developmental delays including disabilities. Early identification and free surgical/medical treatment has saved thousands of children from lifelong disability or death.
RBSK was launched in February 2013 by the Ministry of Health and Family Welfare. It is the world's largest child health screening programme, targeting approximately 27 crore children aged 0-18 years. The programme's premise is that early detection and treatment of the four Ds prevents lifelong disability, reduces under-5 mortality, and yields massive social and economic returns. RBSK covers children in three settings: facility-based screening at delivery points for birth defects, community-based screening by mobile health teams for children 6 weeks to 6 years, and school-based screening for children 6 to 18 years.
| D | Examples | Screening Method |
|---|---|---|
| Defects at birth | Cleft lip/palate, congenital heart disease (CHD), Down syndrome, neural tube defects, talipes equinovarus, developmental dysplasia of hip, congenital cataract, congenital deafness | Newborn examination; pulse oximetry for critical CHD; physical inspection |
| Diseases in childhood | Septicemia, pneumonia, malaria, kala-azar, TB, leprosy, dental caries, skin conditions, rheumatic heart disease, asthma | Clinical examination; screening for RHD by echocardiography in selected states |
| Deficiencies | Anemia, Vitamin A deficiency, Vitamin D deficiency, Iodine deficiency, severe acute malnutrition (SAM) | Clinical signs; Hb estimation; MUAC measurement; goitre screening |
| Developmental delays & disabilities | Delay in motor, cognitive, language, social development; autism; hearing impairment; visual impairment; learning disability; behavioural disorders | Standardised screening tools (e.g., Trivandrum Developmental Screening Chart) |
Each block has 2-3 RBSK Mobile Health Teams (MHTs). Each team comprises:
- 2 Medical Officers (1 AYUSH, 1 MBBS) — required to be male and female for privacy
- 1 Pharmacist / ANM
- 1 Helper / Driver
Teams visit Anganwadi centres (for children 6 weeks to 6 years) and government schools (for children 6 to 18 years) on a fixed schedule — typically once every 6 months at each site. A team screens approximately 8,000-10,000 children per year. India has over 11,500 RBSK teams operating in 740 districts, employing more than 24,000 doctors on contractual basis.
At each visit, the MHT conducts:
- Facility-based newborn screening: All newborns screened at delivery points for visible birth defects (cleft lip, neural tube defects, talipes, congenital cataract) before discharge. Pulse oximetry at 24 hours for critical congenital heart disease.
- Anganwadi screening (6 weeks to 6 years): General physical examination, MUAC, dental check, vision and hearing check, developmental screening using Trivandrum Developmental Screening Chart (TDSC) for 0-6 years.
- School screening (6 to 18 years): General physical examination, dental check, vision screening (Snellen chart), hearing screening, screening for rheumatic heart disease by echo in selected districts, screening for scoliosis, skin and behavioural issues.
Screen-positive children are entered into the RBSK IT portal (RBSK-TRS) and referred to designated District Early Intervention Centres (DEICs) or higher facilities for confirmation and management.
Each district has a District Early Intervention Centre (DEIC) — usually located at the district hospital — for management of screen-positive children. The DEIC has a multidisciplinary team: paediatrician, paediatric surgeon, ophthalmologist, ENT specialist, dental surgeon, audiologist, physiotherapist, occupational therapist, clinical psychologist, speech therapist, and optometrist. Children requiring surgery (e.g., congenital heart disease, cleft lip/palate) are referred to empanelled tertiary care centres for free treatment under NHM/RAN (Rashtriya Bal Swasthya Karyakram — Referral Assistance Network).
Examples of free surgical interventions: ASO repair for CHD, cleft lip/palate repair, surgical correction of talipes, cochlear implant for congenital deafness, surgery for congenital cataract, treatment for developmental dysplasia of hip. The cost is borne by NHM with co-funding from state government.
RBSK is one of the most operationally ambitious child health programmes globally — and for MBBS doctors, it is also one of the largest contractual employment avenues under NHM. For UPSC CMS aspirants, knowing the 4 Ds, the composition of Mobile Health Teams, and the role of DEICs is essential PSM knowledge.