This is a story of multiple stars: Mir Asifa from Parnewa, Khansahib, District Budgam; Irfan from Pattan, District Baramulla; Khan Muskil from Banihal, District Ramban; Saraswati from village Kalsote, Pancheri, District Udhampur; Hafia from Block Basohli; Muraid from Udhyanpur, District Doda; Bhat Hukumat from Sopore, District Baramulla. All these children have a common story to tell. They all arrived as bundles of joy to their parents when they were born waiting patiently for months. However, at different points of their tiny little existence on this part of the planet, joys turned into pain as smiling faces started manifesting signs of illness, bringing unmitigated distress, rising tension and worry among their parents. The little stars needed urgent and timely medical attention which the parents either could not afford or were too ignorant of where to go and access the services. Time is an important dimension between life and death, between becoming a healthy cheerful, intelligent youth, to an adult forced to accept a lifelong disability. Do we teach the parents to accept it as a predestined eventuality or do we stand up with the child and help him/her to achieve their dreams, their potential? However, times were merciful and all of them received quality treatments from reputed institutes including major surgeries to enable them to enjoy the fruits of modern medicine and the beauty of their land. They are now enjoying near normal life like any other child much to the relief of their parents. Or else would have been deprived of the joy of seeing the diversity of colours, listening to the music of rain sounds, distant thunders, and chirping of the birds. They can see, they can hear, they can dream. The above are true stories of a few of the 258 children from Jammu and Kashmir, who were identified early and managed early under the Rashtriya Bal Swasthya Karyakram of National Health Mission for tertiary Super Specialist services in last one year. (*Only the names of the children have been changed). Rashtriya Bal Swasthya Karyakram (RBSK) is a unique programme that is being implemented under the National Health Mission across the country irrespective of one’s economic status, caste, creed or religion with an aim to improve the overall quality of life of our children and provide comprehensive care in the community in an equitable and accessible manner and link their management at zero cost, be it at a primary, secondary or tertiary center. The larger picture is to allow every child to reach his or her genetic potential and to intervene timely during the critical period of brain development of a child to improve his/her cognition. The uniqueness of this programme is that it has both the community and facility components linked, simple for people to access, brings together the integration of modern and traditional medicines without diluting science. Believes in comprehensive screening from head to toe by the generalist led by the team of Ayush doctors along with pharmacist and nurses but management by the specialist. Teaches you to examine the child holistically and not from the prism of a super specialist focusing on a particular organ. But for the sake of quality management one is free to involve the super specialist, even if available in a private sector, across state boundaries at no cost to the parents. It has the potential to integrate all vertical programmes meant for the child. Rashtriya Bal Swasthya Karyakram (RBSK) is an initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Diseases, Deficiencies, Defects at birth, Development delays including disability covering diverse health conditions. Birth defects and Developmental delay have received focused attention for the first time. After birth, billions of neurons or wires get connected at a phenomenon speed of 7,00,000 connections per second to form the intelligence of a young child. Brain size reaches approximately 90 per cent of adult volume by 2 years of age. This period is critical for a human child. To ensure justice to this period special emphasis is to screen all newborns for visible and functional birth defects at all health facilities by the existing doctors/nurses and during the home visits from birth to 6 weeks by ASHAs as a part of Home Based New Born Care (HBNC). The second part of the emphasis is to focus on optimal development of both the body and the brain. Every pregnant mother is given an MCP (Mother and Child Protection Card) to empower her to identify any developmental delay in the newborn child after birth and ways to improve the child’s cognitive development. Understanding that the immediate environment a child gets in the formative period has a decisive role in shaping the brain, Health ministry has come up with a novel programme, “Early Child Development” or ECD relating to low cost intervention to improve the quality of care a child receives during his/her first 1000 days (270 days spend in mother’s womb plus 365 days of the first year after birth and 365 days of second year) based on incorporating the best practices of both the modern and traditional world. This also has linkages with the Home-Based Care for Young Child Programme (HBYC) and incorporates early child developmental services by the ASHA. Adding to this is Comprehensive screening done at regular intervals of 6 months by dedicated mobile health teams stationed at every block led by Ayush doctors for children aged 6 weeks to 6 years at the local Anganwaris centers apart from annual screening at all government schools for children aged 6-18 years. Once identified with any health issues including developmental delay in children from birth to 6 years, would be referred and managed at District Early Intervention Center (DEIC). Here the child can access services of a Pediatrician, Dentist, Physiotherapist/Occupational therapist, Clinical Psychologist, Audiologist cum speech pathologist, Pediatric Optometrist, Ophthalmologist (Part time), Early interventionist, Nutritionist all under one roof. In children from 6 -18 years’ age group, their health conditions would be managed through existing public health facilities. DEIC would act as referral linkages for both the age groups. The programme offers flexibility to States to utilize services of private empaneled hospitals which have entered Memorandum of Understanding with the State governments to provide treatment for conditions like congenital heart disease, cleft palate, etc. free of cost and helping families to reduce out of pocket expenditure. Networking with the Ministry of Women and Child Development for facilitating the screening of children till 6 years at Anganwari Centres irrespective of their enrolment and with Ministry of Human Resource Development for screening children at schools. In the UTs of Jammu & Kashmir and Ladakh, there are a total of 230 dedicated RBSK Mobile Health Teams (MHT) in position, of which 210 teams are in UT of Jammu & Kashmir and 20 in Ladakh. Besides this there are 15 DEICs functional in both these UTs. There are a total of 14.39 lakh children enrolled in Government and Government aided schools in both the UTs. All the children who are screened have a RBSK screening card wherein their personal health information is entered by the visiting MHT. These cards are kept safely at the respective schools for ease of access by the returning team next year. During the year 2019-20, 11.61 lakh children were screened in schools by the MHTs in both J&K and Ladakh, despite the interrupted school session and the COVID-19 pandemic. Out of these, 10 per cent (1.08 lakh) were identified with the 4Ds and almost 68,000 children were referred for higher level of care. Out of these, 38 per cent availed the services. This is much higher than that of last year where only 33 per cent availed these referral services. The quality of service provision has also improved. This shows that the quality of referral has improved as have the follow up efforts by the teams. This also goes to show that despite the hilly terrain and inclement weather children were screened in J&K and Ladakh by the dedicated Mobile Health Teams in their respective schools. Additionally, 8.8 lakh children in the age group 0-6 years were screened at the Anganwari centers by the MHTs in the year 2019-20. The Health Infrastructure in Jammu and Kashmir has improved with a special focus on primary, secondary and tertiary level care institutions. The funds have been utilized judiciously to ensure overall development of the institutions in terms of infrastructure, equipment, manpower, etc. so as to improve the patient care. This has also led to better utilization of referral services by the RBSK beneficiaries and led to the success of the programme. All this would make it into a land of healthy, happy and intelligent people. Prof. Dr. Arun Kr. Singh Head of Department of Neonatology AIIMS, Jodhpur & National Advisor Rashtriya Bal Swasthya Karyakram Ministry of Health & Family Welfare.
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