Know why parents in Vijayapura are delighted because the ZP CEO ensured the screening of 7.66 lakh children in a year under RBSK scheme.
Rahul Shinde and Dr Gundbowdi Kesarsingh. (Supplied)
It all began with a meeting between two newly appointed officials — the reproductive and child health officer (RCHO) and the chief executive officer (CEO) of the Zilla Panchayat (ZP) of the Vijayapura district in Karnataka — in April 2022.
The duo — Dr Gundbowdi Kesarsingh and Rahul Shinde — noticed that the Rashtriya Bal Swasthya Karyakram (RBSK) programme in the district had taken a backseat and several children seemed to be suffering from many illnesses, with some even needing urgent surgeries.
The officers did not just discuss this issue at length, but decided immediately to look into the reasons behind this gap. Then they chalked out a strategy.
Their planning paid off, and the district screened 7,66,581 children in the last year and identified 34,929 — including newborn babies, preschoolers, and Classes 1-12 children — who needed early intervention to treat their illnesses.
Speaking to South First, Bidar native Rahul Shinde — an IIT graduate from Mumbai who the locals of Vijayapura have profusely praised — said: “It was all teamwork. We just ensured that there was coordination between the stakeholders of all the departments, and got the screenings done.”
In 2014, the Union government, determining that the largest chunk of the population — from newborns to 18 years of age (about 23 percent) — had an important role to play in building the future of India, came up with the Rashtriya Bal Swasthya Karyakram.
This initiative targets children from birth till they turn 18, and is aimed at screening over 27 crore children for the four Ds — defects at birth, diseases, deficiencies, and development delays including disabilities.
“After screenings at anganwadis and government schools, the children diagnosed with illnesses receive treatments. If it is a primary-level illness, like fever, worms in the stomach, cough, or cold, or a secondary-level of illness, they are sent to the primary healthcare centres (PHCs) and community healthcare centres,” explained Shinde.
He said if tertiary care was needed, then they receive follow-ups — including surgeries at the tertiary level — free of cost under the National Rural Health Mission.
The target group for screening and intervention are checking babies born in public and private health facilities for birth defects, deficiencies, or any illness.
Preschool children are screened at anganwadis, and the screening of schoolchildren enrolled in Classes 1-12 takes place in government and government-aided schools.
These children, once screened, are identified for intervention and mobilised for treatment strategy.
He explained that the task was gigantic, but not impossible.
Through a systematic approach and when implemented correctly, it showed results.
A district early intervention cell in action. (Supplied)
Dr Kesarsingh told South First: “When we had a meeting under the guidance of ZP CEO, we found that our progress in RBSK was slow. It could either be due to Covid-19 or no proper supervision.”
He recollected: “I was newly appointed as the RCHO, and I explained to CEO that we needed some special attention given to this programme. As a programme officer, when I did some homework, I found that there needed to be coordination between three departments for this to be a successful.”
The officials then decided to hold a meeting with the Department of Women and Child Welfare (WCD), the Department of Education, and the Department of Health.
Surprisingly, the officials involved were not very aware of the gap in the coordination.
“We found that the officials from the WCD used to regularly visit the anganwadis and schools and screen the children, but follow-ups were not done. So, this part was lagging and hence we planned a strategy on how to ensure follow-ups were done,” explained Kesarsingh.
The officials explained to each of these departments that they would have to do their part in the programme.
Shinde explained that a team of one staff nurse, two medical officers, and an ophthalmic officer, led by the RCHO prepared a micro-plan for their visits to anganwadis and schools. This was then shared with the Education Department and WCD.
The officials ensured that the teams adhered to the scheduled plan and a spreadsheet was prepared where the children were separated according to their illness.
“If it was only issues like fever or cough, the children were treated right there. For secondary illnesses, like some vitamin deficiencies or eye-related issues, they were taken to PHC and CHCs. And for tertiary care, where cases needed surgical interventions, like congenital heart disease, cleft lip, and orthopaedic surgeries, they were taken to district hospitals,” said Dr Kesarsingh.
By September 2022, the officers had listed out the children who needed surgical interventions. Then, camps were started accordingly at taluka levels where there were surgeons and specialists.
“Almost all facilities are available in district hospitals. So we divided the teams. We decided what surgery was required and where it had to be done. Most of them were to happen in district hospitals, some in private empanelled hospitals in Vijayapura, and a few cases had to be referred to Bengaluru,” he explained.
Nearly 50 percent of the surgeries were dealt with at the district level, and the remaining — cardiac surgeries and a few major surgeries — saw the officials needing help of a few other agencies, like NGOs.
“We started searching for these agencies. One, Smile Foundation, does cleft-lip surgeries. It agreed to conduct a once-in-a-month camp in these villages. Then, several cardiac institutions approached us to conduct free health camps. Then we started camps at the taluka levels, so that parents and students were able to access it early,” he explained.
This way, all cases were treated regularly and surgeries were planned and conducted according to their needs.
A district-level coordination committee meeting. (Supplied)
Praising the officers’ efforts, Chalawadi, a resident of the B Bagewadi Taluka Manjunath and the father of a seven-year-old, told South First, “The RBSK team detected my son’s cardiac disease during a health camp. He was referred to Vaidehi Hospital in Bengaluru for surgery. The surgery was completed in February this year, and he is doing very well,” he said.
Another parent, Mohan Rathod, who is currently in Bengaluru for his 10-month-old daughter Umashree Rathod’s cleft-lip surgery, said, “When we first went to a doctor, they said we would have to take my daughter to Delhi for surgery. I don’t have so much money. I decided it was my fate. However, at the health camp, we were referred to the Inga Foundation in Bengaluru for surgery. I am very grateful to the officers and our CEO.”
The families were happy that the agencies even took care of their accommodation and meals, and ensured that not a single rupee was collected from them.
Shinde explained that the teams from all three departments ensured they went case by case, did follow-ups, and made sure that the children underwent surgery.
Meanwhile, Gangamma, a villager from Bagewadi whose child was given hearing aids, thanked the officials.
Similarly, 12,791 anganwadi children and 22,138 schoolchildren — a total of 34,929 children — were identified with the 4Ds.
A total of 681 children received surgical intervention and 30,932 were given medical treatment.
The remaining 1,631 children were tracked, and 87 of them were found to be in need of surgical intervention.
These children’s parents are to be convinced. It is a task that ASHA workers, anganwadi teachers, and school teachers will have to do.
As per the data available with the Health Department, the target numbers for screening activity in 2022-23 was around 8,34,570, while it was around 4,54,255 in 2021-22 and 16,856 in 2020-21.
A total of 34,929 children were identified with 4Ds in 2022-23, which was the highest number when compared to 21,997, and 17,617 in the previous years. However, the screening numbers were also low then.
Meanwhile, 768 children were selected for surgery in 2022-23 when compared to 270, 61, and 145 surgeries in the previous years.
“Of these surgeries done, 138 were cardiac cases, 19 cataract cases, one hearing impairment, 70 cleft-lip cases, and 454 other surgeries,” explained the officials.
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