Child’s Health, Management and Early Intervention

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By: Prof. Dr. Arun Kr. Singh

This is a story of multiple stars: Mir Asifa from Parnewa, Khansahib under Budga district; Irfan from Pattan under Burramulla district; Khan Muskil from Banihal under Ramban district; Saraswati from village Kalsote, Panchrai under Udhampur district; Hafia from Block Basholi; Muraid from Udhyanpur under Doda district; Bhat Hukumat from Sopore under Baramulla district (all children’s names changed).

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 and rising tensions to 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 a near normal life like any other child much to the relief of their parents. The above are but a few true stories of the 258 children from Jammu and Kashmir, who were identified early and managed under the Rashtriya Bal Swasthya Karyakram of National Health Mission for tertiary Super Specialist services in last one year.

Rashtriya Bal Swasthya Karyakram (RBSK) is a unique programme 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 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 centre. 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 to improve his/her cognition. The uniqueness of this program 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. Led by the team of AYUSH doctors along with pharmacists and nurses it teaches you to examine the child holistically. 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 programs 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 has received focused attention for the first time.

After birth, billions of neurons or wires get connected at a phenomenon speed of 700,000 connections per second to form the intelligence of a young child. Brain size reaches approximately 90% 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 ASHA 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, the Health Ministry has come up with “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 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 Anganwadi centres 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, the child would be referred and managed at District Early Intervention Centre (DEIC).

Here the child avails services of a paediatrician, dentist, physiotherapist/occupational therapist, clinical psychologist, audiologist cum speech pathologist, paediatric optometrist, ophthalmologist (part time), early interventionist, nutritionist – all under one roof. The programme offers flexibility to states to utilize services of private empanelled 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 help families reduce out of pocket expenditure. The programme also includes networking with the Ministry of Women and Child Development for facilitating the screening of children till 6 years at Anganwadi centres irrespective of their enrolment 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% (1.08 Lakh) were identified with the 4Ds and almost 68 thousand children were referred for higher level of care. Out of these, 38% availed the services. This is much higher than that of last year where only 33% 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, 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 Anganwadi centres 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. (PIB feature)

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