REGIONALISATION OF PERINATAL CARE

RBSK AND JSSK IMPACT ON PERINATAL OUTCOME

-Prakash duraisamy
 WHAT IS REGIONALISATION ?
• 'Regionalization of health services' has been defined as ‘the
rational distribution of medical services across the territory,
ensuring that services and facilities at all three levels
(primary, secondary and tertiary) are located in such a way as
to offer both easy access to the population and cost-effective
care’.
• The two goals of regionalization as described in the American Medical
Association (AMA) document are:
• i. Programs to identify the high risk pregnancy in sufficient time to
allow for delivery at those hospitals which are staffed, equipped and
organized for optimal perinatal care
• ii. Programs for the early recognition of high risk infants not identified
during the prenatal period which provide for the prompt transfer of a
distressed infant to a more appropriately equipped facility when
indicated.
 AIM
• Early identification and intervention
• Birth to 18 years
• 4 D’s

- Defects at birth
- Deficiencies
- Diseases

- Developmental delay
 RBSK envisages to cover 30 selected health conditions

• Defects at birth:

1. Neural tube defects

2. Downs syndrome

3. Cleft lip and palate

4. Talipes( club foot)

5. Developmental dysplasia of hip

6. Congenital cataract
7. Congenital deafness

8. Congenital heart disease

9. Retinopathy of prematurity
• Deficiencies:

10. Anemia especially severe anemia

11. Vitamin A deficiency (Bitot spot)

12. Vitamin D deficiency (Rickets)

13. Severe acute malnutruiton

14. Goiter
• Diseases of childhood:

15. Skin conditions(scabies, fungal infection,eczema)

16. Otitis media

17. Rheumatic heart disease

18. Reactive airway disease

19. Dental conditions
20. Convulsive disorders
• Developmental delays and disabilities

21. Vision impairment

22. Hearing impairment

23. Neuro- motor impairment

24. Motor delay

25. Cognitive delay

26. Language delay

27. Behavioural disorder

28. Learning disorder

29. ADHD

30. Congenital hypothyroidism ,sickle cell anemia, beta thalassemia(optional)

 Target age group
Categories Age group Estimated coverage

Babies born at public Birth to 6 weeks 2 crores

health facilities and
home
Pre school children in 6 weeks to 6 years 8 crores
rural areas and urban
slum
School children (1st to 6 years to 18 years 17crores
12th) government and
government aided
schools
 Screening
RBSK

Facility level Community level

screening screening

Primary health centre Anganwadi ,

Community health centre Government and
District hospital Government aided
schools
 India has succeeded in
reducing the IMR from 57 per
1000 live births in 1990 to
27.69 per 1000 live births in
2022
Kerala has the lowest IMR
among the larger states of
india = 6/1000
OCULAR HISTORY
WHOM TO SCREEN ?
 WHEN TO SCREEN ?
• First screening at 4 weeks of birth

• Infants with period of gestation less than 28 or weight less

than 1200 gram should be screened at 2 to 3 weeks of
delivery
 TEAM
• District opthalmologist/visiting trained opthalmologist
• One doctor and one nurse from SNCU
• Optometrist from DEIC

PLACE OF EXAMINATION : Neonantal unit under the supervision

of attending pediatrician/neonatologist(not to shift to
ophthalmology outpatient /ward)
• In general screening examinations will continue at least every
2 to 3 weeks until
1. Vascularisation of retina reaches normal completion
2. Until ROP regress
3. Unstill ROP requiring treatment develops
• Screening at anganwadi:

- 6 weeks to 6 years of age

- At least twice a year
- Age specific tools for developmental delay

(Screened by mobile health team)

 MOBILE HEALTH TEAM
• Two medical officers – male and female AYUSH
• One ANM
• One pharmacist with proficiency in computer for data
management
• Screening at schools:

- School children age 6 years to 18 years

- At least once a year

- Questionnaire and clinical examination
 One of the ‘D’ present

Refer to DEIC (DISTRICT EARLY INTERVENTION

CENTRE)
Activities in DEIC
Sensory integration room
Theraphy ball
• Launched Under NRHM by MOFHW – June 1 2011

AIM: To promote institutional deliveries so that skilled

attendance at birth is available
Women and newborn can be saved from pregnancy related
deaths