Policy Update
Sudeepti Joshi
Introduction
The Rashtriya Bal Swasthya Karyakram (RBSK) was launched on 6th February 2013, at Palghar in Maharashtra under the National Rural Health Mission, with the aim of identifying health problems in children at an early stage (Ministry of Health & Family Welfare, 2013). Its approach was built around the “4 Ds”:
defects at birth, diseases, deficiencies and developmental delays, including disability, with an initial target of screening more than 27 crore children between 0 and 18 years of age (Ministry of Health & Family Welfare, 2013).
The programme was designed around a lifecycle-based screening system rather than a single point of intervention (Ministry of Health & Family Welfare, 2013). Newborns are screened at delivery points, with Accredited Social Health Activists (ASHA) workers supporting home-based screening during the early weeks of life (Ministry of Health & Family Welfare, 2013).
Children aged 6 weeks to 6 years are screened at Anganwadi Centres, while those between 6 and 18 years are covered in government and government-aided schools through dedicated Mobile Health Teams. Each block is supported by three such teams, comprising two AYUSH doctors, an ANM or staff nurse and a pharmacist (Ministry of Health & Family Welfare, 2013).
The model was intended to take preventive healthcare closer to children rather than relying on families to identify health problems and seek treatment on their own. The original guidelines identified 30 health conditions for screening (Ministry of Health & Family Welfare, 2013), while subsequent programme documents have referred to an expanded list of 32 conditions (National Health Mission, n.d.).
More than a decade on, the programme is being expanded through the RBSK 2.0 Guidelines released by the Ministry of Health and Family Welfare in 2026 (PIB, 2026). The revision was introduced in response to changing child-health needs, with the existing framework needing to account for emerging concerns such as non-communicable diseases, mental health and behavioural problems, while also strengthening referral and follow-up. (PIB, 2026) The revised framework continues to use the 4Ds and the lifecycle-based approach, but gives greater attention to non-communicable diseases, mental health conditions and behavioural concerns. It also introduces digital health cards and real-time tracking systems, which could make monitoring of children more continuous rather than limited to periodic screening (PIB, 2026).
Functioning
RBSK operates through a two-level screening system that combines health-facility and community-based approaches. Newborns are screened at PHCs, CHCs and district hospitals by existing Medical Officers, Staff Nurses and ANMs. For older children, Mobile Health Teams conduct screenings at Anganwadi Centres and schools, allowing the programme to reach children within the settings where they already spend much of their time (Ministry of Health & Family Welfare, 2013).
The frequency of screening varies by age group. At Anganwadi Centres, children between 0 and 6 years are screened at least twice a year. Children aged 6 to 18 years in schools are screened once a year (Ministry of Health & Family Welfare, 2013). This allows children to be checked regularly instead of depending on a single screening.
Identification is followed by referral and treatment through District Early Intervention Centres (DEICs), which function as the programme’s district-level referral hubs. Located at district hospitals, DEICs are responsible for confirming conditions, coordinating treatment and following up on identified cases. For children aged 0 to 6 years, DEICs serve as the main point of management. Older children can be treated through existing public health facilities, with DEICs helping with referrals where necessary. As of 2022–23, 367 DEICs were functional across the country (Ministry of Health & Family Welfare, 2023).
Monitoring takes place through quarterly reports, field visits, meetings of State Nodal Officers, Annual Programme Implementation Plan reviews and Common Review Missions. States receive funding through their Programme Implementation Plans, while approvals and expenditure are also tracked at the state level (Ministry of Health & Family Welfare, 2023).
Under RBSK 2.0, the existing system is expected to receive additional support through digital health cards, real-time monitoring and formal referral tracking. The guidelines also call for greater coordination with the Ministries of Women and Child Development and Education (PIB, 2026). The aim is to make sure that children identified during screening continue to receive care instead of being lost somewhere between identification and treatment.
Performance
RBSK’s scale is substantial. Between 2013–14 and 2022–23, States and Union Territories reported screening 157.35 crore children, of whom 10.11 crore were identified with a selected health condition. Around 4.73 crore children were subsequently provided secondary or tertiary care (Ministry of Health & Family Welfare, 2023).
| Indicator | Number |
| Children Screened | 157.35 crore |
| Children identified with selected health conditions | 10.11 crore |
| Children provided secondary or tertiary care | 4.73 crore |
| Identified children receiving recorded secondary/tertiary care | 46.8% |
Source:Ministry of Health & Family Welfare (2023)
These figures show the programme’s reach, but they also point to significant differences in how screening translates into identification and treatment across states.
The variation is particularly visible in detection rates. Bihar reported screening 1,711.07 lakh children but identified 29.92 lakh with selected health conditions, a rate of around 1.7 per cent. Gujarat, despite a broadly comparable screening volume of 1,333.74 lakh children, reported 163.47 lakh identified cases (Ministry of Health & Family Welfare, 2023), or about 12.3%.
The difference is therefore not simply a measure of programme performance: a higher detection rate may reflect differences in the underlying prevalence of conditions, screening quality, reporting practices or diagnostic capacity.
The wide interstate variation raises questions about how consistently screening is being implemented and linked to diagnosis and care. Differences in training of screening teams, reporting practices, availability of specialists, referral mechanisms and the capacity of health facilities could potentially contribute to these patterns.
However, these should be treated as possible explanations rather than established causes, particularly in the absence of state-level evidence that directly links these factors to differences in detection rates. Delhi, meanwhile, reported zero children screened under RBSK in the same dataset, with the government explicitly noting that the capital was not conducting screening under the programme (Ministry of Health & Family Welfare, 2023).
The programme also faced an external disruption during the COVID-19 pandemic. Community-level screening was affected in 2020–21 and 2021–22 as Anganwadi Centres and schools remained closed, while Mobile Health Teams were diverted to COVID-related duties (Ministry of Health & Family Welfare, 2023). This interruption highlights the programme’s dependence on routine access to schools, Anganwadi Centres and frontline health teams for sustained screening.
Capacity constraints remain another concern. The distribution of DEICs is uneven, with Andhra Pradesh and Tamil Nadu reporting 34 centres each, compared with just six in Uttar Pradesh and none in Andaman and Nicobar Islands or Lakshadweep (Ministry of Health & Family Welfare, 2023).
These gaps suggest that RBSK’s next challenge is not simply expanding coverage, but ensuring that screening consistently leads to diagnosis, treatment and follow-up.
Impact
One of RBSK’s intended benefits is to reduce the financial burden on families by providing identified children with secondary and tertiary care, including surgeries, free of cost. This is particularly important for conditions that might otherwise require families to bear significant out-of-pocket expenses.
The national data, however, shows a gap between identification and recorded treatment. Of the 10.11 crore children identified with selected health conditions between 2013–14 and 2022–23, 4.73 crore received secondary or tertiary care during the same period (Ministry of Health & Family Welfare, 2023). On the face of it, this means that around 53% of identified children did not have treatment or care recorded in the available cumulative data (Ministry of Health & Family Welfare, 2023).
However, this gap should not necessarily be interpreted as evidence that these children remained untreated. It could also reflect incomplete reporting, differences in follow-up practices or cases where treatment was not required or recorded within the reporting period. Nevertheless, the difference highlights the importance of tracking what happens after a child is identified, rather than measuring programme performance primarily through screening numbers.
This becomes even more relevant with RBSK 2.0, which expands the programme’s focus to include non-communicable diseases, mental health conditions and behavioural concerns (PIB, 2026). The revised approach is framed around moving from “survival to healthy survival”, signalling a broader understanding of child health that goes beyond detecting immediate or physical conditions (National Health Mission, n.d.) (PIB, 2026).
The impact of RBSK will therefore increasingly depend on what happens after screening: whether children are successfully referred, receive appropriate care and remain connected to the health system through follow-up. Strengthening this continuum could determine whether the programme’s expansion translates into better health outcomes rather than simply wider screening coverage.
Emerging Issues
The next stage of RBSK will depend less on expanding screening numbers and more on strengthening the system that supports them. CAG findings from Punjab point to staffing shortages in Mobile Health Teams, which can directly affect the quality and consistency of screening. The non-availability of essential medicines with these teams, despite their inclusion in centrally prescribed drug kits, also highlights a last-mile supply issue that can limit the programme’s effectiveness during the post-screening referral and treatment process.
Similar capacity constraints appear at the referral stage. Inadequately staffed DEICs and delays in establishing new centres can restrict the ability of the health system to confirm conditions, provide treatment and maintain follow-up. This becomes more significant as RBSK 2.0 expands screening to areas such as mental health, behavioural concerns and non-communicable diseases, which may require more specialised and sustained care.
The differences between states also deserve closer attention. Bihar and Gujarat reported detection rates of around 1.7% and 12.3% respectively (Ministry of Health & Family Welfare, 2023), while Uttar Pradesh had six DEICs compared with 34 each in Tamil Nadu and Andhra Pradesh (Ministry of Health & Family Welfare, 2023). Such variation raises questions about differences in implementation capacity, staffing and access to referral services across states. Delhi’s reported absence of RBSK screening in the national cumulative data is another gap that warrants explanation (Ministry of Health & Family Welfare, 2023).
The disruption caused by COVID-19 also raises a longer-term question, whether community-level screening has returned to its pre-pandemic intensity. Alongside this, gaps between State Programme Implementation Plan approvals and actual expenditure suggest that fund utilisation should be monitored more closely. Together, these issues point to a broader priority for RBSK: improving the consistency of implementation across states, rather than measuring progress through national coverage figures alone.
Way Forward
The next phase of RBSK should focus on strengthening implementation rather than simply expanding its coverage. The CAG’s recommendations from the Punjab audit provide a useful starting point: monitoring mechanisms for centrally sponsored schemes need to ensure that human and financial resources are aligned with actual requirements. For RBSK, this would mean addressing staffing gaps in Mobile Health Teams and DEICs while ensuring that essential medicines and other resources reach the teams responsible for delivering care.
Improving the quality of programme data should be another priority. The CAG’s recommendation to review data-collection mechanisms is particularly relevant given the gap between children identified with health conditions and those recorded as receiving secondary or tertiary care. Better tracking could help distinguish between cases that remain untreated and those where follow-up or treatment has simply not been captured in the data.
RBSK 2.0 already proposes several tools that could address these weaknesses. Digital health cards, real-time referral tracking and integrated monitoring platforms could allow a child’s journey from screening to treatment and follow-up to be tracked more systematically. This would make it easier to identify where children are being lost in the referral process and where additional resources are needed.
At present, the limited availability of recent, publicly accessible and disaggregated data on screening, identification and treatment also makes it difficult to assess whether these gaps are narrowing. A regularly updated public dashboard, with state-wise and district-wise data, could improve transparency and allow policymakers to identify implementation gaps much earlier. For RBSK 2.0, stronger monitoring and better use of data may ultimately matter as much as expanding the programme’s reach.
Selected References and Important Links
Comptroller and Auditor General of India. (2024). Performance audit report on public health infrastructure and management of health services in Punjab (Report No. 4 of 2024)
Ministry of Health & Family Welfare. (2013). Rashtriya Bal Swasthya Karyakram (RBSK): Operational guidelines—Child health screening and early intervention services under NRHM. National Health Mission.
Ministry of Health & Family Welfare. (2023, December 15). Update on Rashtriya Bal Swasthya Karyakram. Press Information Bureau, Government of India.
https://www.pib.gov.in/PressReleasePage.aspx?PRID=1986705&lang=2®=48
National Health Mission. (n.d.). Rashtriya Bal Swasthya Karyakram 2.0. Ministry of Health & Family Welfare, Government of India.
https://nhm.gov.in/index4.php?lang=1&level=0&linkid=499&lid=773
Press Information Bureau. (2026, May 3). Union Health Ministry releases RBSK 2.0 guidelines at National Summit on Good Practices and Innovations in Public Healthcare Service Delivery. Ministry of Health & Family Welfare, Government of India.
https://www.pib.gov.in/PressReleasePage.aspx?PRID=2257617®=3&lang=1
Rashtriya Bal Swasthya Karyakram. (n.d.). Frequently asked questions (FAQs). Ministry of Health & Family Welfare, Government of India.
https://rbsk.mohfw.gov.in/RBSK
About The Contributor
Sudeepti Joshi is an undergraduate student pursuing a B.A. (Hons.) in Economics at Dyal Singh College, University of Delhi. Her interests lie at the intersection of economics, public policy and development.
Acknowledgements
The author extends sincere gratitude to Dolly Kaushik, Kavin Adithya CB and the IMPRI team for their expert guidance and constructive feedback throughout the process.
Disclaimer
This article is intended for academic purposes only. The views expressed are those of the author and do not necessarily reflect the views of IMPRI or any government institution.
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