India's public health system is a vast network designed to provide healthcare services to its large and diverse population, with a special
focus on rural
areas.
The government has implemented various initiatives like the National Health Mission (NHM), to strengthen healthcare delivery in remote regions. Primary Health Centers (PHCs) and Community Health
Centers (CHCs) serve
as the backbone of rural
healthcare, supported by
Identifying birth defects in children presents several challenges due to factors like
1. access to healthcare,
3. low incidence in absolute numbers In order to raise awareness
o
about
clubfoot,
Anushkaa Foundation works very closely with the RBSK Mobile Health Teams.
Our experience suggests that there are multiple factors that can help improve the identification of birth defects in these settings. Key factors are mentioned below
· Newborn Screening Programs: In defects where, antenatal screening is not possible, perinatal assessments immediately after birth are critical. Training healthcare providers to perform neonatal screenings at birth helps detect visible congenital anomalies. Scaling
up newborn screening helps in early detection. With high institutional delivery rates in India and the presence of a doctor and nurse, this is a very important part of the program.
· RBSK (Rashtriya Bal Swasthya Karyakram): RBSK integrates birth defect identification into child health services.
RBSK Mobile Health
Teams focus on newborn screening directly and through
frontline health workers and are best placed to lead efforts around
this.
· Training of Frontline Health Workers (FHWs): FHWs can play a significant role in identifying
and referring children
with visible birth defects. By training
local health workers to recognize the signs of clubfoot, identification can occur even in remote
areas.
· Reducing Stigma: In many cases, birth defects are stigmatized, which can delay or prevent early identification. Education of frontline health workers and parents of children born with clubfoot can address myths and reduce stigma, allowing for better reporting and access
to care.
·Health System Strengthening: Investing in better health infrastructure, particularly in rural areas, allows for earlier and more accurate detection of birth defects. This is done through identifying, training and regular contact of Specific Point of Contacts (SPOCs)
Health system:
55% children were identified and enrolled through the public health system
AFEC coordinates and reviews its awareness efforts with over 2,800 number of RBSK Mobile Health Teams based at Community Health Centres across 1,423 blocks of 161 districts. This coupled with sensitising ASHA workers who route their identification through RBSK mobile health teams is the largest pathway for identifying and enrolling patients.
Direct to Hospital:
17.2% children were identified and enrolled at the district hospital
Parents list this as a pathway as they are aware of the presence of the district hospital and have faith that a solution
can be found here.
Other sources:
14% children were identified and enrolled through other sources
Parents list this as a pathway and the majority of such parents are referred to the clubfoot clinic at the district hospital either by a healthcare provider or administrator who is aware of the Anushkaa clubfoot clinic. These healthcare providers or administrators could be either from a government hospital or a private hospital / clinic.
Frontline health workers:
7.6% children were identified and enrolled through the frontline health workers
While this pathway is part of the Health System, we track this independently. ASHAs directly referring to AFEC could
be because of multiple reasons
including recency in sensitisation,
absence of RBSK mobile health teams etc.
Parents of children born with clubfoot patients:
4.6% children were identified and enrolled through parents of children born with clubfoot
While clubfoot is not common, we do come across cases where parents have been advised by parents whose children are undergoing treatment or have completed treatment. This is both a recommendation of existing facilities and signifies the importance of more and more children completing treatment, thereby creating references in local communities.
Conclusion
To effectively identify birth defects in children, a multifaceted approach is required. It involves-
strengthening health systems and the various stakeholders, raising awareness, and demonstrating successful completion of treatment.
Blog Courtesy - Suresh Subramanian
Health system:
55% children were identified and enrolled through the public health system
AFEC coordinates and reviews its awareness efforts with over 2,800 number of RBSK Mobile Health Teams based at Community Health Centres across 1,423 blocks of 161 districts. This coupled with sensitising ASHA workers who route their identification through RBSK mobile health teams is the largest pathway for identifying and enrolling patients.
Direct to Hospital:
17.2% children were identified and enrolled at the district hospital
Parents list this as a pathway as they are aware of the presence of the district hospital and have faith that a solution
can be found here.
Other sources:
14% children were identified and enrolled through other sources
Parents list this as a pathway and the majority of such parents are referred to the clubfoot clinic at the district hospital either by a healthcare provider or administrator who is aware of the Anushkaa clubfoot clinic. These healthcare providers or administrators could be either from a government hospital or a private hospital / clinic.