A Retrospective cohort study on Utilization of RashtriyaBalSwasthyaKaryakram (RBSK) Services among children screened at an Urban Health Centre (UHC) of Ahmedabad Municipal Corporation (AMC)

Abstract

Introduction: Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. Objectives: (1) Document utilization of RBSK services within a year of referral, (2) Assess reasons for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Method: Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) taking two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Results: Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; major reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. Conclusion: After referral by RBSK team, only half utilized the services. Among users, OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.