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17 Nov 2013

GO319 Jawahar Bala Arogya Raksha - School Health Referral Guidelines

Jawahar Bala Arogya Raksha - School Health Referral Guidelines – Orders –Issued

G.O.Ms.No 319                                                      Dated:27.10.2011
Read the following:-
(1) G.O.Ms No. 316 HM&FW (F1) Department, dated 10.11.2010.
(2) G.O. Ms. No. 7, SW (TW Edn) Department, dated 07.03.2006.
(3) G.O. Ms. No. 20, SE (PE) Department, dated 03.03.2011.

1. Government launched the School Health Programme across the state on
14.11.2010, under the name of Jawahar Bala Arogya Raksha (JBAR). Under this
scheme, all school children will be screened by a school health team and referral
of children requiring secondary and tertiary care to the appropriate facility for
specialist review, appropriate investigations, treatment of the disease and followup
will be undertaken.
2. Government of India has enacted the Right to Education where the state
should ensure free education for all children between 5-14 years age. JBAR in a
way ensures this by reducing drops out from school due to health reasons. As
Jawahar Bala Arogya Raksha (JBAR) is ensuring screening of all the children,
there is a gap to take further action on the children requires further treatments.
Thus, there is a need to develop referral system under JBAR for the school
children requiring specialist care is imperative to the success of not just the
school health programme but also for every child to realize their right to

3. In order to ensure minimal dropouts of the children with ill health reasons,
there is necessity of issue of specific guidelines to the field functionaries on the
implementation of the programme and for proper screening referring the children
for further treatment and to ensure healthy schooling.
4. Hence, the following guidelines are issued for referral of the children under
the JBAR Scheme.

(i) Referral Mechanism: The referral for school health will be under
the following three modes.
a) By the PHC Medical Officer during the bi-annual school health
b) By the MPHA(F) during the monthly visit to the schools
c) In case of emergency the student is immediately taken to the
nearest medical facility by 108 ambulance services by the
concerned head master/parent.
(ii) Referral Procedure:
A. School level:
a) Medical Officer and his/her team will screen all children and
identify those children requiring specialist referral services (As
per referral criteria).

b) If the referred student requires immediate medical attention,
then the student must be sent to the CHC/FRU at the earliest
else the student must be referred on the referral day (i.e.
c) The MO will refer to the nearest CHC/ FRU (or even secondary/
tertiary specialist services) along with the necessary medical
history and referral form.
B. Mandal Level:
Student requires further treatment have to be referred directly to the
Aarogyasri Network Hospitals.
C. CHC/ FRU/ Aarogyasri Network Hospital Level:
a) Separate counter to be established to give priority to school
health referrals on Tuesdays.
b) A pediatrician and general physician must be available at the
school health referral counter who will examine all school health
referrals. In case the students require consultation with other
specialists like gynecologist etc., then the pediatrician available
at the school health referral cell will intimate the specialist and
the child will be examined in the referral cell.
c) Necessary investigations and diagnosis need to be conducted
by the referral hospital free of cost . In case the necessary
diagnostic facilities/ treatment facilities are not available with the
referred hospital, then the student should be referred to the
nearest medical facility where such services are available in
normal conditions and in emergency conditions the referral
hospital has to provide treatment on par with Aarogyasri
d) For any student requiring super specialty medical attention/ any
surgical intervention (if not possible at the FRU) then the
student should be referred to tertiary care hospitals.
e) If the student's ailment/illness falls under the approved
procedures of Aarogyasri and subject to the student’s eligibility
under Aarogyasri necessary action has to be taken to treat the
student under the Aarogyasree scheme.
f) If referred students are not eligible under Aarogyasri then the
District JBAR Coordinators should coordinate with the State
School Health Cell/ Addl. Director, School Health to ensure the
child receives proper treatment.
D. Tertiary Care Hospitals:
a. Conduct necessary investigations and diagnosis. Treatment has
to be provided and may even be hospitalized if necessary.
b. In case the necessary diagnostic facilities/ treatment facilities
not available then the student should be referred to the nearest
super speciality facility where such services are available.
c. If the student's ailment/illness falls under the approved
procedures of Aarogyasri and subject to the student eligibility
under Aarogyasri necessary action has to be taken to treat the
student under the Aarogyasri scheme.

(iii) Other logistics: Transport and other financial support for the
referral will be provided under the scheme.
a) For tribal areas: A lump sum amount of Rs.5,000/- to be made
available at all tribal PHCs which will be earmarked for school
health referrals. The PHC Medical Officer in consultation with
the Project officer, ITDA will arrange transport for all students
and their parents/guardians who have been identified as
requiring referral services.
b) For plain areas: The parents of the students requiring referral
services will be intimated to take the child to the specified
referral centers.

<<some text missing>>

(v) Other Guidelines:
a) Any dropout due to health reasons/ after diagnosis, must entail
analysis and adequate follow up/ corrective measures for re-enrolment
by class teacher/MPHA(F) in consultation will Principals/ Headmasters
and Medical Officers including house visits, motivation of family etc.
b) The District JBAR Coordinators (NRHM)and JBAR Coordinators(RVM)
must ensure that the District School Health Committee consisting of
the DMHO, DEO, PO RVM meet regularly to review the JBAR
screening and referral.
c) The Addl. Director, School Health will ensure that the State School
Health Committee will meet regularly to review the JBAR screening
and referrals.
d) Heads of Departments and District Officials of concerned departments
ie. Health & Family Welfare, School Education, Tribal Welfare, Social
Welfare, BC Welfare, Minority Welfare, Women & Children, Disabled
Welfare, DRDA etc. are requested to monitor the JBAR programme
and take up random field visits.
5. The Commissioner Family Welfare, Mission Director (NRHM)/ the Director
of Public Health, State Project Director of Rajiv Vidya Mission and Director &
Commissioner School Education shall take necessary action in this regard.
6. This order is issued with the concurrence of School Education


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