Leprosy Control Programmes in India

Avanthika Lakshmanan

Need for a Control Programme Prevalence:

- 1966 - 8.4/ 10,000- 1985 - 12/ 10,000

One of the main causes of crippling & deformities. People not treated in early stage- 25% develop

anaesthesia and/or deformities

National Leprosy Control Programme(1955)

(1980) Govt. decided to “eradicate” leprosy

(1983)National Leprosy Eradication

Programmme

1997 - Modified Leprosy Elimination Campaign (MLEC)

2001 to 04 - SAPEL and LEC

2005 - Urban Leprosy Control Programme

Evolution of NLEP

National Leprosy Control Programme Since 1955, centrally aided To control Leprosy through

Early detection of cases Dapsone monotherapy

Fourth Five year plan- centrally sponsored 1980- ‘Eradicate’ Leprosy ‘Working Group’

Revised strategy based on multi- drug chemotherapy Aimed at Eradication

Eradication was planned through Reduction in the quantum of infection in the population Reduction in the sources Breaking the chain of transmission

National Leprosy Eradication Programme- 1983

National Leprosy Eradication Programme

Goal : Eradicating leprosy by 2000 Aim : to reduce the case load to 1 or less than 1 per

10,000 Revised strategy based on

1. Early detection of cases(population /school surveys, contact examn., voluntary referral)

2. Short term multi drug therapy3. Health Education4. Ulcer and Deformity care5. Rehabilitation

Other activities Endemic districts

-Free domiciliary treatment through specially trained staff Moderate to Low endemic districts

-Mobile treatment units

-Primary health care personnel

Modified Leprosy Elimination Campaign Mid term appraisal of NLEP in 1997 Though progress was satisfactory at

national level, it was uneven in some states MLEC involved

1. Orientation training to health staff

2. Increase public awareness

3. House to House search in endemic districts to detect new leprosy cases throughout the country for 6 days

•Five such campaigns•Fourth campaign- states were divided into 3 categories based on endemicity of leprosy

SAPEL & LEC In addition to regular surveillance activities Rural areas- Special Action Project for

elimination of Leprosy Urban Areas- Leprosy Elimination

Campaigns

1. For early detection and prompt treatment

2. IEC in rural/ tribal/ slum areas

3. 1440 SAPEL/LEC projects – decentralized during 2001-04

World Bank funding in NLEP projects1st Phase - 1993-94 to 2000- Rs. 290 crores (550)- “National Leprosy Elimination project”- Prevalence rate (per 10,000) - 24 3.7- Disability grade 2 and above- 2.7%- MDT coverage- 99.5%

2nd Phase- 2001-02 to 2004- Rs. 166.35 crores (249.8)- MDT drugs free- Rs. 48 crores- Prevalence rate- 2.4- Annual detection rate- 3.3

NLEP is being continued now with Indian Govt. funding from Jan 2005

Additional funding from WHO and ILEP Free MDT drugs- Novartis through WHO

Other Programmes Focused Leprosy Elimination Plan (FLEP) 2005-06

- high priority districts and blocks- Cut off Point:

PR > 5 /10,000 in 2004-05 > 3 / 10,000 in 2005-06

Situational Activity Plan (SAP) in 2007- 19 high priority districts

Block Leprosy Awareness Campaign(BLAC)2007- 275 high priority blocks in 19 states

Urban Leprosy Sensitization and Awareness Campaign

- - 49 urban areas

Urban Leprosy Control Programme Since 2005, Govt. of India funding Population >1 lakh Graded assistance- 4 categories

1. Township

2. Medium Cities-1

3. Medium Cities-2

4. Mega cities

Leprosy Elimination Monitoring (LEM)

- to asses performance of leprosy services

- Drug supply management, IEC etc. With WHO assistance, through NIHFW. 12 priority endemic states

1st Jun ‘02

2ndMay-Jun ’03 (13)

3rd May- Jun ’04

Independent surveys- The Leprosy Mission

NLEP : National Action Plan for ’06-07

Objectives:- To continue the efforts to achieve elimination of Leprosy- To maintain the gains achieved and to continue efforts

at district and block level- To make quality leprosy services available

Strategies:1) Decentralization and institutional development

- services available in all PHCs

- District nucleus to Supervise and monitor

- State leprosy societies merge with state health society

2) Strengthening and integration of service delivery- Diagnosis and treatment- more easily available- Daily outdoor services in PHC/ CHC- Counseling of patient and Family

3) Disability care and prevention- Reconstructive surgery is promoted- Rehabilitation institutions- Supply of MCR footwear- persons affected by Leprosy to receive

Disability certificate to enable them to get the facilities available under schemes of Social welfare department.

4) IEC- Country –wide press advertisement on Anti Leprosy Day i.e. 30th January

- The year 2008-09 was observed as a campaign on the theme “Leprosy Free India”, all over the country

5) Training

Under NRHM

NLEP is horizontally integrated to other services for improved delivery

Conforms to ‘Indian Public Health Standards’ Minimum services

- Diagnosis- Treatment- Management of reactions- Advice on disability

care & prevention

Officials/ Staff attached to District Leprosy Organisation Deputy Director of Medical Services

(Leprosy) Medical Officer- Deputy Director (Leprosy) Health Educator Non Medical Supervisor Physio Technicians Health Inspectors Lab technician

ASHA Involvement 2008-09, ASHAs were involved for suspecting

leprosy cases and after diagnosis, follow up till treatment completion.

Incentive for confirmed leprosy cases out of suspect brought by them (Rs. 100/-) and for completion of treatment in time (PB- Rs. 200/-, MB – Rs. 400/-).

The scheme was initially put on pilot basis in 5 major states of Uttar Pradesh, Bihar, Chhattisgarh, West Bengal and Jharkhand

Research

- Central JALMA institute at Agra- Central Leprosy teaching and Training institute,

Chengalpet- Regional training & research institutes at Aska(orissa),

Raipur( Chattisgarh), and Gouripur(W.B.)

Evaluation To assess the impact of control operations on the

endemicity of disease Two types of indicators:

1. Operational indicators- Monitor the ongoing activities- Related to case finding, treatment, relapses and disability- Eg. : Relapse rate, Case detection ratio, proportion of children/

females/ MB cases

2. Epidemiological indicators- Incidence

- most sensitive index of transmission, the only index to measure the effectiveness of a control programme

- Prevalence- - useful in planning treatment services

New Cases with Grade – II disabilities ( A new Indicator) •XIth Five year plan -“No. of Gr. II disabled cases – 25% reduction by March 2012, taking 2006-07 as the base year”. •Recently WHO has also proposed to introduce this as the key indicator to monitor progress

WHO global strategy (2006-10)

- Sustain leprosy control activities in all endemic countries

- Use Case detection as the Main indicator to monitor progress

- Ensure high quality diagnosis, case management, recording & reporting

- Strengthen routine & referral services- Discontinue campaign approach- Develop tools/ procedures that are home /

community based, locally appropriate – for prevention of disabilities; rehabilitation services

- Promote operational research

Partners

WHO UNICEF SIDA DANIDA Damien Foundation

Anti Leprosy Activities in India Leprosy Mission (W.B.)- founded in 1874 in H.P.

Hind Kusth Nivaran Sangh Gandhiji Memorial Leprosy Foundation,

Sevagram, Wardha The German Leprosy Relief Association Damien Foundation The Danish Save the Child Fund JALMA- taken over by ICMR in 1975

National Leprosy Organisation- 1965

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