National Leprosy Eradication Programme

Milestones in NLEP1955 - Govt. of India launched National Leprosy Control Programme.

1970s - It was only in 1970s that a definite cure was identified in the form of Multi Drug Therapy. However the National programme remained with Dapsone treatment.

1981 - Govt. of India established a high power committee under chairmanship of Dr. M.S. Swaminathan in 1981 for dealing with the problem of leprosy.

1982 - The MDT came into use from 1982, following the recommendation by the WHO Study Group, Geneva in October 1981.

1983 - Based on its recommendations of the Swaminathan Committee, the National Leprosy Eradication Programme (NLEP) was launched in 1983 with the objective to arrest the disease activity in all the known cases of leprosy.

Milestones in NLEP (Continue)

1991 - At this stage in view of substantial progress achieved with MDT, in 1991 the World Health Assembly resolved to eliminate leprosy at a global level by the year 2000.

1993-2000- The 1st phase of the World Bank supported National Leprosy elimination Project was implemented successfully.

1998-2004- The National Leprosy Eradication Programme introduced the modified Leprosy Elimination Campaign activities in the year 1997-98. Five such campaigns were conducted up to the year 2004.

2001-2004- The 2nd phase of the World Bank supported National Leprosy elimination Project was started from 2001 and completed in December 2004.

2005 - India achieved elimination of Leprosy as a Public Health Program at National Level.

Background

•Govt. of India started National Leprosy Control Programme in 1955.•It was based on Dapsone domiciliary treatment through vertical units implementing survey education and treatment activities.• In 1970s a definite cure was identified in the form of Multi Drug Therapy.• The MDT came into wide use from 1982.• NLEP was launched in 1983 with the objective to arrest the disease activity in all the known cases of leprosy.

The 1st Phase of the World Bank supported National Leprosy Elimination Project started from 1993-94 and completed on 31.3.2000.This Project involved a cost of Rs. 550 crores of which World Bank loan was Rs. 292 crores.During this phase, the prevalence rate reduced from 24/10,000 population in 1992 before starting 1st Phase project to 3.7/10,000 by March 2001.The 2nd Phase of World Bank Project on NLEP started for a period of 3 years from 2001-02.The project involve a cost of Rs. 249.8 crore including World Bank loan of Rs. 166.35 Crore and WHO to provide MDT drugs free of cost worth Rs. 48.00 crore.The project successfully ended on 31st Dec. 2004.

Strategy - Leprosy Elimination in IndiaDecentralized integrated leprosy services through General Health

Care system.

Early detection & complete treatment of new leprosy cases.

Carrying out house hold contact survey in detection of

Multibacillary (MB) & child cases.

Early diagnosis & prompt MDT, through routine and special efforts

Strategy - Leprosy Elimination in India (Continue)

Involvement of Accredited Social Health Activists (ASHAs) in the detection & complete treatment of Leprosy cases for leprosy workStrengthening of Disability Prevention & Medical Rehabilitation (DPMR) services.Information, Education & Communication (IEC) activities in the community to improve self reporting to Primary Health Centre (PHC) and reduction of stigma.Intensive monitoring and supervision at Primary Health Centre/Community Health Centre.

Institutions

Four premier Leprosy Institutes are working under Directorate General of Health Services, Ministry of Health & F.W., Government of India are involved in research (basic and applied ) in Leprosy and Training of different categories of staff involved for Leprosy elimination.

A. CENTRAL LEPROSY TEACHNING & RESEARCH INSTITUTE (CLTRI) CHENGALPATTU (TAMILNADU)

B. REGIONAL LEPROSY TRAINING & RESEARCH INSTITUE (RLTRI) RAIPUR (CHHATTISGARGH)

C. REGIONAL LEPROSY TRANING & RESEARCH INSTITUTE(RLTRI) ASKA (ORISSA)

D. REGIONAL LEPROSY TRAINING & RESEARCH INSTITUTE RLTRI, GOURIPUR, BANKURA (WEST BENGAL)

DISABILITY PREVENTION & MEDICAL REHABILITATION

Objectives a. Elimination of leprosy i.e. prevalence of less than 1 case per

10,000 population in all districts of the country.

b. Strengthen Disability Prevention & Medical Rehabilitation of

persons affected by leprosy.

c. Reduction in the level of stigma associated with leprosy

Targets

PROGRAMME STRATEGY•Integrated leprosy services through General Health Care system.

•Early detection & complete treatment of new leprosy cases.

•Carrying out house hold contact survey for early detection of cases.

•Involvement of Accredited Social Health Activist (ASHA) in the detection & completion of treatment of Leprosy cases on time.

•Strengthening of Disability Prevention & Medical Rehabilitation (DPMR) services.

•Information, Education & Communication (IEC) activities in the community to improve self-reporting to Primary Health Centre (PHC) and reduction of stigma.

•Intensive monitoring and supervision at block Primary Health Centre/Community Health Centre.

Case Detection and Management

(i) To improve access to services. (ii) To involve women including leprosy affected persons in case detection. (iii) To organize skin camps for detecting leprosy patients while providing services for other skin conditions. (iv)To undertake contact survey to identify the source in the neighbourhood of each child or M.B. case. (v) To increase awareness through the ANM, AWW, ASHA and other Health Workers visiting the villages & people affected by leprosy, to suspect and motivate leprosy affected persons for early reporting to the Medical Officer.

Services in urban areas (i) Identify human resources available with Govt., Civil societies, NGOs and Private Medical Practitioners for leprosy services like suspect and referral. Population groups may be allocated to each human resource, and for follow up of the cases.

(ii) Build capacity of the identified human resources at the time of induction and periodically. (iii) Examination of all household contacts of all new cases at least once before the completion of treatment of index case.

(iv) Identify one referral centre in each urban location for diagnosis and to manage leprosy with or without complications.

(v) Supervision and monitoring of the programme is the responsibility of the District Leprosy Officer, and Medical Officer of the referral centre.

Services in urban areas ( Continue)

(vi) Mobile Health Clinics of General Health services include leprosy services on their visit to slums, peri urban villages and migrant agglomerations. (vii) Develop a system of record keeping and reporting by each participating Centre.

(viii) Develop a system of regular MDT supply to each Health Centre. (ix) Procure additional requirement of drugs, dressing material, aids and appliances for inhabitants of leprosy colony requiring regular care for their disabilities.

(x) Organise sensitization meetings for IEC and advocacy, participate in exhibitions, quiz competition for awareness to reduce stigma.

ASHA Involvement

The ASHA will be entitled to receive incentive as below

(i) At confirmation of diagnosis – Rs. 250/- (ii)On completion of full course of treatment in time – PB - additional Rs.400/

MB - additional Rs.600/-

Activities to be performed by ASHAs

(i) Search for suspected cases of leprosy i.e. before any sign of disability appears. Such early detection will help in prevention of disability and also cut down transmission potential.

(ii)Follow up all cases for completion of treatment in scheduled time. During follow up visit also look for symptoms of any reaction due to leprosy and refer them to the Health Workers/PHC for treatment. This will again reduce chances of disability occurring in cases under treatment.

(iii) Advise and motivate self-care practices by disabled cases for proper care of their hands and feet during the follow up period. This will improve quality of life of the affected persons and prevent deterioration of disabilities.

(iv) Spreading awareness.

Information, Education and Communication (IEC/BCC)To develop communication material vis-à-vis the target audiences and deliver effectively.To complement and support the detection and treatment services being provided free of cost through the General Health Care System.To remove stigma associated with leprosy and prevent discrimination against leprosy affected persons.To specifically cover beneficiaries, health providers, influencers and the masses.