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National Leprosy Eradication Programme
The National Leprosy Eradication Program in India has achieved major milestones since its inception in 1955. Through strategies like introducing multi-drug therapy in 1983 and nationwide campaigns, prevalence rates have declined from over 20 per 10,000 people in the early 1990s to less than 1 per 10,000 in 2005, allowing India to achieve the goal of eliminating leprosy at the national level. Ongoing challenges include preventing disability through early detection, reducing stigma, ensuring treatment adherence, and sustaining control efforts. International support from organizations like WHO and NGOs continues to aid India's leprosy elimination efforts through technical guidance and resource provision.
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National Leprosy Eradication Programme
- 1. National Leprosy EradicationProgram
- 2. Contents • Milestones • Updatesand innovations • Strategies • Lessons learnt • Drawbacks • Challenges
- 4. • Centrally sponsoredHealth Scheme MoH&FW Govt. of India • Headed by the Deputy Director of Health Services (Leprosy ) under the DGHS • Supported as Partners by the WHO, ILEP and few NGO’s
- 5. Chaulmoogra tree, oil Untillate 1940 leprosy was treated by injecting chaulmoogra oil in skin
- 6. Early 20 thCentury • 1941: Promine a sulfone drug used for treatment • 1950s: Dapsone, pioneered by Dr. R. G. Cohrane at Carville • 1983: MDT introduced by WHO
- 7. MILESTONES in NLEPin India 1955 Govt. of India launched National Leprosy Control Programme 1970s Definite cure through MDT was identified 1981 WHO study group recommended use of MDT 1983 Govt. of India launched NLEP and introduced MDT 1991 WHO declaration to eliminate leprosy global level by 2000. 1993 - 2000 – World Bank supported NLEP – I The prevalence rate <<< 24/10,000 (1992) to 3.7/10,000 (2001)
- 8. 2001 - 2004– World Bank supported NLEP – II 2005 Elimination of Leprosy at National Level (Dec.2005) 2005 NRHM covers NLEP 2006 Focused leprosy elimination plan (FLEP) 2007 Situational activity plan(SAP) 2007 Block leprosy awareness campaign (BLAC) WHO provided MDT drugs free of cost worth Rs. 48.00 cr. < 1/10,000
- 9. Special efforts forleprosy case detection & prompt MDT • SAPEL – Special Action Project for Elimination of Leprosy (2001-04) • LEC – Leprosy Elimination Campaign For early case detection Mainly in difficult and inaccessible rural/tribal areas & slums
- 10. • MLEC –Modified Leprosy Elimination Campaign • Five such nation wide campaigns • Carried out during 1997-98 to 2003-05 • Helped in bringing out 9.9 lakh new cases under treatment in a short span of time
- 11. • As aresult of the hard work the country achieved the goal of elimination of leprosy to less than 1 case per 10,000 population December, 2005 • As on 31st December 2005, Prevalence Rate recorded in the country was 0.95/10,000 population
- 12. CHENNAI Total Population: 78,32,273 Prevalencerate: 0.29 ANCDR/1,00,000: 4.32 MB Rate : 61.70 Child rate: 20.57 Deformity rate: 1.15 Female rate: 36.17 0.39
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- 14. Staff attached toDistrict Leprosy Organization • Deputy Director of Medical Services (Leprosy) • Medical Officer- Deputy Director (Leprosy) • Health Educator • Non Medical Supervisor • Physio Technicians • Health Inspectors • Lab technician
- 15. Clinico-epidemiological factors leadingto Multi Case Family (MCF) in the surveyed village in village Salaunikhurd in Balodabazar district of Chhattisgarh 1. Delay in detection 2. The patient related (patient hoped that it will be cured on its own) 3. Health system delay can be attributed to the lack of interest and involvement of ASHA of the village 4. Nature of disease spectrum: De-Novo MB spectrum of cases
- 17. Stigma • Felt stigma(Guilt or self-blame related to the stigmatized ) • Enacted stigma (e.g. divorce, denying someone access to public transport) • Institutional stigma (e.g. separate clinic arrangements for people affected by leprosy, buildings without elevators, sidewalks without ramps)
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- 19. Three pronged strategyfor early case detection I. Leprosy Case Detection Campaign (LCDC) specific for high endemic districts II. Focussed Leprosy Campaign (FLC) in hot spots of non LCDC districts III. Special plan for case detection in hard to reach areas
- 20. Other major innovationsintroduced were • Sparsh Leprosy Awareness Campaign • Post Exposure Prophylaxis (PEP) specific to LCDC districts • Grade II disability case investigation • Launch of Nikushth online reporting system with Patient tracking mechanism • ASHA based Surveillance for Leprosy Suspects (ABSULS) for enhanced early case reporting in routine.
- 21. Mycobacterium Indicus Pranii(MIP) • An exclusive vaccine for leprosy, developed in India • The protective efficacy of MIP was • 68.6% at the end of 1st year, • 59% at the end of 2nd year • 39.3% at the end of third follow up survey. • The effect of vaccine is 7-8 years.
- 22. • MIP Vaccinein new PB patients and patients already taking treatment should be 2 doses, 6 months apart. • In new MB cases, the dosage schedule of MIP Vaccine should be 3 doses, 0, 6 and 12 months after initiation of therapy. • The dosage of MIP will be same in all age groups. • Booster will be given at the time of follow up after 4-5 years.
- 23. SPARSH- Monthly activityschedule Sep 2018- October 2019 • Leprosy Case Detection Campaign (LCDC): LCDC to be conducted twice in 251 districts identified on the basis of Grade II disability (G2D) rate >3%.
- 24. Focussed Leprosy Campaign(FLC) • Routine FLC in non LCDC districts against each grade II disability case detected within 15 days of detection • Clearance of back log of FLCs, if any
- 25. Self-care kits distribution •Identification and line listing of the PAL needing self-care kits (assessment through review of last 5 years Patient’s cards of Persons Affected by Leprosy (PAL) having grade I & II disability (over Hands and Feet)
- 26. MCR footwear distribution •Identification and line listing of the PAL requiring MCR footwear • Distribution of MCR footwear through existing system and work on Health & Wellness centre involvement for distribution of same
- 27. Re-constructive Surgeries • Anincentive of Rs 8000/- will be paid to all patients affected by leprosy undergoing RCS. • Processing of proposal for inclusion of RCS under tertiary care provisions of Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (PMJAY)
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- 30. SET scheme (Survey, educationand treatment) • Disability prevention and ulcer care • IEC • Referral for RCS • Research • Rehabilitation
- 31. Strategies a) Decentralization ofNLEP to States & Districts b) Early detection and complete treatment of new leprosy cases c) Carrying out house hold contact survey (MB, child cases) d) Involvement of ASHAs in the detection & complete treatment e) Intensified IEC using Local and Mass Media approaches f) Disability Prevention & Medical Rehabilitation (DPMR) g) Monitoring & Evaluation – Regular - Monthly Reports – Special Efforts - Independent Evaluation - Leprosy Elimination Monitoring (LEM) D
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- 34. National sample survey • Bynational JALMA institute Agra • Started in 2010. • House to house survey to access burden of active leprosy cases, leprosy persons with grade 1 & 2 disability and magnitude of stigma and discrimination in society.
- 35. Involvement of ASHAs • Incentivesprovided for ASHAs for bringing out cases from their villages • Rs 250 for confirmed diagnosis of cases • On completion of treatment within specified time Rs 400 for PB & Rs 600 for MB.
- 36. Involvement of NGOs •Help reduce burden of leprosy • Serve in remote, inaccessible, uncovered, urban slums, industrial/labour populations and other marginalised population groups
- 37. Information education communication • IEC helpreduction of stigma & discrimination against leprosy affected persons. • Carried out through mass media, out door media, rural media & advocatory meetings. • More focus on inter personal communication.
- 40. • Intensive survey(100% slum population covered) • Skin camps: 5 per zone • School survey: 1str to 8th std children screened, 9th to 12th std - IEC
- 41. Disability prevention and medicalrehabilitation • Inform patients (specially MB) about common s/s of reactions • Ask them to come to centre (as soon as possible) • Start treatment for reaction • Inform them how to protect insensitive hands/ feet eyes • Involve family members • Patients provided with dressing materials, supportive medicines & MCR footwear • Correction of disability through reconstructive surgery
- 42. Training • Training toMedical officers, health workers, lab technicians, ASHAs conducted every year • Training of state & district Leprosy officers organized at Schieffline institute of health research & leprosy centre Vellore, TN and RLTRI Raipur
- 43. Monitoring & Supervision •By analysis of monthly progress reports • Through field visits by supervisory officers • Programme review meetings held at central, State & District levels.
- 44. • PRIMARY INDICATOR: -Annual New Case Detection Rate (ANCDR) - Treatment Completion Rate (cohort analysis) • INDICATORS FOR CASE DETECTION: - Proportion of new cases with Gr II disability - Proportion of child cases(<15yrs) among new cases - Proportion of MB cases among new cases - Proportion of Female cases among new cases • INDICATORS FOR QUALITY OF SERVICE: - Proportion of new cases correctly diagnosed. - Proportion of defaulters. - Number of relapses during a year. - Proportion of cases with new disabilities. Monitoring & evaluation
- 45. Budget and internationalsupport • Since 2005, the program is being conducted with Govt. of India funds with technical support from WHO & International federation of anti leprosy association(ILEP)
- 46. Anti Leprosy Activitiesin India • Leprosy Mission - founded in 1874 in H.P. • Hind Kush 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 (Japanese leprosy mission for Asia) • National Leprosy Organisation- 1965
- 48. Lessons learned fromNLEP 1. Strong Political commitment 2. Special programme for important health problems offer the advantages of attracting both resources and community support 3. Providing community wide services, reaching the most unreachable 4. Intensified supervision and Monitoring
- 49. 5. Quality controlthrough quality of service indicators. 6. Involvement of NGO’s to support the program.
- 50. Drawbacks • Social Stigma –Even in the present time people with leprosy have to leave their villages or socially isolated. • Leprosy Legislation – Certain legislation still exists that construct leprosy as highly contagious disease. – Eg: Hindu Marriage Act 1955 – Leprosy patients cannot contest a civic election or hold a municipal office.
- 51. • Resistant toleprosy drug: – Resistance to MDT could be a problem. – New alternative regimen is lacking presently • Transmission of infection: – elimination campaign is actually a control strategy. – It may come to the same level as it was before if control measures are relaxed.
- 52. 6) Elimination criteria: –Duration of infection, treatment duration, mortality rate would be affecting prevalence rate
- 53. Challenges in “goingthe last mile” – The level of international attention and political commitment is declining – Knowledge about diagnosis and treatment is decreasing in many countries. – While leprosy cases have decreased significantly from 1984 to 2004 (see figure 1), a stagnation has occurred from 2005 onwards.
- 55. GLOBAL LEPROSY STARTEGY(2016-2020) Accelerating towards a leprosy-free world
- 56. 3 Pillars a) StrengthenGovt ownership, Coordination and partnership b) Stop leprosy and its complications c) Stop discriminating and promote inclusion
- 57. 3 Targets a) Zerograde 2 disability among children diagnosed with leprosy b) The reduction of new leprosy cases with G2D to < 1 case per million population c) Early detection and complete treatment with MDT remains the fundamental principle of leprosy control
- 58. References • http://www.who.int/lep/en/ 09/05/2019,14.00hrs • http://www.who.int/mediacentre/factsheets/fs101/en/ 08/05/2019, 16.30 hrs • Text book of public health and community medicine. 1st ed. Pune (India). Dept. of Community Medicine AFMC; 2009 • J Kishore. National Health Programs of India. 10th ed. Century Publication. New Delhi. 2012 • Park.K. Text Book of Preventive and Social Medicine.25td ed. Jabalpur: M/S. Banarasidas Bhonot Publishers;2013.P.60