NATIONAL LEPROSY

ERADICATION
PROGRAM

Dr. Rajesh Kumar Konduru

Professor
Department of Community Medicine.
 Introduction
 Oldest disease affecting the
mankind.
 Maximum social stigma attached to
it.
 In vedic reference it is mentioned as
‘kustha Rog’.
 There is a belief that leprosy is a
hereditary disease and incurable.
 Introduction
 Hansen of Norway during 1873
discovered Laprae bacilli, therefore
the disease is known as Hansen ‘s
disease.
 Dapsone was discovered in 1943.
 Introduction
 Introduction of MDT during 1981 this
disease is very well under control
and may be eradicated.

 At the global level ,the leprosy

elimination program is a success
story.
 Introduction
 Last 15-20 years, the Global leprosy
caseload has decreased from more
than 10 million to about 0.5 million.

 113 countries had attained the

leprosy elimination Goal by
December 2003.
 Milestones of Leprosy Eradication
 1955-NLCP

 1983-NLEP (MDT started)

 1991-World Health Assembly

resolution to eradicate leprosy by
2000AD.
 Milestones of Leprosy Eradication
 1993-World Bank Supported the MDT
program phase –I

 1997-Mid term appraisal

 1998 to 2004- Modified Leprosy

Elimination campaign.
 Milestones of Leprosy Eradication
 2001 to 2004- NLEP project phase II

 2002- Simplified information system.

 2005-National Wide Evaluation of

Project II
 Milestones of Leprosy Eradication
 2005, Dec –Prevalence Rate
0.95/10,000 and Govt. declared
achievement of elimination target.

 2005-NRHM covers NLEP.

 National Leprosy Control
Program (NLCP)
 Launched in 1955.
 Objective –controlling leprosy
through domiciliary treatment with
Dapsone.
 Causes of failure
 social obstacles,
 Non availability of the drugs.
 Lack of primary prevention.
 National Leprosy Elimination
Program (NLEP)
 Launched in 1983.
 NLEP is based on a revised strategy---
MULTI DRUG CHEMOTHERAPY
 Objective –to eliminate leprosy as a
public health problem by the year
2000AD.
 To reduce the case load to 1 or less
than 1 case per 10,000 population
 NLEP
 The program was initially taken up in
endemic districts and was extended
to all districts from 1993-94 with
world bank assistance.

 NRHM seeks to provide effective

health care ,which have weak public
health indicators.
 NLEP
 The minimum service available at
CHC-
 diagnosis of leprosy
 Treatment of the cases
 Management of the reaction
 Prevention of disability care.
 Major Initiatives
1. More focus on new case detection
2. Treatment completion rate (ensure
treatment completion)
3. More emphasis on Disability
Limitation and Rehabilitation—
4. Dressing materials, dressing kits and other supportive
medicines.
5. Provision of Microcellular rubber footwear (MCR footwear)
6. An amount of Rs.5000.00 to be provided to leprosy
affected persons below poverty line
7. Support of Rs.5000/- to PMR centers and hospitals for
each reconstructive surgery
 Major Initiatives Cont…..

 Mobilisation of Acreddited Social Health Activists

(ASHAs) for diagnosis and treatment of cases:
a. On confirmation of diagnosis– Rs.250/-
b. An early case before the onset of physical
deformity– Rs.250/-
c. Completion of treatment. For PB—Rs.400/- and
for MB– Rs.600/-

a. Establishment of self sustaining leprosy colonies

b. Intensive campaign with the theme, “ Towards

Leprosy free India”.
 National Health Policy 2002
 Goal is to ‘Eliminate Leprosy by
2005’
 Project phase II 2001 Onward
 Part A--National plan setting out the
project design for the country.

 Part B—Plan for 8 high endemic

states.

 Part C—Plan for the remaining 27

states and union territories.
 Urban Leprosy Control Programme
 Initiated in 2005

 To address the complex problem of larger population

size, migration, poor health infrastructure and
increasing leprosy cases.

 Under this component, assistance would be given to

areas with population more than 1 lakh.

 For providing good assistance, the urban areas are

divided into 4 categories—
Township, Medium cities 1, Medium cities 2 and Mega
cities
 Disability Prevention and
Medical Rehabilitation (DPMR)
 Main activities are—
1. Treatment of leprosy reaction
2. Treatment of ulcers
3. Reconstructive surgeries
4. Providing MCR footwear
5. Integration of DPMR activities with various other
departments under other ministries
6. To develop a referral system to provide
prevention of disability services in an integrated
set-up.
 Disability Prevention and
Medical Rehabilitation (DPMR)
 The tertiary level institutions involved actively in
DPMR activities are—
 Central Government Institutions like
CLTRI,Chengalpattu and RLTRI at
Aska/Gauripur/Raipur

 ICMR Institute JALMA<Agra

 ILEP Supported Leprosy Hospitals

 All PMR departments of medical colleges

 Components
 Decentralization and Institutional
Development.

 Strengthening and Integration of

service Delivery.

 Disability care ,prevention,

rehabilitation
 Components
 Information ,Education,
Communication (IEC)

 Training of staff of General Health

Services.
 Monitoring and Evaluation
 Simplified Information System
[SIS-2002] is used in which monthly
and annual reports are prepared.
 Simplified Information System
(2002)
 Indicators -
 prevalence rate of leprosy,
 New case detection rate
 Child proportion among new cases
 Female proportion among new cases
 Visible Deformed case proportion
among new cases etc.
 Involvement of NGOS
 290 NGOs working in the field of
leprosy throughout the country.

 54 NGOs are getting grant in aid

from Government of India for survey
Education treatment in leprosy.
 Involvement of NGOS
 Aim-
 Reducing the prevalence of leprosy.
 Providing facilities for Hospitalization
and Disability and Ulcer care.
 Conducting reconstruction surgeries
 Supply of a pair of MCR chappal.
 Involvement of WHO and Other
Agencies
 Providing anti leprosy drugs,
monitoring ,Capacity building etc.

 Providing state NLEP coordinators in

11 states.
•
 Zonal NLEP coordinators in the high
endemic states of Bihar ,UP, Orissa.
 Involvement of WHO and Other
Agencies
 There is strong support of
International Federation of Anti
Leprosy Association (ILEP) .

 WHO,ILEP which involves 8 agencies.

 Prophylaxis against Leprosy
 BCG gives variable efficacy against
Leprosy, ranging from 34%-80%.

 BCG induced 50% protective efficacy

against clinical Leprosy.

 Re-immunization with BCG increased

the protective effect by a further
50%.
 Achievement of program
 31st Dec 2005,record comes down to
1.07 lakh giving PR of 0.95/10000
population.

 Less than 1/10000 is considered as

the level of elimination as a public
health problem.
 Eleventh Plan
 The Government of India proposes to
carry on the leprosy program with
the same intensity to further reduce
the leprosy burden in 11th plan.

 The GOAL is to achieve PR <1 per

10000 population in all states and
UTs.
 Focus for program in Future
 PR on 31st March 2006 was
0.84/10000 at National level.

 Sustained activity plan -06 was

approved by ministry to cover 29
districts and 433 blocks as priority
areas.
 Global Leprosy Elimination
Program
 Revised Intensified Strategy 2000-05 for leprosy
elimination were Modified Leprosy Elimination
Campaign (MLEC) and Special Action Projects for
Elimination of Leprosy (SAPEL).

 Elements of the Intensified program are:

 Identification of endemic districts
 Integration of MDT services
 Global Leprosy Elimination
Program
 Monitoring and elimination at
districts level
 Promoting community action
 Social marketing /advocacy
 Remotivating the research
community
 Prevention of disability and
rehabilitation.
Declaration against Stigma and
Discrimination 2006
• In a joint Declaration on the 27th Jan
2006 in New Delhi all the world leaders
appeal global people to end stigma and
Discrimination against people affected
by leprosy.
 Initiative in the NLEP of India
 Modified MDT management

 Deformity management and medical

Rehabilitation

 Sustained Action Plan

 Modified MDT management

 The Government of India has

initiated
 Based on the requisition as per the
no of patient detected in the each
PHC.
 Suggested by WHO
 Started experimentally in Orissa and
Kerala.
Thank you