National Leprosy Eradication Programme

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20 May 2024

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National Leprosy Eradication Programme

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Introduction

Since the inception of National Leprosy Eradication

Programme (NLEP) in the year 1983 spectacular
success have been made in reducing the burden of
Leprosy. The country achieved the goal of leprosy
elimination as a public health problem. i.e.
prevalence rate (PR) of less than 1 case / 10,000
population at National level by December 2005, as
set by National Health Policy 2002. Although
prevalence has come down at national and state
level, new cases are being continuously detected and
these cases will have to be provided quality leprosy
services through GHC system.

Leprosy is probably the oldest disease afflicting the

mankind. Possibly it was originated in Africa and
spread very early to India and from there to China.
There are references in Buddhist literature. In Vedic
reference it is mentioned as "Kushth Rog". It has the
maximum social stigma attached to it. A common
belief that leprosy is due to past sins committed by
the person. There is a belief that leprosy is hereditary
and incurable. There are many misconceptions about
disease that causes social aversion and ostracism
against leprosy patients leading to the high
deformity. But due to scientific inventions leprosy
has been identified a disease that can be eradicated.
Hansen of Norway during 873 discovered leprae
bacilli, therefore the disease is also known as
Hansen's disease. Sulfone drug, e.g. Dapsone was
discovered in 1943 for the treatment of leprosy. With
the introduction of Multi-Drug Treatment (MDT)
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during 1981 this disease is very well under control

and may be eradicated.
The establishment of the Indian Council of the British
Empire Leprosy Relief Associated in 1925 (Renamed
as Hind Kushth Nivaran Sangh in 1947) laid the
foundation of organised leprosy work in India. The
availability of Dapsone monotherapy for leprosy laid
the foundation of National Leprosy Control
Programme in 1955 with the main objective of
controlling leprosy through domiciliary treatment
with Dapsone. Social obstacles, non-availability of
drugs, lack of primary prevention (vaccination) and
leprae resistance to Dapsone caused programme
failure. In 1981, Govt. of India asked the Indian
Scientists to develop a leprosy eradication strategy
and subsequently launched the National Leprosy
Eradication Programme (NLEP) in the year 1983 with
the objective to eliminate leprosy as a public health
problem by the year 2000 AD. Later WHO in 1991
adopted a resolution calling for elimination of leprosy
as a public health problem by the year 2000 AD
(reducing prevalence to less than one case per
10,000 population).

Prevalence Rate (PR) is 3.74/10,000 population

(March 2001) which was 57/10,000 in 1981.
Elimination level <1/10,000) achieved in 13 states. 4
State close to achieve elimination. Leprosy is
endemic mainly in states of Bihar, Jharkhand,
Chattisgarh, U.P., West Bengal, Orissa and M.P.

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XII th Plan 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.

Background:

The National Leprosy Control Programme was

launched by the Govt. of India in 1955. Multi Drug
Therapy came into wide use from 1982 and the
National Leprosy Eradication Programme was
introduced in 1983. Since then, remarkable progress
has been achieved in reducing the disease burden.
India achieved the goal set by the National Health
Policy, 2002 of elimination of leprosy as a public
health problem, defined as less than 1 case per
10,000 population, at the National level in December
2005.
Following are the programme components :
 Case Detection and Management
 Disability Prevention and Medical Rehabilitation
 Information, Education and Communication (IEC)
including Behaviour Change Communication
(BCC)
 Human Resource and Capacity building
 Programme Management

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Activities under NLEP:

 Diagnosis and treatment of leprosy- Services for

diagnosis and treatment (Multi drug therapy) are
provided by all primary health centres and govt.
dispensaries throughout the country free of cost.
Difficult to diagnose and complicated cases and
cases requiring reconstructive surgery are
referred to district hospital for further
management.
 Training- Training of general health staff like
medical officer, health workers, health
supervisors, laboratory technicians and ASHAs are
conducted every year to develop adequate skill in
diagnosis and management of leprosy
cases.
 Urban leprosy control- To address the complex
problems in urban areas, the Urban Leprosy
control activities are being implemented in urban
areas having population size of more than 1 lakh.
These activities include MDT delivery services &
follow up of patient for treatment completion,
providing supportive medicines & dressing
material and monitoring & supervision.
 IEC- Intensive IEC activities are conducted for
awareness generation and particularly reduction
of stigma and discrimination against leprosy
affected persons. These activities are carried
through mass media, outdoor media, rural media
and advocacy meetings. More focus is given on
inter personnel communication.
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 NGO services under SET scheme- Presently, 43

NGOs are getting grants from Govt. of India under
Survey, Education and Treatment (SET) scheme.
The various activities undertaken by the NGOs
are, IEC, Prevention of Impairments and
Deformities, Case Detection and MDT Delivery.
From financial year 2006 onwards, Grant-in-aid is
being disbursed to NGO through State Health
(Leprosy) Societies.
 Disability Prevention and Medical Rehabilitation –
For prevention of disability among persons with
insensitive hands and feet, they are given
dressing material, supportive medicines and
micro-cellular rubber (MCR) footwear. The patients
are also empowered with self-care procedure for
taking care of themselves. More emphasis is being
given on correction of disability in leprosy affected
persons through reconstructive surgery (RCS). To
strengthen RCS services, GOI has recognized 112
institutions for conducting RCS based on the
recommendations of the state government. Out of
these, 60 are Govt. institutions and 52 are NGO
institutions.
 Special Activity in High Endemic Distt.- 209
Districts had reported ANCDR (Annual New Case
Detection Rate) more than 10 per lakh population.
Special activity for early detection and complete
treatment, Capacity building and extensive IEC,
Adequate availability of MDT, Strengthening of
distt. nucleus, Regular monitoring & supervision
and review, Regular follow up for neuritis and
reaction, Self care practices, Supply of MCR

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footwear in adequate quantity and Improvement

in RCS performance through camp approach are
planned in the above districts to reduce the
disease burden.
 Supervision and Monitoring –Programme is being
monitored at different level through analysis of
monthly progress reports, through field visits by
the supervisory officers and programme review
meetings held at central, state and district level.
For better epidemiological analysis of the disease
situation, emphasis is given to assessment of New
Case Detection and Treatment Completion Rate
and proportion of grade II disability among new
cases. Visit by Joint monitoring Teams with
members from GOI, ILEP and WHO has been
initiated from the year 2012-13 and to be
continued annually.

Initiatives:

i. Involvement of ASHA– A scheme to involve

ASHAs was drawn up to bring out leprosy cases
from their villages for diagnosis at PHC and follow
up cases for treatment completion. To facilitate
involvement, they are being paid an incentive as
below:
o On confirmed diagnosis of case brought by them –
Rs. 250/-
o On completion of full course of treatment of the
case within specified time – Pauci bacillary (PB)
leprosy case – Rs. 400/- and Multibacillary (MB)
Leprosy case – Rs. 600/-.The scheme has been

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extended to involve any other person who brings

in or reports a new case of leprosy.
o An early case before onset of any visible deformity
– Rs 250
o A new case with visible deformity in hands, feet or
eye – Rs 200
ii. E Newsletter- is a Quarterly publication from the
house of CLD. NLEP Newsletter will share
guidelines, feedback/best practices, experiences
and activities undertaken in the programme in
coordination with partner/
States/NGOs/Institutes/Medical Colleges &
Associations etc. Newsletter will serve as one of
the important tools for communication to keep
inform, update and educate our stakeholders as
well as target groups. This will be a platform for
States/UTs/NGOs/A PAL to join their hands and
share relevant articles which will be a source of
inspiration for readers.

ii. In order to detect the hidden leprosy

cases, Leprosy Case Detection Campaigns
(LCDC), a unique initiative of its kind under NLEP,
is being implemented in high endemic districts of
the country, in line with Pulse polio Campaign by
Central Leprosy Division. In this campaign each
and every person in a house in the selected high
endemic districts will be examined to detect all
hidden cases in the community. This will interrupt
the transmission of the disease in the community,
and expedite achievement of elimination status at
district and sub-district level. The important

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activities under LCDC are micro planning,

selection of male volunteer for house to house
search teams, training of field level staff and
intensive IEC activities. All activities related to
LCDC will be monitored by CLD and coordinated
by States through various subcommittees formed
at State and District level. The first LCDC is
planned to be conducted in 50 selected high
endemic districts of 7 States namely, Bihar,
Chhattisgarh, Jharkhand, Madhya Pradesh,
Maharashtra, Odisha and Uttar Pradesh, in March
2016.

iii. In order to strengthen planning, implementation

and monitoring of activities in Central Leprosy
Division , GIS Mapping has been initiated . GIS
mapping was used in analysis of annual data
received from states and UTs for the financial year
2014-15. Preparing GIS maps enabled
visualization of district wise data pertaining to
annual new case detection rate and prevalence of
the disease spatially which was previously done
manually. Pinpointing of high endemic districts in
a color coded fashion helped us in micro planning
for the special campaign in 50 high endemic
districts across seven states

Q:

Describe National Leprosy Eradication Programme

National Leprosy Eradication Programme 9