National Leprosy Eradication

Programme

✓ The NLEP Emblem symbolizes beauty and purity in lotus.

✓ It captures the spirit of hope positive action in the eradication
of Leprosy.

Dr. A. Revanth Kumar

Associate Professor
Community Medicine
SIMS, Hapur
 ✓ Anti Leprosy Day : is celebrated every
year, all over the India on 30th January
(Martyrdom Day of Mahatma Gandhi)

Gandhi nurses Parchure Shastri, a sanskrit scholar afflicted by leprosy, at Sabarmati Ashram, 1940
 Overview of the presentation
✓ Introduction ✓ Disability & its management
✓ History ✓ IEC
✓ Evolution ✓ Monitoring & evaluation
✓ Milestones ✓ Urban leprosy eradication
✓ Burden in India ✓ programme
✓ Objectives & components ✓ Involvement of NGOs
✓ Elimination strategy ✓ SWOT analysis
✓ Diagnosis of leprosy ✓ References
✓ Management of leprosy
✓ Lepra reaction & its management
 Hansen’s disease
❖Chronic infectious disease - Mycobacterium leprae.

Skin
Affects Nerves
Other organs

❖Long incubation period generally 3-5 years.

❖Leading cause of permanent physical disability.
THE "SOCIAL DEATH"

Historically, patients were ostracized, forced to carry bells, and

isolated in "Leper Colonies".

This deep-rooted fear persists as Stigma, which remains the

biggest barrier to eradication today.

THE BREAKTHROUGH (1873)

Gerhard Armauer Hansen (Norwegian physician) identified Mycobacterium
leprae under a microscope. It was the first bacterium identified as causing
disease in humans, debunking the theory that leprosy was hereditary or a
curse.
 History
• Word leper - a Greek word “scaly”

• Oldest disease known to mankind, mentioned in ancient texts (Sushruta Samhita, Bible)
as Kushtha Rog - attributed to punishment or curse from God

• Earliest records are from Egypt – Papyrus document written around 1550 B.C.

• Around 600 B.C. Indian writings describe a disease that resembles leprosy

• In China and India the 1st records, sixth century BC.

• In India, leprosy was 1st described in the Susruth Samhita and treatment with
‘chaulmoogra’ oil.

• Clay statues of leprosy patients Mesopotamia, 400 BC.

 Milestones
YEAR Milestones

1873 Dr. Gerhard Armauer Hansen– Discoverd M. leprae

1940s “Dapsone” was discovered

1955 National Leprosy Control Programme (NLCP) - launched
1983 National Leprosy Eradication Programme – launched (Multidrug therapy in Phases)

1991 World Health Assembly resolution to eradicate leprosy by 2000

1993 World bank supported the MDT programme, NLEP phase I

1998 - 2004 Modified Leprosy Elimination Campaign

2001 - 2004 NLEP project phase II

2005 Dec PR – 0.95/10,000 & govt declared achievement of elimination target

2005 NRHM covers NLEP

 Leprosy in India

• India contributes to more than 50% of new cases detected globally every year

• Achieved goal of leprosy elimination in December 2005.

• 32 states/UTs achieved elimination.

• Bihar, Chattisgarh and Dadra & Nagar Haveli has remained with PR between 1
and 2.3 per 10,000 population.

• A total of 0.92 lakh cases during 2013-14

• 2013 – 14 → the PR 0.73 per 10,000 Pop. (1st April 2012 PR – 0.68)
Epidemiology: 2024-2025 Scenario

CHILD CASES
PREVALENCE RATE BURDEN
4.68% incidence
0.57 per 10,000 population
(National Average 2025) >50%
India still accounts for more than Indicates active recent transmission.
half of the global new leprosy
Goal: < 1/10,000 achieved
cases detected annually.

KEY EPIDEMIOLOGICAL TRENDS:

Age: Any age group, but peak incidence is 20-30 years. Gender: Male:Female (2:1)

Reservoir: Multibacillary (MB) human cases are the only significant source of
infection.
 National Leprosy Control Programme (NLCP)

▪ Control of leprosy – early case detection & DDS (Diaminodiphenyl

Sulfone or Dapsone)
▪ Objectives
▪ to arrest transmission
▪ to reduce magnitude of problem.
▪ Strategies adopted

▪ To detect cases of leprosy early

▪ Registration of cases for treatment
▪ Monotherapy with Dapsone
▪ Health Education
• After 2 decades - No desired results.

• Leprosy scenario did not change much

• Lack of momentum -

– Sulfone (DSS) monotherapy resistance

– Administrative issues

– Delay in release of funds

 National Leprosy Eradication Programme

Goal – To eradicate leprosy from India by 2000.

Strategies adopted
• Early detection of cases

• MDT

• Health Education
▪ Rehabilitation of needy patients
• Problems in NLEP
– coverage remained limited

– organizational issues

– fear of the disease

– associated stigma
• 1991 the World Health Assembly resolved to eliminate leprosy at a global
level by the year 2000.

• to strengthen the process of elimination in the country, the first World Bank
supported project was introduced in 1993.
 The 1st Phase of the World Bank supported
National Leprosy Elimination Project
PR ↓ from 24/10,000 popln. in
1993-94 to 2000. 1992 to 3.7/10,000 by 2001.

The 2nd Phase of World Bank Project on NLEP

2001 - 04

2005 onwards NLEP – GOI, WHO, ILEP & free of cost MDT drugs
 Objectives
To be achieved during 12th plan period (2012-2017)

• To improve early case detection

• Improve case management

• Stigma reduction.

• Development of leprosy expertise sustained

• Research supported evidence based programme practices

• To improve Monitoring supervision and evaluation system

• Increased participation of persons affected by leprosy in society

 Elimination strategy
• To eliminate leprosy GOI has accepted Modified Leprosy Elimination
Campaigns (MLEC) & Special Action Project for Elimination of Leprosy
(SAPEL) strategic actions for early detection of leprosy cases & mass

awareness.
Modified Leprosy Elimination Campaigns (MLEC)

• Organizing camp for 1 or 2 weeks

• Detection, treatment & referral to reconstruction facilities available

• Prior wide level information will be provided

• Quite effective for case finding

• 5th MLEC – Feb to March 2004 in eight endemic states

Special Action Project for Elimination of Leprosy (SAPEL)

❖SAPEL for Rural areas

❖Modified Leprosy Elimination Campaigns (MLEC) for Urban

• Providing MDT services to patient living special difficult to access areas or

neglected population.

• To reach every one who needs MDT services.

 Components

1. Decentralized integrated leprosy services through general health care system;

2. Capacity building of all general health services functionaries;

3. Intensified information, education and communication;

4. Prevention of disability and medical rehabilitation; and

5. Intensified monitoring and supervision

 2005 onwards NLEP – GOI, WHO, ILEP & free of
cost MDT drugs
• National Health Policy, Govt. of India set the goal of elimination of leprosy

• Because of hard work and meticulously planned and executed activities,

• The country achieved the goal of elimination of leprosy as a public health

problem, at the National Level in the month of December, 2005.

• PR – 0.95/10,000 population.
 Strategic plan of action (2004-05)
• Intensified focused action with strong supervisory support in 72 high priority
districts with PR > 5/10000 & 16 moderately endemic districts.

• > 2000 cases were detected – 2003-04.

• ↑ effort put on IEC, training & integrated service delivery.

• 31st March 2004 – in 836 blocks with PR > 5/10,000.

• 2 week long Block Leprosy Awareness Campaign (BLEC)

• IEC & Through leprosy counselling centres at SC level

• To ensure follow up of existing leprosy patient & self reporting of cases.

 Focused Leprosy Elimination Plan (FLEP 2005)
• 31st March 2005

• Priority areas identified

• PR > 3/10000

• 42 districts & 552 blocks were identified

• Focussed action with strong supervisory support – Districts

• ↑ effort put on IEC, training & integrated service delivery – Districts

• To ensure follow up of existing cases, reporting new cases

• Capacity building of GHS staff

• 31st March 2006 PR – 0.84/10000 at national level

 Intensified supervisory & monitoring
• Month from Oct-Dec 2005

• Intensified supervision of programme activities in all states & UTs.

• Supervisory officers from state & UTs, state/zonal NLEP co-ordinators, State
& District technical support team (STST & DTST) were advised to visit all
PHCs to monitor programme activities.

• Ensured regular treatment to pts, follow up of pts on irregular treatment &

availability of MDT at all level.
 Major initiatives
1. Focus on – New case detection than prevalence.

– The new case detection rate is the main indicator for programme monitoring.

2. Treatment completion rate has been taken as an important indicator, to be

calculated by states at yearly basis.

3. More emphasis is being given on providing Disability Prevention And Medical

Rehabilitation (DPMR) services to leprosy affected persons.

4. ASHAs have been involved in bringing out suspected leprosy cases from their
villages for diagnosis and treatment at PHC and follow-up of confirmed cases for
their treatment completion.
 Major initiatives
The aid provided to patients is as follows :

a) Dressing materials, supportive medicines and ulcer kits are provided to leprosy affected
persons with ulcers and wounds.

b) Micro-cellular rubber footwear is provided for protection of insensitive feet.

– 41 NGOs and 42 Govt. Medical Colleges have been strengthened for providing reconstructive
surgery services - disability correction. (83 centres).

c) Rs. 5000/- incentive to each affected person from BPL family undergoing reconstructive
surgery in these institutions to compensate for loss of wages.

d) Support is also provided to government institutions/ PMR centres in the form of Rs

5000/- per reconstructive surgery conducted.
 Major initiatives
To facilitate the involvement of ASHA in the programme, they are being paid incentive
money as below :

a) On confirmed diagnosis of case brought by them - Rs. 250/-

b) On completion of full course of treatment of the case within specified time

– PB leprosy case - Rs. 400/-

– MB leprosy case - Rs. 600/-.

c) An early case before onset of any visible deformity - Rs. 250/-.

d) A new case with visible deformity in hands, feet or eye - Rs. 200/-.
 DPMR Institutes (Tertiary Level)

1. Central Leprosy Teaching and Research Institute (CLTRI) located in

Chengalpattu, Tamil Nadu, India

2. Regional Leprosy Training and Research Institute - Aska, Odisha;

Gouripur, Bankura, West Bengal; Raipur, Chhattisgarh

3. National JALMA Institute for Leprosy & Other Mycobacterial Diseases,

Agra (ICMR)
 PROGRAMME IMPLEMENTATION PLAN FOR 12TH PLAN PERIOD
(2012-13 to 2016-17)
OBJECTIVES:

a) Elimination of leprosy i.e., prevalence of <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:
S. Targets
Indicators Baseline (2011-12)
No. (By March 2017)

1 Prevalence Rate (PR) < 1/ 10,000 543 Districts (84.6%) 642 Districts (100%)

Annual New Case Detection Rate (ANCDR)

2 445 Districts (69.3%) 642 Districts (100%)
<10/ 100,000 population

Cure rate Multi Bacillary Leprosy cases (MB)

3 90.56% >95%

95.28% >97%
4 Cure rate Pauci Bacillary Leprosy Cases (PB)

[Link] disability rate in percentage of New cases 3.04% (35% reduction)

5
1.98%

50% Reduction
6 Stigma reduction over the percentage
reported by NSS
 PROGRAMME STRATEGY:
a) Integrated leprosy services through General Health Care system.

b) Early detection & complete treatment of new leprosy cases.

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

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

e) Intensive monitoring and supervision at block Primary Health Centre/Community Health

Centre.

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

g) Information, Education & Communication (IEC) activities in the community to improve

self-reporting to Primary Health Centre (PHC) and reduction of stigma.
 PROGRAMME COMPONENTS:

The following components are approved in the 12th Plan:

[Link] Detection and Management

[Link] Prevention and Medical Rehabilitation

[Link], Education and Communication (IEC) including Behaviour Change

Communication (BCC)

[Link] Resource and Capacity building

[Link] Management
 Global Leprosy Strategy 2016-20
Vision: • Zero Disease
A Leprosy • Zero Transmission
free World • Zero disability
• Zero Stigma & Discrimination

Goal: • Reduce global & local burden further

No. of children with leprosy & visible deformities – Zero

Targets • Rate of newly diagnosed patients with visible deformities - <1/1 million
by 2020
• No. of countries with legislation allowing discrimination on basis of
Leprosy - Zero
Treatment: MDT Drugs

Drug Mechanism Role Side Effects

Inhibits RNA
Rifampicin Bactericidal (Kills 99.9% bacilli in days) Red urine, Flu-like syndrome, Hepatotoxicity.
Polymerase

Bacteriostatic + Anti-inflammatory (Prevents Red/Black Skin Pigmentation, Dry skin (Ichthyosis), GI

Clofazimine Binds to DNA
reaction) upset.

Inhibits Folate Hemolysis (G6PD deficiency), Dapsone Syndrome

Dapsone Bacteriostatic
Synthesis (Hypersensitivity).
NEW: Uniform MDT Protocol (2025)

UNIFORM 3-DRUG REGIMEN

Effective April 1, 2025. Rifampicin + Clofazimine + Dapsone is now used

for BOTH PB and MB cases.

DOSAGE (ADULT > 15Y)

• Rifampicin: 600mg (Monthly Supervised)
• Clofazimine: 300mg (Monthly) + 50mg (Daily Self)
• Dapsone: 100mg (Daily Self)

DURATION
• PB Leprosy: 6 Months (6 Packs)
• MB Leprosy: 12 Months (12 Packs)
NLEP Goals (2023-2027)
VISION: "LEPROSY FREE INDIA"
• Elimination (Phase 1): Achieved in 2005 (PR < 1/10,000).
• Current Target: Interruption of Transmission.

STRATEGIC TARGETS 2027

• Zero Indigenous Cases.
• Zero Grade 2 Disability in new child cases.
• Zero Stigma and discrimination.
 National Strategic Plan (NSP) 2023 – 2027
• Lays framework to achieve interruption of leprosy transmission at the district level
by 2027.

• Developed in consultation with national experts, WHO, and key stakeholders, the
plan aligns with the WHO Global Leprosy Strategy 2021–2030

• reflects India’s commitment to the Sustainable Development Goals (SDGs).

• The NSP promotes a patient-centric, rights-based approach to leprosy control and

elimination.
NSP (2023 – 2027) - Five strategic pillars
 NSP (2023 – 2027) - Five strategic pillars

• 2023 : Acceleration

• 2025 : Sustained momentum with surveillance

• 2026 : Continued efforts & targeted interventions for interruption of transmission

• 2027 : move towards ZERO Leprosy

 NSP (2023 – 2027) - Five strategic pillars

1. Leadership, Coordination, and Partnerships - strengthening political

commitment, inter-sectoral collaboration, and accountability at national, state, and
district levels to ensure cohesive programme implementation.

2. Accelerated Case Detection (2023): Emphasizes proactive case finding through

Active Case Detection Campaigns (ACDC), contact tracing, Focused Leprosy
Campaigns (FLC), and integration with other health programmes to identify cases
early and interrupt transmission.
 NSP (2023 – 2027) - Five strategic pillars
3. Comprehensive, Quality Leprosy Services: Ensures universal access to free
diagnosis, treatment (MDT), disability care, reconstructive surgery, counseling, and
post-treatment support through the general health system.

4. Prevention of Disease, Disabilities, and Discrimination: Aims to prevent Grade II

disabilities and reduce stigma through Post-Exposure Prophylaxis (PEP), disability
prevention strategies, community engagement, and behavioral change
communication.

5. Robust Surveillance and Health Information Systems: Strengthens digital

platforms like Nikusth 2.0, enables real-time case tracking, and supports data-driven
planning, monitoring, and reporting across all administrative levels.
Key NLEP Strategies

1. ACTIVE CASE FINDING 2. ZERO TRANSMISSION 3. DIGITAL HEALTH

LCDC: Leprosy Case Detection PEP-SDR: Post Exposure Prophylaxis Nikusth 2.0: Web portal for case-based
Campaign. House-to-house surveys in with Single Dose Rifampicin. tracking.
endemic districts (like Polio rounds). Given to all contacts (family/neighbors) Ensures patient is followed from
ACD&RS: Routine surveillance by of a confirmed case to kill incubating detection -> treatment -> cure -> follow
ASHA/ANM. bacteria. up.
 I. E. C

• A culturally acceptable stigma reduction

programme is developed & executed.
• It has to be sustained & initiative for “leprosy free
India” to be taken.
• Sustainability: IEC should become integral part of
services.
 I. E. C

Objectives
• To develop effective communication with the
target audiences.
• To complement & support the detection &
treatment services being provided through GHC
system.
• To strive to remove stigma surrounding leprosy &
prevent discrimination against leprosy affected
persons.
• Active participation of communities & clients.
 I. E. C

Targets & priorities

• Community – where stigma is deep routed.
• Leprosy affected person.
• GHC staff.
• Local NGOs & community based organizations
(CBO)
• Disable person organizations (DPOs)
 I. E. C

Other activities
• Posters & exhibitions.
• Wall painting.
• Rallies.
• Quiz.
 SWOT Analysis

Strength
• Integrated among general health services.
• Adequate man power logistics, MDT supply & funds are
available to carry out activities.
• High political commitment towards NLEP
 SWOT Analysis
Weakness
• MOs are overburden with other assignments, so monitoring
& supervision aspect is lacking.
• Health care staff is also lacking motivation & skills.
• newly untrained contractual health care staff under NRHM.
• Less involvement of private hospitals/doctors in the
programme.
• IEC is insufficient.
 SWOT Analysis
Opportunities
• Leprosy services are under NLEP, centrally
supported programme.
• Number of NGOs & community volunteers, ILEP
and WHO is also providing support
• Free supply of MDT and other aids to the patients.
• RCS services are also provided by some tertiary
care institutions
• Communities are changing their behaviour towards
leprosy & its related services.
 SWOT Analysis
Threats
• Elimination targets are still in the minds of
administrators and policy makers hence other
aspects of the program are not paid attention.
• Discontinuation of external support from ILEP &
WHO will create some gaps in the services.
Beneficiaries are not aware about availing the
services.
• Large number of migratory and floating population is
the main problem of service providers.
• Resistance MDT.
 References
• Park K, Parks textbook of preventive & social
medicine, 22nd edition, 2013.
• Kishore J, National health programs of India,
11th edition, 2014.
• NLEP training manual for Medical officers, 2013.
• NLEP – Progress Report for the year 2013-14
• [Link]
• Suryakantha AH, community medicine with
recent advances, 3rd edition. 2014.
• WHO - Fact sheet N°101Updated January 2014.
Thank you