Introduction

Leprosy

Also known as Hansen’s Disease, Leprosy is a chronic, progressive bacterial infection.

It is caused by a bacterium called Mycobacterium Leprae, which is an acid-fast rod-
shaped bacillus. It is a disease that leaves a terrifying image in its wake of mutilation,
rejection, and exclusion from society.

 Oldest Disease
o Leprosy is one of the oldest diseases in recorded history, afflicting humanity
since time immemorial.
o A written account of Leprosy date as far back as 600 B.C.
o It was well recognized in the oldest civilizations of China, Egypt and India
thousands of years ago.
o Genetic evidence supports the existence of Leprosy infections in hundred-
thousand-year-old remains.
 Areas of Infection: Skin, Peripheral nerves, Upper respiratory tract and Lining of
the nose.

Stats:
 According to WHO, India accounts for more than half of leprosy cases,
detected worldwide. In 2017, India accounted for the 60% of new cases,
detected in the year (1.26 lakh cases out of 2.10 lakh cases).
 As per the recent report by the National Leprosy Elimination Program (NLEP),
of the total new cases detected in India, Children accounted for about 8.7% of
total Leprosy cases.

Issues with leprosy in India

 Persisting discrimination against people affected by leprosy.
 There is lots of myths, socio-cultural beliefs, and the stigma attached to
leprosy
 Lack of awareness about its cure
 Presence of obsolete laws
 There are a total of 295 obsolete laws, including an 1898 Act which
discriminates against leprosy affected people.
 Hindu Marriage Act considers leprosy a ground for divorce.

 Many employers terminate the employment of persons under Industrial

Disputes Act, 1947.
  Many States in India prohibit leprosy patients from running in local elections
and deny them employment privileges and benefits.
 There are several laws containing discriminatory policies against leprosy
victims, like, prohibition of leprosy patients from standing in elections
 Motor Vehicle Act of 1939 which restricts leprosy patients from obtaining a
driving license and the Indian Rail Act of 1990 which prohibits leprosy patients
from traveling by train.
 Leprosy is still considered as a legitimate ground for divorce, according to
some of the marriage acts, which declares leprosy incurable.
 They are denied their fundamental right to food.
 They are not issued BPL cards.
 They are deprived of other basic amenities.

Government’s Initiative
 Govt. of India started the National Leprosy Control Programme in 1955. It was
only in 1970s that a definite cure was identified in the form of Multi-Drug Therapy
(MDT).
 The 1st Phase of the World Bank supported the National Leprosy Elimination
Project started from 1993-94.
 In the year 2001, after the global elimination was achieved, India was among the
14 countries that missed the target of eliminating leprosy.
 The National Leprosy Eradication Programme that was launched after this,
achieved the goal 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.
 In 2016, the draconian colonial era’s Lepers Act was repealed.
 In 2017, the SPARSH Leprosy Awareness Campaign was launched to promote
awareness and address the issues of stigma and discrimination.
 The measures included in the campaign like contact tracing, examination,
treatment, and chemoprophylaxis are expected to bring down the number of
Leprosy cases.
 The special emphasis on women, children and those with disabilities are
expected to flush out more hidden cases.
 In addition to continuing to administer MDT to patients, new preventive
approaches such as Chemoprophylaxis and immunoprophylaxis are being
considered to break the chain of transmission and reach zero disease status.
 In 2019, Lok Sabha passed a Bill seeking to remove Leprosy as a ground for
divorce.
 In commemoration of the 150th birth anniversary of Mahatma Gandhi on 2nd
October 2019, the NLEP has prepared the comprehensive plan to reduce the
grade to disability to less than one case per million people by October 2019
 Ayushman Bharat’s 1,50,000 Health and Wellness Centres across the country
plan to screen all Indians for leprosy.

WHO Initiative

 Free distribution of MDT to all endemic countries since 1995.

 Global Leprosy Strategy 2016-2020: Aims to reinvigorate efforts to control Leprosy
and avert disabilities, especially among children, still affected by the disease in
endemic countries.

Challenges
 Undetected new cases
 After 2005 the reporting of new cases is voluntary which may lead to
many cases being detected late or people getting treated after disability
has set in
 State National Leprosy Eradication Programme units have become diluted with
the inclusion of leprosy into the public health programme
 Leprosy health workers were made multipurpose workers with additional
responsibilities of HIV and tuberculosis control
 The presence of leprosy in children
 The use of term “elimination” also leads to confusion among general public and
to many even in the medical profession.
 Short duration drug trials
 The NLEP in its recent evaluation have acknowledged that there are cases
occurring in the community and detection capacity is not matching the level
and intensity of disease occurrence
 Since 1982 same three drugs constitute MDT for leprosy is being used which
increase the chances of emerge of resistance to these drugs

Wayforward
Strategies for Leprosy Elimination
 Decentralized 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
 Involvement of Accredited Social Health Activists (ASHAs) in the detection &
complete treatment of Leprosy cases for leprosy work
 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 Primary Health Centre/Community Health
Centre.
 Avoid shallow declarations: India remains a long way away from elimination
at the state or district levels, let alone eradication. It is necessary to learn
lessons and avoid creating an environment of complacency.
 Speedy implementation of the Health and Wellness Centres
(HWC) initiative in the true spirit of comprehensive primary healthcare
approach.
 Enhancing training of health-care providers: in communication and
behaviour change skills, and by improving the patients’ access to quality care
and friendly services.
 Adherence to MDT: can be improved by multiple initiatives that target the
views and actions of patients, health-care workers, and society.
 Removal of stigma: Leprosy program managers should design positive health
messages and use innovative media to appeal to and reach target groups to
motivate leprosy patients to seek early treatment and the community to accept
leprosy patients.
 Creating Livelihood Opportunities: Those who have been cured at an early
stage and can work, should be given opportunities to learn skills and trades that
would enable them to work.
 Long-standing stigma associated with Leprosy and the archaic laws
applicable to them needs to be removed.
 Government, NGOs and private agencies need to work together.
 Continued training, skill development and best practice needs to be evolved to
provide quality diagnosis and treatment of leprosy.