National Leprosy Eradication Programme

http://www.nihfw.org/NationalHealthProgramme/NATIONAL
LEPROSYERADICATIONPROGRAMME.html
https://dghs.gov.in/content/1349_3_NationalLeprosyEradicatio
nProgramme.aspx

For final year BAMS students

27July 2020

For internal circulation only

vac|ollur doctorviswagiri@gmail.com 27/07/2020

National Leprosy Eradication Programme

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

National Leprosy Eradication Programme 2

vac|ollur doctorviswagiri@gmail.com 27/07/2020

treatment of leprosy. With the introduction of Multi-Drug

Treatment (MDT) 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.

National Leprosy Eradication Programme 3

vac|ollur doctorviswagiri@gmail.com 27/07/2020

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

National Leprosy Eradication Programme 4

vac|ollur doctorviswagiri@gmail.com 27/07/2020

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.
 NGO services under SET scheme- Presently, 43 NGOs
are getting grants from Govt. of India under Survey,
Education and Treatment (SET) scheme. The various
National Leprosy Eradication Programme 5
vac|ollur doctorviswagiri@gmail.com 27/07/2020

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 footwear in adequate quantity and
Improvement in RCS performance through camp
approach are planned in the above districts to reduce
the disease burden.

National Leprosy Eradication Programme 6

 vac|ollur doctorviswagiri@gmail.com 27/07/2020

 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 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

National Leprosy Eradication Programme 7

 vac|ollur doctorviswagiri@gmail.com 27/07/2020

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
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,
National Leprosy Eradication Programme 8
 vac|ollur doctorviswagiri@gmail.com 27/07/2020

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