NATIONAL LEPROSY ERADICATION PROGRAMME

Background: National Leprosy Control Programme (NLCP) was launched by the

Govt. of India in 1954- 55.  Multi Drug Therapy (MDT) came into wide use from
1982, and the National Leprosy Eradication Programme was introduced in
1983. The strategy of NLEP was based on controlling the disease through
reduction in the quantum of infection in the population and reduction in infective
source, thus breaking the chain of disease transmission. The programme was
initially taken up in endemic districts and was extended to all districts in the
country from 1993-94 with World Bank Assistant. Four Research & Training
Institutes were established directly under DGHS, namely Central Leprosy
Training and Research Institute Institutes (CLTRI) Chengalpattu, Regional
Leprosy Training and Research Institute (RLTRI) at Raipur, Gauripur and
Aska. In addition, a Training Centre was established at Agra under
ICMR. Remarkable progress has been achieved in reducing the disease burden in
the country.

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.

VISION:

“Leprosy-free India” is the vision of the NLEP.

Mission:

The NLEP’s mission is to provide quality leprosy services free of cost to all
sections of the population, with easy accessibility, through the integrated healthcare
system, including care for disability after cure of the disease.

Objectives:

⮚ To reduce Prevalence rate less than 1/10,000 population at sub national and
district level.
⮚ To reduce Grade II disability % < 1 among new cases at National level
⮚ To reduce Grade II disability cases < 1 case per million population at National
level.
 ⮚ Zero disabilities among new Child cases.
⮚  Zero stigma and discrimination against persons affected by leprosy.
Strategy:
To achieve the aforementioned objectives, the main strategies to be followed are:
1)      Integrated anti-leprosy services through General Health Care system.
2)       Early detection and complete treatment of new leprosy cases.
3)       Carrying out household contact survey for early detection of cases.
4)       Involvement of Accredited Social Health Activist (ASHA) in the
detection and completion of treatment of Leprosy cases on time.
5)       Strengthening of Disability Prevention and Medical Rehabilitation
(DPMR) services.
6)       Information, Education and Communication (IEC) activities in the
community to improve self-reporting to Primary Health Centre (PHC) and
reduction of stigma.
7)       Intensive monitoring and supervision at Health and Wellness Centers and
Block Primary Health Centre/Community Health Centre.
Following are the programme components:
o    Case Detection and Management
o    Disability Prevention and Medical Rehabilitation (DPMR).
o    Information, Education and Communication (IEC) including Behavior
Change Communication (BCC)
o    Human Resource and Capacity building
o    Programme Management
Salient features of the National Leprosy Eradication Programme are:
1.      Leprosy Eradication programme is a centrally sponsored scheme of Government
of India.
2.      NLEP functions under the umbrella of National Health Mission (NHM).
3.      NLEP follows decentralized health planning and funds are sent to the states
through State Health Societies.
4.      Quality of services and sustainability is the main focus.
5.      Disability Prevention & Medical Rehabilitation (DPMR) is a priority

6.      Removal of stigma and discrimination is a part of the strategy.

Epidemiological Trends of important NLEP indicators from 1998 to 2020:

 
Various leprosy endemicity maps from 1981 to 2020, showing the prevalence of
leprosy at different points of time, which evidently show that the burden of leprosy
is shrinking in India.

Milestones of NLEP:

1948 Hind Kusht Nivaran Sangh

1955 National Leprosy Control Programme
1970 Definite cure in form of MDT was identified
1982 WHO - study group recommended use of MDT
1983 National Leprosy Eradication Programme, MDT started
1991 World Health Assembly resolution to eradicate leprosy by 2000AD
1993 World Bank supports the MDT programme phase -NLEP1
1997 Midterm appraisal of NLEP
1998-2004 Modified Leprosy Elimination Campaign
2001-2004 NLEP Project Phase II
2002 Simplified Information system Introduced
2005 Nationwide Evaluation of Project II
2005, Dec Prevalence Rate of leprosy dropped to 0.95 /10000 population, and
India achieved elimination status Nationally
2005 After Elimination, NLEP vertically run programme services
integrated with General Health Care System under newly launched
National Rural Health Mission 
2007 Disability Prevention & Medical Rehabilitation Guidelines introduced
for preventing disabilities at primary, secondary, and tertiary level
2007 – XI Five Year Plan advocated inclusion of Persons Affected with
2012 leprosy in all decision-making exercise
2012 XII Five Year Plan adopted the Special Leprosy Action Plan for 209
High endemic districts in 16 States/UTs
2014 Independent Evaluation of NLEP by World Health Organisation
2014 Upgraded Simplified Information system implementation
2016 Rights of Persons with Disabilities Act, 2016
2017- 2019 New Initiatives
∙         Active Case Detections Campaigns (14 days) in high endemic
districts
∙         Focused Leprosy Campaign (FLC) in low endemic districts

∙         ASHA Based Surveillance for Leprosy Suspects (ABSULS)

 ∙         Grade II Disability Epidemiological Investigation

∙         Implementation of Post Exposure Prophylaxis (administration

of Single Dose of Rifampicin)
∙         Sparsh Leprosy Awareness Campaigns

∙         Introduction of NIKUSTH - A real time leprosy reporting

software across India
2019
∙         External Evaluation of NLEP by World Health Organisation

∙         Convergence of leprosy screening with Comprehensive

Primary Health Care programme of Ayushman Bharat, to
screen 30+ years population at HWCs
∙         Convergence of leprosy screening with Rashtriya Bal
Swasthya Karyakram (RBSK) to screen children (0-18 years) at
Anganwadi Centers and Govt. schools,
2020
∙         Active Case Detection and Regular Surveillance (ACD&RS)
guidelines rolled out.
∙         Convergence of NLEP with Rashtriya Kishore Swasthya
Karyakram (RKSK) for counselling the children of teen age
group (13-19 yrs.) about leprosy at Adolescent Friendly Clinics

Activities under NLEP:

● Diagnosis and treatment of leprosy- Free of cost Services for diagnosis

and treatment (Multi drug therapy) are provided by all public health care
facilities like primary health centres, govt. dispensaries, CHC, DH and
Medical colleges throughout the country. Difficult to diagnose, complicated
cases, reaction cases and G2D cases requiring reconstructive surgery are
referred to district hospital for further management. All drugs, diagnostics
and surgical /non-surgical interventions are provided free of cost to all
patients of leprosy across the board.
 ● Capacity building- Training of general health staff like Medical Officer,
health workers, health supervisors, laboratory technicians and ASHAs are
conducted every year to develop adequate skills for diagnosis and
management of leprosy cases.                                     
● IEC and counselling - Intensive IEC activities are conducted to generate
awareness which will help in reduction of stigma and discrimination
associated with persons affected with leprosy. These activities are carried
through mass media, outdoor media, rural media and advocacy meetings.
Major focus is also given on inter personnel communication.
● Disability Prevention and Medical Rehabilitation –For prevention and
management of disability, dressing material, supportive medicines and
micro-cellular rubber (MCR) footwear are provided to leprosy patients. The
patients are also empowered with trainings in self-care procedure for
preventing aggravating disability to the insensitive hands/feets. Emphasis is
also being placed on correction of permanent disability through
reconstructive surgeries (RCS). To strengthen RCS services, GOI has
identified 112 institutions for conducting RCS based on the
recommendations of the state governments. Out of these, 60 are Govt.
Institutions and 52 are NGO institutions. The patients concerned are
provided RCS facility not only free of cost, but are also paid welfare
allowances.
● 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 put on assessment of New Case Detection and
Treatment Completion Rate and proportion of grade II disability among new
cases. Visits by Joint monitoring Teams with members from GOI, ILEP and
WHO have been as integral part of NLEP.
● NGO services under SET scheme- NGOs are getting grants from Govt. of
India under Survey, Education and Treatment (SET) scheme. 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 NGOs through State Health
Societies. 

Prioritization of the Districts to reduce the leprosy Burden:  The World Health

Organization (WHO) facilitated an independent evaluation of NLEP from 1 to 14
November 2019. Districts were prioritized based on the leprosy
 burden. Annual new cases detected, ANCDR, G2D rate, prevalence rate during
2008-2018 were taken into consideration for categorization of the districts.

Geometric mean for ten years of each of the data element was considered more
appropriately representing the situation in the country. Weightages were applied for
new case detection, number of new cases with G2D, number of child cases and
registered prevalence and used for categorizing districts according to endemicity.
The weightages for each of the cases was as follows:

✔  Number of the new cases: 40%

✔  Registered prevalence: 20%

✔  Number of child cases: 20%

✔  Number of the new cases with G2D: 20%

Details of endemicity

 
State Of Total High Moderate Low Districts
Union Districts endemic endemic endemic with
Territory districts districts districts sporadic
cases only
Total Country 708 118 206 260 124
Number
 Total Country 100% 17% 29% 37% 17%
%
Percentage of 100% 24% 39% 30% 7%
country
population

Achievements during 2020:

•      Percentage of Grade II Disability (G2D)/visible deformity among new

cases decreased from 3.05% in 2018-19 to 2.39% (2019-20).

•      The G2D amongst new cases/ million population decreased from

2.65/million population as on 31st March, 2019 to 1.94/million population as
on 31st March 2020.

•      Child cases percentage has reduced from 7.67% as on 31st March 2019 to
6.86 % as on 31st March 2020.

NEW INITIATIVES:

1)  Enhanced active & early case detection strategy has been introduced through
ACD&RS (Active Case Detection and Regular Surveillance strategy throughout
the year).

2) Convergence of leprosy screening for targeting different age groups like

under RBSK (for 0-18 yrs.), RKSK (13-19 yrs.), and CPHC – Ayushman Bharat
(above 30+ yrs. population). 

3) Timely referral and follow up for treatment completion on time through Multi
Drug Therapy (MDT) available free of cost in all public health facilities

4)  For prevention of leprosy amongst contacts: Post Exposure

chemoprophylaxis administration (PEP)

5)  Awareness Activities:  Routine IEC activities are conducted by states and

districts throughout the year, Special Annual Mass Awareness campaigns
named Sparsh Leprosy Awareness Campaigns (SLAC) were launched on
30th January, 2017 i.e., Anti Leprosy Day, to reduce stigma and discrimination
 against persons suffering from leprosy. Since then, every year, nationwide Gram
Sabhas in villages across the country are being organized in cooperation and
coordination with allied sectors of health department. Appropriate messages from
District Magistrates and appeals from Gram Sabha Pramukh (Heads of Village
councils) to reduce discrimination against persons affected with
leprosy are read out; pledge is taken by all Gram Sabha members to reduce the
burden of disease in the community, and felicitation of persons affected with
leprosy is done. Village community is encouraged to participate in these
meetings, and school children are encouraged to spread awareness about the
disease through plays, posters etc.

“Sapna” is a concept (mascot) designed and developed using a

common girl living in community, who will help spread awareness in
the community, through key IEC messages. Sapna can be local
school going girl who is willing to be ‘Sapna’. There can be any
number of Sapna’s in a village.