National Leprosy Eradication Programme (NLEP)

Historical Background

• 1874: Anti-leprosy work in India began when the Mission to Lepers was founded by Baily at Chamba, Himachal Pradesh.
• 1954-55: The National Leprosy Control Programme (NLCP) was initiated as a centrally aided programme, focusing on early case detection and dapsone (DDS) monotherapy on an ambulatory basis.
• The programme gained momentum during the Fourth Five Year Plan when it became a centrally-sponsored programme.
• 1980: Government of India declared its resolve to "eradicate" leprosy by the year 2000. A Working Group was constituted to advise accordingly.
• 1982: The Working Group submitted its report, recommending a revised strategy based on multi-drug chemotherapy (MDT) to reduce the quantum of infection, sources of infection, and chain of transmission.
• 1983: The NLCP was redesignated as the National Leprosy "Eradication" Programme (NLEP).
• Goal: Reduce case load to 1 or less than 1 per 10,000 population.

World Bank Support and Integration

• Programme integrated with the general health care system in 2002-03.
• Leprosy diagnosis and treatment services now available at all PHCs and government hospitals.

Components of the Programme

1. Decentralized integrated leprosy services through the general health care system
2. Capacity building of all general health service functionaries
3. Intensified Information, Education and Communication (IEC)
4. Prevention of disability and medical rehabilitation
5. Intensified monitoring and supervision

Achievements

• After MDT introduction, recorded case load fell from 57.6 per 10,000 population in 1981 to less than 1 at national level in December 2005.
• 34 states/UTs achieved leprosy elimination status.
• Only Chhattisgarh and Dadra & Nagar Haveli were yet to achieve elimination.
• Bihar, Goa, Chandigarh, and Odisha (who had achieved elimination earlier) showed PR >1 per 1,000 population.
• 209 high endemic districts identified for special action during 2012-13.

Major Initiatives

1. New Case Detection Rate (NCDR) is now the main monitoring indicator (replaced prevalence).
2. Treatment Completion Rate is tracked annually at state level.
3. Disability Prevention and Medical Rehabilitation (DPMR) services expanded:
   • Dressing materials, supportive medicines, and ulcer kits provided.
   • Micro-cellular rubber (MCR) footwear provided for insensitive feet.
   • 41 NGOs and 42 Government Medical Colleges strengthened for reconstructive surgery (RCS) - total 83 centres.
   • Rs. 5,000/- incentive to BPL patients undergoing RCS.
   • Rs. 5,000/- support to government institutions/PMR centres per surgery.
4. ASHAs involved in case detection and treatment follow-up.

ASHA Incentives

• (a) Search for suspected cases - ASHA Based Surveillance for Leprosy Suspects (ABSULS) launched 1st July 2019
• (b) Follow-up all cases for treatment completion; detect reaction symptoms
• (c) Advise and motivate self-care for disabled cases
• (d) Spreading awareness
• (e) There are 612 self-settled leprosy colonies in the country

Three-Pronged Strategy (from 2016-17)

1. Leprosy Case Detection Campaign (LCDC)
2. Focused Leprosy Campaign
3. Special Plan for Hard-to-Reach Areas

• LCDC 2016-17: Carried out in 163 districts of 20 states - 34,672 cases detected and put on treatment.
• LCDC 2017-18: Extended to 305 districts in 23 states.
• Focused Leprosy Campaign: House-to-house survey in villages/urban areas covering 300 households around a Grade 2 disability case.
• Special plan targets naxalite-affected areas and geographically difficult locations.

Sparsh Leprosy Awareness Campaign

• Launched in 2017 through Gram Sabhas.
• Carried out with help of Panchayat and Village Health and Sanitation Community.
• Aims: Generate awareness, reduce stigma, improve self-reporting.
• Covered 60% of total villages across India.

Disability Prevention and Medical Rehabilitation (DPMR)

Referral System in NLEP (Fig. 1)

• Village Health & Sanitation Committee/ASHA/PAL: Supervise self-care, MCR use, dressing; refer Neuritis, Reaction, Disability, Ulcer
• Sub Centre/Sector PHC: Self-care advice, RCS counselling, ASHA supervision, follow-up; refer Reaction, Disability, Neuritis, Ulcer
• Block PHC: Manage reactions, ulcer dressing, identify RCS candidates, supply MCR footwear; refer complicated leprosy reactions, eye problems, RCS cases, Gr-II footwear needs
• District Hospital/Apex Group: Manage complicated ulcers and lepra reactions, screen for RCS, diagnose difficult/relapse cases
• District Nucleus: Supply footwear, manage lepra reactions; refer for RCS
• Reconstructive Surgery Centre: Perform RCS/amputation, follow-up post-RCS, supply footwear to district nucleus

IEC/BCC Strategy

• Focus on behavioural change against stigma and discrimination.
• Making public aware of MDT availability, deformity correction through surgery, and that leprosy-affected persons can live a normal life with family.
• IEC theme: "Towards Leprosy Free India"
• Activities through mass media and local media.

Survey, Education and Treatment (SET) Scheme

• Disability prevention and ulcer care
• IEC
• Referral of suspected cases
• Referral for Reconstructive Surgery (RCS)
• Research and rehabilitation
• NGO support is mainly for follow-up in urban locations and difficult-to-reach areas

Incentive to Patient

• Rs. 8,000/- paid to all patients undergoing major reconstructive surgery (irrespective of financial status), as of January 2017.
• As on January 2017: 115 recognized RCS centres (61 Government + 54 NGO).

ILEP Agencies

1. The Leprosy Mission
2. Damien Foundation of India Trust
3. Netherland Leprosy Relief
4. German Leprosy Relief Association
5. Lepra India
6. ALES
7. AIFO
8. Fontilles-India
9. AERF-India
10. American Leprosy Mission

Research Institutions

• Central JALMA Institute of Leprosy, Agra
• Central Leprosy Teaching and Training Institute (CLTRI), Chingalpettu (Chennai)
• Regional Training and Referral Institutes at:
  • Aska (Odisha)
  • Raipur (Chhattisgarh)
  • Gouripur (West Bengal)

Targets (12th Plan: 2012-13 to 2016-17)

• (a) Elimination of leprosy (PR < 1/10,000) in all districts
• (b) Strengthen DPMR for leprosy-affected persons
• (c) Reduction in stigma associated with leprosy

District Leprosy Cell

Urban Leprosy Services

• (a) Town/City (1 lakh - 5 lakh): 432 areas
• (b) Medium city (>5 lakh - 10 lakh): 53 areas
• (c) Mega city (>10 lakh - 45 lakh): 34 areas
• (d) Areas >45 lakh population: 5 areas

NLEP at Primary Health Care Level (PHC Functions - NHM Essential Services)

1. Health education to community regarding leprosy
2. Diagnosis and management of leprosy and its complications including reactions
3. Training of leprosy patients having ulcers for self-care
4. Counselling for leprosy patients for regularity/completion of treatment and prevention of disability