Dr. CP Thakur, Honorable Minister for Health and Family Welfare, Mr. Yohei Sasakawa, Dr. Uton Rafei, Dr. Maria Neira, Prof. Kiikuni, Dr. Yuasa, Dr. Kim-Farley, distinguished participants, ladies and gentleman, at the onset, let me express my gratitude to the organizer of this meeting on leprosy elimination in India.

You all know, as we have heard today, that at the end of the year 2000, globally, leprosy remained public health problem in only 15 counties situated in Asia, Africa and Latin America. Out of these, we now focus on only top 6 endemic countries including India. In the year 2000, India alone represented around 64% of prevalence and 78% of new cases worldwide.

　

The country has made much progress during the last two years. During the year 2001 and 2002, the 3^rd round of MLEC was carried out in all the states of the country with the objectives to increase mass awareness among the population including those living in remote and difficult-to-access areas. Case detection was carried out by different methods like active case search by house-to-house visits in 10 states and opening of voluntary reporting centers in 22 states. Nearly 0.16 million new leprosy cases were detected. All these cases have been put under MDT and due to be released as cured later this year. Present leprosy prevalence in the country is about 0.44 million cases giving the prevalence rate of 4.2 per 10,000 population. The prevalence of the end of the previous year, 2000 and 2001, was 3.74 per 10,000. as no MLEC was carried out in that year. Present increase of prevalence rate should be neutralized by release of these cases after completion of treatment in another 2 to 5 months time.

　

During the year 2001 and 2002, a total of 0.61 million new cases were detected, of which 16.3% were children below 15 years of age and 2.1% had visible deformity. Number of states achieving elimination has remained 13 out of the total states. However, the number of districts that has reached elimination during the same year has gone up to 181 that is 31.4% out of the total 576 districts having district leprosy societies. However, 51 districts that are 8.8% are still having prevalence rate more than 10 per 10,000 population. These districts are located in the 5 major endemic states of Bihar, UP Chhattisgarh, Jharkand and Orissa. Although these 5 states are home to 72% of the total leprosy cases in the county, 5% Out of 238 districts in the 7 states have achieved elimination goal and 10% are nearly in that level. Leprosy situation in the remaining 202 districts that is 85% is the biggest challenge before the country at present. Special attention has been given to these states, under the 2^nd phase of World Bank assisted National Leprosy Elimination Project (NLEP), which started in April 2001.

　

Leprosy elimination monitoring (LEM) exercise is being carried out in 12 state of the country beginning from 6 June 2002. Although 74 districts will be covered by 27 teams of 2 monitors each, the exercise will be completed in two weeks time. Through this LEM, we hope to get a good insight into the program status and the drawbacks for taking suitable immediate actions whenever needed. I would like to thank WHO for supporting this activities both financially and with technical inputs.

　

It is presumed that the country still has gotten quite a number of undetected cases hidden within the communities in isolated pockets. We have planned the 4^th modified leprosy elimination campaign (MLEC) to take place in September and October this year. The objectives of the campaign will remain the same as in the previous MLECs namely to create awareness about leprosy among the masses for reducing fear and stigma associated with the disease, to promote capacity building among general staffs in order to enable them to handle leprosy cases independently and to detect as many hidden cases as possible in a short time and to put them under treatment with MDT. In this campaign, in the major endemic states, active house-to-house search for leprosy cases is planned to be carried out in all blocks with prevalence more than 5 per 10,000 population. In the remaining blocks and in urban areas, passive case detection at voluntary reporting centers is also panned. In addition, special action project for elimination of leprosy (SAPEL), Leprosy Elimination Campaign (LEC) projects are to be carries out along with MLEC in all isolated inaccessible population groups. We expect to detect about 0.1 million cases in this year's MLEC.

　

Non-compliance of guidelines regarding fixed dose therapy with MDT of 6 months for PB cases and 12 months for MB cases results in accumulation of cases, which remain registered even after they were cured. This calls for cleaning of registers campaign with specific guidance to states to be carried out in May and June 2002. It is expected 30,000 cases may be released from treatment through this exercise.

　

India has over 1.5 million leprosy patients with disability and ulcer problems. Their management along with prevention of deformity services to the newly detected patients is an important activity under the project. Recently, states have been also advised to develop plan for imparting POD training to their general health care staffs so that they can deliver this service during the routine contact with the patients. Training of faculty trainers from states who can further organize training in their respective states is being planned by leprosy division in association with Schieffline Leprosy Research and Training Centre, Karigiri. Effective Information, Education and Communication (IEC) is essential as you know to spread awareness about leprosy in the general public for the disease like leprosy. IEC through person-to-person contact may be the only way to instill confidence in people, to remove their fears, apprehensions, false belief and stigma attached to this disease. Thus, media campaign needs well-thought of and focused planning, and must be executed with locally available materials and methods. Some materials have already been prepared and prototype materials have been given to the states for use during the last MLEC. The states are requires to develop their own innovative media plans to suite the people all through of the year for the next 2 to 3 years.

　

Ladies and gentlemen, I have spoken of some of the challenges that have confronted NLEP in India and actions in hand to tackle them. I am sure with coordination of support of all the partners involved in leprosy programs in the country, these challenges will be met in a very short period of time. We are confident India would achieve the leprosy elimination as planned.

　

Finally, I once again thank TNF, SMHF, Mr. Yohei Sasakawa, Dr. Uton Rafei, for organizing this Tokyo Meeting on achieving leprosy elimination in India.