Marching Towards Leprosy Elimination in India by Dr. Ashok Kumar, Deputy Director-General (Leprosy), Ministery of Health & Family Welfare, Government of India, New Delhi
The Current Leprosy Situation in India
Current statistics indicate that India has a prevalence rate of 3.22 per 10,000 inhabitants, with eleven endemic states contributing 92% of the country's leprosy caseload.During the year 2002-03, a total of 476,000 new leprosy cases were detected, of these, 14.9% were child cases, 1.8% were visible deformity cases and 35.2% were multibacillary cases. MDT coverage has been extended to all primary health centers and hospitals in all districts of India, and an estimated 10.8 million patients have been cured by MDT through March 2003.
Epidemiological Achievements
With efficient implementation of well-planned efforts since 1954-55, India has substantially succeeded in its fight against leprosy. During 1981, India had a
leprosy prevalence rate of 57.6. This has come down to only 3.2 as of March 2003. The Annual New Case Detection (ANCD) rate has also declined.
Elimination has been achieved in fifteen regions, and another six regions are close to leprosy elimination with a prevalence rate of between one and two.
Strategy and Plan of Action for Leprosy Elimination
State-specific action plans for the year 2003-04 have been drawn up by all 35 regions and approved by the Government of India. The main thrust in this third and final year of the second phase of the World Bank-supported National Leprosy Elimination Project can be summarized as follows:
1. Decentralization and Integration of Leprosy Services with General Health Care Services:
This has enabled the General Health Care Services (GHS) to implement integrated leprosy services. Full involvement is ensured at the grassroots level at subcenters (each covering areas with about 5,000 inhabitants), to deliver the second and subsequent doses of MDT to leprosy patients already diagnosed by Medical Officers at primary health centers.
2. Leprosy Training of General Health Care Staff:
Training was given to Medical Officers, Health Supervisors, Health Workers and village-level functionaries in all districts of all regions during the last four nationwide Modified Leprosy Elimination Campaigns, held between 1998 and 2003.
Similarly, one-day training in Leprosy IEC1 has been arranged by the states for District Mass Media Officers, Block Extension Educators, Health Educators and Selected Health Supervisors. The district chief medical and health officers of twelve priority-endemic regions have also been oriented through three-day “ILEP Management Courses.”
The National Leprosy Eradication Program has also initiated the orientation of General Health Care Staff regarding Prevention of Deformity and Disability Care through Block POD2 Camps in which patients are taught about self-care.
Health Worker Holding Leprosy Pamphlet−Uttar Pradesh,India
3. Continued IEC to Facilitate Early Case Detection and Prompt MDT Treatment:
Four nationwide Modified Leprosy Elimination Campaigns (MLEC) have been carried out by all regions since 1997-98. Each time, the number of new cases detected has declined, as follows: 4.63, 2.13, 1.65 and 1.02 lakhs3. The positive benefits of community education, detecting hidden leprosy cases and prompt application of MDT treatment are clearly apparent.
Each State has been encouraged to draw up district-and urban-specific plans for IEC for the year 2003-04.
4. SAPEL4 / LEC5:
The Special Action Plan for Elimination of Leprosy in rural areas and the Leprosy Elimination Campaign in urban areas are covering identified groups that are
normally inaccessible due to location or other complicating circumstances.
5. Prevention of Disability (POD) & Care:
The training of General Health Services staff for POD, education of patients for self-care, and reconstructive surgical services for patients with deformities are all being continued. This is being carried out through specialized NGO institutions, district hospitals and tertiary referral centers.
6. Monitoring and Evaluation:
The Government of India has recently developed a Simplified Information System under the National Leprosy Eradication Programme. This has been implemented in the country since October 2002. With the Simplified Information System, the country is now equipped with an inbuilt information system for monthly monitoring, feedback and timely corrective actions at various levels.
Involvement of Partners for Elimination in India
India's Programme for Leprosy Elimination continues to be a combined effort of all the regions of India and the various organizations involved, e.g. the World Bank, WHO and DANLEP. Support received from the Novartis, The Nippon Foundation, and Sasakawa Memorial Health Foundation have been of tremendous help.
NGOs have been involved in the cause of leprosy elimination for many decades and their contributions have had a strong, positive impact. More than 290 NGOs are working in the field of leprosy throughout the country. The roles and responsibilities of the NGOs have recently been redefined, with a new focus on the integration of leprosy services into General Health Care Services. Efforts have also been made to invite NGOs from different health fields to take appropriate actions towards leprosy elimination.
（拡大画面：53KB）
The International Federation of Anti-Leprosy Associations is actively involved as an NLEP partner and supports 145 District Technical Support Teams around the country. These are assisting in the integration of leprosy services into General Health Care Services. In addition, the International Leprosy Association, in collaboration with Sasakawa Memorial Health Foundation and other NLEP India Partners, is organizing National Conference on the Elimination of Leprosy−India, planned for December 19th - 22nd, 2003, in Raipur, Chhattisgarh. Active participation of a large number of regional level NLEP managers will further enhance their involvement and commitment towards achieving the national goal of leprosy elimination in India.
1
IEC − Information, Education & Communication
2
POD − Prevention of Disability
3
One lakh = 100,000
4
SAPEL − Special Action Plan for Elimination of Leprosy
