It is indeed a great pleasure for me to be present here today for this important meeting on achieving "Leprosy Elimination in India. I would like to take this opportunity to thank the Nippon Foundation/Sasakawa Memorial Health Foundation and the WHO Regional Office for South East Asia (SEARO) for jointly organizing this meeting. Holding a meeting specifically for India's Leprosy Elimination program, shows the highest concern felt by the organizers for my country's leprosy problem, which till now unfortunately is contributing the highest number of the global leprosy burden.

　

As on 31 March 2002, India has a total of 0.44 million-recorded- leprosy cases, which gives a prevalence rate (PR) of 4.2 per 10,000 populations. Detection of nearly 0.16 million new cases during the 3^rd Modified Leprosy Elimination Campaign in the later part of last year has mainly caused slight higher PR than the previous year's prevalence rate of 3.7/10,000 on 31^st March 2001. All these cases are under treatment and most of them will be released as cured by June this year.

　

We have here the Health Secretaries of the seven high endemic states of Bihar, Jharkhand, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Orissa and West Bengal. The states are jointly contributing about 72% of the country's caseload. We also have the representatives of DANLEP and the eight ILEP agencies, which are supporting the leprosy program activities in these states. These 7 states have a total of 238 districts. Current status of prevalence rate district wise has shown that only 12 district (5%) of Madhya Pradesh and Uttar Pradesh have achieved level of elimination i.e. PR<1/10,000. 24 districts (10%) in M.P., U.P. and West Bengal are having PR between 1 and 2/10,000. As many as 202 districts (85%) have PR above 2. Five districts spread over the states of Jharkhand (1), Chhattisgarh (2) and Orissa (2) have PR more than 20/10,000. This is one of the big challenges in hand. The caseload in each of these districts will have to be neutralized by early detection and treatment with MDT.

　

Another challenge before us is the continued detection of high number of new leprosy cases every year. The last three Modified Leprosy Elimination Campaign helped in detection of as many as 0.82 million. New cases are still coming up, although successive MLEC have shown gradual reduction in case detection. The 4^th round of MLEC planned for later this year is expected to bring out yet another around 0.1 million cases. The reasons for these new cases emerging every year need to be assessed quickly. Is the transmission still going on at high sale? How to involve the people on a massive scale towards this end?

　

India is committed to bring the leprosy menace down to below 1 case per ten thousand at national level by the year 2004. So, time in our hand is really very short. Lot of things need to be done quickly.

　

After our commitment expressed in the 1^st Global Alliance Meeting in January 2001 in Delhi, we have launched the second phase of National Leprosy Elimination Project starting from 1^st April 2001 for 3 years with a total allocation of Rs. 250 crore (US $54 million) Since then impressive progress has been made in the leprosy elimination activities. Under the Second Project different strategies have been adopted for the seven high endemic states and for the moderate and low endemic states.

　

One of the main strategies in the second project is decentralization of the program management to the state level autonomous society. Although the technical guidelines and directions are issued from the central level, the state societies are free to plan and execute the program as per their need and local convenience. For example, the 3^rd Modified Leprosy Elimination Campaign was carried out in different states starting from October 2001 to March 2002 to suit local conditions. Financial management and its monitoring within the state has also been given to the State Society with additional manpower support and computerized Project Financial Management System (PFMS). Careful monitoring of the program activities in the states is of paramount importance. These seven states have also been organizing the state level review meetings in which all the district Program Officers and Chief Medical Officers are involved on quarterly basis. The World Health Organization has been providing support to the states for this purpose, for which we are thankful.

　

To achieve elimination, it is important that MDT services should be available and accessible at the most peripheral level so that patients can get treatment at their nearest health center. The integration of the MDT services within the general health services is regarded as the key to achieving the elimination. The rationale behind this approach is that the general health services are relatively more widely distributed, and have close and frequent contact with the local community. Involving the general health services will also improve case-finding and case- holding activities. In addition, such integration will also help to demystify the disease and increase awareness about the disease in the community. In 14 states, the integration has taken place.

　

Information, Education and Communication (IEC) is the back bone for a program like leprosy elimination in which social stigma against the disease is very high, preventing people to go out to seek diagnosis and treatment. In the second project, the Mass Media Campaign through print and electronic media is being carried out through a professional agency. These seven endemic states are being specifically targeted for coverage by the local press, TV and Radio in addition to national coverage. What needs to be done is urban and rural outreach media activities to be carried out by the State and District Leprosy Societies. This has a tremendous scope and each state needs to have its own plan of carrying out these IEC campaigns to the farthest corners of the state. Under the project funds provision is made for the rural and outdoor media amounting to Rs. 8.50 crore (US $ 1.8 million) during the 3-year period. The fund is allocated particularly during the MLECs. We may need to think for a continuous IEC campaign in the rural areas involving the local folk media and other resources to generate more public awareness amongst the very poor, illiterate/semiliterate and socially backward masses. A suitable beginning has already been made.

　

Another area where some support is needed is to develop IEC dissemination skill amongst some selected health supervisors, health educators, block extension educators and mass media officers working in the health departments. A well-designed course curriculum and planned training courses need to be organized in the states early. We are working on this aspect.

　

Prevention of deformity in leprosy patients after they are diagnosed and put on MDT is very essential under proper health care service delivery. Yet this component is still not fully developed and utilized under the program as so far detection and treatment of leprosy cases and to reach elimination was given top priority. Provision for prevention of deformities (POD) training to the general health care staff has been kept in the second leprosy project. Some support may be required in developing a suitable training module for POD and to impart the training to some core faculty members from each state. I believe, the Leprosy Division has already approached Schieffline Leprosy Research and Training Centre, Karigiri for this purpose, who have agreed to provide the technical support.

　

The program is being given special assistance by WHO in the form of a package which covers support to all the state leprosy cells with men and material, increased technical support and supervision through state coordinators in 12 states and also 6 zonal coordinators in the highly endemic states of Bihar and Jharkhand. Other areas of support from WHO are the periodic review meetings at state and national level, leprosy elimination monitoring in 12 states, development of a simplified information system and capacity building of the state and district level officials in program management. WHO also continues to meet entire requirement of anti-leprosy drugs to the country with assistance from Novartis.

　

Danish International Development Assistance (DANIDA) is supporting the program in 4 states of M.P., Chhattisgarh, Orissa and Tamil Nadu through their 3^rd phase of DANLEP project. The project is likely to end by November 2003.

　

Out of the ILEP agencies, eight agencies viz. The Leprosy Mission, LEPRA India, Damien Foundation of India Trust, German Leprosy Relief Association, Netherlands Leprosy Project, Amici di Raoul Foollereau (AIFO), Aide aux Lepreux Emmaus Suise (ALES) and American Leprosy Mission are supporting the Indian Program in 12 states in the form of District Technical Support Teams and also in capacity building of Primary Health Care staff.

　

The support coming from the Nippon Foundation/Sasakawa Memorial Health Foundation, although not in a direct way but through WHO and ILEP agencies is very substantial which helps the program in a strong manner. I take this opportunity to thank them on behalf of my country.

　

We are committed to carry forward the efforts in the field of leprosy control, which have yielded substantive result so far to its logical conclusion of elimination of leprosy by the year 2004 at national level. The strategy developed to achieve this goal in the next 3 years would surely help in further progress in the district and sub-district level, may be in another 2-3 years time. Let our association with all the partners for this noble cause be further strengthened after today's deliberation, which will lead to a leprosy free India as also the world. I can assure you on behalf of my country that we are resolved and committed to elimination leprosy.