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Leprosy Situation in India
April 2005
III.
Overview of the National Leprosy Eradication Programme (NLEP)
For the
past years, the National Leprosy Eradication Programme (NLEP) of Government
of India has been supported by the World Bank (2nd phase
2000-2004), the WHO, DANLEP and nine international leprosy NGOs (ILEP).
During the
2001-2004 period, the objectives were to decentralise the NLEP
responsibilities to the States/UTs, to accomplish integration of leprosy
services into the General Health Care (GHC) system, and to achieve
elimination at the national level.
The
strategies that were used included:
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Creation of State and District Leprosy Societies,
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Training of General Health Care functionaries,
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Dismantling of the vertical infrastructure and redeployment of vertical
(leprosy) staff to GHC infrastructure,
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Increased accessibility to leprosy services by making diagnosis and
treatment available through out the government health facilities
(Hospitals, Primary Health Centres, and Health Sub-Centres),
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Provision of free treatment (MDT) through WHO,
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Surveillance through the establishment of a Simplified Information
System (SIS),
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Intensifying case detection through five national campaigns (1998-2004),
and focused active detection for difficult to reach areas/communities
through Special Action Project (SAPEL, LEC),
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Intensified IEC activities to raise awareness about leprosy and decrease
the stigma attached to the disease, by using large scale local and mass
media approaches,
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Prevention of disability (POD) and care, through POD camps,
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Monitoring and evaluation on a regular basis, through a combination of
monthly, quarterly and annual review at district, state and national
levels, as well as special activities such as large scale annual surveys
(Leprosy Elimination Monitoring – LEM, independent evaluation.
Status as
on April 2005
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The
decentralisation has been achieved,
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The
integration of leprosy into the GHC system is still an on-going process,
but has made significant progress in the past two years,
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Most
of the GHC staff has been trained in leprosy and redeployed to GHC
infrastructures,
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Leprosy services are available at most government health facilities, as
for any other common disease, however with some variations from state to
state,
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The
leprosy simplified information system was implemented in early 2003,
through out the country,
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The
fifth and last Modified Leprosy Elimination Campaign (MLEC), was
conducted during 2003-2004, showing a steady decline in detection of
backlog cases, though some over detection and re registration of treated
cases was detected.
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At
present, the emphasis for detection is based on routine voluntary
reporting, with no more routine active case detection,
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IEC
activities are twofold: mass media around special events (campaigns,
etc.), and routine IEC promoting inter-personal communication,
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Monitoring is regularly conducted through regular reviews and special
surveys: A study to assess the latest leprosy situation in the country
is scheduled towards the end of 2005.
Challenges
Ahead
The main
challenges are:
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To
sustain political commitment at all levels, given the reduction in
prevalence,
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To
strengthen the integration into a sustainable process,
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To
continue to built the capacity of the General Health Care staff in
quality diagnosis and treatment,
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To
prevent over-reporting of new cases due to wrong diagnosis or
re-registration of old cases,
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To
streamline the MDT supply and stock management, especially at health
facility and district levels,
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To
ensure a wide coverage of leprosy services, especially in remote rural
areas and in urban slums,
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To
ensure social rehabilitation of disabled leprosy patients,
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To
sustain advocacy and IEC activities to increase awareness and decrease
the stigma attached to leprosy.
WHO
specific contributions to the NLEP
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Free
supply of MDT drugs,
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Establishment since 2001 of State/Zonal coordinators in most endemic
states (19 national
coordinators
posted),
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Setting up of a leprosy specific management training targeting district
level managers from the general health care system, through the National
Institute of Health & Family Welfare, New Delhi
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Regular monitoring of key indicators through LEM surveys,
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Support to the Central Leprosy Division, Government of India, in policy
matters and national leprosy guidelines (Information system, MDT supply
& stock management, urban strategies, etc.),
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Support to regular review meetings at national and state levels,
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Technical support to increase the quality of diagnosis, through
Validation of diagnosis studies (2003 & 2004),
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Support to the Central Leprosy Division in human resources, equipment
and maintenance,
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Support to the 35 State leprosy societies in human resources and
computer equipment.
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