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Leprosy
Situation in India
May
2004
The sources of the data presented in
this report are from the Central Leprosy Division, Government of India. The
figures are from the end March 2004, end of the fiscal year.
 Introduction
In 2003, the South-East Asia Region is the
only region where the leprosy prevalence is above the elimination goal of one
case per 10,000. Leprosy in the SEAR countries contributes to 73% of the
global prevalence and 83% of total new detected cases. In the region, three
countries are still having a prevalence rate (PR) above the elimination goal:
India (PR: 2.4), Nepal
(PR: 2.4), and Timor Leste (PR: 2.5). India alone represents 87% of
prevalence and 90% of new detected cases in the SEA Region. It clearly shows
that India
is the key country for elimination of leprosy in the region.
Epidemiological
Situation in India
The trends of leprosy
prevalence had declined steadily since the inception of Multi-Drug Therapy
(MDT) in 1983. The trends of new cases detected were stagnant from 1991 to
1998, followed by an increase in 1999 due to the first elimination campaign,
and had declined since then, as shown below.
On 1st April 2004, the number of
leprosy registered was 265 781, down from 344 003 the previous year,
representing a 25% decline.
Similarly, the number of
new cases detected from April 2003 to March 2004 was 367 143, down from 476
000 during the previous year, representing a 23% decline.
As on 1st April 2003, eleven
endemic states (Andhra Pradesh, Bihar, Chhattisgarh, Jharkhand, Karnataka,
Madhya Pradesh, Maharashtra, Orissa, Tamil Nadu, Uttar Pradesh and West Bengal) contributed for 91% of registered cases,
during the year 2003-2004.
Out of 35 States/Union
Territories, 17 had a PR below 1/10,000. 10 states/UTs between 1 and 2.9, 6
states/UTs between 3 and 4.9, one state between 5 and 9.9 and one UT above
10/10,000.
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:
 Creation
of State and District Leprosy Societies,
Training
of General Health Care functionaries,
Dismantling
of the vertical infrastructure and redeployment of vertical (leprosy) staff
to GHC infrastructure,
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),
Provision
of free treatment (MDT) through WHO,
Surveillance
through the establishment of a Simplified Information System (SIS),
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),
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,
Prevention
of disability (POD) and care, through POD camps,
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 May
2004
The
decentralisation has been achieved,
The
integration of leprosy into the GHC system is still an on-going process, but
has made significant progress in the past two years,
Most
of the GHC staff has been trained in leprosy and redeployed to GHC
infrastructures,
Leprosy
services are available at most government health facilities, as for any other
common disease, however with some variations from state to state,
The
leprosy simplified information system was implement early 2003, through out
the country,
The
fifth and last Modified Leprosy Elimination Campaign (MLEC), was conducted
during 2003-2004, showing a steady decline in detection of backlog cases,
At
present, the emphasis for detection is based on routine voluntary reporting,
with no more routine active case detection,
IEC
activities are twofold: mass media around special events (campaigns, etc.),
and routine IEC promoting inter-personal communication,
Monitoring
is regularly conducted through regular reviews and special surveys: the third
LEM annual survey will be carried out in 13 priority states during May-June
2004.
Challenges Ahead
The main challenges are:
To
sustain political commitment at all levels, given the reduction in
prevalence,
To
strengthen the integration into a sustainable process,
To
continue to built the capacity of the General Health Care staff in quality
diagnosis and treatment,
To
prevent over-reporting of new cases due to wrong diagnosis or re-registration
of old cases,
To
streamline the MDT supply and stock management, especially at health facility
and district levels,
To
ensure a wide coverage of leprosy services, especially in remote rural areas
and in urban slums,
To
ensure social rehabilitation of disabled leprosy patients,
To
sustain advocacy and IEC activities to increase awareness and decrease the
stigma attached to leprosy.
WHO specific contributions to the NLEP
Free
supply of MDT drugs,
Establishment
since 2001 of State/Zonal coordinators in most endemic states (18 national
medical officers posted),
Set
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,
Regular
monitoring of key indicators through LEM surveys,
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.),
Support
to regular review meetings at national and state levels,
Technical
support to increase the quality of diagnosis, through Validation of diagnosis
studies (2003 & 2004),
Support
to the Central Leprosy Division in human resources, equipment and
maintenance,
Support
to the 35 State leprosy societies in human resources and computer equipment.
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