NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)

The National Leprosy Control Programme (NLCP)  has been  in  operation  since  1955,  as  a  centrally  aided programme  to  achieve  control  of  leprosy  through  early detection of cases and DDS (dapsone) monotherapy on an ambulatory basis. The NLCP moved ahead initially at a slow pace,  presumably  for  want  of  clear-cut  policies  or operational  objectives  for  nearly  two  decades.  The programme gained momentum during the Fourth Five Year Plan after it was made a centrally-sponsored programme. In 1980  the  Government  of  India  declared  its  resolve  to "eradicate"  leprosy  by  the year 2000 and constituted  a Working Group to advise accordingly. The Working Group submitted its  report in  1982 and recommended a  revised strategy based on multi-drug chemotherapy aimed at leprosy "eradication" through reduction in the quantum of infection in the population, reduction in the sources of infection, and breaking the chain of transmission of disease. In  1983 the control  programme  was  redesignated  National  Leprosy "Eradication" Programme with  the goal of eradicating the disease by the turn of the century. The aim was to reduce case load to 1 or less than 1 per 10,000 population. 

To strengthen the process of elimination of leprosy in the country,  the  first  World  Bank  supported  project  was introduced in  1993. On completion of this project, the 2nd phase of project with  World  Bank support was started in 2001-02 which ended in  December 2004. Since then, the programme is  being continued with  Government of India funds with  technical support from  WHO and International Federation  of  Anti-Leprosy  Association  (ILEP) organizations.  The  programme  has  been  integrated  with general health care system in 2002-03, since then leprosy diagnosis and treatment services are available at all PHCs and government hospitals. 

The components of the programme are as follows : 

1. Decentralized    integrated    leprosy    services    through general health care system; 
2. Capacity   building   of   all    general   health    services functionaries; 
3. Intensified information, education and communication; 
4. Prevention of disability and medical rehabilitation; and 
5. Intensified monitoring and supervision. 

After  introduction  of MDT,  the recorded case  load  of leprosy came down from 57.6 cases per 10,000 population in 1981 to less than one at the national level in  December 2005, and the country could achieve the goal of leprosy elimination at national level as set by the National Health Policy (2002). 33 states/UTs achieved the status of leprosy elimination. Only 2 States/UTs viz. Chattisgarh and Dadra & Nagar Haveli are yet to achieve elimination 

A total of 209 high endemic districts were identified for special action during 2012-13. 1792 blocks and 150 urban areas were  identified  for  special  activities,  i.e.,  house  to house survey along with IEC and capacity building of the workers and volunteers.

Major initiatives 

Major initiatives taken are as follows : 

1. More focus has now been given to new case detection than prevalence which only gives the number of cases on record at a point in time. The new case detection rate is the main indicator for programme monitoring. 
2. Treatment   completion   rate   has   been  taken   as   an important indicator, to be calculated by states at yearly basis.
3. More  emphasis  is  being given  on  providing disability prevention and medical rehabilitation (DPMR) services to leprosy affected persons. The aid provided is as follows :
1. Dressing materials, supportive medicines and ulcer kits  are  provided to  leprosy affected ,persons with ulcers and wounds. These services are also provided to  leprosy  affected  persons residing  in  self settled colonies.
2. Micro-cellular  rubber  footwear  is  provided  for protection of insensitive feet. 41 NGOs in the country and 42  Government Medical  Colleges  have  been strengthened  for  providing  reconstructive  surgery services to leprosy affected persons for correction of their  disability,  thus  totalling  to  83  centres  for conducting reconstructive surgeries in the country.
3. An  amount of Rs.  5000/- is provided as incentive to each  leprosy  affected  person  from  BPL  family undergoing reconstructive surgery in these identified institutions to compensate for loss of wages. 
4. Support is also provided to government institutions/ PMR  centres  in  the  form  of  Rs  5000/- per reconstructive surgery conducted.
4. ASHAs  have been involved  in  bringing out suspected leprosy  cases  from  their  villages  for  diagnosis  and treatment at PHC and follow-up of confirmed cases for their treatment completion. To facilitate the involvement of  ASHA  in  the  programme,  they  are  being  paid incentive money as below :
1. On confirmed diagnosis of case brought by them - Rs. 100/-
2. On completion of full course of treatment of the case within specified time - PB leprosy case - Rs  200/-, and MB leprosy case  Rs 400/-
5. There are 612 self settled colonies in the country where more than 50,000 leprosy affected persons reside. Free medical facilities  like  care of ulcers,  self care training, counselling and MCR  footwear are provided to leprosy affected persons residing in these colonies through para- medical workers/NGOs on weekly/fortnightly basis.
6. Intensive !EC campaign with a theme "Towards Leprosy Free  India"  has  been  carried  out  towards  further reduction  of leprosy burden  in  the  community,  early reporting  of  cases  and  their  treatment  completion, provision of quality  leprosy services and reduction of stigma  and  discrimination  against  leprosy  affected persons. Awareness generation activities are carried out through mass media and local media.

Urban leprosy control programme 

The urban leprosy control programme was  initiated  in 2005 to address the complex problem of larger population size,  migration,  poor health  infrastructure  and increasing leprosy cases in urban areas. 

Under this component, assistance is  provided to urban areas having population size  of more than 1 lakh.  For the purpose of providing graded assistance, the urban areas are grouped in four categories i.e. Township I, Medium Cities I, Medium Cities II, and Mega Cities. 

Disability prevention and medical rehabilitation (DPMR)

 The  main  activities  carried  out  under  DPMR  are  as follows :

1. Implementation of DPMR activities as per guidelines and reporting its outcome eg. treatment of leprosy reaction, ulcers,  physiotherapy,  reconstructive  surgery  and providing MCR footwear.
2. Integrating  DPMR  services  - There  are  provision  of services  to  persons  with  disability  by  various departments under different ministries. Convergence of NLEP services into NRHM facilitates this integration.
3. To  develop a  referral system to provide prevention of disability services to all leprosy disabled persons in an integrated set-up.

                        The DPMR activities are planned to be carried out in  a three tier system  i.e.  the primary level  care  (First  level), secondary level care (Second level)  and the tertiary level care (Third level). The primary level care institutions are all PHCs,  CHCs,  Sub-divisional hospitals and urban leprosy centres/dispensaries. The secondary level care institutions are all District Head Quarter Hospitals and District Nucleus Units. The tertiary level care institutions are :

1. Central Government Institutes (CLTRI Chingalpettu and RLTRI at Aska/Gauripur/Raipur)
2. ICMR Institute JALMA, Agra.
3. ILEP supported Leprosy Hospitals.
4. All PMR Institutes and departments of medical colleges.

        The other support units are :

1. Orthopaedics and plastic surgery departments of medical colleges.
2. Identified NGO institutions.
3. All  National Institutes under Ministry  of Social Justice and Empowerment.
4. Contractual surgeons skilled in  RCS a'nd Rehabilitation Programmes.

The referral system in NLEP is as shown in Fig. 1. 

Decentralization     and    institutional    development Integration of leprosy services into the general health care system has been completed. Services are available from all PHCs, and other health centres where a medical officer is available. District nucleus has been formed to supervise and monitor the programme. State leprosy societies formed will merge with the state health society under the National Rural Health Mission.

Programme Implementation Plan for 12th Plan Period (2012-13 to 2016-17)

            As the disease is still prevalent with moderate endemicity in about 15 per cent of the country, the plan objectives are set as follows

1. Elimination of leprosy i.e. prevalence of less than 1 case per 10,000 population in all districts of the country.
2. 
   
   
3. Strengthen      disability      prevention      and      medical rehabilitation of persons affected by leprosy. 
4. Reduction in the level of stigma associated with leprosy.