NLEP

1. NLEP
Leprosy work is not merely medical relief, it is transforming
frustration in life into the joy of dedication, personal ambition
into selfless service.” Mahatma Gandhi
Dr. Krithiga S.
PG Community Medicine

2. The NLEP Emblem
Symbolizes beauty and purity in lotus
• Leprosy can be cured and a leprosy patient can
be a useful member of the society in the form of
a partially affected thumb;
• a normal fore-finger and the shape of house;
• the symbol of hope and optimism in a rising sun.
• The Emblem captures the spirit of hope positive
action in the eradication of Leprosy.

3. Framework
• Milestones in eradication
• Current scenario
• Objectives
• Elimination strategies
• Various activities in the programme
• Infrastructure
• Support of NRHM
• Challenges

4. • Pre independence Leprosy patients were isolated . ‘The Lepers Act 1898’ was
enacted, which discriminated the Leprosy patients and segregated them socially.
• 1955 launched National Leprosy Control Programme with the objective of
controlling leprosy with Dapsone.
• 1983 Launched National Leprosy Eradication Programme(NLEP) and introduced
MDT
– (Reduction in the quantum of infection in the population
– Reduction in the sources
– Breaking the chain of transmission)

5. • 2001 - 2004 World Bank supported NLEP - II
• 2005 NRHM covers NLEP
1991 WHO declaration to eliminate leprosy at global level by 2000
1993 World Bank supported NLEP - I
1998-2003 Integration of leprosy services with GHC system in 2002-03,
leprosy diagnosis and treatment services area available free of
cost at all PHCs
2002 National Health Policy had set the goal of elimination of
leprosy by the year 2005

6. The global registered prevalence of leprosy at 2011 stood - 192,246 cases

7. • India achieved elimination of leprosy at National Level in Dec
2005
• Recorded Prevalence Rate (PR) - 0.95/10,000 (<1/10,000)
• 2011-12, prevalence rate 0.69/10,000.
• 32 states achieved elimination
• Leprosy Situation : (March 2011 PR/10000)
• Pondicherry 0.34
• Tamilnadu: : 0.44

9. Objectives of NLEP II (2001 onwards)
1.To decentralize the NLEP responsibilities to the
states.
– State level societies will be formed
– funding to the districts will be done by state societies
2.Integration of Leprosy Control Activities with the
general health services and capacity building
3. To achieve elimination at national level

10. Elimination Strategies
1. Special Action Project for Elimination of Leprosy (SAPEL) for rural
and Leprosy Elimination campaigns for urban areas:
– It is an initiative aimed at providing MDT services in difficult to reach
areas.
2. Modified Leprosy Elimination Campaign (MLEC):
– organizing camps which include a package of teaching, training,
intensified IEC, case detection and prompt MDT.
– Wide publicity is given prior to camp.
– Five such nation wide campaigns have been carried out.(9.9 lakh new
cases under treatment)

11. Activities
1. Early detection through active surveillance
– More focus on new case detection than prevalence
– Treatment completion rate – important indicator
2. Regular treatment of cases by providing Multi-Drug
Therapy

13. Surveillance after treatment
● PB cases clinically examined once a year for
minimum two years
● MB cases -clinically examined once a year for a
minimum period of 5 years

14. • Intensified health education and public awareness campaigns to
remove social stigma attached to the disease.
– Essential to control the disease
– Includes educating public about the symptoms, early treatment
• Prevention of Disability & Medical Rehabilitation
– Dressing materials, supportive medicines, MCR footwears,
– Aids for reconstructive surgeries and incentives for family BPL
undergoing reconstructive surgery
– Free medical facilities in leprosy self settled colonies

15. 5.Leprosy Training of General Health Services functionaries
• All staff of the general health services in government hospitals, PHCs,
CHCs, are trained to detect, treat, refer and to prevent and rehabilitate
disability.
6. Information Education and Communication (IEC) using Local & Mass
Media for reduction of Stigma & Discrimination.
7. Monitoring & Evaluation
8. Inter-sectoral collaboration

16. Information, Education and Communication (IEC) :
• Stigma reduction and discrimination , general awareness and focus on inter
personal communication
Theme : Towards leprosy free India
Objectives in low endemic states : encourage voluntary self-reporting, as the
strategy for case detection
Objectives high endemic states
• early signs of leprosy, its Curability, encourage people to support leprosy
affected people to live a normal a life
• The targets are community, leprosy affected people, influencers, general health
services and private providers,NGOS
• Next phase are women, children, difficult to reach groups-urban remote areas,

18. Monitoring and Evaluation of NLEP
• NLEP has an inbuilt information system for monitoring and supervision of
the programme activities at all level.
Simplified Information System (SIS) :
• Computerised system introduced in 2002
• This has drastically improved recording, reporting
• The programme is monitored routinely at all levels through scrutiny of
regular monthly reports.
Leprosy Elimination Monitoring (LEM) :
• Undertaken with WHO support through the NIH&FW, New Delhi, to assess
leprosy services and the programme achievement.

19. ILEP Agencies :
• International Federation of Anti-leprosy Association (ILEP)
is actively involved partner in NLEP.
• In India ILEP is constituted by 10 Agencies The Leprosy
Mission, Damien Foundation of India Trust, Netherland
Leprosy Relief, German Leprosy Relief Association, Lepra
India, ALES,AIFO, Fontilles - India, AERF - India and
American Leprosy Mission.
• Activities carried out - capacity building of GHC staff,
provision of technical support ,planning and monitoring.

20. Involvement of NGOs
• 285 NGOs working in the field of leprosy throughout the country
• 39 NGOs are getting grant-in-aid from government of India for
Survey, Education and Treatment (SET) scheme.
• They serve in remote, inaccessible, uncovered, urban slums & other
marginalized population
Activities
• IEC, Prevention of Impairments and Deformities, Case Detection and
MDT Delivery
• provide facilities for hospitalization and disability and ulcer care &
conducting reconstruction surgeries.

21. Leprosy Institutions :
• 4 premier Leprosy Institutes under
Directorate General of Health Services,
MOHFW ,GOI .
• CLTRI, Chengalpattu, RLTRI, at Aska, Raipur
and Gouripur.
• They are involved in research (basic and
applied ) in Leprosy and Training of different
categories of staffs
• Play an important role in
1. management of referral patients,
2. providing quality care to chronic ulcer
and disabled patients
3. Minor & Major Reconstructive
Surgeries.

22. Urban Leprosy Control Programme
• NEED -To address the complex problems
(larger population, migration, poor health
infrastructure and increasing prevalence in
urban areas)
• Implemented since 2005
• Assistance is being provided by GOI to
urban areas having population size of more
than 1 lakh.
• The urban areas are grouped Township-I,
Medium Cities-I, Medium Cities-II, Mega
Cities.

23. Infrastructure
• NLEP was implemented through the establishment of Leprosy control units
Survey Education and Treatment centers (SET) and urban leprosy centers.
LCU Endemic areas
1 medical officer, 2 nonmedical supervisors and
20 para medical workers. covered a population
of 4.5 lacs
SET 1 paramedical worker for 20-25,000 population and
1 non medical supervisor for 5 paramedical workers
Attached to PHCS
Mobile leprosy treatment units Non endemic areas.
Each mobile unit consisted of 1 medical officer, 1
non medical supervisor, 2 paramedical workers and
a driver.

24. state level State leprosy officer the chief
coordinator and technical advisor
The center directorate general health
services(planning, supervision and
monitoring of the program)
Deputy Director General

25. Support of NRHM
• Presently NLEP has been horizontally integrated into the general
health services system under NRHM, for implementation at primary
level
• Guidelines of GOI but will conform to IPHS
• ASHA plays an important role
– Generating awareness
– Encouraging self reporting
– Refer suspected cases
– Monitoring treatment
– Self care
• Incentives are being given

26. Post Elimination Period - NLEP
• Needs to expand the scope of leprosy services provided to the patients, their
families and community at large.
• The aims and objective under the 11th Plan (2007-2012) are as below.
1.Further reducing leprosy burden in the country
2. Provide good quality leprosy services.
3. Enhance Disability Prevention and Medical Rehabilitation.
4. Increase advocacy towards reduction of stigma and stop discrimination
5.Strengthen monitoring and supervision.
• The WHO global strategy aims to reduce the global rate of new cases
with grade-2 (i.e. visible) disabilities per 100 000 population by at least
35% by the end of 2015,

27. Challenges
• Leprosy remains a public health problem
• Poor coverage with MDT services in some difficult to reach
areas
• Hidden cases who continue to spread the infection
• Late detection of patients, many with visible deformities
• Poor treatment completion and cure
• Fear, prejudice and stigma surrounding leprosy
• Leprosy is a social disease little efforts have been made for
elimination of social factors related to the disease.
• Limited community awareness and involvement