The National Leprosy Eradication Programme (NLEP) in India is a centrally sponsored health scheme implemented in each state. Key points of the NLEP include: 1) It was launched in 1983 and introduced multi drug therapy (MDT) for treatment, achieving the goal of eliminating leprosy at the national level by 2005. 2) The current strategy focuses on decentralization, integration with general health services, training, information/education campaigns, and monitoring/evaluation to further reduce prevalence. 3) Important initiatives include incentivizing ASHA workers, increasing focus on new case detection rates, treatment completion rates, and disability prevention and management services.

1. National Leprosy Eradication
Programme- an Update
Presented by : Abdul
Samieh Deva
Moderator: Dr.
Syed Mubashir
Consultant; Deptt.
Of Dermatology
POSTGRADUATE DEPARTMENT OF DERMATOLOGY, STD
AND LEPROSY

2. National Leprosy Eradication
Programme
 Centrally sponsored health scheme
 the Ministry of Health and Family Welfare,
Govt. of India.
 headed by the Deputy Director of Health
Services (Leprosy )
 administrative control of the Directorate
General Health Services Govt. of India
 plans are formulated centrally, the
programme is implemented by the
States/UTs.

3. NLEP
Ministry of Health
and Family Welfare,
Govt. of India
WHO
ILEP
Other
NGOs

4. 1955
• National Leprosy Control Programme
• Dapsone monotherapy
1983
• Launched NLEP and introduced MDT for treatment.
1991
• WHO declaration to eliminate leprosy at global level
by 2000.
1993 -
2000
• World Bank supported NLEP – I (552 crore/292 crore
WB)
2001 -
2004
• World Bank supported NLEP – II( 249.8 crore/. 166.35
Crore WB)
2005
• India achieved elimination of leprosy at National Level
in December’ 05. (0.95/10,000 Prevalence)

5. 0 10 20 30 40 50 60
1981
Mar/01
Mar/11
57.6
3.74
0.69
PREVALENCE OF LEPROSY IN INDIA

6. Decentralization
Integration
with General
Health Care
System
Training
IEC
Early
diagnosis &
prompt MDT
DPMR
Monitoring
and
Evaluation
STRATEGY
OF NLEP

8. SELF CARE ADVICE
ADVICE TO RCS CASES
MONITORING
REACTION
DISABILITY
MANAGE REACTIONS OR
REFER
IDENTIFY PATIENT FOR RCS
AND NEEDING FOOT-WEAR
ADVICE TO RCS CASES
SELF CARE ADVICE
DIFFICULT LEPRA
REACTIONS
COMPLICATED ULCERS
EYE PROBLEMS
RCS CASES
PERSONS NEEDING
FOOTWEAR
MANAGE ULCERS/
LEPRA REACTIONS
REFER DIFFICULT
ULCERS TO RCS CENTRE
MANAGEMENT OF
LEPRA REACTIONS
SUPPLY OF FOOT-
WEAR
RCS
SUPPLY OF fw
to DN
Sub
centre
PHC
DISTRICT
HOSPITAL
DISTRICT
NUCLEUS

9. NEED FOR A REFERRAL SYSTEM
 2001-2002: Leprosy
services integrated into
GHS
 The strength of erstwhile
vertical leprosy staff was
reduced to 25% by March 2004.
The staff was kept at CHC/PHC
level and under DLO in District
nucleus for support of
peripheral staff.
 GH Service Personnel are
trained to clinically diagnose
cases using WHO case
definition.
• Diagnosis of doubtful
cases.
• Cases with reactions
under treatment with
steroids if there is no
response after 4 weeks.
• Complications with other
system involvement
including eye
involvement.
• Reconstructive surgery
(RCS).

10. GUIDELINES FOR DRAWING UP STATEWISE REFERRAL SYSTEM
 The Dermatologist/ Medical Specialist-main referral
point in district hospital
 Diagnosed patients should be referred back to PHC for
MDT or they may be shortly managed there for
complications.
 The states have to draw up suitable referral card from
PHC to the Referral centre and back
 The identified Medical Specialist/ Dermatologist will
preferably be given a specialized training for diagnosis of
doubtful leprosy cases and management of complicated
cases. The ILEP organizations have agreed to provide
such training in 122 apex leprosy institutions in the
country.

11. Incentives to ASHA workers in NLEP
• The scheme will be initiated in five States viz.
Chhattisgarh, Jharkhand, Bihar, West Bengal
and Uttar Pradesh
• Half day training/sensitization for ASHA in
leprosy
• ASHA will refer suspect cases to health facility
• Diagnosis by MO
• ASHA will monitor daily drug intake
• An amount of Rs. 300/- and Rs. 500/- will be
paid to ASHA per PB and MB case respectively.

12. Major initiatives under NLEP
 New case detection rate is given more focus
over prevalence
 Treatment completion rate needs to be
calculated by states on yearly basis
 More stress on DPMR services
 Involvement of ASHAs
 Above types of services to 612 leprosy colonies
on fortnightly/weekly basis through NGOs or
paramedics.
 Intensive IEC campaign on a theme- “Towards
Leprosy Free India”

13. DPMR
o Implementation of DPMR and reporting its outcome
o Integration of DPMR services via NRHM
o Develop a referral system
o Tertiary institutions- CLTRI Chingelpettu and
RLTRIs/ICMR Institute JALMA, Agra/ILEP supported
Leprosy Hospitals/All PMR institutes and departments of
medical colleges
o Other support centres: ortho/plastic surgery departments
of med. colleges; NGOs; All National Institutes under
Ministry of Social Justice and Empowerment;
Contractual surgeons skilled in RCS and Rehabilitation
Programmes

14. DPMR SERVICES
o Dressing materials, supportive medicines and
ulcer kits for ulcer patients individually/or in
colonies
o MCR footwear for insensitive feet
o RCS
o Rs 5000/=as incentive to leprosy affected BPL
person for undergoing reconstructive surgery(At
discharge: Rs 3000/ At 1 month follow up: Rs
1000/ At 3rd month : Rs 1000)
o Rs 5000/= to Govt. institution/PMR centre per
RCS performed

15. Correction of claw
hand and Opponens
plasty
Wrist drop correction
Stabilization
procedures
Tissue reconstruction
procedures such as
contracture release
and flap cover
Hand RCS
under NLEP

16. Foot drop correction claw toe correction
Soft tissue
reconstruction of the
sole
Arthrodesis
Foot RCS
under NLEP

17. Lagophthalamos
correction
Reconstruction
of collapsed
nose

18. Indicators used to monitor
progress in NLEP

19. • New case detection rate
• Treatment completion rate
Core indicators
• Disability proportion
• MB Case proportion
• Child proportion
Epidemiological
indicators
• Proportion of defaulters
• Number of relapses reported during the year
• Proportion of new cases correctly diagnosed
• Proportion of cases with new disabilities
Quality of
service
indicators

20. Annual New Case Detection Rate
ANCDR = No. of new cases detected during the year × 100
Population as on 31st March
ANCDR will be the main indicator for NLEP
ANCDR to be assessed on 31st March each year. New cases
detected from April of previous calendar year to March of current
year are included.
The definition of new case – “A case with signs of leprosy, who have never received
treatment before” should be strictly followed.

21. Quaterly assessment of NCDR
• Quarterly assessment of NCDR at
State/District/Block level will better help in
understanding of the leprosy status in
different areas, on which action can be
initiated in time.
• Both the actual number of new cases
detected during the year and ANCDR are
important for assessment for leprosy
situation.

22. Treatment Completion Rate
o It is to be ascertained for:
o PB and MB cases treated
o PB Male/PB Female and MB Male/Female treated
o Rural/Urban areas
o
PB TCR = No. of new PB cases who completed MDT in 9 months × 100
No. of new cases who started MDT
Example: For reporting year 2006-2007
PB- All new cases detected and started treatment between April 2005-
March 2006 are taken
MB- All new cases detected and started treatment between April 2004-
March 2005 are taken

23. USES OF TCR
• TCR is a proxy indicator for cure rate.
• It is indicator for how well the leprosy
patients are being served by the health
services

24. Disability proportion
It is the percentage of people with disability among the
new leprosy cases detected during the reporting year.
DG I proportion = Number of new cases with disability grade I × 100
Total number of new cases detected
Similarly Disability grade II proportion is also calculated.

25. Interpretation of Disability Grade
The grade II disability proportion will be higher at the
beginning of the programme activities.
It would also rise when unserved leprosy endemic
pockets are taken up for intensive campaign.
A high percentage of grade II disabilities is a
sign of late case detection.
Another reason may be a diminishing
awareness and poor skill among health
workers.

26. MB Proportion
MB Proportion = Number of MB cases among newly detected cases × 100
Total number of new cases detected
Uses:
It is essential for knowing about the likelihood of leprosy
transmission in community and for calculating drug
requirements.

27. Interpretation of
MB Proportion
It is increased by
• the start of leprosy
control programme
• wide definition of
MB cases
• A shift from active
to passive case
detection
It is decreased by
• A shift from initial phase
to intermediate leprosy
control
• Narrow definition of an
MB case
• Active case detection
including school survey
(This will detect cases at
PB stage)

28. Child proportion
Child proportion = No. of children among new cases detected × 100
Total no. of new cases detected
 Age < 15 years
 A high child proportion may be a sign of recent and active
transmission. It is also valuable in calculating drug requirements.
 CP is low at the beginning of programme. Then once an
accumulated backlog of adult cases is dealt with CP rises and
stabilizes at a higher rate. The CP towards the end would
decrease but that is a slow process.

29. What influences CP?
CP is increased by
 School surveys
 Middle of a programme
CP is decreased by
 if previously untouched
leprosy endemic pockets
are taken up for work.
 due to increased
immunity of the
population on account of
BCG vaccination and to
other mycobacterial
infections.

30. Proportion of female cases
Proportion of female cases = No. of female cases detected in a year × 100
New cases detected
 It is an indicator of adequate access of
women to health services
 Normally a ratio of 2 males to 1 female is
seen

31. Prevalence rate
Prevalence rate = No. of balance new cases under treatment as on 31st March ×10,000
Population as on 31st March
 It is calculated as a point prevalence as on 31st
March.
 Not a good indicator after elimination has been
achieved
 Proposed to be used till all states achieve elimination.

32. Proportion of defaulters
Proportion of defaulters = no. of cases defaulted from treatment × 100
No. of cases started on treatment
Defaulter is a leprosy patient who does not
complete the treatment within 9 months for
PB or 18 months of MB treatment

33. Actions suggested to reduce default
o Cases must be followed regularly instead
of waiting for 9 or 18 months.
o Reasons for default should be recorded by
MOs for each patient routinely instead of
tracing them at the end which may be
difficult
o Corrective actions should be taken by
PHCs/UHCs if possible.
o Services of ASHAs under NRHM be
suitably utilized.

34. Number of relapses
 A relapse case of leprosy is defined as
the re-occurrence of the disease at any
time after completion of the treatment.
 Actions required:
o The relapse is to be suspected at primary level
o It is to be confirmed by a dermatologist at secondary
level
o DLO will have to maintain a record of relapse cases and
report it to State Leprosy Office. SLO will analyse data
from the districts and if any area is showing high relapse

35. Proportion of New cases correctly diagnosed
• The correction of diagnosis is to be
assessed by the District Nucleus
• A sample of new cases that have been
diagnosed at primary level are to be
validated within 3 months of diagnosis
•
Proportion of new cases = No. of correctly diagnosed × 100
correctly diagnosed No. of New cases validated
Actions required: DLO has to identify the persons involved in
wrong diagnosis and arrange for their additional training and
skill development.

36. Proportion of cases with new disabilities
Proportion of cases with new disabilities = No. of cases developing new disability × 100
No. of cases put on MDT during the year
 The indicator gives information on quality of services at PHC/UHC level.
 The DLO is to compile the record of this information for the district
PHC/urban area wise and work out the indicator annually

37. Behaviour change communication
• An intensive IEC campaign towards
“Leprosy free India”
• Centre to formulate core messages, mass
media and advocacy events besides
overall leadership
• States to base their strategies on core
framework
• A dist level ‘Advisory cum monitoring
committee’ will take help from all
stakeholders

38. BCC (contd.)
• The MO block will be the coordinator of
IEC activities in the block
• Target groups- Community, LAPs,
GHCS, NGOs, CBOs, Disabled Peoples
Organizations.

39. BCC
activities
Village
level
meetings
Health
camps
Advocacy
meetings
Community
feasts
Media
sensitizati
on
Posters
News ads
FGDs

43. Prevalence 0.16/10,000 population 0.68
MB proportion 76.57% 49
MB Female 18.86% 37
Child MB proportion 1.71% 9.7
Grade I disability 1.71% 3.78
Grade II disability 2.29% -
RCS 0 %
Child case rate 0.02 / 100,000 population 1
New disability case rate 0.31/million population -
% of country’s case load 0.25 -
% of country’s population 1.04 -
No. of districts with gr II
disability >2/million
population 2

44. Thank
You