The National Leprosy Eradication Programme (NLEP) in India aims to eliminate leprosy, prevent disabilities, and reduce stigma associated with the disease. Key components of the program include case detection and treatment, disability prevention and rehabilitation, information/education campaigns, and human resource training. The NLEP is decentralized and integrated into general healthcare. It focuses on early detection and treatment using multidrug therapy, as well as preventing disabilities through services like reconstructive surgery. Monitoring and evaluation involves routine reporting and field visits to track indicators like prevalence and detection rates.

1. NATIONAL LEPROSY
ERADICATION
PROGRAMME
04 April 2018
Presentor : Dr. Bushra Jabeen
Moderator: Dr. Shanthi M
1

2. CONTENTS
 Introduction
 Milestones
 Targets
 Burden of disease
 Strategy
 Components
 Referral system
 Monitoring and evaluation
2

3. INTRODUCTION
 Beauty and purity in lotus
 Leprosy can be cured and
 leprosy patient can be a useful member
of the society in the form of a
 partially affected thumb;
 normal fore-finger and the shape of house;
 Symbol of hope and optimism - rising
sun.
The Emblem captures the spirit of hope
positive action in the eradication of
Leprosy.
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4. INTRODUCTION
 Leprosy – oldest disease
 "Kusht Rog”
 Causative agent - Mycobacterium leprae bacillus
 Mode of transmission - Airborne (droplet) dissemination, direct skin-to-
skin contact, mechanical transfer, inoculation.
"Chaulmoogra" oil
Sulfone drug, e.g. Dapsone was discovered in 1943
MultiDrugTreatment (MDT) - 1981
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5. INTRODUCTION
oNational Leprosy Eradication Program (NLEP) in 1983
- Objective to arrest the disease activity in all the known cases of leprosy
oHeaded by the Deputy Director of Health Services (Leprosy )
oStrategies and plans formulated centrally
oSupported as Partners by the World Health Organization, The International
Federation of Anti-leprosy Associations (ILEP)
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6. OBJECTIVES
 Elimination of leprosy
 Strengthen Disability Prevention & Medical Rehabilitation of
persons affected by leprosy.
 Reduction in the level of stigma associated with leprosy.
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7. MILESTONES
oThe Indian Council of the British Empire Leprosy Relief Association in 1925
oRenamed as Hind Kusht Nivaran Sangh in 1947
oNational Leprosy Control Program in 1955
oCentrally aided program for control through
– early detection of cases and
– treatment with Dapsone (DDS) monotherapy
o1981 - Leprosy eradication strategy planned
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8. MILESTONES
 1981 – definite cure = MDT
 1983 - National Leprosy Eradication Programme launched
 2005 - Elimination of Leprosy at National Level
 2012 - Special action plan for 209 high endemic districts in 16
States/UTs
 2016 - Leprosy Case Detection Campaign (LCDC) have begun
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9. TARGETS
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10. GLOBAL BURDEN-
2016
There were 2,16,108 new leprosy cases registered globally in 2016,
Based on 1,73,358 cases at the end of 2016, prevalence rate corresponds to 0.29/10,000.
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11. PROBLEM STATEMENT-INDIA
 The year 2016-17 started with 0.86 lakh leprosy cases on record
as on 1st April 2016, with PR 0.66/10,000.
 Till then 34 States/ UTs had attained the level of leprosy
elimination.
 554 districts (81.23%) out of total 682 districts also achieved
elimination by March 2017.
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12. 2016
12

13.  Table 1
NLEP REPORT
FOR THE YEAR
2016-17
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 Bihar
 Chhattisgarh
 Goa
 Odisha
 Chandigarh
 D & N Haveli
 Lakshadweep

14. FIG 1. TRENDS OF PREVALENCE RATE (PR) AND
ANNUAL NEW CASE DETECTION (ANCDR) (PER
10,000 POPULATION)
Note: The increase in new cases and prevalence during 2012-13 was
attributable to the NLEP strategy to carry out extensive house to house survey
for new case detection. Further increase in ANCDR during 2016-17 is
attributable to Leprosy case detection campaign.
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15. LEPROSY IN INDIA: GRADE II DISABILITY
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16. KARNATAKA STATE BURDEN
 Capital : BANGALORE
 Districts : 30
 Achieved the Goal of elimination in the year 2005
 Estimated Population : 64805227 ( as on Mar 2015)
 Leprosy PR : 0.42/10000 pop. (March 2015 )
 Low endemic state up to end of 30/09/2015.
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17. THE HINDU- KARNATAKA,
NOV 07, 2017.
17
 Total number of cases (including new and on treatment) in 2017
till September = 2,501.

18. STRATEGY
• Decentralized integrated leprosy services through General
Health Care system
• Early detection and complete treatment of new leprosy cases
• Carrying out house to house contact survey for detection of MB
and child cases
• Early diagnosis and prompt MDT, through routine and special
efforts
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19. STRATEGY
• Involvement of ASHAs in the detection and complete treatment
of leprosy cases for leprosy work
• Strengthening of Disability Prevention & Medical
Rehabilitation (DPMR) services
• IEC activities in the community to improve self-reporting to
PHC and reduction of stigma
• Intensive monitoring and supervision at PHC/ CHC
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20. PROGRAMME COMPONENTS
Approved in the 12th Plan (2013 - 2017):
1. Case Detection and Management
2. Disability Prevention and Medical Rehabilitation
3. Information, Education and Communication (IEC) including
Behaviour Change Communication (BCC)
4. Human Resource and Capacity building
5. Programme Management
20

21. 1. CASE DETECTION
AND MANAGEMENT
21

22. CASE DETECTION AND
MANAGEMENT
Stigma associated with the disease.
Cut down the transmission potential
(i) To improve access to services.
(ii) To involve women including leprosy affected persons in case
detection.
(iii) To organize skin camps.
(iv) To undertake contact survey to identify the source.
(v) To increase awareness, to suspect and motivate leprosy affected
persons for early reporting to the Medical Officer.
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23. ASHA INVOLVEMENT
To bring out suspected cases for diagnosis
Follow up the patients for completion of treatment.
The ASHA will be entitled to receive incentive as below:
(i) At confirmation of diagnosis – Rs. 250/-
(ii) On completion of full course of treatment in time –
PB - additional Rs.400/
MB - additional Rs.600/-
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24. NGO’S INVOLVEMENT
 SET Scheme:
 Disability prevention, ulcer care, Research.
 IEC/BCC and stigma reduction
 Referral of suspects, diagnosis and provision of MDT
 Follow up of under treated cases.
 DPMR
 Referral for RCS
 Conduct of RCS
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25. ADDITIONAL ACTIVITIES IN
URBAN AREAS
(i) Identify human resources available for leprosy services.
(ii) Capacity building at time of induction.
(iii) Examination of all household contacts of all new cases at least once
before the completion of treatment of index case.
(iv) Identify one referral centre in each urban location for diagnosis and to
manage leprosy with or without complications.
(v) Supervision and monitoring of the programme.
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26. (vi) Mobile Health Clinics with leprosy services.
(vii) System of record keeping and reporting.
(viii) System of regular MDT supply to Health Centre.
(ix) Procure additional requirement
(x) Organise sensitization meetings for IEC and advocacy, participate in
exhibitions, quiz competition for awareness to reduce stigma.
ADDITIONAL ACTIVITIES IN
URBAN AREAS
26

27. LEPROSY CASE DETECTION
CAMPAIGN (LCDC)
 Implemented in high endemic districts
 Monitored by CLD and coordinated by states
 Online reporting system with patient tracking mechanism
(Nikusth)
 GIS mapping to study and project geographic distribution of
disease
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28. 2. DISABILITY PREVENTION
AND MEDICAL
REHABILITATION (DPMR)
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29. DISABILITY PREVENTION AND
MEDICAL REHABILITATION (DPMR)
 All suspected cases of leprosy reaction, relapse, insensitive hands and feet
are referred to PHC for diagnosis.
 The patient needs to be empowered in self-care to prevent worsening of
disability.
 All PHC Medical Officers diagnose cases of reaction and treat them.
Severe reaction cases may be referred to the District Hospital, if not
responded within 2 weeks of starting treatment.
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30. DISABILITY PREVENTION
Service and care for disabilities at all the Health Institutions.
Complicated ulcer cases are referred to District Hospital.
Microcellular Rubber (MCR) footwear - by the District cell through
PHC/CHC.
PHCs - follow up treatment to all patients referred back by the secondary
and tertiary level units for reaction, complication or post-surgery care.
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31. MEDICAL REHABILITATION
SERVICES
 Patients with grade II disability diagnosed at the PHC are referred to the
district hospital/ district cell
 Cases suitable for reconstructive surgery (RCS) are referred to RCS
centers recognized by Govt. of India in Govt. or NGO sector.
 Aids and appliances for medical rehabilitation are supplied to the patients.
 Disability care services
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32. MAJOR RCS UNDER NLEP
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33. QUALITY INDICATOR FOR RCS
SURGERY
 The cohort analysis report, at quarterly interval
 Proportion of Operated Cases with Improved Functional
Ability.
 It can be calculated as:
Number of cases with improved functional ability
at 6 months after operation × 100
Number of cases operated
upon during the cohort period
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34. INCENTIVE
to Patient :
Rs. 8,000/- - major RCS - District Leprosy Officer
to Institutions :
(a) To all Govt. Institutions - Rs. 5000 per RCS.
(b) To all Govt. Hospitals/Institutions, providing RCS in
camps organised outside the Institution, an
additional amount of Rs. 5000 per RCS will be
paid.
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35. 3. INFORMATION, EDUCATION AND
COMMUNICATION (IEC) INCLUDING
BEHAVIOR CHANGE COMMUNICATION
(BCC)
35

36. INFORMATION, EDUCATION AND
COMMUNICATION (IEC/BCC)
Focus on communication for behavioral changes in the general
public.
Objectives of IEC :-
 To develop communication material.
 To complement and support the detection and treatment services
 To remove stigma.
 Active participation of communities
36

37. INTERPERSONAL COMMUNICATION
Priority Areas:
Low literacy rates.
Tribal population
Endemic districts (ANCDR
>10/100,000 pop.).
Urban areas with problem of
migration.
Target groups:
Women from the areas where
literacy rate is low.
School children
Population groups residing in
remote inaccessible areas;
Tribal population.
Migratory population.
People living in urban slums.
Through the health staff involving communities, panchayat leaders and NGO.
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38. INTER PERSONAL COMMUNICATION
Women mobilization
Old Leprosy Peoples’ association
Complain mechanism - toll free number
Use of IVRS (interactive voice recognition system)
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39. NLEP-GUIDELINES ON REDUCTION OF
STIGMAAND DISCRIMINATION AGAINST
PERSONS AFFECTED BY LEPROSY
Objective :-
Provide at one place, the facts about stigma against leprosy, its
various determinants and types
Indicate intervention strategies to be followed under NLEP
Suggest line of action to be taken by the states/Uts
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40. INTERVENTION STRATEGIES
 Spreading awareness:
 Developing understandings & concepts based on scientific knowledge
 Preventing iatrogenic stigma
 Involving communities/societies
 Some interventions
 empowerment, counseling and education.
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41. INDICATORS FOR MONITORING
BCC ACTIVITIES
1. New Case Detection Rate and Proportion of Early case detection
in voluntary reported
2. Proportion of gr. ii disability among new cases
3. Treatment Completion Rates in predefined areas
4. Number of cases availed Rehabilitation services
5. Number of cases reported / noticed discrimination.
6. Number of cases (under care) developed new disability
7. Number of group meetings (IPC) held.
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42. “LEPROSY FREE INDIA”
 IEC Campaign Fortnight organized every year from 30th January,
 Observed as Anti Leprosy Day in the country.
 The following activities are to be carried out during this campaign:
Mass publicity to improve early reporting of cases
Capacity building of health staff including ASHAs and volunteers
Intensive case detection drives
Activities to reduce stigma and discrimination
Participation of persons affected by leprosy
42

43. 4. HUMAN RESOURCE
AND CAPACITY
BUILDING
43

44. HUMAN RESOURCE AND
CAPACITY BUILDING
The learning materials for training large number of GHC staff
were modified, shortened to 3 days duration
Learning material was also prepared and used for ASHAs
training.
A revised training manual also prepared for Medical Officers and
supplied to all States/UTs.
DPMR component major focus in all
Training for Health Supervisors (Male & Female) and Health
Workers (Male & Female) - every year.
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45. 5. PROGRAMME
MANAGEMENT
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46. PROGRAMME MANAGEMENT
Supervision and Travel cost
 Services through the General Health care system with supervisory
support from the District cell.
 Supervisory visits - Central/State level officers & experts from
other organization.
46

47. PROGRAMME MANAGEMENT
Programme Appraisal
 Programme monitored through analysis of routine reports and
through field visits by the supervisory officers.
 Programme Appraisal by a committee of experts identified by
Central Leprosy Division will be undertaken during the 2nd and
the 4th year of the 12th Plan.
Annual Programme Assessment
 Performance under the programme assessed annually by an
Independent expert group.
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48. PROGRAMME MANAGEMENT
National Sample Survey
 to assess the leprosy incidence in the country along with the
disability load and IEC status, in the year 2015-16.
Inter personal communication –
 The effective way to deal with difficult challenge of stigma
removal is to embark on intensive interpersonal communication
(IPC) with the target groups.
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49. REFERRAL SYSTEM
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50. 50

51. MONITORING AND EVALUATION
Simplified information system: indicators :
 Prevalence rate of leprosy,
 New case detection rate,
 Child proportion among new cases,
 Visible deformed case proportion among new cases,
 MB proportion among new cases.
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52.  Female proportion among new cases,
 New cases detection rate in scheduled castes,
 New cases detection rate in scheduled tribes,
 Patient month blister calendar packs stock,
 Proportion of health sub-centers providing MDT; and
 Absolute number of patients made RFT should also be
monitored.
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MONITORING AND EVALUATION

53. Monthly report form for PHC/Hospital and Dispensary and for
district and state:
 Patient Care Card,
 Patient Treatment Record and
 MDT Drug stock register.
Report and receipts examined by the concerned official at the level
of block PHC, District, State and Center.
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MONITORING AND EVALUATION

54. BRIEF ABOUT NEWER
INDICATORS UNDER NLEP
• Main or Core indicators
– New case detection rate
– Treatment completion rate.
• Epidemiological indicators.
– Disability proportion
– MB case proportion
– Child proportion
55

55. OTHER INITIATIVES
 Newsletters – Jan 2016
 Nikusht
 GIS mapping
 Uniform multidrug therapy regimen
 Mass drug administration
56

56. INSTITUTIONS
 Four premier Leprosy Institutes
 Working under Directorate General of Health Services, Ministry of
Health & F.W., Government of India
 Purpose :
Research (basic and applied ) in Leprosy and
Training of different categories of staff
 Management of referral patients,
 Providing quality care
Supervising and providing consultancy services to the State NLEP Units.
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57. 58

58. GLOBAL LEPROSY STRATEGY
2016–2020
 “Accelerating towards a leprosy-free world” - 20 April 2016.
 Goal :
Further reduce the burden of leprosy
Comprehensive and timely care following the principles of equity and
social justice.
Purpose :
provide guidance for managers of national leprosy programmes (or
equivalent entities) to adapt and implement the Global Leprosy Strategy
in their own countries.
Structure : three strategic pillars
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59. 60

60. 61

61. THE FINAL PUSH STRATEGY
FOR ELIMINATION OF LEPROSY
• Expand MDT services to all health facilities
• Ensure that all existing and new cases are given appropriate MDT
regimens
• Encourage all patients take treatment regularly and completely
• Promote awareness in the community on leprosy
• Set targets and time table for activities
• Keep good records of all activities - monitor the progress.
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62. REFERENCES
 Regional Office for South-East Asia, World Health Organization. (2017). Global Leprosy
Strategy 2016–2020. Accelerating towards a leprosy-free world. Monitoring and Evaluation
Guide. World Health Organization. Regional Office for South-East
Asia. http://www.who.int/iris/handle/10665/254907. License: CC BY-NC-SA 3.0 IGO
 Kishore J. National Health Programs Of India: National Vector Borne Disease Control
Programme. 12th edition
 Park K. Textbook of Preventive and Social Medicine: National Health Programs. 24th edition.
 National Leprosy Eradication Programme (NLEP)Training Manual for Medical Officer. Central
Leprosy Division, Directorate General of Health Services Nirman Bhawan, New Delhi.
 www.nlep.nic.in
 Karnataka - National Leprosy Eradication Programme (NLEP); nlep.nic.in/karnataka.html
 Karnataka - Latest news, Live Updates, Politics, Events - The Hindu;
www.thehindu.com/news/national/karnataka/
 K. Park; textbook of preventive and social medicine; 24th edition.
 Textbook of public health & community medicine 1st edition; AFMC Pune (2009); Ashok K.
Jindal, Puja Dudeja.
 https://scroll.in/pulse/808951/the-world-wont-be-free-of-leprosy-unless-india-delivers
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