NLEP is a centrally sponsored public health programme of
GOI
• It has evolved over a period of time with remarkable changes
from NLCP to NLEP
• Various milestones are there in the programme to reach the
ultimate goal of leprosy free India
• Multiple stakeholders in the programme
National Leprosy Eradication Programme
Date of creation- Feb 2019
Authors - Dr. Madhushree Acharya, Junior Resident, Community Medicine and Family Medicine, AIIMS Bhubaneswar; Dr. Durgesh Prasad Sahoo, Senior Resident, Community Medicine and Family Medicine, AIIMS Bhubaneswar
NACP (National AIDS Control Programme) launched on February 12 ,2014. The Objectives was:
- Reduce new infections by 50% (2007 Baseline of NACP III)
- Comprehensive care, support and treatment to all persons living with HIV/AIDS
RMNCH+A is a NEW approach to address the health problems Mother, Newborn, Child & Adolescence simultaneously at different stages of life through 'CONTINUUM OF CARE'.
Hope this presentation will help to have a glimpse of the program.
This slides helps to know the history of Immunisation along with the present programs & conditions. This also consists of Immunisation Schedule of Nepal along with features of some vaccines.
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).
National Leprosy Eradication Programme
Date of creation- Feb 2019
Authors - Dr. Madhushree Acharya, Junior Resident, Community Medicine and Family Medicine, AIIMS Bhubaneswar; Dr. Durgesh Prasad Sahoo, Senior Resident, Community Medicine and Family Medicine, AIIMS Bhubaneswar
NACP (National AIDS Control Programme) launched on February 12 ,2014. The Objectives was:
- Reduce new infections by 50% (2007 Baseline of NACP III)
- Comprehensive care, support and treatment to all persons living with HIV/AIDS
RMNCH+A is a NEW approach to address the health problems Mother, Newborn, Child & Adolescence simultaneously at different stages of life through 'CONTINUUM OF CARE'.
Hope this presentation will help to have a glimpse of the program.
This slides helps to know the history of Immunisation along with the present programs & conditions. This also consists of Immunisation Schedule of Nepal along with features of some vaccines.
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).
This ppt contains all the information about National Leprosy Eradication programme (NLEP). It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved) and everyone who is interested in in knowing about it
Leprosy is an age-old disease and is described in the literature of ancient civilizations. It is a chronic infectious disease which is caused by a type of bacteria called Mycobacterium leprae. The disease affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early stages can prevent disability. Apart from the physical deformity, persons affected by leprosy also face stigmatization and discrimination
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
National Strategic Plan for Malaria Elimination in India (2017 2022).Anup Soans
The National strategy on malaria control has undergone a paradigm shift with the introduction of new interventions for case management and vector control, namely rapid diagnostic tests, artemisinin based combination therapy and long lasting
Insecticide impregnated nets. Modern concepts in monitoring and evaluation have]also been incorporated into the programme which take account of the new interventions. A Strategic Action Plan for malaria control has accordingly been prepared by the
Directorate of NVBDCP focussed around the package of these new interventions to decrease malaria transmission and increase access and improve quality of curative services over the 11th five year plan period (2007-12) and beyond.
National Prioritized Disease Control Programs of Nepaljkrasik07
This is the extract of the various national prioritized control programs of Nepal containing data and progress regarding HIV/AIDS and STI, Tuberculosis, Malaria, Kala-Azar, Lymphatic Filariasis, Dengue, Leprosy and Immunization Programme. These slides contain data majorly from the Annual Health Report of 2078/79 (21/22) published by MoHP.
Primary Health Care to CPHC
Primary care has been very selective in the past, covering less than 20% of primary
health care needs. This has made primary care less responsive to felt health care
needs and created the image of the under-performing system.
Primary Health Care is necessarily comprehensive- addressing primary care for all of
reproductive and child health, communicable, and non-communicable diseases and
accidents and injuries through appropriate health communication, technologies and
care provision.
Comprehensive primary health care package will also include nutrition, geriatric health
care, palliative care and rehabilitative care services.
To denote this important policy change, facilities which start providing the larger
package of comprehensive primary health care will be called Health and Wellness
centers.
Anticipation/prediction
so that epidemics be prevented
e.g. meningitis, measles
2. Early detection
to know when there is a problem
e.g. EWARS
3. Rapid Response
guidelines/trained staff/supplies
in place before epidemic
4. Effective Response
appropriate control methods
adequate resources and logistics
1 Establish Epidemic Committee
2. Set priorities
3. Agree epidemic preparedness plan
4. Implement surveillance
5. Respond rapidly and effectively
In India, approximately 25 million people are
presently affected by fluorosis and 66 million
are at risk of developing fluorosis, including
children of age 14 years. India is situated in
the geographical fluoride belt and in areas
where fluoride content is high in rocks or soil,
leaching of fluoride occurs, causing excess
fluoride level in groundwater.
Endemic fluorosis is an important health
problem in some districts in the states of
Andhra Pradesh, Punjab, Karnataka, Tamil
Nadu, Jharkhand and Rajasthan
Fluorosis is a disease caused by the consumption
of excessive amounts of mineral fluorine for long
periods. Fluorine is essential for the development
and maintenance of normal bones and teeth.
However, if it is consumed in excessive amounts
it leads to fluorosis
Implemented in India among all ST/UT s for the control of SIX
vector borne diseases
Started in 2002-2003
1. Malaria
2. Dengue
3. Filariasis
4. Kala azar
5. JE
6. Chikungunya
The Main activities of the programme
1) Formulating policies and guidelines
2) Technical guidance
3) Planning
4) Logistics
5) Monitoring and evaluation
6) Coordination of activities through state/UTs and in consultation with National Centre
for disease control (NCDC),National Institute of Malarial Research (NIMR)
7) Collabaoration with intl agencies
8) Training
9) Facilitating research through NCDC, NIMR, Regional medical research centers
10) Coordinating control activities in the inter-state and inter country border areas.
Iodine is an essential micronutrient required daily at
100-150 micrograms for normal human growth
and development. Deficiency of iodine can cause
physical and mental retardation, cretinism,
abortions, stillbirth, deaf mutism, squint & various
types of goiter.
As per the surveys conducted by the Directorate
General of Health Services, Indian Council of
Medical Research, Health Institutions and the
State Health Directorates, it has been found that
out of 414 districts surveyed in all the 29 States
and 7 UTs, 337 districts are endemic i.e where
the prevalence of Iodine Deficiency Disorders
(IDDs) is more than 5% (Annexure-I).
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating Women's Health: Understanding Prenatal Care and Beyond
NLEP_Program Management_DLO.pdf
1. National Leprosy Eradication Programme
(NLEP)
Programmatic Management of Leprosy
Dr. K. KUMARESAN
Public Health Specialist Gr II
Assistant Director (Epidemiology)
CLTRI
CLTRI Online training _ DLO_ Sep 2021
2. Learning Objectives
At the end of the session, the participants should be able
to:
– To discuss the milestones in NLEP with programme
objectives and current strategies
– To discuss the implementation of NLEP at various levels
– To describe the programmatic management of leprosy
CLTRI Online training _ DLO_ Sep 2021
3. NLEP – National Leprosy Eradication Programme
Introduction:
• NLEP is a centrally sponsored public health programme of
GOI
• It has evolved over a period of time with remarkable changes
from NLCP to NLEP
• Various milestones are there in the programme to reach the
ultimate goal of leprosy free India
• Multiple stakeholders in the programme
CLTRI Online training _ DLO_ Sep 2021
4. 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.
CLTRI Online training _ DLO_ Sep 2021
5. Year PROGRAMME MILESTONES Key implementations
Before
1955
Gandhi Memorial Leprosy
Foundation (GMLF) Wardha / Hind
Kusht Nivaran Sangh / NGOs
Survey, Education and Treatment (SET) programme
Precursor for NLCP and organized leprosy control
services
1955 National Leprosy Control Programme
(NLCP)
LCU – 4.5 L popl, SET centres – PR 5/1000 Dapsone
Monotherapy
1983 National Leprosy Eradication
Programme (NLEP)
Introduction of MDT in Phases, initially high
endemic districts
Urban leprosy centres , Mobile treatment units
1991 World Health Assembly resolution –
44.9
Eliminate leprosy as PHP at global level by the year
2000 [PR < 1/10000 popl]
1993 –
2000
First phase World Bank supported
project
MDT made available to all registered patients,
NLEP extended to all districts in the country
Midterm appraisal of NLEP (1997)
1998 - 04 Modified Leprosy Elimination
Campaign (MLEC)
SAPEL (2000)
Increasing awareness about leprosy, training to GHC
personnel and to detect the hidden cases
[> 1 Million cases detected]
Difficult, inaccessible/hard to reach population
NLEP – Milestones (1)
6. Year PROGRAMME MILESTONES Key implementations
2001-
04
World Bank supported project II
phase
Decentralization of NLEP responsibilities, integration
under general health care system, training GHC
personnel, Surveillance for early diagnosis with prompt
MDT, awareness for voluntary reporting
2002 National Health Policy 2002
Simplified Information System
introduced
NHP set the goal of leprosy elimination by 2005
SIS - Better monitoring of NLEP with recording and
reporting made easier for GHC staff.
2004-
05
Block Leprosy Awareness Campaign
(BLAC)
High priority districts & blocks with an aim to increase
the awareness for self reporting, detection of hidden
cases with capacity building of service providers
Dec
2005
Leprosy elimination as Public Health
Problem
PR <1/10000 (0.95) elimination declared at the National
level
2005 National Rural Health Mission
(NRHM)
Vertical programme integrated with general health care
system under NRHM
Dist. Nucleus Team (DNT) – Health societies
Urban leprosy control programme
NLEP – Milestones (2)
7. Year PROGRAMME MILESTONES Key implementations
2006 Disability Prevention & Medical
Rehabilitation (DPMR) introduced
Guidelines for management at primary, secondary and
tertiary level.
2012 12th plan [2012 – 2017] Special action plan for 209 high endemic districts in 16
States/UTs
Target to reduce the visible disabilities <1 per 10,00,000
population in by 2020.
2014 Upgraded Simplified Information
System (USIS) implementation
ULF formats introduced for uniformity and better decision
making
2016-
17
Newer initiatives in the programme
Three Pronged strategy
Chemoprophylaxis
LCDC – 14 day active case detection campaign in high
endemic districts
FLC – non-endemic districts
Special plan for hard to reach areas
SDR implementation to eligible contacts of new cases
Immunotherapy - MIP Vaccine as pilot phase
2017 Sparsh Leprosy Awareness
Campaign (SLAC)
Increasing the awareness, addressing high level of stigma &
discrimination - Convening special Grama sabha meeting
NLEP – Milestones (3)
8. Year PROGRAMME MILESTONES Key implementations
2017
- 18
Newer initiatives:
Introduction of “NIKUSTH”
ASHA based Surveillance for Leprosy
Suspects (ABSULS)
Real time monitoring of leprosy patients across
the country and facilitating better monitoring and
evaluation of NLEP.
ABSULS - active surveillance of leprosy
suspects with prioritizing leprosy case detection
by ASHA & treatment followup
2018
- 19
Sparsh Leprosy Elimination Campaign
(SLEC)
150th Birth anniversary of Mahatma
Gandhiji
Enhancement of recently launched initiatives –
LCDC, SLAC
G2D target to reduce <1case/Million & reduce
backlog of RCS cases
Grade II disability investigation
2018
-19
WHO Guidelines for Diagnosis, treatment
and prevention of Leprosy
Evidence based recommendations in accordance
with procedures established by the WHO
Guidelines Review Committee
Independent Evaluation of NLEP by WHO
(2019)
NLEP – Milestones (4)
9. Year PROGRAMME MILESTONES Key implementations
2019 Convergence of leprosy screening under
major programmes of National Health
Mission
i) Comprehensive Primary Health Care
of of Ayushman Bharat - Community Based
Assessment Checklist (CBAC) to screen 30+ popl.
at HWCs
ii) Rashtriya Bal Swasthya Karyakaram
(RBSK) to screen children
2020 Active Case Detection and Regular
Surveillance (ACD & RS)
Convergence under Rashtriya Kishore
Swasthya Karyakaram (RKSK)
ACD & RS guidelines rolled out – active case
finding to be continuous and regular
Flexibility for states to plan and implement
Frontline workers (FLWs)
RKSK – screening and counselling of adolescent
children
District Award Scheme for achievements in NLEP
NLEP – Milestones (5)
10. NLEP VISION:
CLTRI Online training _ DLO_ Sep 2021
“Leprosy-Free India”
NLEP MISSION:
“to provide quality leprosy services free of cost to all
sections of the population, with easy accessibility, through
the integrated healthcare system, including care for disability
after cure of the disease”
11. NLEP Objectives:
CLTRI Online training _ DLO_ Sep 2021
S No Objectives Current levels*
1. To reduce the prevalence rate to less than 1/10,000 population
at sub national and district level.
85% districts
2. To reduce Grade II disability % to < 1 among new cases at
National level
2.4%
3. To reduce Grade II disability cases to < 1 case per million
population at National level.
1.96
4. Zero disabilities among new Child cases 63 cases
5. Zero stigma and discrimination against persons affected by
leprosy
>100 laws
*2019-20 data
12. NLEP Strategies:
1. Decentralized integrated leprosy services through General Health Care system.
2. Early detection & complete treatment of all new leprosy cases.
3. Carrying out house hold contact survey for early detection of cases
4. Capacity building of all general health services functionaries
5. Involvement of ASHAs in the detection & completion of treatment of leprosy
cases on time
6. Strengthening of Disability Prevention & Medical Rehabilitation (DPMR)
services.
7. IEC activities in the community to improve self reporting to PHC and reduction
of stigma.
8. Intensive monitoring and supervision at Health and Wellness centres and at
PHC/CHC.
CLTRI Online training _ DLO_ Sep 2021
13. Recent strategies in NLEP
1. Three pronged strategy- LCDC, FLC, Hard to reach areas
2. ASHA based Surveillance for Leprosy Suspects (ABSULS)
3. ‘Sparsh Leprosy Awareness Campaign’(SLAC)
4. Post Exposure Prophylaxis - Single Dose Rifampicin (PEP-SDR)
5. Immunoprophylaxis - Mycobacterium indicus Pranii (MIP) vaccine
6. Implementation of online reporting system (‘Nikusth’) for improved
monitoring and supervision
7. Detailed investigation Grade II disability cases
8. Drug resistance surveillance
9. Modelling studies in leprosy
10. Active Case Detection & Regular Surveillance (ACD & RS)
11. District Award Scheme for achievements in NLEP
CLTRI Online training _ DLO_ Sep 2021
14. Decentralized planning for achievements of results
• All the activities of NLEP was
planned, implemented and
monitored under the umbrella of
NHM
• Decentralized planning through
district health plans, formulated
through bottom up process
• Programme Implementation Plan
(PIP) should be prepared as a
result oriented process.
• Funds sent to states through State
Health Societies
CLTRI Online training _ DLO_ Sep 2021
• Improved early case detection & case
management
• Stigma reduced
• Development of leprosy expertise
sustained
• Research supported evidence based
programme practices
• Monitoring supervision and evaluation
system improved
• Increased participation of persons
affected by leprosy in society
• Programme management ensured
15. NLEP - Institutional framework & Programme management
CLTRI Online training _ DLO_ Sep 2021
• Ministry of Health & Family Welfare
• DGHS
• Central Leprosy Division - DDG (L)
• Training Institutes - CLTRI, RLTRIs
Centre level
• State Health Society
• State Leprosy Officer / State Leprosy Consultant
State level
• District Health Society
• District Leprosy Officer / Deputy Director
• District Nucleus Team (DNT)
District level
• Block PHC / CHC - Rogi Kalyan samiti / PRI
• Block Medical Officer / incharge MO CHC
Block level
• PHC - Rogi Kalyan samiti / Panchayati Raj Institution
• Medical Officer
PHC level
• Grama Panchayat
• Male / Female Health Worker
Sub-Centre level /
Health & Wellness Centre
• Village Health & Sanitation Committee
• ASHA / AWW
Village level
16. Job responsibilities
Medical
Officer
• Planning of NLEP activities
• Case Confirmation, treatment, Lepra reaction Mx, referral of complications
• On Job Training to PHC Staff
• Supervision & Monitoring
• Review of activities & Feedback to DNT
HS/ HI /
ANM/
MPHW/
VHN
• Suspect identification
• Availability of MDT and providing MDT, compliance
• Record Maintenance & Report Preparation
• IEC activities
• DPMR activities
• Supervision of ASHA/ AWW / Volunteer
• Assist MO
ASHA/
AWW
• Suspect identification & referral to PHC
• Timely completion of treatment
• Counselling & IEC
• Contact Screening, support for active case detection campaigns
CLTRI Online training _ DLO_ Sep 2021
17. District level
• Districts remain the core centre for NLEP activities
• District Nucleus Team (DNT), headed by DLO with other
necessary staff.
• District PIP is prepared by the DNT by compiling the action
plans from block/PHC level and forwarded to state.
• Regular capacity building of health care workers
• Supervision, Monitoring & Evaluation of NLEP in the
district
• Budget utilization and statement of expenditure (SOE)
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19. Programmatic management of leprosy (1)
• Suspect identification
• Case diagnosis & confirmation
- Govt. & Non-Govt.
- Guidance & support to field workers
• Difficult to diagnose, reactions & complications
– identification & referral services
• Survey – Routine / Active surveys
• School health activities – screening of children
• Contact screening as per guidelines
• Special activities
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Case detection
activities
20. Programmatic management of leprosy (2)
• Initiation of MDT & ensuring Compliance
• Adverse effects monitoring
• Defaulter retrieval
• Treatment for complications
• Drugs
- MDT availability
- Supportive drugs: steroids, others
• Free of cost
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Treatment
21. Treatment of leprosy
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Characteristics Pauci-bacillary (PB) Multi-bacillary (MB)
Skin lesions 1 – 5 lesions 6 and above
Peripheral nerve
involvement
No nerve / only one
nerve involvement
> 1 nerve irrespective
of no. of skin lesions
Skin smear Negative at all sites Positive at any site
WHO Classification:
# Operational Classification – helps in selecting correct combination of drugs for a given patient
22. Treatment of leprosy
• MDT – Cap. Rifampicin, Tab. Dapsone & Cap. Clofazimine
• Standard regimen of MDT
• MDT provided in convenient to use Blister Calendar Packs
(BCPs)
• Four weeks / 28 days
• Dosage
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Rifampicin : 10mg/kg body weight, monthly once
Dapsone : 2mg/kg body weight, daily
Clofazimine : 1 mg/kg body weight daily & 6mg/kg body
weight, monthly once
23. Indications for prescribing MDT
New case
Person with signs of leprosy
who have never received
treatment before
Other case
under NLEP all previously
treated cases, who need further
treatment are recorded as other
cases
Relapse:
Re-occurrence of the disease at any time after the
completion of full course of treatment.
Re-entered for treatment:
These are previously treated cases, where clinical
assessment shows requirement of further treatment and
patient admits that treatment was not completed.
Referred cases:
Patient referred for completion of treatment (remaining
doses) by tertiary or second level institutions after
diagnosis and issue of first dose, or from another Health
centre on patient request or migratory patient from
another District/State
Re-classified:
Persons with PB leprosy; reclassified to MB and need full
course of MB treatment.
A person who is residing for more than six month and is likely to stay till
completion of treatment, be recorded as indigenous case and will not be
categorized under “other cases”.
24. MDT Regimen
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Type of
leprosy
Drugs used Frequency of
Administration
Adults (children in
bracket)
Dosage
(adult)
15 years &
above
Dosage
(Children 10-14
years)#
Dosage
Children below
10 years*
Criteria for
RFT
MB
leprosy
Rifampicin Once monthly 600 mg 450mg 300mg Completion of 12
monthly pulses in 18
consecutive months
(12 BCP / 18 months)
Clofazimine Monthly 300 mg 150 mg 100mg
Dapsone Daily Once 100 mg 50 mg 25mg
Clofazimine Daily for adults
(every other day for
children)
50 mg 50mg (alternate
days)
50mg (Weekly
twice)
PB
leprosy
Rifampicin Once monthly 600 mg 450 mg 300mg Completion of 6 monthly
pulses in 9 consecutive
months
(6 BCP / 9 months)
Dapsone Daily 100 mg 50 mg 25mg daily or
50 mg alternate
days
# For children 10 – 14 yrs with body weight > 35 kgs, adult BCP should be given
* For children < 10 yrs, doses (as per body weight) should be provided loose after opening appropriate BCP
29. Assessing fitness for MDT
• Jaundice: wait till subsides
• Anaemia: start treatment for anaemia simultaneously along
with MDT
• TB: if the patient is taking Rifamicin, ensure to take
Rifampicin in the dose required for treatment of TB along
with other drugs
• Allergy to sulpha drugs: known allergic – avoid Dapsone
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30. Follow up of treatment
• All efforts must be made to complete the doses in 6 months /
12 months
• During follow up – side effects of MDT and signs/
symptoms of reaction / neuritis
• Once the patient has completed the required pulses, the
treatment is stopped and made RFT (Release from
treatment)
• Self care
• Complications
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31. Advantages of MDT
CLTRI Online training _ DLO_ Sep 2021
• Stops progress of the disease, prevents further
complications and reduces chances of relapse
• Interrupt transmission of infection as rapidly as possible
• Reduces the chances of development of resistance to
drugs
• Duration of treatment is short & fixed
• Safe, minimal side effects and increased patient
compliance
32. To ensure regularity of treatment
• Adequate counselling at the start of treatment
- disease / skin lesions
- duration of treatment
- method of taking drug
- regular treatment
- side effects & reporting
• Regular follow up of patient – timely RFT
• Patients who are absent should be contacted immediately to
identify the reasons and take corrective actions.
• Flexibility in MDT delivery
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33. Accompanied MDT (A-MDT)
• Difficult in getting the drugs – underserved areas
• Emergency situations
- health / pandemic: COVID – 19
- seasonal
- conflicts / war
• Migration
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Given more than one BCP at a time
(usually 3 BCPs are given)
34. Irregular treatment
• Patients should be reassessed clinically to ascertain the type & any
disability
• Treatment history
• Look out for period of discontinuation
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Classification Period of treatment
discontinuation
Treatment
PB < 3 months Continue the same course
> 3 months* Re-start
MB < 6 months Continue the same course
> 6 months* Re-start
*Defaulter – Register as other case (re-entered for treatment)
35. Treatment regimens for special situations
Due to side-effects
or intercurrent
diseases, such as
chronic hepatitis, or
who have been
infected with
rifampicin-resistant
M. leprae
• Daily 50 mg clofazimine + any 2 drugs (400
mg ofloxacin, 100 mg minocycline or 500 mg
clarithromycin) – 6 months
• Followed by daily 50 mg clofazimine + any
1drug (100 mg minocycline or 400 mg
ofloxacin) - 18 months
• If available, ofloxacin may be replaced by
moxifloxacin 400 mg, which has stronger
bactericidal activity against M. leprae.
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Patients who cannot take rifampicin
36. Treatment regimens for special situations
Due to side-effects -
skin discolouration
• MDT may be replaced by 400 mg
ofloxacin / moxifloxacin daily, or by
minocycline 100 mg daily, for 12
months.
• Alternatively – Rifampicin 600 mg once
a month, ofloxacin 400 mg once a
month, and minocycline 100 mg once a
month for 24 months.
CLTRI Online training _ DLO_ Sep 2021
Patients who cannot take Clofazimine
37. Treatment regimens for special situations
Due to side-effects -
severe toxic effects
PB / MB leprosy
• Dapsone to be stopped immediately
• MB leprosy:
- No further modification
• PB leprosy:
- clofazimine in standard dose of
MB-MDT
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Patients who cannot take Dapsone
38. WHO Guidelines for Diagnosis, Treatment and Prevention of Leprosy (2018)
Area of the
recommendation
Recommendation
Diagnosis of leprosy The diagnosis of leprosy may be based on clinical examination, with or
without slit-skin smears or pathological examination
Diagnosis of leprosy
infection
There is currently no test recommended to diagnose leprosy infection (latent
leprosy) among asymptomatic contacts.
Treatment of leprosy The same 3-drug regimen of rifampicin, dapsone and clofazimine may be used for
all leprosy patients, with a duration of treatment of 6 months for PB leprosy and of
12 months for MB leprosy.
Treatment of drug
resistant leprosy
Two of the following second-line drugs: clarithromycin, minocycline or a
quinolone (ofloxacin, levofloxacin or moxifloxacin), plus clofazimine daily for 6
months, followed by clofazimine plus one of the second-line drugs daily for an
additional 18 months.
Chemoprophylaxis for
contacts of leprosy
cases
Single-dose rifampicin (SDR) may be used for contacts of leprosy patients
(adults and children aged 2 years and above), after excluding leprosy and
tuberculosis (TB) disease, and in the absence of other contraindications.
39. • Develop adequate skills for diagnosis
& management of cases
• Training of general health care staff
• Regular training & refresher training
• Training data base particulars
• Follow up of training
• PIP – No. trained / No. need to be
trained – key healthcare staff
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Capacity building
Programmatic management of leprosy (3)
40. • DPMR – primary / secondary / tertiary level
• Detection of complications & referral
• Assessment of disability status
• Line list of beneficiaries
• Conduction of POD activities
• Self care demonstration & provision of kits
• Provision of MCR / aids & appliances
• RCS referral / surgery – clearing backlog of RCS
• Identification of RCS institutions
• Incentives for RCS
• Social welfare measures – identification & assistance
• Special activities / programmes
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Disability
Prevention &
Medical
Rehabilitation
(DPMR) activities
Programmatic management of leprosy (4)
41. Information,
Education &
Communication
(IEC) / BCC
• Generate awareness about leprosy, treatment and
reducing stigma & discrimination
• IEC campaigns – schools/colleges, community
• Inter-personal communication (IPC)
• New strategies & methods
• Focus on Behaviour change communication
• Tangible increase in voluntary reporting
• Involvement of PAL
• Training of health staffs / volunteers
• Special campaigns – Sparsh Leprosy Awareness
Campaign (SLAC)
• “Leprosy Free India”
CLTRI Online training _ DLO_ Sep 2021
Programmatic management of leprosy (5)
42. Planning,
Supervision &
Monitoring
• Assess the leprosy situation in the area &
action plan
• Planning surveys, field visits - PIP
• Supervision of field level health care
workers
• Record maintenance - Records & reports -
Complete, accurate & timely
• Monitoring & Evaluation of program
performance – Indicators
• Training need assessment
• “NIKUSTH” implementation
• Review meetings & feedback – all levels
CLTRI Online training _ DLO_ Sep 2021
Programmatic management of leprosy (6)
43. Involvement of NGOs in NLEP
• Partnership with NGOs is envisaged under NLEP and the objective is to provide
uniformity in diagnosis, treatment and monitoring through a wider programme
base to maximize access to NLEP services
• Complement and supplement the government efforts in reducing the disease
burden
• Bring about betterment in the quality of life and socio-economic condition of the
affected persons and families.
CLTRI Online training _ DLO_ Sep 2021
Activities:
1. IEC/BCC and stigma reduction
2. Referral of suspects, Diagnosis and provision of MDT
3. Follow up of cases and treatment adherence
4. Out-patient and In-patient care
5. DPMR services
6. Referral & conduction of RCS
44. Grant in aid Schemes for NGOs
1. Scheme 1A - Designated Referral Centres (DRC 1A) Out-patient facility
2. Scheme 1B - Designated Referral Centres (DRC 1B) Out-patient and In-patient
3. Scheme 1C - Designated Referral Centres (DRC 1C) Out-patient, In-patient and
RCS
4. Scheme 2 - Comprehensive Care for Underserved Areas
5. Scheme 3 - Contact Survey and Home Based Self Care
6. Scheme 4 - Disability Care Centre - Leprosy Colonies
7. Scheme 5 - Advocacy Communication and Social Mobilisation with activities to
reduce Stigma and Discrimination in Leprosy
8. Scheme 6 - Partnering with community for elimination of leprosy
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• Grant-in-aid schemes are available under NLEP for the NGOs to build
partnership and implement the schemes.
• > 285 NGOs working in the field of leprosy throughout the country &
54 NGOs are getting grant-in-aid from Government of India.
45. NGO – Eligibility Criteria
• Registration of the NGO for at least last two years
• Necessary infrastructure and manpower support
• Experience of work related to leprosy or health or
community development as appropriate in public sector.
Applications requesting for the Grant-in-aid under the NGO
scheme shall be made through the District Leprosy Officer
(DLO) to the State Leprosy Officer (SLO).
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46. ILEP
International Federation of Anti-leprosy Associations
Members:
1. Americal Leprosy Missions
2. Associazione Italian Amici di Raoul
Follereau (AIFO)
3. German Leprosy and Tuberculosis
Relief Association (DAHW)
4. Damien Foundation Belgium
5. effect:hope
6. FAIRMED
7. Foundation Raoul Follereau
8. Fontilles
9. Lepra
10. Leprosy Relief Canada
11. NLR International
12. Sasakawa Health Foundation
13. The Leprosy Mission
International
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ILEP is a consortium of international non-governmental organisations
with a shared desire to see a world free from leprosy
47. NLEP – Budget under NHM
FMR
codes
Major Heads Total Budget
proposed for FY
Total Budget
approved for FY
1. Service Delivery - Facility based
2. Service Delivery – community based
3. Community intervention
6. Procurement
9. Training & Capacity Building
11. IEC/BCC
12. Printing
15. PPP
16. Programme Management
Total Budget
52. Mapping of districts by level of Endemicity
52
Districts Total (%)
High Endemic 118 (17)
Moderate Endemic 206 (29)
Low Endemic 260 (37)
Sporadic cases only 124 (17)
Source: Independent Evaluation of the Indian NLEP.WHO; Nov 2019
(n = 708 districts)
53. WHO and Strategic and Technical Advisory Group for NTD
[Generic framework 2015]
Elimination as a Public Health Problem
• related to both infection and
disease.
• defined by achievement of
measurable global targets set by
WHO in relation to a specific
disease. When reached, continued
actions are required to maintain the
targets and/or to advance the
interruption of transmission
Elimination of transmission
• also referred to as interruption of
transmission
• mean reduction to zero of the
incidence of infection caused by a
specific pathogen in a defined
geographical area, with minimal
risk of reintroduction, as a result
of deliberate efforts; continued
actions to prevent re-establishment
of transmission may be required
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Prevalence < 1 case/10000 population Zero new case of leprosy
54. GLOBAL LEPROSY STRATEGY
2016 – 2020
“Accelerating towards a leprosy
free world”
2021 – 2030
“Towards Zero Leprosy”
55. GLOBAL LEPROSY STRATEGY
What does it mean in terms of numbers to India?
S.No Impact Indicators Target GLS 2016-2020
1. No. of children diagnosed with leprosy
and visible deformities
0 162 63 (>60% )
2. Rate of newly diagnosed leprosy patients
with visible deformities
<1/million 4.5 1.96 (>56%)
3. No. of laws / legislation allowing
discrimination on the basis of leprosy
0 119 102 (14%)
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S.No Impact Indicators Target GLS 2021-2030
1. Annual No. of new cases detected 70% 110000 34,000
2. Rate of newly diagnosed leprosy patients
with G2D (per million popl)
90% 1.96 0.2
3. Rate of new child cases with leprosy
(per million child popl)
90% 20 2
56. Leprosy - Elimination / Eradication
• Diagnosed by clinical signs
• Availability of effective treatment to interrupt transmission
• Single significant reservoir – Humans
• Chemoprophylaxis /+ immunoprophylaxis
• Human resources
• Country experiences
• National & International efforts
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57. NLEP - Challenges
• Weak link in establishing the
transmission chain
• long & variable incubation period
• Difficult to diagnose subclinical
infections
• Reactions & nerve damage
• Effective vaccine not available
• Involvement of health workers after
integration
• Lack of trained manpower –
Knowledge gap & skills
• Need for new drugs / regimens
CLTRI Online training _ DLO_ Sep 2021
• Hidden cases - case detection – less
voluntary reporting
• Stigma & discrimination
• Notification from private providers
• Disability / loss of productivity -
DPMR activities
• Weak Monitoring & supervision
• Underserved /difficult to reach areas/
Migrants
• Lack of Research in new tools /
interventions
• Drug resistance
• Reduced resource allocation