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8.Leprosy Control Programmes In India


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Published in: Health & Medicine

8.Leprosy Control Programmes In India

  1. 1. Leprosy Control Programmes in India Avanthika Lakshmanan
  2. 2. Need for a Control Programme <ul><li>Prevalence: </li></ul><ul><ul><ul><li>1966 - 8.4/ 10,000 </li></ul></ul></ul><ul><ul><ul><li>1985 - 12/ 10,000 </li></ul></ul></ul><ul><li>One of the main causes of crippling & deformities. </li></ul><ul><li>People not treated in early stage- 25% develop anaesthesia and/or deformities </li></ul>
  3. 3. National Leprosy Control Programme (1955) (1980) Govt. decided to “eradicate” leprosy (1983) National Leprosy Eradication Programmme <ul><li>- Modified Leprosy Elimination Campaign (MLEC) </li></ul><ul><li>2001 to 04 - SAPEL and LEC </li></ul><ul><li>2005 - Urban Leprosy Control Programme </li></ul>Evolution of NLEP
  4. 4. National Leprosy Control Programme <ul><li>Since 1955, centrally aided </li></ul><ul><li>To control Leprosy through </li></ul><ul><ul><ul><li>Early detection of cases </li></ul></ul></ul><ul><ul><ul><li>Dapsone monotherapy </li></ul></ul></ul><ul><li>Fourth Five year plan- centrally sponsored </li></ul><ul><li>1980- ‘Eradicate’ Leprosy </li></ul><ul><li>‘ Working Group’ </li></ul><ul><ul><ul><li>Revised strategy based on multi- drug chemotherapy </li></ul></ul></ul><ul><ul><ul><li>Aimed at Eradication </li></ul></ul></ul>
  5. 5. <ul><li>Eradication was planned through </li></ul><ul><ul><ul><li>Reduction in the quantum of infection in the population </li></ul></ul></ul><ul><ul><ul><li>Reduction in the sources </li></ul></ul></ul><ul><ul><ul><li>Breaking the chain of transmission </li></ul></ul></ul><ul><li>National Leprosy Eradication Programme- 1983 </li></ul>
  6. 6. National Leprosy Eradication Programme <ul><li>Goal : Eradicating leprosy by 2000 </li></ul><ul><li>Aim : to reduce the case load to 1 or less than 1 per 10,000 </li></ul><ul><li>Revised strategy based on </li></ul><ul><ul><li>Early detection of cases </li></ul></ul><ul><ul><ul><li>(population /school surveys, contact examn., voluntary referral) </li></ul></ul></ul><ul><ul><li>Short term multi drug therapy </li></ul></ul><ul><ul><li>Health Education </li></ul></ul><ul><ul><li>Ulcer and Deformity care </li></ul></ul><ul><ul><li>Rehabilitation </li></ul></ul>
  7. 7. <ul><li>Other activities </li></ul><ul><ul><li>Endemic districts </li></ul></ul><ul><ul><ul><li>-Free domiciliary treatment through specially trained staff </li></ul></ul></ul><ul><ul><li>Moderate to Low endemic districts </li></ul></ul><ul><ul><ul><li>-Mobile treatment units </li></ul></ul></ul><ul><ul><ul><li>-Primary health care personnel </li></ul></ul></ul>
  8. 8. Modified Leprosy Elimination Campaign <ul><li>Mid term appraisal of NLEP in 1997 </li></ul><ul><li>Though progress was satisfactory at national level, it was uneven in some states </li></ul><ul><li>MLEC involved </li></ul><ul><ul><ul><li>Orientation training to health staff </li></ul></ul></ul><ul><ul><ul><li>Increase public awareness </li></ul></ul></ul><ul><ul><ul><li>House to House search in endemic districts to detect new leprosy cases throughout the country for 6 days </li></ul></ul></ul><ul><li>Five such campaigns </li></ul><ul><li>Fourth campaign- states were divided into 3 categories based on endemicity of leprosy </li></ul>
  9. 9. SAPEL & LEC <ul><li>In addition to regular surveillance activities </li></ul><ul><li>Rural areas- Special Action Project for elimination of Leprosy </li></ul><ul><li>Urban Areas- Leprosy Elimination Campaigns </li></ul><ul><li>For early detection and prompt treatment </li></ul><ul><li>IEC in rural/ tribal/ slum areas </li></ul><ul><li>1440 SAPEL/LEC projects – decentralized during 2001-04 </li></ul>
  10. 10. World Bank funding in NLEP projects <ul><li>1 st Phase - 1993-94 to 2000 </li></ul><ul><li>Rs. 290 crores (550) </li></ul><ul><li>“ National Leprosy Elimination project” </li></ul><ul><li>Prevalence rate (per 10,000) - 24 3.7 </li></ul><ul><li>Disability grade 2 and above- 2.7% </li></ul><ul><li>MDT coverage- 99.5% </li></ul><ul><li>2 nd Phase- 2001-02 to 2004 </li></ul><ul><li>Rs. 166.35 crores (249.8) </li></ul><ul><li>MDT drugs free- Rs. 48 crores </li></ul><ul><li>Prevalence rate- 2.4 </li></ul><ul><li>Annual detection rate- 3.3 </li></ul>
  11. 11. <ul><li>NLEP is being continued now with Indian Govt. funding from Jan 2005 </li></ul><ul><li>Additional funding from WHO and ILEP </li></ul><ul><li>Free MDT drugs- Novartis through WHO </li></ul>
  12. 12. Other Programmes <ul><li>Focused Leprosy Elimination Plan (FLEP) 2005-06 </li></ul><ul><ul><ul><li>high priority districts and blocks </li></ul></ul></ul><ul><ul><ul><li>Cut off Point: </li></ul></ul></ul><ul><ul><ul><li>PR > 5 /10,000 in 2004-05 </li></ul></ul></ul><ul><ul><ul><ul><ul><li>> 3 / 10,000 in 2005-06 </li></ul></ul></ul></ul></ul><ul><li>Situational Activity Plan (SAP) in 2007 </li></ul><ul><ul><ul><li>- 19 high priority districts </li></ul></ul></ul><ul><li>Block Leprosy Awareness Campaign(BLAC)2007 </li></ul><ul><ul><ul><li>- 275 high priority blocks in 19 states </li></ul></ul></ul><ul><li>Urban Leprosy Sensitization and Awareness Campaign </li></ul><ul><ul><ul><li>- 49 urban areas </li></ul></ul></ul>
  13. 13. Urban Leprosy Control Programme <ul><li>Since 2005, Govt. of India funding </li></ul><ul><li>Population >1 lakh </li></ul><ul><li>Graded assistance- 4 categories </li></ul><ul><ul><ul><li>Township </li></ul></ul></ul><ul><ul><ul><li>Medium Cities-1 </li></ul></ul></ul><ul><ul><ul><li>Medium Cities-2 </li></ul></ul></ul><ul><ul><ul><li>Mega cities </li></ul></ul></ul>
  14. 14. <ul><li>Leprosy Elimination Monitoring (LEM ) </li></ul><ul><li>- to asses performance of leprosy services </li></ul><ul><li>- Drug supply management, IEC etc. </li></ul><ul><li>With WHO assistance, through NIHFW. </li></ul><ul><li>12 priority endemic states </li></ul><ul><ul><ul><li>1 st Jun ‘02 </li></ul></ul></ul><ul><ul><ul><li>2 nd May-Jun ’03 (13) </li></ul></ul></ul><ul><ul><ul><li>3 rd May- Jun ’04 </li></ul></ul></ul><ul><li>Independent surveys- The Leprosy Mission </li></ul>
  15. 15. NLEP : National Action Plan for ’06-07 <ul><li>Objectives: </li></ul><ul><ul><ul><li>To continue the efforts to achieve elimination of Leprosy </li></ul></ul></ul><ul><ul><ul><li>To maintain the gains achieved and to continue efforts at district and block level </li></ul></ul></ul><ul><ul><ul><li>To make quality leprosy services available </li></ul></ul></ul>
  16. 16. <ul><li>Strategies: </li></ul><ul><ul><ul><li>1) Decentralization and institutional development </li></ul></ul></ul><ul><ul><ul><ul><li>- services available in all PHCs </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- District nucleus to Supervise and monitor </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- State leprosy societies merge with state health society </li></ul></ul></ul></ul><ul><ul><ul><li>2) Strengthening and integration of service delivery </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Diagnosis and treatment- more easily available </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Daily outdoor services in PHC/ CHC </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Counseling of patient and Family </li></ul></ul></ul></ul></ul>
  17. 17. <ul><ul><ul><li>3) Disability care and prevention </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Reconstructive surgery is promoted </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Rehabilitation institutions </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Supply of MCR footwear </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>persons affected by Leprosy to receive Disability certificate to enable them to get the facilities available under schemes of Social welfare department. </li></ul></ul></ul></ul></ul><ul><ul><ul><li>4) IEC </li></ul></ul></ul><ul><ul><ul><ul><li>- Country –wide press advertisement on Anti Leprosy Day i.e. 30th January </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- The year 2008-09 was observed as a campaign on the theme “Leprosy Free India”, all over the country </li></ul></ul></ul></ul><ul><ul><ul><li>5) Training </li></ul></ul></ul>
  18. 20. Under NRHM <ul><li>NLEP is horizontally integrated to other services for improved delivery </li></ul><ul><li>Conforms to ‘Indian Public Health Standards’ </li></ul><ul><li>Minimum services </li></ul><ul><ul><ul><li>Diagnosis </li></ul></ul></ul><ul><ul><ul><li>Treatment </li></ul></ul></ul><ul><ul><ul><li>Management of reactions </li></ul></ul></ul><ul><ul><ul><li>Advice on disability </li></ul></ul></ul><ul><ul><ul><li>care & prevention </li></ul></ul></ul>
  19. 21. Officials/ Staff attached to District Leprosy Organisation <ul><li>Deputy Director of Medical Services (Leprosy) </li></ul><ul><li>Medical Officer- Deputy Director (Leprosy) </li></ul><ul><li>Health Educator </li></ul><ul><li>Non Medical Supervisor </li></ul><ul><li>Physio Technicians </li></ul><ul><li>Health Inspectors </li></ul><ul><li>Lab technician </li></ul>
  20. 22. <ul><li>ASHA Involvement </li></ul><ul><ul><ul><li>2008-09, ASHAs were involved for suspecting leprosy cases and after diagnosis, follow up till treatment completion. </li></ul></ul></ul><ul><ul><ul><li>Incentive for confirmed leprosy cases out of suspect brought by them (Rs. 100/-) and for completion of treatment in time (PB- Rs. 200/-, MB – Rs. 400/-). </li></ul></ul></ul><ul><ul><ul><li>The scheme was initially put on pilot basis in 5 major states of Uttar Pradesh, Bihar, Chhattisgarh, West Bengal and Jharkhand </li></ul></ul></ul>
  21. 23. Research <ul><ul><ul><li>Central JALMA institute at Agra </li></ul></ul></ul><ul><ul><ul><li>Central Leprosy teaching and Training institute, Chengalpet </li></ul></ul></ul><ul><ul><ul><li>Regional training & research institutes at Aska(orissa), Raipur( Chattisgarh), and Gouripur(W.B.) </li></ul></ul></ul>
  22. 24. Evaluation <ul><li>To assess the impact of control operations on the endemicity of disease </li></ul><ul><li>Two types of indicators: </li></ul><ul><ul><li>Operational indicators </li></ul></ul><ul><ul><ul><ul><li>Monitor the ongoing activities </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Related to case finding, treatment, relapses and disability </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Eg. : Relapse rate, Case detection ratio, proportion of children/ females/ MB cases </li></ul></ul></ul></ul><ul><ul><li>Epidemiological indicators </li></ul></ul><ul><ul><ul><li>Incidence </li></ul></ul></ul><ul><ul><ul><ul><li>- most sensitive index of transmission, the only index to measure the effectiveness of a control programme </li></ul></ul></ul></ul><ul><ul><ul><li>Prevalence </li></ul></ul></ul><ul><ul><ul><ul><li>- useful in planning treatment services </li></ul></ul></ul></ul>
  23. 25. <ul><li>New Cases with Grade – II disabilities ( A new Indicator) </li></ul><ul><li>XIth Five year plan -“No. of Gr. II disabled cases – 25% reduction by March 2012, taking 2006-07 as the base year”. </li></ul><ul><li>Recently WHO has also proposed to introduce this as the key indicator to monitor progress </li></ul>
  24. 26. WHO global strategy (2006-10) <ul><li>Sustain leprosy control activities in all </li></ul><ul><li>endemic countries </li></ul><ul><li>Use Case detection as the Main indicator to monitor progress </li></ul><ul><li>Ensure high quality diagnosis, case management, recording & reporting </li></ul><ul><li>Strengthen routine & referral services </li></ul><ul><li>Discontinue campaign approach </li></ul><ul><li>Develop tools/ procedures that are home / community based, locally appropriate – for prevention of disabilities; rehabilitation services </li></ul><ul><li>Promote operational research </li></ul>
  25. 27. Partners <ul><li>WHO </li></ul><ul><li>UNICEF </li></ul><ul><li>SIDA </li></ul><ul><li>DANIDA </li></ul><ul><li>Damien Foundation </li></ul>
  26. 28. Anti Leprosy Activities in India <ul><li>Leprosy Mission (W.B.)- founded in 1874 in H.P. </li></ul><ul><li>Hind Kusth Nivaran Sangh </li></ul><ul><li>Gandhiji Memorial Leprosy Foundation, Sevagram, Wardha </li></ul><ul><li>The German Leprosy Relief Association </li></ul><ul><li>Damien Foundation </li></ul><ul><li>The Danish Save the Child Fund </li></ul><ul><li>JALMA- taken over by ICMR in 1975 </li></ul><ul><li>National Leprosy Organisation- 1965 </li></ul>
  27. 29. Join Hands for a better tomorrow...