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Leprosy control programmes and their current status
PROGRAMES AND THEIR
PRESENTER – DR AMAL SHYAM
MODERATOR – DR BIFI JOY
• World health assembly in May 1991 adopted a
resolution for global elimination of leprosy by
• Leprosy elimination achieved globally by 2001
• Elimination achieved through WHO’s strong
leadership, commitment of endemic
countries, active support of NGO’s and other
• Target was reset for remaining 14 countries
including India to achieve elimination on
• India achieved this goal on 31st December
2005, and prevalence rate was 0.95/10,000
Status in India
• 2011-2012 started with 0.83 lakh leprosy
cases on record as on 1st April 2011.
• Prevalence rate was 0.69/10,000 population
• 32 states/ UT had achieved leprosy
• A total of 530 districts (82.8%) out of total 640
districts also achieved elimination by March
• A total of 1.27 lakh new cases detected during
• Annual new case detection rate (ANCDR) was
10.35 per 1,00,000 population
there was a marginal reduction of ANCDR by
1.24% from 2010-11 (10.48)
• A total of 0.83 Lakh cases on record as on 1st
• Prevalence rate 0.68/10,000 population
• Grade 2 disability rate 3.14/million population
• Grade 1 disability constitute 3.78% of new
• A total of 12305 new child cases were
recorded which gives the child case rate of
• One state (Chattisgarh) and one union
territory (Dadra & Nagar Haveli) has remained
with prevalence rate between 1 & 3 per
• Bihar reached PR< 1/10,000 population during
• 32 states already reached the level of
elimination, ie PR < 1/10,000
• Increased no of new cases detected during
2011-12 in following 15 states/ UT. They are:
• Orissa, Gujarat, Maharashtra, Madhya
Pradesh, Dadra & Nagar Haveli, AP, Tripura,
Haryana, Sikkim, Nagaland, WestBengal,
Andaman and nicobar islands, Chandigarh,
Daman & Diu, Lakshadweep.
• Proportion of child cases was more than 10%
of new cases detected in 10 states/UT.
• PB child proportion was high in 3states/UT –
Bihar, D & N Haveli, Puducherry.
• Of the 1.26 lakh new cases detected, 1.16 lakh
(92.5%) completed their treatment within the
specified period and were released from
treatment as cured during 2011-12.
• Poor performing states were Delhi, Tripura,
Meghalaya, Himachal Pradesh.
• The total no of persons affected by leprosy
cured of the disease in the country with MDT
from the beginning till date to 12.67 million.
History of programmes in india
• National leprosy control programmes
launched in 1955 – early detection of cases &
regular sustained dapsone monotherapy
• Very long duration of treatment & irregular
• National leprosy eradication programme
(NLEP) 1983 – subsequent to advent of MDT &
success in pilot studies.
• By 1998 whole country was covered by MDT
• With implementation of MDT Prevalence of
leprosy declined from 57/10,000 in 1983 to
24/10,000 in 1992, 1.34/10,000 in April 2005
and finally 0.95/10,000 population in
• Phase 1 of world bank assisted project was
completed in September 2000.(1993-2000)
• It was a vertical programme.
• Rs 290 Crores.
• Prevalence rate 24 to 3.7/10,000 population
• Phase 2 project was initiated with world bank
support and was completed in December
• 166.35 Crores
• Since Jan 2005, NLEP is being carried out with
government funds and technical support from
WHO & ILEP.
• Free MDT drugs –Novartis through WHO
• During phase 2 project most of NLEP vertical
staff and infrastructure has been integrated
with general health care system.
• Only 20-30% of these vertical staff has been
retained to constitute state & district NLEP
• Consequently leprosy services have been
made available through general health care
services & MDT has been made available to all
PHCs, subcentres, dispensaries & hospitals.
• Active case finding through various types of
surveys has been done previously.
• Now the reliance is on voluntary reporting
enabled by IEC efforts.
• In blocks where PR>5/10,000 active efforts at
case findings are continuing.
Special efforts for leprosy case
detection & prompt MDT
• SAPEL – Special Action Project for
Elimination of Leprosy
• LEC – Leprosy Elimination Campaign
For early case detection .
Mainly in difficult and inaccessible
rural/tribal areas as well as slums
• MLEC – Modified Leprosy Elimination
• Five such nation wide campaigns
• Carried out during 1997-98 to 2003-05
• Helped in bringing out 9.9 lakh new cases
under treatment in a short span of time
• Helped in increasing leprosy awareness among
• LEM – Leprosy Elimination Monitoring
• Helped asses the performance of
leprosy services, collect key information on
issues like integration with general health
• These special services are no longer being
carried out, as most of the country have
achieved leprosy elimination
• National conference on elimination of leprosy
held from 27-30 Jan 2004 at Raipur, at the
initiative of international leprosy association.
• It urges national and state programmes to
promote more vigorous integration of leprosy
to general health services
Vigorously intensify their efforts towards case
detection and completion of treatment
• Take steps to rehabilitate leprosy patients in
• Ensure leprosy patients continue to get the
necessary treatment services even after
leprosy is eliminated.
Mile stones of leprosy eradication
• 1898 – Leper act Later abolished by British india
• 1948 – Hind Kush Nivaran Sangh
• 1955 – National leprosy control program
• 1982 - MDT
• 1983 – National leprosy eradication program
• 1991 – World health assembly resolution to
eradicate leprosy by 2000.
• 1993 – World bank supported the MDT
program phase NLEP 1
• 2005 December – Prevalence rate 0.95/10,000
and Govt declared achievement of elimination
• 2005 – NRHM covers NLEP
Current activities under NLEP
• Diagnosis and treatment of leprosy
MDT provided to all PHCs free of cost
difficult to diagnose cases & complicated
cases referred to district hospitals
ASHAs under NRHM helps bring out leprosy
cases from villages for diagnosis and
• Training to Medical officers, health workers,
lab technicians, ASHAs conducted every year
• Training of state & district Leprosy officers
organized at Schieffline institute of health
research & leprosy centre Vellore, TN and
• Involvement of NGOs
• Help reduce burden of leprosy
• Serve in remote, inaccessible, uncovered,
urban slums, industrial/labour populations
and other marginalised population groups.
• Information, education & communication
• IEC help reduction of stigma & discrimination
against leprosy affected persons.
• Carried out through mass media, out door
media, rural media & advocatory meetings.
• More focus on inter personal communication.
• Disability prevention and medical
• Patients provided with dressing materials,
supportive medicines & MCR footwear
• Correction of disability through reconstructive
• Urban leprosy control
• Implemented in 422 urban areas with
population size more than 1 lakh
• Includes MDT delivery services & follow up of
patients with treatment completion, providing
supportive medicines and dressing materials.
• Monitoring & Supervision
• By analysis of monthly progress reports,
through field visits by supervisory officers, and
programme review meetings held at central,
State & District levels.
• Reconstructive surgery
• Amount of Rs 5000 provided as incentive to
leprosy patients from BPL families for
undergoing major reconstructive surgeries in
identified Govt/NGO institutions
• Involvement of ASHAs
• Incentives provided for ASHAs for bringing out
cases from their villages
• Rs 100 for confirmed diagnosis of cases
• On completion of treatment within specified
time Rs 200 for PB & Rs 400 for MB.
• Special activities in High Endemic areas
• Involves training, intensified IEC, case
detection & prompt MDT through health care
• National sample survey
• By national JALMA institute Agra
• Started in 2010.
• House to house survey to access the burden of
active leprosy cases, leprosy persons with
grade 1 & 2 disability and magnitude of stigma
and discrimination in society.
• Budget and international support
• Since 2005, the program is being conducted
with Govt of India funds with technical
support from WHO & International federation
of anti leprosy association(ILEP)
Officials/ Staff attached to District Leprosy
• Deputy Director of Medical Services (Leprosy)
• Medical Officer- Deputy Director (Leprosy)
• Health Educator
• Non Medical Supervisor
• Physio Technicians
• Health Inspectors
• Lab technician
Anti Leprosy Activities in India
• Leprosy Mission - founded in 1874 in H.P.
• Hind Kush Nivaran Sangh
• Gandhiji Memorial Leprosy Foundation,
• The German Leprosy Relief Association
• Damien Foundation
• The Danish Save the Child Fund
• JALMA- taken over by ICMR in 1975
• National Leprosy Organisation- 1965
1.National leprosy eradication programme,Annual
report (2011-12), M/O H&FW, Govt of India.
2.National leprosy eradication programme,Annual
report (2010-11), M/O H&FW, Govt of India.
3.Health Policies and Programs in India,
D.K.Taneja, 10th edition, Page 185-190.
4.National Health programs of India, J.Kishore, 9th
edition, Page 362-380.
5.IAL Textbook of Leprosy,