Ministry of Health and Family Welfare (MHFW)

National Leprosy Eradication Programme (NLEP)

Leprosy, a chronic bacterial disease with long incubation period affects all age groups and is classified mainly as Pauci Bacillary (PB) and Multi Bacillary (MB). Since the leprosy bacilli affect the peripheral nerves, the patients lose sensation by and large in their hands, feet and eyes if not properly cared for. Injuries to these insensitive parts may lead to disfigurement, the main consequence of this disease which generates fear and stigma. Thus early detection and prompt treatment of leprosy with prescribed Multi Drug Therapy (MDT) not only cures leprosy, but also interrupts its transmission to others.

Leprosy Situation in India

With efficient implementation of well planned efforts since 1953-54, India has very substantially controlled leprosy. The goal of leprosy elimination at National level (i.e. PR of andlt;1 case/10,000 population) as set by National Health Policy 2002 has been achieved in the month of December 2005 when the PR was 0.95/10,000 population. During 1981 our country recorded a prevalence of 57.6 cases per 10,000 population whereas in March 2006 it has come down to only 0.84 per 10,000 population with 0.95 lakh cases on record. As on March 2006, 26 States/UTs have achieved the status of leprosy elimination and 9 more States/ UTs are having PR between 1 to 2 and are near to this goal.

During 2005-06, a total of 1.61 lakhs new leprosy cases were detected out of which 45.3% were MB cases, 10% Child cases, 33.8% female cases and 1.9% were visible deformity cases. The Leprosy Prevalence and Annual New Case Detection (ANCD) Rates/10,000 populations have shown a substantial declining trend as can be seen in diagram below.

The Elimination level has been achieved in 26 States of Nagaland, Haryana, Meghalaya, Himachal Pradesh, Mizoram, Tripura, Punjab, Sikkim, Jammu and Kashmir, Assam, Manipur, Rajasthan, Kerala, Arunachal Pradesh, Daman and Diu, Andaman andamp;N Islands, Pondicherry, Gujarat, Karnataka, Lakshadweep, Tamil Nadu, Andhra Pradesh, Uttaranchal, Madhya Pradesh, Maharashtra and Goa, the last 2 states are new entrants this year. The remaining 9 States/ UTs are also nearing elimination level and their PR stands between 1 to 2/10,000 population and these include Bihar, Chhattisgarh, Jharkhand, Orissa, Uttar Pradesh, West Bengal, Chandigarh, Dadra andamp;Nagar Haveli and Delhi.

Further, of the 596 districts in the country 439 (73.7%) have achieved leprosy elimination level and 69.5% of blocks have also recorded PR andlt;1/ 10,000 population.

Urban Leprosy Control Programme

To address the complex problem like larger population size, migration, poor health infrastructure and increasing prevalence in urban areas, there was a need for Urban Leprosy Programme.

Urban Leprosy Control Programme has been implemented since 2005 under which assistance is being provided by Govt. of India to urban areas having population size of more than 1 lakh. For the purpose of providing graded assistance, the urban areas are grouped in four categories i.e. Township-I, Medium Cities-I, Medium Cities-II, Mega Cities.

Involvement of NGO

Non Governmental Organizations (NGOs) have been involved for the cause of leprosy elimination for many decades and their contributions have made a positive impact in reducing the prevalence of leprosy. Presently 30 NGOs are getting grant-inaid from Govt. of India under Survey Education and Treatment (SET) scheme. Few NGO run Hospitals are also conducting reconstructive surgeries (RCS) where facility for these services are available.

The NGOs serve in remote, inaccessible, uncovered, urban slums, industrial / labour population and other marginalized population groups. The various activities undertaken by the NOGs are, IEC, Prevention of Impairments and Deformities, Case followup and MDT Delivery. From current financial year (2006-07), Grant-in-aid is being disbursed to NGO by the State Leprosy Society directly.

ILEP Agencies

International Federation of Leprosy Elimination (ILEP) is actively involved as partner in NLEP. In India ILEP is constituted by 10 Agencies viz. The Leprosy Mission, Damien Foundation of India Trust, Netherland Leprosy Relief, German Leprosy Relief Association, Lepra India, ALES, AIFO, Fontilles – India, AERF - India and American Leprosy Mission. ILEP is supporting the Programme by various ways including Technical Support in 19 States with 165 District Technical Support Teams (DTST) covering 267 districts. In addition there are 9 State Level Technical Support Teams (STST) covering 17 States/ UTs. Each team has one Medical Officer supported by Non Medical supervisor / Non Medical Assistant (NMS/ NMA). ILEP also supports various NGOs in the country for care and Rehabilitation of leprosy patients.

WHO Support

The NLEP is being supported by WHO in the form of a package which covers support to all the state leprosy cells, technical support through deployment of State NLEP Coordinators in 10 states and also Zonal NLEP Coordinators in the high endemic states. WHO also extends financial support to NLEP for conducting periodic review meetings at national and state levels, monitoring and evaluation, simplified information system and capacity building of the state and district level officials in programme management. WHO also continues to provide entire requirement of antileprosy (MDT) drugs to the country with assistance from NOVARTIS.

Monitoring and Evaluation of NLEP

NLEP is equipped with an inbuilt information system for concurrent monitoring and feedback for timely corrective measures at Central, State, District and Peripheral level of programme implementation.

Future Strategy

After elimination of leprosy at National level, the country has still many areas in State, District andamp; Block level that need extra focus. The programme will continue with following strategy :-

  • Maintaining the gains achieved in each of the States / UTs in which elimination has already achieved by providing existing MDT services through integrated General Health Care system.
  • Achieving elimination of Leprosy in remaining States, Districts and Blocks by providing quality MDT services with Focused attention on – Endemic Districts, Endemic Blocks, Endemic Urban localities, Districts with high disability rate andamp; States with high child proportion.
  • Capacity Building of all categories of staff by Induction and reorientation training.
  • Increase emphasis on Disability Prevention and Medical Rehabilitation (DPMR) for prevention of development of disabilities in newly detected leprosy patients and to provide medical rehabilitation services to existing deformity cases.
  • Increasing awareness about Leprosy among masses and Inter Personal Communication (IPC) to remove social stigma.
National Programme for Control of Blindness
National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3%. As per Survey in 2001-02, prevalence of blindness is estimated to be 1.1%. Target for the 10th Plan is to reduce prevalence of blindness to 0.8% by 2007.

The objectives of the programme are: -
  • To reduce the backlog of blindness through identification and treatment of blind
  • To develop Eye Care facilities in every district
  • To develop human resources for providing Eye Care Services
  • To improve quality of service delivery
  • To secure participation of Voluntary Organizations in eye care.
New Initiatives proposed under the Programme
  • A Task Force has been set up to chalk out the strategy for 11th Plan under NPCB.
  • Construction of dedicated Eye Wards and Eye Operation theaters in Districts and Sub Districts Hospitals in North-Eastern States, Bihar, Jharkhand, Jammu and amp;Kashmir, Himachal Pradesh, Uttaranchal and few other States as per demand.
  • Appointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts in District Hospitals and Sub District Hospitals.
  • Appointment of Ophthalmic Assistants in PHCs/ Vision Centers where there are none (at present ophthalmic assistants are available in block level PHCs only).
  • Appointment of Eye Donation Counselors on contract basis in Eye Banks under Government Sector and NGO Sector.
  • Grant-in-aid for NGOs for management of other Eye diseases other than Cataract like Diabetic, Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of childhood blindness etc of Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye Diseases as described above. For North- Eastern States, Hilly and Desert Areas Rs. 850 for Cataract and Rs.1100 for other major Eye Care Management is proposed.
  • Special attention to clear Cataract Backlog and take care of other Eye Health Care Centers from NE States.
  • Telemedicine in Ophthalmology {Eye Care Management Information and Communication Network}
  • Vitamin A supplementation and M.M.R Vaccination through DBCS corpus funds as per requirement to take care of Childhood Blindness.
  • Setting up of five Centers of Excellence for Eye Care Services.
  • Provision of vehicles to state Programme Managers and District
  • Programme Managers under NPCB.
  • Provision of Computers, Fax and Photocopier to District Blindness Control Societies under NPCB.
  • Involvement of Private Practitioners.
  • A provision of Rs.1550 crore has been proposed to implement various activities under the programme.

National Iodine Deficiency Disorders Control Programme

Iodine is an essential micronutrient with an average daily requirement of 100-150 micrograms for normal human growth and development. There is an increasing evidence of distribution of environmental Iodine deficiency in various parts of the country. On the basis of surveys conducted by the Directorate General of Health Services, Indian Council of Medical Research and the State Health Directorates, it has been found that out of 324 districts surveyed in 28 States and all the 7 Uts, 263 districts are endemic i.e. where the prevalence of IDDs is more than 10%. It is also estimated that more than 71 million persons are suffering from goiter and other Iodine Deficiency Disorders. These disorders include abortions, stillbirth, mental retardation, deaf mutism, squint, goiter and neuromotor defects.

Objectives of NIDDCP

  1. Surveys to assess the magnitude of Iodine Deficiency Disorders
  2. Supply Iodated salt in place of Common salt.
  3. Resurveys to assess the impact of control measures after every 5 years
  4. Monitoring the quality of Iodated salt and assess Urinary Iodine excretion pattern.
  5. Health Education and Publicity.(Information, Education andamp; Communication, IEC)
National Mental Health Programme (NMPH)
Severe mental disorders that include schizophrenia, bipolar disorder, organic psychosis and major depression affect nearly 20 per 1000 population. This population needs continuous treatment and regular follow-up attention. Close to ten million severely mentally ill are in our country without adequate treatment by this estimate. More than half remain never- treated. Lack of knowledge on the treatment availability andamp; potential benefits of seeking treatment are important causes for the above. With a large population in our country and very few psychiatrists being available, less than one psychiatrist is available for every 3 lacs population. The psychiatrist / population ratio in rural areas that account for 70% of country’s population, could well be under one for every million.

To address this huge burden NMHP was started in 1982 with the following objectives:
  • To ensure availability and accessibility of minimum mental health care for all in the near foreseeable future, particularly to the most vulnerable sections of the population.
  • To encourage mental health knowledge and skills in general health care and social development.
  • To promote community participation in mental health service development and to stimulate self –help in the community.

A model for delivery of community based mental health care at the level of district was evolved and field-tested in Bellary district of Karnataka by NIMHANS between 1986- 1995. This model was adapted as the District Mental Health Programme (DMHP) and it was implemented in 27 Districts across 22 states/UTs in the IXth plan beginning in the year 1996.

Barriers to Implementation of the Programme:

  • Shortage of trained manpower in the field of mental health.
  • Social stigma andamp; lack of knowledge of psychiatric patients andamp; their families.
  • Negative attitude of general practitioners, primary care physicians andamp; other specialists.
  • NGOs/Voluntary Organizations do not find this field attractive
  • Inadequate staff andamp; infrastructure of mental hospitals and psychiatric wings of medical colleges.
  • Uneven distribution of sparse resources limiting the availability of mental health care to those living in urban areas.
  • Inadequate funding for mental health, which remains a relatively low priority area.
The approach to the treatment of mental disorders is based upon the following strategies:
  • Integrating mental health with primary health care through the National Mental Health Programme
  • Provision of tertiary care institutions for treatment of mental disorders.
  • Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority and State Mental Health Authority.
Icone PdfScheme of Financial Assistance for Corrective Surgery and Rehabilitation of Polio Affected Children.
CCPD Annual Report 2006-2007