Although India had achieved the target for elimination of leprosy in 2005, the disease has raised its head again due to slackness of Governments and medical authorities. The Modi regime’s new thrust comes at a right time
From March, the Modi Government will kick-start an intensive fortnightly leprosy Case Detection Campaign in several phases in 50 high-endemic districts in seven States across the country under the National leprosy Elimination Programme spanning a month. The lCDC, prepared by the Union Ministry of Health, will see Accredited Social Health Activist (Asha) workers helped by male health workers visiting each house in leprosy-endemic districts and screen suspected patients and detect early signs of the crippling disease. The programme aims at the treatment of all detected cases in the community which, the Government hopes, will lead to a depletion of the source of infection in society.
Though it was in 2005 that India had achieved the target for elimination of leprosy — reaching a prevalence of less than one leprosy case per 10,000 population, as per the WHO norms, it did not ensure enough aggressiveness, sustained investment and human resources to maintain the much-acclaimed achievement.
Moreover, lack of interest by the States, laidback attitude of the Union Government and stigma attached with the disease, have ensured that India continues to be the home for 60 per cent of the leprosy-affected persons in the world. There are over 700 colonies inhabited by leprosy-affected people across the States.
leprosy is not a public threat simply because the disease affects only five per cent to 10 per cent of the population. It is cured through a multi-drug therapy and the patient becomes non-infective within 24 hours of starting treatment. Disabilities occur only if the disease is left untreated for long.
While many States have shown good progress, we still have something like 1,25,000 new cases each year. In statistical terms, it is a small number but in actual numbers it is large. At the end of March 2015, there were 8,8,833 leprosy cases on record (under treatment) with a prevalence rate at the national level of 0.69 per 10,000 population. In 2014-15, a total 12,5785 new leprosy cases were detected and put under treatment, giving an Annual New Case Detection Rate of 9.73 per 1,00,000 population.
If one goes by the data available on the website of the National leprosy Elimination Programme, it is observed that the trend of two important indicators of National leprosy Eradication Programme, India Annual New Case Detection Rate and Prevalence Rate — are almost static since 2006-2007. In addition, the percentage of grade II disability (visible deformity that can include severe visual impairment)amongst new cases detected has been increased from 3.10 per cent (2010 - 2011) to 4.61 per cent (2014 - 2015), which indicates that the cases are being detected late in the community and there may be several cases which are lying undetected or hidden from authorities.
But what is a matter of concern is that children are also coming in the grip of this crippling disease. In 2014-15, out of 11,365 children with leprosy, 245 had Grade II disability. Of 2,392 children in Bihar, at least 77 had Grade II disability; the numbers are 37 out of 2,045 for Maharashtra and 46 out of 1,375 for Uttar Pradesh.
The Government has begun to scale up efforts to curb the disease, with the launch of the lCDC being one of the various major steps. According to the lCDC guidelines prepared recently the by NlEP, all persons irrespective of age present at home will be examined for the presence of light color patch, redness, swelling or nodule on skin, while only children below two years of age may be exempted from physical examination. The detailed guidelines enlist do’s and don’ts with focus on intensive campaigns and awareness about the disease as well. last year, the Health Ministry also announced fiscal incentives to people for bringing cases to the fore. They will be given an incentive of Rs250 for bringing in an early case before the onset of any visible deformity and Rs200 for a new case with visible deformity in hands, feet or eyes. On completion of the full course of treatment in time, Asha workers will be given Rs400 in Paubacillary cases and Rs600 in Multi-bacillary cases.
A plan is also afoot to set up a task force to chalk out plans for the integration of leprosy affected people living in the colonies into the mainstream, a much-needed move to ensure a dignified life.
However, what remains challenge is sustaining the focussed attention, removing stigma and discrimination and ensuring availability of medicines on time. There is also a need to rope in private health providers who extend more than 70 per cent of primary health delivery in India, reduce devastating discrimination that keeps people from getting the care they need.