What is the Ailing National Leprosy control programme in India under the integrated set-up?
Leprosy probably is the only disease of the mankind that is mired with myths, superstitions, discrimination and stigmatization — and are all largely man made.
Science of leprosy: As early as 1895 it was established that the leprosy disease is caused by a bacillus, Mycobacterium Leprae (M.leprae). Even before that it was known that this disease causes damage to the peripheral nerves that result in loss of sensation in hands and feet and unsightly deformities. Therefore two important facts are; leprosy spreads and leprosy disfigures.
The first attempt to deal with leprosy as a public health problem was taken up in 1952 by the Gandhi Memorial Leprosy Foundation (GMLF) an institution started under the Gandhi memorial trust. A field study was piloted at GMLF which envisaged identification of all leprosy patients, house to house survey in a fixed geographical area followed by domiciliary treatment with dapsone.
The national leprosy control programme (NLCP) was started in 1955 and the Survey, Education and Treatment (SET) initiated by GMLF became a standard procedure for leprosy control in the entire country. Later WHO also endorsed the method and it was successfully adopted world over.
In 1982, there was a major advance in the treatment of leprosy. Life long monotherapy with dapsone was replaced with a fixed duration of treatment with combination of antimicrobial drugs. An incurable disease became a curable disease. Other advances in treatment included reaction management with immunosuppressive drugs Viz corticosteroids for the control of reaction typical of leprosy and resultant nerve damage.
In 2002, the Govt took another major step towards expansion of the NLCP leprosy work, which was a vertical programme, was integrated into the general health services. There were no more special leprosy clinics. No more surveys for active case detection, only IEC activities to promote case detection. Patients were expected to self report which unfortunately failed to yield result.
Two most important advantages of integration of services with general health care are -:
1) Scope of easy availability and accessibility of a wide range of services for leprosy affected person under the general health care facility.
2) Reduction in stigma and discrimination that was ailing leprosy.
Are we seeing the desired effect? Are all leprosy patients getting their due treatment /attention/after care in the integrated set up?
The answer is NO.
We need to retrospect as to why? and What is ailing the National Leprosy Control Programme in the integrated set-up in India?
In 1991, WHO passed a resolution aimed at eliminating leprosy as public health problem by 2000.Elimination was defined as less than 1 case per 10000 population This resolution indeed energized leprosy programme in many ways, but it also had negative effects on operational activities, professional expertise, health service planning funding and research.
Assumption underlying elimination strategy is that MDT will reduce transmission by reducing the number of contagious individuals in the community. Contrary to this assumption and expectations the new case detection rate (NCDR) has remained unchanged over the years and there is no major change in overall burden of leprosy in terms of deformity and disability. .
Already over burdened general health service staff at the PHC level neither have the time nor the expertise to manage leprosy patients. To add to this there is frequent turnover of Medical staff at PHC. To overcome this problem Leprosy referral centers (LRCs) were opened at different places but there also basic facilities and manpower are lacking thus fail to fulfill patients needs.
Problem associated with leprosy disease are at many levels — medical, physical, emotional, psychological, social and societal. They are all interlinked and need to be addressed in a comprehensive manner. It is time we wake up to the fact that a postal delivery type of service approach under practice now is not suitable for Leprosy.
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Foundation for Medical Research practices a combination of basic biomedical and translational research. Our traditional research areas are leprosy, tuberculosis and medicinal plants.
If you want to read more about what we do, then have a look at www.fmrindia.org
