Chronic infectious disease caused by Mycobacterium leprae. It usually affects the skin and peripheral nerves Long incubation period generally 5-7 years. Classified as paucibacillary or multibacillary permanent disability Timely diagnosis and treatment of cases

1. NATIONAL LEPROSY
ERADICATION PROGRAM
By: Kavya
MSc (N)

2. 1983
Mahatma Gandhi says: "Leprosy work is not merely
medical relief, it is transforming frustration of life into
joy of dedication, personal ambition into selfless
service. ..."

3. 1983
Objectives:
• list the objectives of NLCP and NLEP
• enumerates the strategies of NLEP
• discuss MDT
• explains the strategies for NLEP
• states the organization of NLEP
• describe the roles of key persons
• enumerate the infrastructure

4. 1983
• list the institute involved in anti-leprosy activities
• discuss Modified leprosy elimination campaign
• explains NLEP action plan, strategies and indicators
• describes the DPMR
• list nurses responsibility

5. 1983
Introduction
Chronic infectious disease caused by Mycobacterium leprae.
It usually affects the skin and peripheral nerves
 Long incubation period generally 5-7 years.
Classified as paucibacillary or multibacillary
permanent disability
Timely diagnosis and treatment of cases

6. 1983
Background
 Global registered Prevalence : 181, 941 cases (2012)
 Nation leprosy control program – 1995
 MDT came in to wide use from 1982
 National leprosy eradication Program -1983
 NHP 2002 – Eliminated leprosy by 2005

7. 1983
Milestones in NLEP
1948 – hind kusht nivaran sangh
1955- govt. of India launched NLCP
1983- launched NLEP and introduced MDT for
treatment
1991- WHO declaration to eliminate leprosy at global
level by 2000
Modified leprosy elimination campaign
1993-2000 World bank supported NLEP 1st

8. 1983
2001-2004 World bank supported NLEP 2nd
2005 national program continues with GOI funds
2005 – India achieved elimination of leprosy at
national level December 05
Sponsored by central government
Funding pattern central government
Ministry / department – DGHS
Beneficiaries – individual and community
Eligibility criteria anyone

9. 1983

10. 1983
Objectives of NLCP - 1955
 Early case detection
 To provide domiciliary treatment to render infectious
cases to non-infectious

11. 1983
Objectives of NLEP - 1983
 To detect all cases of leprosy
 Irrespective of endemicity of the area
 To treat all detected cases of leprosy and its complication
till its cure or recovery
 To impart training to all categories of health personnel
 Vision : The Attainment of Leprosy Free Status for the
People of India

12. 1983
 To recommend grant in aid to various voluntary
agencies engaged in anti-leprosy work
 To promote medico surgical rehabilitation of the
disease arrested deformed cases.
• To encourage research on various aspects of leprosy

13. 1983
Strategies for NLEP
 Early case detection
 Short term multi drug therapy (MDT)
 Health education
• Rehabilitation services

14. 1983
Multi Drug Therapy
• Multibacillary
a)Intensive phase (lasting for 14 days )
•Rifampicin 600 mg daily (supervised )
•Clopazimine 300 mg daily (supervised )
•Dapsone 100mg daily (unsupervised)

15. 1983
a)Continuation Phase (lasting for 2 or more years )
•Rifampicin 600 mg once a month (supervised )
•Clopazimine 50 mg daily and 300 mg/month (supervised
•Dapsone 100mg daily (unsupervised)
•Ethionamide and protionamide (duration:2 years are until
2 consecutive skin smears taken at monthly interval
become negative. )
•The follow up is done once in 6 month for 5 year

16. 1983
Paucibacillary
• Rifampicin 600 mg once a month (supervised )
• Dapsone 100mg daily (unsupervised)

17. 1983
Strategies for NLEP during 9th five year plan
 Identifying case detection and MDT coverage in high
prevalence states and areas difficult to access
 Strengthening laboratory services PHC/CHC ,
establishing surveillance
 Preparing for and initiating horizontal integration of
leprosy program in to primary health care system,

18. 1983
 Providing greater emphasizes on disability prevention
and treatment
 Implementation of modified leprosy elimination
campaign
 Ensuring rehabilitation of cured patients
• Repeal of discriminating provision under marriage act
where leprosy is ground for divorce

19. 1983
Organization of NLEP in India
• Center level : DGHS and NLEP officer [ NLEP
commissioner for planning and policy ]
• State level : director of health and services and state
NLEP officer
• Regional level : Regional NLEP officer [Leprosy control
unit , Survey education and treatment , and Urban leprosy
unit ]

20. 1983
Role of key persons: Health worker
 Identification of persons with hypo pigmented patches or
thickened tender nerves
 Help and motivate VHG to detect such cases
 Ensure that cases are clinically examined for diagnosis
 Ensure that the treatment is taken regularly by all cases till
cure.
 Motivate defaulter to take treatment regularly

21. 1983
 Educate patients on care of feet, skin , eyes etc
 Educate members of family and community by
imparting correct knowledge. Dispel misconception,
misbeliefs. Help to remove stigma
 Examine contacts of diagnosed cases for presence of
hypopigmented patch, thick/ tender nerve
 Keep record of suspected cases and cases under
treatment

22. 1983
Role of key persons :Village heath guide
 Identification of persons with hypo pigmented patches and
getting such person examined clinically
 Reassuring diagnosed cases of cure if treatment is taken
regularly and motivate them to take such treatment as long
as necessary
 Keeping in touch with cases to ensure that the treatment is
taken regularly

23. 1983
 Educate family members about the curability ,
infective nature of disease and remove misconception
if any
 Educate community by imparting correct knowledge.
Dispel misconception, misbeliefs. Help to remove
stigma

24. 1983
Health assistant / supervisor
 Supervise the activity of health worker
 Compilation of reports

25. 1983
Medical officer
 Confirm suspected case of leprosy
 maintain register of cases under treatment an
defaulters
 supervise activities of health assistant
 ensure drug supply

26. 1983
 compile records and assess the activities with the help
of indicators
 find out the problem faced by health worker , health
assistant during monthly meeting and try to find
solution
 inform / educate patients / contacts and populations

27. 1983
Infrastructure
1.the leprosy control units
2.survey education and treatment (SET)centers
3.urban leprosy centers

28. 1983
The leprosy control units:
• these are established in endemic areas with one
medical officer 2 non-medical supervisor and 20 para
medical worker .Each unit covering a population of
4.5 lakhs. each paramedical workers covers a
population of 15 to 20000 and is expected to examine
at least 8000 persons per year

29. 1983
Survey education and treatment (SET) centers
• the team consists of one paramedical workers for 20-
25000 population. One medical supervisor for every 5
paramedical workers. these centers attached to PHCs

30. 1983
Urban leprosy centers:
• one established for every 30-40 thousand population.
At central level, the leprosy division of the directorate
general of health services, New Delhi is responsible
for planning, supervision and monitoring of program.

31. 1983
Institute involved in anti-leprosy activities
 Central leprosy teaching research institute ,Chengalpattu
 Regional leprosy training and research institute ,Raipur
Chhattisgargh
 Regional leprosy training and research institute< gauripur
(West Bengal)
 International agencies such as SIDA Swedish international
development agency), DANIDA (Danish international
development agencies), WHO, UNICEF (United Nations
international children’s emergency fund), Damien foundation
Etc.

32. 1983
World bank supported project on NLEP
 The first Phase -1993
•Reduce the prevalence rate and increase MDT
coverage. 550 cr. Used.
 The second phase-2001
•249.8 cr. Including World bank loan of Rs. 166.35 cr
and WHO to provide MDT drugs free of cost.

33. 1983
Modified leprosy elimination campaign
• Multibacillary cases
 Rifampicin 600 mg daily (supervised )
 Clopazimine 50 mg daily (supervised )
 Dapsone 100mg daily (unsupervised)
 Duration of treatment 12 month
 Follow up once a year for 5 years

34. 1983
Paucibacillary cases
• Single nerve lesion
 Rifampicin 600 mg once a month (supervised )
 Dapsone 100mg daily (unsupervised)
 Duration of treatment 6 month
 Follow up once a year for 5 years

35. 1983
Single skin lesion
 Rifampicin 600 mg
 Ofloxacin 400 mg
 Minocycline 100 mg
 Follow up once in a year for 2 year

36. 1983
This campaign it comprises of a package of 4
activities namely
1.Teaching and training of all health staff
2.Intensified IEC activities
3.Case detection by house to house visits to detect new
leprosy case
4.Correct and complete treatment

37. 1983
Urban leprosy control program 2005
•This was initiated in 2005 to address the complex
problem of leprosy cases in urban areas.
•Assistance :422 urban areas
•Population size:one lakh.
•Urban areas are grouped in 4 categories
•i.e. Township I, medium cities I, medium cities II
mega cities 3.

38. 1983
NLEP : National action plan for 2006-2007
 Continue the efforts to achieve elimination of leprosy
 To maintain the gains achieved and to continue the
efforts to achieve elimination at block and district
level
 To make quality leprosy services available

39. 1983
Strategies NLEP
 Decentralization of NLEP to states and districts
 Integration of leprosy services with general health
care system
 Leprosy training of GHS functionaries
 Early diagnosis and promote MD, through routine
and special efforts

40. 1983
 IEC using local and mass media for reduction of
stigma and discrimination
 Prevention of disabilities and medical rehabilitation
(DPMR)
 Inter-sectoral collaboration
 Monitoring and evaluation

41. 1983
Leprosy elimination monitoring
•This consists of assessing the performance of elimination
campaign on various issues like case detection, quality of
services like treatment, IEC activities, drug supply and
management etc.
•Carried out by NIHFW, New Delhi, and every year in 12
endemic states for 3 years since June 2002.
•Slogan is prevalence rate is reduced to <1/10000 populations

42. 1983
Indicators for evaluation and monitoring
 Proportion of suspected leprosy cases , suspected /
investigated to the total outdoor patients
 Proportion of new cases detected to those suspected
 Number of new cases detected
 Number of skin smears taken and number found positive
for lepra bacilli
 Inventory control of items under NLEP especially drugs

43. 1983
Disability prevention and medical rehabilitation
services
1.Dressing materials, supportive medicines and ulcer
kits
2.Microcellular rubber footwear is provided for
protection of insensitive feet.
3.NGOs in the country and 42 govt. medical college
have been strengthened for providing reconstructive
surgery services.

44. 1983
•An amount of Rs.5000 provided as incentives to each
leprosy affected persons from BPL family undergoing
reconstructive surgery
•Support is also provided to govt. institute PMR centers in
the form of RS.5000 per reconstructive surgery conducted

45. 1983
The main activates carried out during 2009-10 were
as follows
1.Implementation of DPMR activities as per guidelines
and reporting its outcomes.
2.Integrating DPMR services –Convergence of NLEP
services in to NRHM facilitates this integration.
3.To develop a referral system.

46. 1983
Responsibilities of nurse
 Find the source of infection
 Assist in the examination of household contacts
especially children
 Education on the early sign and symptoms of leprosy
 Help the patients and family to understand the nature
of disease
 Observe all patients in clinic

47. 1983
 Demonstrate nursing care
 Assist with diagnosis and treatment
 Follow up and contact as needed
 Assist with rehabilitation
• Participate in all programs, including referring to other
agencies for necessary help and treatment

48. 1983
Newer update
• Leprosy Case Detection Campaign (LCDC)
•8 October 2016 |Geneva | New Delhi –– A record 320
million Indians have been screened in a door-to-door
leprosy detection campaign, revealing thousands of
“hidden” cases. In 2015, a total of 127 326 new cases
were detected accounting for 60% of the global total
of new cases, compared with 125 785 new cases in
2014. IE 1541

49. 1983
• In 2016, WHO has launched a new global strategy – The
Global Leprosy Strategy 2016–2020: accelerating towards a
leprosy-free world – which aims to reinvigorate leprosy control
efforts and avert disabilities, especially among children affected
by the disease in endemic countries. This strategy emphasizes
the need to sustain expertise and increase the number of skilled
leprosy staff, to improve the participation of affected persons in
leprosy services and to reduce visible deformities – also called
grade-2 disabilities – as well as stigmatization associated with
the disease.

50. 1983
Conclusion
• Leprosy is curable and treatment provided in the early
stages averts disability if Multidrug therapy provided.
Control of leprosy has improved significantly as a
result of national and subnational campaigns in most
endemic countries. Integration of basic leprosy
services into general health services has made
diagnosis and treatment of the disease more accessible.

51. 1983
REFERENCES
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3.Gulani, K.K. (2009).Community health nursing principles and
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5.National Leprosy Eradication Programme (NLEP). (n.d.).
Retrieved December 20, 2016, from
http://nlep.nic.in/index.html