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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

INTERVIEW: Grounds for Optimism

India’s point man for leprosy eradication says there is much to be hopeful about.

What are the key challenges India faces in eradicating leprosy?

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Under the National Leprosy Eradication Programme (NLEP), India eliminated leprosy as a public health problem, i.e. less than one case per 10,000 population at the national level in December 2005. However, it remains home to around 60% of the world’s leprosy-affected persons. This is because pockets of high endemicity are still present in several states and disease transmission is continuing.

In addition, it is a matter of great concern that the annual new case detection rate (ANCDR) and prevalence rate (PR) are almost static and that the percentage of Grade II disability among new cases has risen from 3.10% (2010-2011) to 4.61% (2014-2015). This clearly indicates that cases are being detected late in the community and there are likely to be hidden cases. A further challenge is to build the capacity of the various human resources categories working for the program.

What measures is the NLEP adopting to address these various challenges?

We are following a three-pronged strategy for early case detection: 1) Leprosy case detection campaigns (LCDCs) specific to high-endemic districts; 2) Focussed leprosy campaigns (FLCs) in hot spots; and, 3) Case detection in hard-to-reach areas.

In order to reduce stigma, an evidence-based information, education and communication (IEC) plan is being prepared, training is being given to all categories of human resources and they are being assessed through training calendars. In addition, online training software is being developed and online monitoring software called Nikushth will be launched soon to keep track of all the activities being implemented under the NLEP.

So you see a need for innovative approaches?

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Communication tool: inaugural issue of the NLEP Newsletter (January-March 2016)

Yes. Other approaches being adopted under the program include the NLEP Newsletter and GIS (geographic information system) mapping.

The newsletter is a platform to share guidelines, feedback, best practices, experiences and activities undertaken in the program in coordination with partners, states, NGOs, institutes, medical colleges and associations. It serves as an important communication tool to inform, update and educate our stakeholders as well as target groups.

GIS mapping is at present being followed under the NLEP to segregate districts based on endemicity. In future, it will be used to correlate the distribution of disease with various factors — geographic, socio-economic, operational — and to study and project geographic distribution.

How big is the gap between the reported number of new cases and the actual number?

In India, cases are being reported passively as well as through active case detection, and around 125,000 new cases are recorded annually. However, the National Sample Survey (2010-11) reported a gap between the number of reported cases and the number of actual cases in the community. To address this, LCDCs have been launched in high-endemic districts, as I mentioned.

How would you characterize the current attitude toward leprosy control?

Right now, the overall scenario in India favors the program. There is new, strengthened political will to fight against this disease and the government is determined to eliminate leprosy at all levels. It is a positive environment with lots to be hopeful about.

What is your message for state leprosy officers (SLOs) who actually implement the program?

Ideally, all the guidelines should be followed, but SLOs are at liberty to introduce their own innovative ideas specific to their state’s situation.

Are you optimistic that it will be possible to achieve a leprosy-free India?

Yes. The ultimate vision and mission of the program is to achieve a leprosy-free India one day, which can be achieved by continuous emphasis on early case detection and treatment. There is also a need to pool all available resources from national as well as international partners. If we want to achieve success, we have to work hard until we achieve our vision. There is no room for complacency in the program.

PROFILE: Dr. Anil Kumar

Dr. Anil Kumar is Deputy Director General (Leprosy) at India’s Ministry of Health & Family Welfare where he is responsible for the National Leprosy Eradication Programme (NLEP).