The leprosy case detection campaign undertaken by India recently was on a scale that boggles the mind. Some 320 million people across 19 states were screened by 300,000 health teams. The results indicate that when new case numbers for 2016 are announced, they will considerably exceed the 127,000 reported in 2015.
A campaign of this size requires careful planning and execution. The revised operational guidelines issued by India’s National Leprosy Eradication Programme lay out how it is done and the challenges to be overcome.
Committees were formed at every level—national, state, district and block—for planning and implementation. Before and during the campaign, intensive information, education and communication activities were carried out to create community awareness and acceptance. Pamphlets, posters, folk plays, puppet theatre, wall painting, drum beating and “miking” were among the tactics, depending on the area and literacy levels. Teams of health functionaries were trained from district to village level in how to suspect cases of leprosy through physical examination of each and every person in every house visited. Micro-plans were drawn up for high-risk areas and underserved populations. Supervisors mapped out the areas they were supervising in advance. The help of “local influencers” was enlisted.
As for the challenges, these included reaching nomadic tribes, boat people, urban slum dwellers and those in remote, sparsely populated areas. There was also the possibility of non-cooperation, because people had lost faith in the health program due to the poor quality of services they receive, were suspicious, poorly informed or because they were of high socio-economic status and “assume that leprosy cannot occur to them.”
Great emphasis was placed on the teams behaving politely and explaining the purpose of their visit clearly. Accredited social health activists and field-level workers were reminded they were not to make diagnoses but only to note suspected cases and refrain from making negative comments. Accurate data collection was paramount.
One piece of advice catches the eye. “This activity is going to benefit your own people,” the local volunteers were told. By extension, the whole country benefits. This, surely, is the message at the core of this massive campaign to detect hidden cases in the community and interrupt transmission of the disease.