India needs to consolidate its achievements, says Dr. P.L. Joshi.
India eliminated leprosy as a public health problem in December 2005, but still accounts for some 70% of the world's new cases. What are the challenges it faces in the"post-elimination era," and how is it addressing them? For some answers, we turned to Dr. P.L. Joshi, the deputy director general (leprosy) at India's Ministry of Health and Family Welfare.
What are your priorities?
India is a leprosy-endemic country. We need sustained action for the coming two to three decades in order to consolidate the achievements we have made so far. This should be across the country, and throughout the year. We should not consider one area as having more burden of the disease than another.
What is the status of the National Leprosy Eradication Program within the ministry?
It is not a high-priority program compared with other programs for epidemic-prone diseases we are facing, such as HIV/AIDS. Leprosy is not a public health problem at the national level. But the government realizes that we have to sustain the program, and political commitment is very high.
How is this commitment expressed?
The government is offering 100% central assistance to states, in addition to funds provided under the National Rural Health Mission. The budget for health has increased from 0.9% of GDP to 1.5%, and in coming years will increase to 3%.
What is the rural health mission's role?
The mission was launched in 2005. Its objective is to provide quality health services to the people of this country. One of the key concepts of the mission is to provide every village with a trained female community health activist, known as an ASHA. Selected from the village itself, she acts as an interface between the community and the public health system. We are training them in leprosy work, and the ASHA will be paid Rs. 100 for every case of leprosy she finds once it is confirmed at a primary health center. After the patient has completed treatment, the ASHA receives a further Rs. 200 in a case of PB leprosy, and Rs. 400 in a case of MB leprosy.
In what other ways is the NRHM contributing to the leprosy program?
There is a lot of emphasis on community participation. At the village level, there is a seven-or eight-member village health and sanitation committee, consisting of members of civil society and health workers. They decide what health services to offer and are provided with Rs. 10,000 annually in untied funds. We are sensitizing members to the issue of stigma and discrimination. At the health subcenter level, which covers a population of 3,000 to 5,000, there are two female health workers and one male worker. Subcenters each receive Rs. 10,000 to be spent on what is needed. This is a good opportunity for all programs, not just leprosy. At the district level, every district has to determine what kind of support it requires for all programs, including leprosy. For example, if there are 10 people in the district with insensitive feet, it becomes a priority to obtain MCR* footwear.
How else is the program evolving?
In the post-elimination era, the program has broadened in scope to take up many other issues that had been left out before. We are working with other ministries such as rural development, social justice and empowerment, and law and justice, to provide help for the socio-economic rehabilitation of people affected by leprosy. We are also providing financial incentives to people affected by leprosy to encourage them to come forward for reconstructive surgery. They receive Rs. 5,000, while the hospital receives Rs. 5,000 to offset the cost of operations.
Your program is called the National Leprosy Eradication Program. What do you understand eradication to mean?
Our goal, our vision is eradication. But I am not talking as a scientist, I am talking as a program manager, and program managers have to have a vision. It is the vision of the country that ultimately we have to make India leprosy free.
* Micro-cellular rubber protective footwear is widely used by persons affected by leprosy with anaesthetic feet.