During my stay in Chhattisgarh I attended a partners’ meeting at which Dr. Anil Kumar, the deputy director general (leprosy) for India’s Ministry of Health & Family Welfare gave a presentation on the situation in the country as a whole. He assumed his post in September 2015, following which there have been some positive developments.
India achieved the elimination of leprosy as a public health problem at the end of 2005. Since then, 34 out of the 36 states and Union Territories have achieved elimination “at some point” although four have subsequently relapsed. Chhattisgarh is one of the two states yet to achieve elimination.
What troubles Dr. Kumar is that since national-level elimination was achieved and leprosy services have been integrated into the general health services, the new case detection rate has remained almost static while the rate of Grade II (visible) disability has started to go up. “After 2005, we did not detect hidden cases. We allowed GII disability to occur for the last 10 years. This is very unfortunate,” he said. “We have to take action to reverse this.”
One of the mistakes of the past was to have assessed the program based only on the number of cases and prevalence of leprosy, he said. To illustrate his point, he displayed two maps of India. The first showed states with a high rate of prevalence, the second showed states with high rates of GII disability. What is apparent is that GII disability is higher in many of the low prevalence states. “We must not concentrate only on states where the prevalence rate is high,” he said. “We have to concentrate on other states also, because ultimately these are the states where the program is not being implemented effectively and so prevalence could again rise and they become problem states.”
To address the challenges, Dr. Kumar has introduced a three-pronged strategy: leprosy case detection campaigns (LCDCs), focused campaigns in hotspots, and special plans for hard-to-reach areas. The LCDCs that were conducted last year uncovered 32,000 new cases and he expects thousands of cases of GII disability to be averted as a result.
The LCDCs are being supplemented by chemophrophylaxis, with a single dose of rifampicin being administered to all contacts of confirmed cases, to help reduce community-level transmission. In hard-to-reach areas, local communities are being empowered with training and supplies of drugs so they can implement the program and detect cases.
Dr. Kumar said that all GII cases around the country detected during 2016-2017 will be investigated, the data entered in a computer and analyzed, and based on this analysis, activities will be implemented to prevent GII disability.
He said he is aiming to achieve zero GII disability among children and less than 1 case per million among the general population by 2019, one year ahead of the target set by the WHO in its current five-year strategy.
“If we work hard, if we detect cases early, if we are honest in our efforts, we will definitely be able to achieve this,” he said. Listening to the determination in Dr. Kumar’s voice, I believe that he will.