National Leprosy Eradication Program

The National Leprosy Eradication Programme (NLEP) is a public health initiative of the Government of India aimed at controlling, reducing, and ultimately eradicating leprosy (Hansen’s disease) from the country. It represents one of India’s most successful disease control programmes and has served as a model for other nations in combating chronic infectious diseases through sustained public health measures, early detection, and community participation.

Historical Background

Leprosy, caused by the bacterium Mycobacterium leprae, is a chronic infectious disease primarily affecting the skin, peripheral nerves, mucous membranes, and eyes, potentially leading to deformities and disabilities if untreated. India historically carried a high burden of leprosy cases, accounting for a large share of global incidence.
Efforts to control the disease in India began during the colonial period, but a systematic approach started only after independence.

• 1955: The Government of India launched the National Leprosy Control Programme (NLCP) with the primary focus on survey, education, and treatment (SET). It was implemented through vertical units with an emphasis on early detection and dapsone monotherapy.
• 1983: The programme was restructured and renamed the National Leprosy Eradication Programme (NLEP), shifting its goal from control to eradication, in alignment with World Health Organization (WHO) strategies.
• 1985 onwards: The introduction of Multidrug Therapy (MDT) revolutionised treatment, drastically reducing the disease prevalence and transmission.
• 1991: The World Health Assembly set a global goal of eliminating leprosy as a public health problem (defined as less than 1 case per 10,000 population) by the year 2000.
• 2005: India achieved the target of leprosy elimination at the national level, though some states and districts continued to report higher prevalence.

Objectives of the NLEP

The National Leprosy Eradication Programme was designed with the following objectives:

1. Early Detection of Cases: Identifying new cases at an early stage to prevent disabilities and transmission.
2. Effective Treatment through MDT: Ensuring free, complete, and supervised Multidrug Therapy (MDT) for all diagnosed patients.
3. Reduction of Disease Burden: Achieving and maintaining leprosy prevalence below 1 case per 10,000 population.
4. Disability Prevention and Rehabilitation: Preventing deformities through timely treatment and providing medical and social rehabilitation for affected individuals.
5. Health Education and Community Awareness: Dispelling myths and social stigma associated with leprosy through Information, Education, and Communication (IEC) campaigns.
6. Integration with General Health Services: Incorporating leprosy care into the general health system to ensure accessibility, efficiency, and sustainability.

Strategy and Implementation

The implementation of NLEP follows a comprehensive strategy built on WHO’s recommendations and adapted to India’s public health context.
1. Multidrug Therapy (MDT): Introduced in 1982, MDT is the cornerstone of leprosy control. It combines three drugs—rifampicin, clofazimine, and dapsone—to eliminate Mycobacterium leprae and prevent drug resistance. MDT is provided free of cost throughout India, supplied by WHO.
2. Decentralisation and Integration: Leprosy services were integrated into general healthcare delivery during the 1990s to increase accessibility and reduce discrimination.
3. Case Detection Campaigns: Special campaigns such as Leprosy Case Detection Campaigns (LCDC) and Special Action Projects for the Elimination of Leprosy (SAPEL) are periodically conducted in endemic areas to identify hidden cases.
4. Disability Prevention and Medical Rehabilitation (DPMR): Introduced in 2008–09, DPMR focuses on:

• Early detection of nerve function impairment.
• Physiotherapy and reconstructive surgery.
• Distribution of aids and appliances for disabled persons.

5. Behaviour Change Communication (BCC): Public education campaigns aim to reduce the stigma and discrimination associated with leprosy by promoting accurate information about its causes and curability.
6. Surveillance and Monitoring: Regular data collection and monitoring are conducted through the Integrated Disease Surveillance Programme (IDSP) and other mechanisms to track prevalence and new case detection rates.

Achievements

The NLEP has made remarkable progress since its inception:

• Elimination as a Public Health Problem: India achieved elimination (prevalence rate <1 per 10,000) at the national level in December 2005.
• Drastic Reduction in Cases: The prevalence rate declined from 57.6 per 10,000 population in 1981 to less than 1 per 10,000 by 2005.
• Universal MDT Coverage: All states and union territories now have access to free MDT through primary health centres.
• Increased Awareness: Community awareness of leprosy symptoms, prevention, and treatment has improved significantly through extensive IEC campaigns.
• Integration into General Health System: Leprosy services have been successfully integrated with routine healthcare delivery, reducing the need for a separate vertical infrastructure.

Current Scenario

Although leprosy has been eliminated as a public health problem at the national level, transmission continues in some pockets. Certain states such as Bihar, Chhattisgarh, Odisha, Jharkhand, and Uttar Pradesh still report higher endemicity.
As of recent data, India accounts for about 50–55% of new global leprosy cases, highlighting the need for sustained vigilance. Many of these are Grade 2 Disability (G2D) cases, detected late, indicating gaps in early case identification.

Key Initiatives under NLEP

1. Active Case Detection and Regular Surveillance: Conducting door-to-door surveys and health camps in high-risk areas.
2. SPARSH Leprosy Awareness Campaign (2017): Launched to promote community participation and reduce stigma through Sammaan Divas (Dignity Day) celebrated on 30th January every year.
3. National Leprosy Awareness Programme (NLAP): Aimed at increasing public awareness and ensuring every detected case receives full treatment.
4. Nikusth Portal: A web-based reporting system developed to monitor case detection, treatment, and outcomes in real-time.
5. Integration with Ayushman Bharat and Primary Healthcare: Ensuring leprosy-related services through Health and Wellness Centres under India’s Universal Health Coverage initiatives.

Challenges

Despite its success, several challenges remain in achieving complete eradication:

• Late Case Detection: Many cases are still detected after visible deformities develop.
• Hidden Cases: Social stigma discourages patients from seeking early treatment.
• Geographical Disparities: Higher prevalence in specific districts and tribal or hard-to-reach regions.
• Resource Constraints: Need for continued funding, trained staff, and sustained surveillance.
• Post-COVID-19 Setbacks: Disruptions in field activities led to reduced case detection rates in some states.

Future Goals

The government’s vision has evolved from elimination to eradication of leprosy, with the following goals:

• Zero Grade-2 Disability due to leprosy by early detection and prompt treatment.
• Zero Discrimination and Stigma against affected individuals.
• Sustained Zero Transmission through active case finding, chemoprophylaxis, and community-based surveillance.
• Digital Health Integration via improved data systems for monitoring and evaluation.

India’s target aligns with the WHO Global Leprosy Strategy 2021–2030, which aims for zero leprosy disease, zero transmission, and zero stigma.

Significance

The National Leprosy Eradication Programme has had far-reaching significance in India’s public health history:

• It demonstrated that long-standing infectious diseases can be controlled through scientific treatment, political commitment, and community involvement.
• It reduced the burden of disability and social stigma attached to leprosy.
• It integrated vertical disease control programmes into the broader primary healthcare framework, setting a precedent for other national health missions.