Prior to formation of Separate state, Maharashtra was the part of Bombay Province till 1960. Post of State Leprosy Officer was in existence since 1943 and was filled in 1949, the main duty then included advising the Govt. on leprosy services based on sample surveys conducted by him. Then the available leprosy services included leprosy asyla run by missionaries to provide sheltered segregation and treatment with hydnocarpus oil. In 1951 treatment with sulphones was initiated.
|1942||Leprosy Hospital at Kondhawa taken over by Govt. from the " Mission to Lepers".|
|1944||Leprosy Hospital Ratnagiri taken over by Govt. from District Local Board.|
|1950||Scheme for Leprosy Control Work in a limited area under Hind Kushtha Nivaran Sangh.|
|1953||Leprosy Control Centre established at Ambewadi in district Sangali. Pilot projects for leprosy control started at Vairag dist. Solapur, Mul dist. Chandrapur, Sevagram dist. Wardha.|
|1955||Treatment with DDS tablets introduced in all local bodies and Govt. hospitals, 1st documentary film on leprosy prepared by Directorate of Publicity. Greater Bombay Leprosy Control Scheme of Bombay Municipal Corporation in collaboration with Gandhi Memorial Leprosy Foundation and State Govt.|
|1955 – 56||Launch of National Leprosy Control Program throughout the country including state with following principles
i) Detection of all cases especially those of the infectious type at as early as possible
ii) Provision of treatment facilities to all patients so detected and
iii) Health Education to create a favorable atmosphere which will help both in case detection as well as case holding program.
|1958||SET centre attached to existing dispensaries and centres started. Thereafter with every 5 year plan SET centres, leprosy control units and urban leprosy centres were established in the entire state.|
|Post of state leprosy officer was upgraded to Deputy Director (Health) in 1965 and further upgraded to Joint Director (Health) in 1981|
|Milestones of NLEP in Maharashtra|
|1955 – 1956||launch of National Leprosy Control Programme.|
|1970s||Definite cure through MDT was identified|
|1983||launching of National Leprosy Eradication Programme., Multi Drug Therapy introduced in selected urban area & Wardha district.|
|1983 – 1997||Remaining districts brought under MDT in phased manner.|
|1993 – 2000||World Bank Assisted NLEP Project Phase – I|
|1.||To support vertical programme structure for endemic dists.
Jan. 1997: Implementation of National Leprosy Elimination.
|2.||Establishment of Mobile Leprosy Treatment Unit (MLTU) in moderate & low endemic dists.
|3.||Formation of district leprosy societies.
Jan. 1997: Implementation of National Leprosy Elimination
|Main Activities–Programme renamed as National Leprosy Elimination Programme with an objective to bring down the P R of leprosy to below 1 per 10,000 population.|
|1998||Introduction of ROM in the state.|
|30 Jan 98–5 Feb 98||1st Modified Leprosy Elimination Campaign|
|Main Activities 3 day technical training for GHCS staff, One month IEC Campaign, Active leprosy search with the help of GHC staff|
|30 Jan 99 – 5 Feb 99||Additional M L E C (1998–99) GOM|
|30 Jan 2000–6 Feb 2000||II M L E C (1999–2000) GOI|
|30 & 31 Jan 2000||V R C|
|Oct 2000 – Mar 2004||World Bank Assisted NLEP Phase–II|
|2001 – 2002||III M L E C, V R C – 30th &31st Oct.2001|
|2002 – 2003||IV Modified Leprosy Elimination Campaign.|
|2003 – 2004||V Modified Leprosy Elimination.|
|2004 – 2005||Block Leprosy Awareness Campaign|
|2005 – 2006||Block Leprosy Awareness Campaign II|
|2005 – 2007||Extended Leprosy Eradication Programme|
- To reduce the load of infection in community by converting the bacteriologically positive cases to bacteriological negativity in order to interrupt the transmission of infection in the community.
- To reduce the prevalence rate of leprosy to a level when leprosy is no longer a major public health hazard i.e less than one case per 10,000 population.
- Ultimately to rid the country of the disease.
The objectives of National Leprosy Eradication Programme
- Early detection of leprosy cases.
- All detected leprosy patient should be brought under regular treatment so as to break the chain of transmission and to cure them without deformity.
- Health education regarding scientific information of Leprosy should be given to the leprosy patients, his family and society.
World Bank Assisted NLEP Project Phase - I
- To support vertical programme structure for endemic districts.
- Establishment of Mobile Leprosy Treatment Unit (MLTU) in moderate and low endemic districts.
- Formation of district leprosy societies.
- To achieve elimination by the end of 2005.
- To rapidly & effectively integrate vertical programme of leprosy eradication with general health care system. To achieve these objective emphasis should be laid on following points.
- To detect new cases (Tribal, Difficult Hilly area) at the early stage.
- To bring them under MDT.
- To provide health education.
- Render services of POD to avoid deformity.
- To provide physiotherapy to needy leprosy patients.
- To perform reconstructive surgery on needy leprosy patients.
|Mile stones||Mar.04||Mar. 05||Dec.05||Mar.06||Mar.07||Mar.09||Mar.12|
|No.of districts having PR<1||0 0%||7 20%||29 85%||34 100%||34 100%||34 100%||34 100%|
|No.of Municipal Corporations having PR<1||1 5%||8 36%||22 100%||22 100%||22 100%||22 100%||22 100%|
|No. of Blocks having PR <1||33 9.73%||78 23%||118 33%||152 45%||203 60%||271 80%||339 100%|
|No. of PHCs||232||578||982||1160||1340||1518||1786|
|MB proportion of New cases||32.12||36.84||55||55||60||65||70|
Strategy of National Leprosy Eradication Programme
- No active searches except for high Prevalence Rate (PR) pockets, Modified Leprosy Elimination Campaign (MLEC), SAPEL/LEC.
- Full integration of anti-leprosy activities with GHS in rural as well as urban area.
- The Male MPW will include leprosy work in his activities with emphasis on case finding, defaulter identification, health education. The female MPW/ANM and the AWW will refer suspected cases. Treatment follow up will be carried out by the male MPW every month at village and sub centre level. He will also advise new patient and provide POD services.
- General hospitals, CHCs, PHCs, additional PHCs and dispensary centres will offer leprosy diagnosis and treatment facilities independently. One PME/NMS will be appointed in blocks with high endemic pockets for guidance and support.
- Promotion of voluntary reporting by creating enhanced awareness among masses.
- Availability of MDT services upto sub-centres.
- Accompanied MDT was needy persons.
- MDT management at all the health facilities.
Establishing and Strengthening of State Leprosy Society (SLS)
The State Leprosy Society has been established on 11th July 2001 under the chairmanship of the Principal Secretary Public Health Department, Maharashtra State, for monitoring and guidance to the District Leprosy Societies. For close monitoring and smooth channelization of MDT funds to the District Leprosy Societies, Budget and Finance Officer and Data Entry Operator, one each, have been appointed on contract basis.
Strengthening of Sample Survey Assessment Unit (SSAU)
The existing SSAU has been strengthened by appointing Epidemiologist & Data Entry Operator, one each, from the World Bank Assistance.
3 days modular technical training in leprosy was imparted to all general health care staff as a part of integration.
Modified Leprosy Elimination Campaign (MLEC)
With following objectives
- To carry out intensive awareness campaign about leprosy in the community.
- Detection of hidden leprosy patients and MDT coverage immediately through Voluntary Reporting Centres (VRC) and Active Searches. During MLEC V 4504 VRCS were organized in the state.
100% validation of all newly detected cases has been accomplished throughout the State except Thane (50% only).
Block Leprosy Awareness Campaign (BLAC)
Two such campaigns were taken up in Nov. 04 and Sept. 05 respectively to provide intensive IEC, leprosy diagnosis, treatment and counseling services in tribal blocks.
Services to Common People
A. Case Detection through
- Promotion of Voluntary Reporting of Cases: Through Intensive IEC activity to increase voluntary reporting.
- Screening in OPD by MO i/c PHC,/Municipal Dispensaries/General hospitals/Rural & Cottage Hospitals/Cantonment Hospitals/ESI Hospitals /Private Clinics.
- Identification of suspect leprosy cases by Health Care Workers during routine house to house visits.
- Made available at all PHCs, Municipal Dispensaries & Health Posts, General Hospitals/Rural Hospitals/ Cottage Hospitals/ Cantonment Hospitals/ESIS & Railway Hospitals and selected Private Practitioners.
- After initiation of first dose at P H C, MDT is made available at subcentres.
- Accompanied MDT available at all these centres as per GOI guidelines.
- Emphasis on I P C (interpersonal communication) during home visits.
- Awareness generation in markets & haats through miking, use of hand–outs, posters & exhibitions etc.
- Bus & Office IPC, strengthening of school IPC.
- Erection of hoarding and wall paintings.
- Radio Jingles, Messages on Leprosy in Cinema Houses, Cable Network, Doordarshan.
- Involvement of Women Groups, Indian Red Cross, Scouts, Other NGOs, School Teachers & students, Scouts & Guides, NCC volunteers, AWWs, ANMs,Cured Leprosy patients, Community Leaders etc.
Deformities and disabilities contribute to the existence of Social Stigma against the disease. Intervention at the right time will prevent occurrence or worsening of deformity and disability. Hence “Care after cure” of deformed patient is a challenge of the decade.
POID at the start and during MDT call for proper recording of base– line information about nerve function, detection and high risk cases and management of reactions. Health education, training of paramedical staff and resources are essential for success of POID. Referral options for specialist POID care are imperative to make an integrated leprosy control system work. For POID, after chemotherapy , the patients must be empowered to understand when and where to request for care of the complications due to leprosy if they arise. High risk cases need periodic follow–up examinations. Patients with established disabilities should receive continued care.
To achieve the concept of “Deformity free patients” POD (Prevention of Deformity) training to selected GHCS staff through POD camps in each district has been initiated.
Key trainers’ training has been organised for faculties In each district 2 POD camps per block are scheduled, 638 completed out of 710 camps in the state. Necessary financial assistance for POD is assured by Govt. of India @ Rs.3150 per camp.
E. Rehabilitation: Medical, Social & Economic
Planning for Rehabilitation
The immediate need is reliable information on practically all aspects of the rehabilitation of leprosy– affected/cured persons for any given area. For this purpose it is probably best to take the district as a unit. Following information shall be needed for this purpose.
Distribution of sites of loss of sensibility, nature of visible impairments, State of eyes and; presence of ulcer and scars in the feet of the subjects.
Demographic data on the leprosy
affected/cured persons including their family details & mode of subsistence and sources of income.
about affected individuals and their families, their overall socio–economic status and dyshabilitation status” (or participation– limitation status); determining their rehabilitation potentials as per their perceived needs; the physical consequences of the disease, & their activities of daily life (mainly their occupation).
Identify and evaluate
availability and usefulness of the rehabilitation recourses in the immediate neighbourhood and in the district.
Assessment of the fitness and willingness of corrective surgery of the visibly impaired individuals.
The rehabilitation project should be a well planned, time–bound and target–oriented programme and should also cover the “Unrehabilitable” to ensure a minimum level of economic security, including food security for this group.
Simultaneously extensive & initially intensive social awakening programme, using all available strategies and resources should be carried out to touch all levels of the society.
Rehabilitation activities will have to address three different issues, namely
- Impoverishment of the affected individual and his/her family.
- Activity limitations of affected persons and
- Participation restriction involving the affected person and their families.
States health departments generally do not have comprehensive health infrastructure in urban areas. Various authorities and public/private sector agencies have jurisdiction in urban areas, but usually have a very limited health setup. Localized approaches will need to be developed for service delivery in urban areas. These could include
- Coordination with medical facilities of public and private agencies to enable them to establish regular diagnosis and treatment facilities.
- Involvement of the Indian Red Cross, Scouts and other Non–Government Organisations (NGOs) in urban areas.
- Sensitization of urban private practitioners.
- Holding of skin camps, supported by IEC for awareness generation.
- Service Delivery Points (SDPs) to be identified in urban slums, industrial township, collieries etc.
- Schools could initiate health programmes – with support from the health department.
Identification of female patients has been a major problem, particularly since almost all leprosy workers are male. During the MLECs it has been the experience that involvement of female community level workers considerably helped to improve access to women, particularly in rural areas. It is envisaged that integration will make it easier to involve female providers and community based workers in helping to detect female patients. Also, for improving case finding in general and identifying female patients in particular, efforts will be made to involve women’s groups, school students suitable NGOs and other such agents.
Management of migratory patients
Migration of patients leads to disruption in the course of treatment. While a few of the patients may get registered elsewhere, the majority may be lost forever, resulting in deterioration of their condition. Such groups may include seasonal, agricultural or industrial labour, or other nomadic group and such groups should be
- Screened in the areas where they are available.
- Their permanent residential address should be recorded.
- All leprosy patients detected from among such groups should be given an identity card wherein the date of registration, diagnosis and number of doses of MDT given is recorded. This card would enable the patients to collect drugs from health institutions in the place they move to.
- They should be given accompanied MDT on priority
- Prepare the state’s annual implementation plan, and submitting it to GOI.
- Help districts to prepare and implement their annual plans.
- Develop special strategies for urban areas.
- Manage SAPEL project. Monitoring access & outcomes of attempts to reach special group.
- Channeling funds to the district societies.
- Close physical and financial monitoring of implementation.
- Monitoring of district societies expenditures.
- Giving regular feedback to districts on the basis of district reports.
- Planning and managing training activities.
- Planning and managing IEC activities.
- Drug inventory management – monitor district drug stocks and send supply requests to GOI.
- Facilitating mobility of staff.
- Facilitating logistics within the districts.
- Monitoring technical aspects.
- Facilitating coordination among the district collector, Chief Medical Officer & DLO.
- Coordination with NGOs.
- Overall facilitation and problem solving.
- Developing a strategy on how the state would manage the programme after the project period.
Leprosy Eradication Work was being performed by following institution under State Govt.
|Sr. No.||Name of Center||Existing No.|
|1||Urban Leprosy Centres (being merged in dist. nucleus)||428|
|2||Supervisory Urban Leprosy Unit at urban towns with population > 5||23|
|3||Leprosy Training Centers (Pune ,Nagpur)||2|
|6||Govt. Leprosy Hospital (Ratnagiri, Osmanabad, Kolhapur, Pune)||4|
|7||Temporary Hospitalization Ward at selected civil hospitals ( merged in general wards)||3|
|8||Non Governmental Organization||46|
Anandvan, Varora. Chandrapur,
Richardson Leprosy, Miraj, dist. Sangli
Dr. Bandorwala Leprosy Hospital Pune,
Acworth Leprosy Hospital, Vadala, Mumbai
Vimala Dermatological Center,Versova, Mumbai
Leprosy Mission, Kothara, Amaravati All General Hospitals & Govt. Medical Colleges being equipped to provide RCS services in near future
Special Features of National Leprosy Eradication Programme
- Only clinical diagnosis.
- No bacteriological examination.
- No registration without confirmed diagnosis.
- Active survey banned.
- Promoting voluntary reporting through IEC.
- Identification of suspect cases through regular home visits.
- SAPEL/LEC for unreached rural and urban areas.
- Accompanied MDT.
- Simplified information system of 11 indicators.
- MDT made available at all Govt./Semi Govt. Hospitals/Health Centres/Dispensaries.
- General practitioners being motivated to start anti leprosy services, MDT drugs to be arranged by state.
- Training of untrained General Health Care Staff including Medical Officers.
- Emphasis on IEC.
Region wise Performance of National Leprosy Eradication Programme
Performance 2008 –2009 (September, 2008)
|Circle||Active Cases||PR/10,000||NCD Oct. 07 to Sept. 08)|
Click here to view full details
District Wise Performance of National Leprosy Eradication Programme
District Wise 2008-09 (Aug. 2008)
|SR. NO.||District||Active Cases||PR/10,000|
Click here To view full details
Expected Community Participation
- Acquiring basic information on leprosy disease : causation, transmission, treatment, prevention from all available sources viz. health workers, publicity media etc.
- Self empowerment on early diagnosis of leprosy patches by inspection of whole body once in six months either with the help of full size mirror or close relatives.
- Neither fear a leprosy patient nor to stigmatise the patient even with deformities.
- Contribute their might to rehabilitation of leprosy cured persons.
- Those who are diagnosed as cases of leprosy should.
i) Accept leprosy on par with any other disease.
ii) Regular and 100% compliance with treatment.
iii) Educate the community members on leprosy basics.
iv) Follow self care practices for prevention and control of deformity.
- Early voluntary reporting and regular treatment completion.
- Minimization of stigma.
- Acceptance of Leprosy affected persons without prejudice/discrimination.
- Motivation of hidden cases to report for treatment.
|Year||PR/1 Lac||NCDR/1 Lac|
|2007–08 (Upto Sept..08)||0.83||11.91|
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Role of NGOs
- 43 NGOs are actively participating in anti leprosy activities. 10 NGOs work on SET pattern, receive Grant in Aid from GOI directly. 12 NGOs receive funds from ILEP agencies directly.
- 17 NGOs work on Hospital Pattern and receive GIA from Govt. of Maharashtra @ Rs.480/bed/month.
Total number of sanctioned beds in the State are 3171. The patients are hospitalized for treatment of reactions, ulcers, nerve involvement and other complications.
- 18 NGOs work for Rehabilitation. They receive GIA from Govt. of Maharashtra @Rs.450/– bed/month.
Total No of Beneficiaries in the state are 2075. These NGOs provide the protective aids like MCR Chappals, Splints and Goggles, Physiotherapy, Reconstructive Surgery, Vocational Training, Socio economic rehabilitation etc to the patients as per their need.
- 2 LRPUs (Leprosy Rehabilitation Promotion Unit) working in the state.
- Liaison with respective primary health centre/urban health institution.
- Special IEC drives.
- Capacity building of staff of PHC and corporation.
- Special drives for detecting hidden cases in endemic and high risk pockets.
- Special attention on migratory population, work sites, slums, labour populations brick works, building sites etc.
- Awareness generation and involvement of school children.
- Regular POD activities.
- Socio–economic rehabilitation of cured leprosy patients.
|Sr. No.||Name of N.G.O.||District|
|1||Vidarbha Maharogi Seva Mandal, Tapovan||Amravati|
|2||Kushtrog Nivaran Samiti, Shantivan Nere||Raigad|
|3||Sarvali Leprosy Welfare Centre,Saravali||Thane|
|4||Kushtrog Nivaran Davakhana, Vadoli||Thane|
|5||Loknayak Jayprakash Narayan, Vasai||Thane|
|6||Anandgram Society, Dudulgaon||Pune|
|7||Sanatorium for leprosy patient, Veermandki||Pune|
|8||Udyog Dham Badrikashram Kushtrog Punarvasan Sanstha, Talegaon||Pune|
|10||Ahmednagar District Leprosy Rehabilitation association||Ahmednagar|
|11||Late Karandikar Guruji Balsadan, Savedi||Ahmednagar|
|12||Hanson Memorial Society, Velu||Satara|
|13||Navnirman Samaj Seva Sangh||Dhule|
|14||Marathwada Lokseva Mandal, Nerli *||Nanded|
|15||Richardson Leprosy Hospital, Miraj **||Sangli|
|16||Maharogi Ashram Kushtsudhar Mandal, Dhamangaon, Kashikhed||Amravati|
|17||Kothara Leprosy Hospital, Achalpur||Amravati|
|18||Leprosy Relief & Rehabilitation Centre, Nimbhora||Amravati|
|19||Maharogi Seva Samiti, Anandvan Warora||Chandrapur|
|20||Mahatma Gandhi Shikshan Sanstha,Chavarda||Buldhana|
|21||Maharogi Seva Samiti, Dattapur||Wardha|
|22||Gandhi Memorial Leprosy Foundation, Hindi Nagar||Wardha|
|23||Eduljee Fremeji Leprosy Home, Traumbe||Mumbai|
|24||Adams Wylie Leprosy Hospital, Mumbai Central (B.L.P.)||Mumbai|
|25||Gurudev Kushtrog Mandir, Amla Vishweshwar.||Amravati|
|26||Ramdevbaba Manav Seva Kushtrog Kendra, Vani||Yavatmal|
|27||Ashwini Medical Foundation, Chinchwad||Pune|
|28||Dr. Babasaheb Ambedkar Medical Trust||Pune|
|29||Ashok Kala Niketan,Dapodi||Pune|
|30||Akhil Bhartiya Kushtrog Nivaran Samiti, Shirur||Pune|
|31||Ackworth Leprosy Hospital, Vadala.||Mumbai|
|32||Hind Kusht Nivaran Sangh, Vadala||Mumbai|
|33||Maharashtra Lokhit Seva Mandal||Mumbai|
|34||Society for Eradication of Leprosy||Mumbai|
|35||Lok Seva Sangam, Sion||Mumbai|
|36||Alert India, Sion||Mumbai|
|37||Dr. Bandorwala Hospital, Kondhwa||Pune|
|38||Pune District Leprosy Committee||Pune|
|39||Dnyan Prabodhini, Khed Shivapur||Pune|
|40||Vikas Sadhak Vahini||Pune|
|42||Leprosy Mission Hospital, Poladpur||Raigad|
|43||Abhinav Dnyan Mandir, Karjat||Raigad|
|44||Mahatma Gandhi Mission Hospital, C.B.D. Belapur||Raigad|
|45||Mukt Jivan Centre, Shahapur||Thane|
|46||Solapur Comprehensive Leprosy Project||Solapur|
|47||Leprosy Hospital, Solapur||Solapur|
|48||A.C.C. Sevadham Nagapalli||Gadhchiroli|
|49||Pralhad Ruikar Trust, Lanza||Yavatmal|
|50||Vimala Dermatological Centre, Varsova.||Mumbai|
|51||Society for Research Rehabilitation & Education, Vadala.||Mumbai|
|52||Sevadham Trust, Pune||Pune|
* This NGO also gets grants under Leprosy Rehabilitation & Promotion Unit (LRPU).
** This NGO works as training Centre as well as Leprosy Rehabilitation & Promotion Unit (LRPU).
Important Health Education Messages
- Leprosy is completely curable with Multidrug Therapy which also prevents disability and deformity.
- A Pale or Red Patch on skin may be Leprosy. Don’t fear leprosy…Treat it.
- Leprosy Free check- up and MDT available in all government and Mahanagarpalika Dispensary and Health Centres.
- Early diagnosis early treatment surely drives away leprosy.
- Early and regular treatment cuts down the transmission of leprosy.
- Multi Drug Therapy, a gift of modern medicine to leprosy patients.
- Rehabilitation of leprosy persons is everybody’s responsibility.
- Multi Drug Therapy shall wipe out leprosy from the globe.
- Let us join the hands to work towards A WORLD WITHOUT LEPROSY.
- Department of Education: To incorporate lessons on leprosy in the curriculum of school children.
- Food and Civil Supplies: To provide benefits under schemes like Antyoday Anna Yojana to deserving leprosy patients.
- Department of Urban Development: To provide necessary facilities under schemes like Valmiki Ambedkar Awas Yojana, Slum Improvement Act. Priority employments to leprosy affected persons and their dependants etc.
- State Transport Corporation: To co–ordinate efforts of health department in health education viz. allowing various advertisements on leprosy to be displayed in ST stands, Buses. Provide travel concessions to leprosy affected persons.
- Information and Publicity: To provide wide publicity to health educational programmes in leprosy.
- Prasar Bharati: To broadcast various programmes on health education in leprosy.
- Railways: To provide travel concessions to eligible leprosy affected persons. To help in generating awareness by assisting in various programmes of IEC.
- Significant decline in active cases, prevalence rate, deformity rate, increase in female case proportion and decrease in child proportion.
- Decline in the misconception and taboos in society due to effective health education.
- Declining need for separate “Kushthadham” for leprosy affected patients.
- Universal availability of MDT including AMDT.
- Increasing awareness about leprosy leading to increased voluntary reporting.
- Achievement of elimination i.e PR < 1/10,000 population by Sept. 2005.