5.3. NATIONAL LEPROSY ERADICATION PROGRAMME 5.3.1 Introduction: National Leprosy Control Programme was started in 1955 in Karnataka based on Dapsone domicillary treatment through vertical units implementing Survey Education and Treatment activities. The Multi Drug Treatment (MDT) came into wide use from 1986. MDT programme was started in Belgaum & Dharwad districts during 1986-87, in Raichur , Gulbarga Bidar & Mysore , during 1988-89, in Bijapur & Bellary during 199091 and started in all the districts of Karnataka during 1992-93. Based on this programme and following the Govt. of India Guidelines, National Leprosy Eradication Programme was launched in Karnataka with the objective of arresting the disease activity in all the known cases of leprosy. This Programme was a 100% Centrally Sponsored Scheme. The National Leprosy Eradication Programme has made tremendous progress in Karnataka. The disease has come down to level of elimination i.e. less than one case per 10,000 population at the national level by March 2005. Still the disease is prevalent with more than one case per 10000 population in two districts. Since the Programme aims for eradication i.e. zero endemicity of leprosy as the ultimate goal sustained control measures need to be continued. 5.3.2 NLEP- Objectives under 11th Plan Further reduce the leprosy burden in the State. Provision of high quality leprosy services for all persons affected by leprosy, through General Health Care System including referral services for complications and chronic care. Enhanced Disability Prevention and Medical Rehabilitation (DPMR) services for deformity in leprosy affected persons. Enhanced advocacy in order to reduce stigma and stop discrimination against leprosy affected persons and their families. Capacity building among Health Service personal in integrated setting both for Rural and Urban areas. Strengthen the monitoring and supervision component of the surveillance system. 5.3.3 NLEP – Strategy • • • • • • Decentralization of NLEP to States & Districts Integration of leprosy services with General Health Care System (GHS) Leprosy Training of GHS functionaries Early diagnosis & prompt MDT, through routine and special efforts Information Education and Communication (IEC) using Local & Mass Media for reduction of Stigma & Discrimination. Prevention of Disability & Medical Rehabilitation.
• • •
Monitoring & Periodic Evaluation Inter-sectoral collaboration Monitoring & Evaluation
5.3.4 Expected Outcome The system of setting targets for leprosy case detection, case treatment and discharge of patients is not being followed in the National Leprosy Eradication Programme in India from the year 2003-04 onwards. These targets are no longer of much use after elimination of leprosy as a public health problem at the National level. Indicators PR/10000 ANCDR/100000 Cured rate MB Cured rate PB No. of Gr. II disabled cases 2007-08 0.51 7.50 86.10 96.70 0.86 2008-09 0.50 7.27 98.00 99.00 1.18 Expect ed outcome during 2009-10. 0.48 7.00 100% 100% 1.00
5.3.5 Magnitude of the problem At the time of starting MDT during March 1986, there were 152642 cases of leprosy and the PR was 40/10000 population. By March 2008 total patients load was 3060 with PR of 0.51/10,000 population. New cases detected during 2007-08 was 4412, the case cured during 2007-08 was 4282. Annual New Case Detection Rate (ANCDR) was 4.7/100000 population. The percentage wise break up of New cases were as follows: Female - (36.5%), MB (57.82%), Child (10.26%) Visible Deformity (Gr-II) (0.86%), Schedule Tribe (1.38%) Scheduled Caste (1.39%). At present there 29 districts in the state. 27 districts have achieved the level of elimination and only 2 districts (Bellary & Chamarajanagar 0 are having PR more than 1/10,000. The PR has drastically come down form 40/10000 population during 1986, to 0.54 /10000 population up to the end of November 2008 5.3.6 PR in TALUKS (Blocks) as on 31/3/2008 Total Taluks 176 0 PR 4 Less Than 1 153 1 to 2 16 More Than 2 3
PR in Districts as on 31/3/2008 Total Districts 0 PR Less Than 1 29 27
1 to 2 2
More Than 2 -
Epidemiological Trend of PR in Karnataka as on 30/11/2008
4 3 2 1 0
PR
Epidemiological Trend of NCDR in Karnataka as on 31/11/08
70 60 50
Ra te
40 30 20 10 0
95-96 (48.86) 96-97 (43.55) 97-98 (39.48) 98-99 (58.19) 99-2000 (51.33) 2000-01 (33.89) 01-02 (40.40) 02-03 (24.78) 03-04 (20) 04-05 (13.97) 05-06 (9.30) 06-07 (7.41) 07-08 (7.67) 08-09 (up to No v) 5.17
Year
1.3.7 Programme Components
De-centralization of the programme has completed, State Society has been merged with the NRHM. In each districts District Nucleus Team has been formed, District Health Societies have merged with the District Health Mission. One Sample Survey cum Assessment Unit (SSAU) working in the State Head quarters. Leprosy services were integrated with the General Health Care System. Urban Leprosy Control Programme were started during the year 2005. Block Leprosy Awareness Campaigns (BLAC) were carried out during 2007-08 in One Block (Hadagalli taluk in Bellary District). Situational Activities has been done in Three Districts 1) Bellary, 2) Chamarajanagar 3) Koppal. A System of case validation was started to avoid wrongly diagnosed cases being labeled as leprosy through the integrated setup. MDT is being supplied free of cost by Govt. of India. Supportive drugs required for management of leprosy patients like Prednisolone, Antibiotics, Dressing Materials and other medicines are procured by the districts. Information Education & Communication (IEC) Hoardings displayed in prominent places in 5 districts Quiz competition in Schools Folk Shows in all district IPC workshop for the opinion leaders Orientation Camp for the NGOs & Mehila Mandals IPC Work shop for Medical Officer & Para Medical Staff. Health Melas Wall Painting Training & Capacity Building • Training for Newly appointed Medical Officer • Training for Newly appointed Para Medical Staff • Training for Vertical staff • One day training for the Pharmacist & Lab-Tec. • Orientation training for the Medical Officer & Para Medical Staff. Deformity Prevention & Medical Rehabilitation (DPMR) • Provided Micro cellular rubber chaples MCR Footwear. • Supportive Drugs to the patients & Self care kits • Splints & Crushers • Reconstructive Surgery (RCS) Operations for the needy patients. NGOs Service Only one NGO, Shantha Jeeva Jyothi, Bangalore is doing Survey Education & Treatment (SET) services to the Urban Slums. Financial Management System State Leprosy Society has been merged with the State Health & FW Society under NRHM. District Leprosy Society has been merged with the District Health & FW Society under NRHM.
Programme Review & Monitoring The Programme is monitored routinely at District, State and Central Leprosy Division level through scrutiny of regular monthly reports. At the State Level Quarterly Review Meeting is being done regularly.
5.3.8 Budget proposal I. Contractual Services During 2009-10 following categories of staff will be required to be provided to the State Leprosy Unit on contract basis for smooth functioning : 1. Epidemiologist /Surveillance Medical Officer @ Rs. 22,000/- p.m x 12 months 2. Budget & Finance Officer (BFO) @ Rs. 15,000/- p.m x 12 months 3. Administrative Assistant @ Rs. 7000/- p.m. x 12 months 4. Data Entry Operator (DEO) @ Rs. 8000/- p.m. x 12 months 5. Drivers @ Rs. 4500/- p.m. x 12 months x 8 nos (NRHM guidelines)
Sl. No. I
Activities and approved PIP norms of expenditure Contractual Services 1. Epidemiologist /Surveillance Medical Officer @ Rs. 22,000/p.m x 12 months 2. Budget & Finance Officer (BFO) @ Rs. 15,000/- p.m x 12 months 3. Administrative Assistant @ Rs. 7000/- p.m. x 12 months 4. Data Entry Operator (DEO) @ Rs. 8000/- p.m. x 12 months 5. Driver cum Assistant @ Rs. 4500 x 12 months 6. Drivers @ Rs. 4500/- p.m. x 12 months x 8 nos (NRHM guidelines) 7. a) TA/DA to Drivers. b) TA/DA to BFO & Surveillance Medical Officer 8. Honorarium for accounts work @ Rs. 500 p.m. / at DLOs office (500 x 29 x 12 months) 9. Incentive to ASHA workers relating to NLEP
Amount Proposed (Rs. in Lakhs) 2.64 1.80 0.84 0.96 0.54 4.32 1.80 1.98 1.74 4.35
Total II. Office Expenditure:
20.97
For the functioning of the State Leprosy Office and the 29 District Leprosy Offices following budget is required for Office Expenditure like, Telephone charges, accessories of Fax, Computer, Xerox & Broad Band Connection at State Leprosy Office: S. No II Activities and approved PIP norms of expenditure Office Expenditure 1. State Health & FW Society, (Leprosy Division)@Rs. 100000/year for Telephone, Fax, Computer, Xerox etc. 2. District Health & FW Society (Leprosy Division) @ 18,750/ yr. for Telephone etc. x 29 district 3. Broad band connection at State Leprosy Office (Rs.1200x12)+ One time installation charges (Rs.3000) Total 1.00 5.44 0.17 6.61 Amount Proposed (Rs. in Lakhs)
III. Consumables For the functioning of the State Leprosy Office and the 29 District Leprosy Offices following budget is required for Consumables like, Stationary: S. No III Activities and approved PIP norms of expenditure Consumables 1. State Health & FW Society, (Leprosy Division) @ 25,000/year for Stationary 2. District Health & FW Society (Leprosy Division) @ 13,000/ yr. per district for Stationery x 29 districts Total 0.25 3.77 4.02 Amount Proposed (Rs.in Lakhs)
Budget: Sl. No. I Activities and approved PIP norms of expenditure Contractual Services 1. Epidemiologist /Surveillance Medical Officer @ Rs. 22,000/- p.m x 12 months Amount Proposed (Rs.in Lakhs)
2.64
2. Budget & Finance Officer (BFO) @ Rs. 15,000/- p.m x 12 months 3. Administrative Assistant @ Rs. 7000/- p.m. x 12 months 4. Data Entry Operator (DEO) @ Rs. 8000/- p.m. x 12 months 5. Driver -cum- Assistant @ Rs. 4500 x 12 months 6. Drivers @ Rs. 4500/- p.m. x 12 months x 8 nos (NRHM guidelines) 7. a) TA/DA to Drivers, 7 b) TA/DA to BFO & Suveillance Medical Officer 8. Honorarium for accounts work @ Rs. 500 p.m. / at DLOs office (500 x 29 x 12 months) 9. Incentive to ASHA workers relating to NLEP Total Office Expenditure 1. State Health & FW Society, (Leprosy Division)@Rs. 110000/year for Telelphone, Fax, Computer, Xerox etc. 2. District Health & FW Society (Leprosy Division) @ 18,750/ yr. for Telephone etc. x 29 district 3. Broad band connection at State Leprosy Office (Rs.1200x12)+ One time installation charges (Rs.3000) Total Consumables 1. State Health & FW Society, (Leprosy Division) @ 25,000/- year for Stationary 2. District Health & FW Society (Leprosy Division) @ 13,000/ yr. per district for Stationary x 29 districts Total IV Vehicle Maintenance and Hiring 1. State Health & FW Society, (Leprosy Division) @ Rs. 85,000 / year x 2 2.District Health & FW Society (Leprosy Division) @ Rs. 75000 / year x 29 dist. X 1 Total V Supportive Medicines 1.Rs.21,500/- per year x 29 Districts. District Health & FW Societies, Leprosy Division. VI Total Materials and Supplies 1. MCR foot wear @ Rs. 250/pair x 120 pairs / dist. X 29 dist.
1.8 0.84 0.96 0.54 4.32 1.8 0.98 1.74 1 16.62 1.10 5.44 0.17 6.71 0.25 3.77 4.02
II
III
1.70 21.75 23.45
6.235 6.235 8.70
VII (I) (II) (iii)
(iv) (v) (vI) (vii)
2. Patient welfare @ Rs. 8750/ yr. / dist. X 29 dist. (Blankets) 3. Printing cost @ Rs. 5000/- yr. Dist. X 29 dist. Total IEC (Behavioural Change Communication) Mass Media (TV, Radio, Press) (Rs. 20000 x 29 districts) Outdoor Media (Hoardings, Bus panel, Wall paintings, Posters, Rallies including Banners) Rs. 20300 x 29 districts. Rural Media (IPC group meetings, School IEC, Folk media Exhibitions & Health Melas.) Rs.18000 x 28 districts & Rs.17700 for Kodagu district. Advocacy (Meetings with ZP, Mahila Mandals, NGOs etc) Rs. 4000 x 25 districts exculding Kodagu, Hassan, Bangalore rural, Chickmaglur districts. Observation of Anti Leprosy month Jan. 2010 State Health FW Society, Leprosy Division Rs. 20000/ year. Observation of Anti - Leprosy Month-Jan. 2010 District Health & FW Societies, Leprosy Division Rs.10000x29 districts. IEC Situational Activities Plan for Block having NCDR more than 20/lakh or PR more (Rs. 1 lakhs x 10 blocks) Total
2.54 1.45 12.69 5.80 5.89 5.21
1.00 0.20 2.90 10.00 31.00
VIII Training 1. 4 days training for newly appointed MOs (Rs.30000/batch x 26 districts exculding Kodagu, Hassan, Chickmaglur. 2. 2 days refresher training to MOs (Rs. 16700 /batch x 29 districts & Rs. 17400 for Gulabarga districts) 3. 3 days training for newly appointed Health Worker (Rs.15000 x 29 districts) Total IX Review Meetings & Workshops 1. State level quarterly DLOs review meeting @ Rs. 25,000/- per meeting x 4 meetings Total X Disability Prevention and Medical Rehabilitation (DPMR) 80 Reconstructive Surgery (RCS ) Patients of BPL category in 29 districts.(Rs. 5,000 x 80) RCS allowances for new institutions Rs.5000 x 20 cases Total XI Survey Education Treatment (SET) Scheme 4.00 1.00 5.00 1.00 1.00 7.80 4.85 4.35 17.00
XII
Amount for NGOs under SET Scheme Total Urban Leprosy Strategy Mega city I. - (Population more than 25 lakhs) Bangalore (U) (Rs.280000 x 1) Medium City I.(Population between 5 and 25 lakhs)- Hubli Dharwad, & Mysore. Rs. 236000 x2 districts. Townships (Population between 1 & 5 lakhs) - 25 cities- at Rs.57000/ city x 25
4.5 4.5 2.80 4.72 14.25 21.77 2.87 12.40 4.73 20.00 170.00
Total XIII Cash Assistance Divisional Training of vertical staff at Divisional Head quarters Rs.71750/districts Vehicle Hiring (Hassan, Bagalkote, Ramanagar, Chamarajanagar districts & for DD (Leprosy) at SLO office. TA/DA for Districts Vertical staff Total Grand Total