Integration

of leprosy control services with Primary Health Care

With the progress of the National Leprosy Eradication Programme (NLEP), there has been a growing realisation among the central and state governments that divorcing leprosy elimination activities from the Public Health Care (PHC) system can turn out to be counter productive, in terms of implementation, outreach and expenditure.

NLEP implementation is based on the stratification of districts according to prevalence and infrastructural development. This vertical approach results in limited geographical coverage. It means limited access to Multi Drug Therapy (MDT), as well as lower levels of compliance with treatment. Leprosy continues to carry a stigma among the population not touched by the NLEP infrastructure which hampers the progress.

Integration of leprosy services with the PHC system becomes an inevitable need after a point, and is desirable for the following reasons.

• Leprosy services can be sustained in a cost effective manner
• Each system benefits from the staff, skills and experience of the other
• The wide PHC network would extend the reach of leprosy services
• A larger population could be screened for leprosy
• The involvement of female health workers in leprosy work would encourage female patients to come forward
• The stigma of seeking specialised leprosy services would be reduced
• As vertical programmes are thought to take away from the comprehensiveness of the PHC system, their inclusion would make the system more effective.

The DANLEP Phase-I (1986-91) project document mentioned integration as a long-term objective, and in Phase-II (1991-96), attempts were made to involve PHC staff in NLEP activities and evolve integration models in the field. In Phase III (1997-2003) integration was achieved in Tamil Nadu and Orissa. These experiences offer some valuable lessons to those involved in leprosy eradication.

Tamil Nadu Experience

Orissa Experience

Madhya Pradesh Experience

Chhattisgarh Experience