Tamil Nadu Experience : Integration

With the National Leprosy Eradication programme (NLEP) efforts, the prevalence of leprosy in the Multi Drug Therapy (MDT) districts of Tamil Nadu fell from 118 persons per 10,000 in 1983 to 10 per 10,000 in 1994. However, a cost analysis by the Department of Health found that NLEP was no longer cost-effective as a vertical programme. Efforts were than initiated to integrate leprosy services with the Public Health Care (PHC) system in order to sustain leprosy services at the operational level. An earlier attempt in 1991 had been abandoned because of resistance from the NLEP staff.

The details of integration were worked out by a committee in 1996, and plans were formulated on the basis of its recommendations. In July 1997, Tamil Nadu became the first state in India where the vertical NLEP was integrated with the PHC system.

In 1998, the state government, with DANLEP support, asked the Christian Medical College, Vellore, to assess the impact of integration, taking a sample of 6 districts. Findings of this evaluation have been published in "NLEP-PHC Synergy: The Tamil Nadu Experience".

Major findings were:

• At the time of evaluation, integration had been accepted in principle by most personnel, including a significant section of former leprosy workers.
• All stakeholders considered the time made available (one month) to accomplish the process as inadequate.

Major lessons from the Tamil Nadu experience are:

• The integration process, as also the protocols following it, should be carefully planned before hand.
• Integration should be preceded by proper training of health workers.
• Supervisory roles should be well-defined.
• Indicators for monitoring performance should be designed with care and instituted before integration is effected.
• The community and patients should be told about the change in advance and be supplied with all information relevant to their treatment in the new set up.
• Records of patients should be transferred to the appropriate PHC before integration and the PHC staff should be familarised with them.
• If possible, the PHC personnel should be exposed to the area's leprosy workers' activities for a short period.
• Steps should be taken to rule out the possibility of friction between personnel after integration

Integrating Leprosy Services into the General Health Care System