Kala-Azar

Kala-azar is a parasitic disease caused by Leishmania donovani transmitted by sand flies Phlebotomus argentipes. The disease is prevalent among socio economically poorer sections of the society living in rural areas. The infected person suffers from recurrent fever, loss of appetite, loss of weight and progressive enlargement of spleen. The disease is chronic and if not treated, it leads to death. Kala-azar is endemic in Bihar, Jharkhand, West Bengal and parts of Uttar Pradesh. The Central Government initiated Kala-azar Control Programme from 1990-91 incorporating assistance in kind provided for procurement of insecticides and anti-leishmanial drugs. The National Health Policy 2002 has envisaged goal of Kala-azar Elimination by the year 2010. The disease incidence has come down from 77,099 cases in 1992 to 31217 cases in 2005 and deaths from 1,419 to 157, respectively. However, during 2006 the recorded cases are 12245 with 66 deaths upto April. To pursue the goal of elimination of Kala-azar by year 2010, the Government of India is providing 100 per cent support to endemic states since 2003, apart from regular technical guidance. Timely and quality Indoor Residual Spraying with DDT for vector control, complete treatment of patients as well as intensive social mobilisation is being stressed upon. For detection of cases, Kala-azar fortnights are being advocated through house to house visits. As the diagnostic procedure at present is clinic based and complex, the Government of India has decided to introduce Rapid Diagnostic Test rK39, which can be used by trained peripheral Health Workers. The treatment of Kala-azar at present is also long and injection based, which affects treatment compliance. To improve compliance, the Government of India has decided to introduce oral drug miltefosine in the programme, particularly for remote and inaccessible areas.

Tuberculosis

Tuberculosis is a major public health problem in India. India accounts for one fifth of the global TB incidence and is estimated to have the highest number of active TB cases amongst all the countries of the entire world. Every year there are approximately 18 lakh new cases in the country of which approximately 8 lakh are new smear positive and therefore highly infectious. Each sputum positive case if not treated, on an average infects 10-15 persons in a year. Two persons die from TB in India every three minutes-more than 1,000 people every day. To control TB, National Tuberculosis Control Programme (NTCP) is in operation in the country since 1962. This could not achieve the desired results. Therefore, it was reviewed by an expert committee in 1992 and based on its recommendations, Revised National TB Control Programme (RNTCP), which is an application to India of WHO-recommended strategy of Directly Observed Treatment Short course (DOTS), was launched in the country on 26 March 1997. The objectives of RNTCP are (i) to achieve and maintain a cure rate of at least 85 per cent among newly detected infectious TB cases and (ii) achieve and maintain detection of at least 70 per cent of such cases in the population. RNTCP was implemented in the country in a phased manner and by 23 March 2006 the entire country has been covered under RNTCP. The Programme is being implanted with assistance from World Bank, DFID, USAID, GDF and GFATM.

Overall performance of the RNTCP for the country has been excellent with cure/treatment completion rate consistently above 85 per cent and death rate among patients registered for treatment reduced to less than 5 per cent. More than ninety per cent of the new smear-positive cases detected are being put under DOTS. Till date, the RNTCP has placed more than 57.52 lakh patients on treatment, averting more than 10.35 lakh deaths. Every month, more than 1,00,000 patients are placed on treatment. In 2005 alone, India placed around 13 lakh cases on DOTS, more than any country in a single year in the world. The Programme envisages developing effective partnerships with health care provider outside the public health system including NGOs, Private Practitioners (PPs), corporate sectors, etc. Treatment of MDR-TB patients by following DOTS Plus strategy is to be implemented in the coming years in a phased manner.

Leprosy

The National Leprosy Control Programme was launched by the Government of India in 1955 based on Dapsone monotherapy. Multi Drug Therapy (MDT) came into wide use from 1982 and the Programme was re-designated as the National Leprosy Eradication Programme (NLEP) in 1983. The Programme was expanded with World Bank assistance and the 1st phase of World Bank supported National Leprosy Elimination Project started from 1993-94 and ended in March 2000. The 2nd phase of World Bank supported National Leprosy Elimination Project started from 1 April 2001 for a period of three years with the objective to achieve elimination of leprosy as a public health problem by 2005, thereby reducing the case load to less than 1/10,000 population. During the second National Leprosy Elimination Project, the NLEP was decentralised to States/Districts and Leprosy Services were integrated with General Health Care System. Free Multi Drug Therapy (MDT) is now available at all sub-centres, PHCs and Government Hospitals and Dispensaries on all working days. State Leprosy Societies were established during 2nd NLEP in 27 major states for overall planning, implementation and monitoring of NLEP in the States. 590 District Leprosy Societies are providing free MDT services across the country. The Government also gives grant-in-aid to NGOs for mainly providing care to persons with leprosy related deformities.

Four nation-wide Modified Leprosy Elimination Campaigns (MLEC) have been conducted from 1998 to 2003, to create mass community awareness about leprosy and to undertake leprosy case detection drive with prompt MDT, during which more than 9.3 lakh leprosy cases were detected and treated with MDT. The Fifth MLEC was implemented in the eight priority States of Bihar, Jharkhand, Orissa, West Bengal, Chhattisgarh, Uttar Pradesh, Maharashtra and Andhra Pradesh in the year 2003-04. During the campaign, 0.58 lakh new cases of leprosy were detected and put under MDT.

The National Health Policy had set the goal of elimination of leprosy i.e. to reduce the number of cases to (1/10,000 population) by the year 2005. India has achieved this goal of elimination of leprosy as a public health problem at national level in the month of December 2005, where the recorded Prevalence Rate (PR) in the country was 0.95/10,000 population. By March 2006, the prevalence rate of leprosy in the country has declined to 0.84 per 10,000 population and 26 States/UTs have achieved the goal of leprosy elimination. The remaining 9 States / UTs viz. Bihar, Chhattisgarh, Jharkhand, Orissa, Uttar Pradesh, West Bengal, Chandigarh, D&N Haveli and Delhi are having PR between 1 and 2 per 10,000 populations and are progressing well towards elimination of leprosy. Since its introduction in the country in 1983, MDT has cured 11.87 million Leprosy Patients and the deformity rate in Leprosy Patients has declined to less than 2 per cent. As a result of intensive IEC activities, the public awareness about the disease and its curability has increased significantly and stigma of the disease has decline appreciably.

The programme will continue the efforts to achieve elimination of leprosy in remaining districts and blocks through existing MDT services with focused attention on endemic districts and urban localities, district with high disability rate and States with high child proportion. The focus will also be at increasing number of institutions for providing Re-constructive Surgery Services to leprosy disabled persons.