Introduction:

India has become the leprosy capital of the world in the 14 years since it was declared free of the disease, as lack of vigilance and unfriendly laws paved the way for its return. India figures among 22 nations considered to have a ‘high burden’ for leprosy according to according to the World Health Organization (WHO).

Body:

Present Status in India:

• India officially eliminated leprosy in 2005, reducing its prevalence rate to 0.72 per 10,000 people at national level.
• But the country now hosts 66% of all leprosy patients in the world, data from the World Health Organization (WHO) showed.
• In 2016-17, at least 1,35,485 cases of leprosy were detected in the country, but public health experts say this is an under-estimate
• One person is diagnosed with leprosy roughly every four minutes in India, accounting for 60% of all new leprosy cases annually
• The current global prevalence is estimated by the World Health Organisation (WHO) to be 0.23 per 10000 population.
• In 2017, India along with Brazil and Indonesia are the only countries where more than 10000 new cases are reported per year.
• Two out of three new global Leprosy cases are detected in India, according to official data.

Reasons for continued high burden:

• Major concerns include undetected new cases, problems with leprosy integration, the presence of leprosy in children, and paucity of education and training for livelihoods.
• It is highly unlikely that India achieves elimination of Leprosy at the state or district levels any time soon.
• Leprosy is becoming more of a disease of most marginalized and underserved populations in far-flung areas.
• In the Adivasi community the percentage of Leprosy patients have increased from 13.3% in 2009, to an alarming 18.8%.
• The earlier gains in containing the disease have stagnated and we are at risk of a re-emergence of Leprosy as a public health problem in substantial areas of the country.
• Rampant stigma against the disease prevents patients from seeking medical treatment.
• A large number of leprosy affected fall in the category of persons with disabilities as they hesitate to come forward for

Government Interventions

• India is currently running one of the largest leprosy eradication programs in the world, the National Leprosy Eradication Program (NLEP).
• The National Health Policy 2017 (NHP) has elimination of Leprosy as a national level target.
• Leprosy Case Detection Campaign (LCDC) is being implemented by the Union Health Ministry.
• SPARSH Leprosy Awareness Campaign (SLAC) was launched on 30th January 2017 to promote awareness and address the issues of stigma and discrimination.
• Since 1984, leprosy has been completely curable at any stage with multi drug therapy (MDT)—a combination of Rifampicin, Dapsone and Clofazimine—for a period of six months or one year depending on the severity of the disease
• The Lok Sabha passed the Personal Laws Amendment Bill, 2018, removing leprosy as a ground for divorce.
• A public interest litigation filed by the Vidhi Centre for Legal Policy has challenged 119 statutory provisions that continue to provide legal sanction to discrimination against people affected by leprosy.
• The Health Ministry has asked the ministers to expedite the process and introduce of the Elimination of Discrimination against Persons Affected by Leprosy (EDPAL) Bill, drafted by the Law Commission of India and annexed in its 256th report.
• The target of Global Leprosy Strategy 2016-2020 is to reduce the number of countries with laws allowing discrimination on grounds of leprosy to zero.

Way forward:

• The emphasis must shift to more policy level changes and sustaining quality of services.
• The government must implement the key recommendations of the Law Commission on rights and special privileges.
• To reduce the burden, it is important to develop a multi-pronged approach that includes public education campaign, sustainable livelihood programmes, skill training workshops and generate employment, identify interventions to dispel stigma and mainstream the affected people.
• Continued training of medical officers, nurses, physiotherapists, and paramedical workers about quality diagnosis and treatment of leprosy must also be given prime focus.
• Public education on the fact that leprosy can be cured and is not to be feared is imperative.
• Those who have been cured at an early stage and can work often need to given opportunities to learn skills and trades that would enable them to work.

Conclusion:

Mahatma Gandhi had an enduring concern for people afflicted with leprosy. His vision was not just to treat them, but also to bring them to mainstream to our society. India, which is among the endemic countries, has been advised to include strategic interventions in national plans to meet the new targets, such as screening all close contacts of persons affected by leprosy; promoting a shorter and uniform treatment regimen, and incorporating specific interventions against stigmatisation and discrimination.