National Leprosy Eradication Programme (NLEP)
India carries approximately 60% of the global leprosy burden despite achieving elimination (prevalence < 1 per 10,000) at the national level in December 2005. The National Leprosy Eradication Programme (NLEP) continues to detect 1.1-1.4 lakh new cases every year, with persistent pockets of high endemicity in states like Bihar, Chhattisgarh, Jharkhand, Maharashtra, Odisha and Uttar Pradesh.
The National Leprosy Eradication Programme (NLEP) is a centrally sponsored scheme under the National Health Mission, with 100% central funding for some components and 60:40 / 90:10 sharing for others. India achieved leprosy elimination at the national level (prevalence < 1 case per 10,000 population) on 31 December 2005 — a milestone celebrated by WHO. However, elimination at the national level does not mean elimination in every district. Today, ~25% of India's districts still have prevalence above the elimination threshold, and Grade 2 Disability (G2D) at diagnosis remains a concern, indicating late detection.
NLEP provides free diagnosis and treatment through all government health facilities. Diagnosis is clinical — no smear or biopsy is mandatory — using the cardinal signs: hypopigmented/reddish skin lesion with loss of sensation, thickened peripheral nerves with loss of sensation, and positive skin smear for AFB.
Diagnosis of leprosy is primarily clinical, based on the WHO cardinal signs:
- Hypopigmented or reddish skin lesion(s) with definite loss of sensation
- Thickened or tender peripheral nerve(s), with associated loss of sensation
- Positive skin smear for acid-fast bacilli (slit-skin smear)
The presence of one or more of these cardinal signs confirms the diagnosis. Skin smears are required only for suspected multibacillary cases or when diagnosis is in doubt — they are not routinely performed under NLEP. Classification into paucibacillary (PB) and multibacillary (MB) is now based on the number of skin lesions: PB = 1-5 lesions, MB = >5 lesions (the older classification based on slit-skin smear positivity was abandoned for programmatic simplicity).
Multidrug Therapy (MDT) is the cornerstone of NLEP treatment. The current regimens, with monthly blister packs supplied free of cost through NLEP:
| Category | Drugs | Duration |
|---|---|---|
| Paucibacillary (PB) — 1-5 lesions | Rifampicin 600 mg once monthly + Dapsone 100 mg daily | 6 months (6 blister packs) |
| Multibacillary (MB) — >5 lesions | Rifampicin 600 mg once monthly + Clofazimine 300 mg once monthly + Dapsone 100 mg daily + Clofazimine 50 mg daily | 12 months (12 blister packs) |
| Single lesion PB | Single-dose ROM (Rifampicin 600 mg + Ofloxacin 400 mg + Minocycline 100 mg) | Single dose |
Rifampicin is the only bactericidal drug; Dapsone and Clofazimine are bacteriostatic. MDT renders a patient non-infectious within the first dose itself (Rifampicin kills 99.9% of bacilli within 24 hours) — so home isolation is not required and patients can continue school, work and family life during treatment.
Since active population-based surveys are no longer cost-effective at the national level, NLEP uses two complementary strategies:
- Voluntary reporting through general health system: All MOs at PHC, CHC and district hospital level are trained to clinically diagnose leprosy and start MDT. The Integrated Disease Surveillance Programme (IDSP) captures leprosy data.
- ASHA-based active case finding: ASHAs conduct house-to-house surveys in endemic districts, paid Rs 250 per confirmed case. This is called ASHA-Based Surveillance for Leprosy (ABSULS).
- Leprosy Case Detection Campaigns (LCDC): Focused 2-week intensive campaigns in high-burden districts, where every household is screened.
- Sparsh Leprosy Awareness Campaign (SLAC): IEC campaigns to reduce stigma and encourage voluntary reporting.
NLEP tracks Grade 2 Disability (G2D) rate as a key indicator of late detection. G2D is defined as visible deformity of hands, feet or eyes at the time of diagnosis. The target is < 1 G2D case per million population. Current national rate is around 3-4 per million. Strategies to reduce G2D include:
- Early case detection through ASHA surveillance and LCDC
- Disability Prevention and Medical Rehabilitation (DPMR) services at district level — physiotherapy, self-care kits, MCR (micro-cellular rubber) footwear
- Reconstructive surgery for corrected deformities — 1,200+ surgeons trained under NLEP
- Reaction management — Type 1 (reversal) and Type 2 (ENL) reactions treated with steroids and thalidomide respectively
Despite three decades of MDT, leprosy persists in India due to: (1) long incubation period (2-10 years) leading to continued transmission from undiagnosed cases; (2) stigma and late presentation; (3) hidden cases among migrant workers and tribal populations; (4) urban slums emerging as new foci; (5) drug-resistant leprosy — rare but documented; (6) lingering inclusion of leprosy in laws that discriminate (recently repealed in part through the LEPRO Act 2019 amendments). The Supreme Court's 2018 judgment directing mandatory nodal officers in every district has improved reporting. Reference: nlep.nic.in.
NLEP is a textbook example of how a vertical disease control programme can scale MDT access but still struggle to eliminate an ancient disease due to its long incubation, social stigma, and persistent hidden cases. For UPSC CMS aspirants, knowing the MDT regimen, the elimination threshold definition, and the G2D indicator is essential for the PSM interview.