Author : Oommen C. Kurian

Originally Published 2018-07-26 05:11:28 Published on Jul 26, 2018
Declaration of leprosy elimination allowed the disease to spread again
Leprosy remains an embarrassing indicator of India’s failure to address health inequities. Adivasis, who are 8.6% of the population, bear the burden of 18.8% of new leprosy cases. In states like Gujarat and Tripura, two-thirds of new leprosy patients are adivasis. Alarmingly, the proportion of districts with prevalence of 1/10,000 population or more has climbed up to 18.8%, up from 15.3% in 2012. Partly due to confusion between elimination – prevalence level of less than one in 10,000 population and eradication – zero new cases elimination of leprosy remains a pet topic of senior ministers. Both Prime Minister and finance minister in his budget speech have called for elimination of leprosy. Reportedly, the Union health minister declared last month that India would be leprosy-free in 2018, achieving an important National Health Policy 2017 (NHP) target. Not to be outdone, the flagship annual publication of the ministry of health and family welfare states that leprosy is “nearly” eliminated. All this when national level elimination was achieved more than a decade ago in 2005. The NHP had some spectacularly unambitious targets, including taking life expectancy from 67.5 (2011) to 70 by 2025. In fact, Indian women had already achieved it in 2013 and India has possibly already crossed this milestone. Finding easy statistical targets and “achieving” them with fanfare is something that India’s health sector is known for. India’s recent declaration of achievement of the Millennium Development Goals maternal mortality rate target is a case in point where the baseline number was cherry-picked to make the fall in MMR look steeper than it actually is. Unfortunately, the rapid rate of reduction in the leprosy burden during the nineties has slowed down and stagnated. It is very clear that the prevalence rate plateaued around the time of the declaration of “Leprosy Elimination” in 2005. While WHO used elimination as an interim goal to create interest in the neglected disease, the meaning of this milestone was not clearly communicated to political leaders. The same remains the case with the media. Even today, both Indian as well as international media often cover the issue while using ‘leprosy-free’ as a synonym for ‘elimination’. The declaration in 2005 had serious implications. It halted progress of the national programme allowing the disease to spread again. The focus got diverted as both funding as well as resources declined. Moreover, frontline workers stopped making household visits to identify undetected cases, shifting instead to voluntary patient registration. Measures were adopted to ensure fewer patients were registered, and between 2004 and 2007 studies show that new case detection dropped by 75%. Even though dermatologists may have diagnosed leprosy cases in the private sector, many didn’t send patients for treatment, as the strong rhetoric of elimination made them believe leprosy is a disease of the past. Finally, in 2007, WHO abandoned the elimination target for leprosy programme. It was noted by researchers that neither funders nor young researchers are attracted to an officially eliminated disease, even if it is still ubiquitous. The exact mechanism of transmission of leprosy is unknown and this puts the focus on case identification, treatment and immunisation. Even as Ayushman Bharat’s 1,50,000 health and wellness centres (HWC) across the country plan to screen all Indians for leprosy, the lagging overall immunisation rate (62%) remains a cause for worry, with even well-off states like Gujarat (50.4%), Tamil Nadu (69.7%) and Maharashtra (56.3%) trailing. It is good to remember that the 12th plan had set out to achieve elimination of leprosy at the district level by 2017. India remains a long way away from elimination at the state or district levels, let alone eradication. The ongoing case detection campaign can help, but it is necessary to learn lessons and avoid creating an environment of complacency by making shallow declarations. If Ayushman Bharat is to be a game changer for an oft-eliminated leprosy, the false rhetoric of India achieving elimination needs to stop. A speedy implementation of the HWC initiative in the true spirit of comprehensive primary healthcare approach can help get rid of leprosy, taking healthcare to the last person.
This commentary originally appeared in The Times of India
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.

Author

Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

Read More +