In 2001, India remained one of the last eight countries to harbor leprosy. In fact, with close to 400,000 new cases diagnosed each year, India accounted for two-thirds of the global burden of the disease.
To reverse this trend, and improve the quality of life for millions of people, the World Bank supported India’s national Leprosy Eradication program (one credit in 1993 and a second in 2001). The Second National Leprosy Elimination Project was designed to help India transform the national leprosy program into an effective and sustainable program through a decentralized approach that increased community access to multi-drug therapy. This included decentralizing leprosy control activities to the states and integrating leprosy control into general health services. The program used the full range of elimination techniques including skin camps in high prevalence areas, school education programs and surveys, and the use of a variety of health workers to identify and treat cases. It reached even the most remote villages plagued by the weakest health systems.
The prevalence of leprosy in India was reduced from 5.3 per 10,000 people to 1.3 per 10,000. Over 2 million people with symptoms were examined and more than 1.2 million people treated during the life of the project.
Highlights:
- In January 2006, India eliminated leprosy as an endemic public health problem.
- The project reduced disability rates from leprosy infection. Cases of grade II disability (limb wasting, claw hand, and foot drop) fell to less than 2 percent simply by providing effective treatment early enough in the disease. This exceeded project expectations.
- The project integrated leprosy services into the general healthcare system through extensive leprosy training for hundreds of thousands of general healthcare workers. This also helped reduce the stigma associated with leprosy.
IDA provided a US$36.1 million credit. While there were no formal co-financing partners, several agencies contributed to the overall leprosy elimination program under a common framework. The International Federation of Anti-Leprosy Associations, the Danish International Development Assistance (DANIDA), and the World Health Organization (WHO) provided management and technical support to 11 highly endemic states. DANIDA also supported service delivery in Chhattisgarh, Madhya Pradesh, Orissa, and Tamil Nadu. The Novartis Foundation provided free drugs, valued at approximated US$10.4 million, supplied through the WHO.
IDA funds permitted the acceleration of the leprosy eradication program, but more importantly it ensured that leprosy eradication was carried out in a sustainable way. IDA assistance helped India consolidate and expand the benefits of the first program, and it improved the design of the national program to decentralize program management and integrate it into general health services. To this end the government agreed to a package of policy reform related to the flow of funds to states, improving incentives, and strengthening monitoring. The Bank facilitated the Government’s efforts to develop the technical framework and build consensus among the Government, states, NGOs and private sector on project objectives and design. The Bank team also provided insights into interventions that had been successful internationally in eliminating leprosy—such as developing systems for surveillance, financial management, and drug management.
India continues to fund its National Leprosy Eradication Program, which is now focused on further eliminating leprosy as a public health issue in each of the Indian states and territories.
RSS