KOLKATA - Every year since 2009, India has reported an annual average of around 130,000 leprosy cases.

This is despite the country having statistically "eliminated" the disease four years earlier.

In a revamped effort to further reduce leprosy cases, the government recently announced a slew of measures to widen population screening and carry out regular surveillance of the disease.

The Ministry of Health and Family Welfare released operational guidelines on Dec 28 that prescribe annual or bi-annual screening instead of occasional campaign drives.

Screening has been proposed once a year in areas with prevalence rates lower than one per 10,000 population and twice a year in areas with higher rates.

The guidelines even propose financial incentives for government health workers to screen communities.

India "eliminated" the disease in 2005 - a statistical distinction that implies a prevalence rate of less than one case per 10,000 people.

This is a threshold prescribed by the World Health Organisation for its goal of "eliminating leprosy as a public health problem". It argues that at such a low prevalence level, the disease tends to die out and any resurgence is "highly improbable".

The country has made great progress in reducing the extent of the disease over the years, bringing down the prevalence rate from more than 25 per 10,000 in the early 1990s to around 0.57 per 10,000 today.

Leprosy, however, remains a challenge with India still accounting for nearly 60 per cent of the global leprosy caseload despite concerns around under-reporting. It accounted for 120,334 of the 208,641 fresh cases globally in 2018, accentuating how vital progress in India is for leprosy eradication worldwide. Other countries with significant caseloads include Brazil, Indonesia and Bangladesh.

While the guidelines have been welcomed, deeply entrenched challenges continue to hold back progress on early detection of the disease, provision of complete treatment, prevention of disability caused by the disease as well as reduction of stigma that hampers the rehabilitation of those affected.

A 2019 paper by Mr Oommen C Kurian at the Observer Research Foundation reported that leprosy is becoming highly concentrated among tribal populations and the number of states and districts with "elimination-level" prevalence is fast decreasing.

Many argue the 2005 "elimination" proved counterproductive, pushing leprosy down the list of government priorities and shifting resources away from the National Leprosy Eradication Programme (NLEP).

"It misguided the government and misinterpreted the ground reality (of a disease that is still prevalent)," said Mr Antony Samy, the founder and chief executive of Association for Leprosy Education, Rehabilitation and Treatment - India, an NGO established in 1978.

"It has had a tremendous negative effect with the state downplaying its manpower need and training institutions cutting down their training programmes," he told The Straits Times. This has whittled down the availability of trained physiotherapists, laboratory technicians and frontline workers who are charged with detecting fresh cases of leprosy.

The state of Maharashtra, for instance, had over 3,000 such trained personnel in 2005 but this has fallen to less than 600 at present.

"They too are retiring every year," Mr Samy added, calling for intensive training of at least 500 personnel who can subsequently pass on their knowledge to other workers on the ground.

Funding for the NLEP has also remained inadequate over the years and formal academic training on the disease sparse. Ms Kasturi Kilaru, Head of Resources and Communications at LEPRA Society, a healthcare NGO, said even qualified medical practitioners are not always able to diagnose the disease and treat it.

She added that since leprosy is often perceived as a "problem of a few countries", funding for NGOs that combat it has been reduced.

"It is one of the biggest challenges being faced in the fight against this disease," she told The Straits Times. The health ministry did not respond to a request for comment from this paper.

Lack of awareness among poor communities who are vulnerable to leprosy is another problem that also contributes to low as well as delayed detection of cases.

Mr Rajni Kant Singh, the Bihar state coordinator for LEPRA Society, said most cases are detected passively when individuals show up with aggravated symptoms at health centres.

"Around seven per cent of the new cases come with disability, which indicates late detection and contributes further to the spread of the infection," he added.

The campaign against leprosy has been harmed also by the pandemic with travel restrictions and diversion of healthcare workers driving down detection rates.

A LEPRA Society study in four Indian states found that detection of new cases had fallen by 68 per cent between April and December last year, compared to an average of the same corresponding period in previous years.

WHAT IS LEPROSY

-Leprosy is an infectious disease caused by the Mycobacterium leprae bacilli

- The incubation period of the disease is 5 years on average.

- Symptoms may occur within one year but can also take as long as 20 years or even more to manifest.

- The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes.

- Leprosy is likely transmitted via droplets from the nose and mouth.

- It is curable with multidrug therapy.

- If not treated in time, leprosy can cause permanent damage to the skin, nerves, limbs, and eyes.

Source: World Health Organisation