Services to Common People
A. Case Detection through

MB adult blister pack, MB child blister pack
• Promotion of Voluntary Reporting of Cases: Through Intensive IEC activity to increase voluntary reporting.
• Screening in OPD by MO i/c PHC,/Municipal Dispensaries/General hospitals/Rural & Cottage Hospitals/Cantonment Hospitals/ESI Hospitals /Private Clinics.
• Identification of suspect leprosy cases by Health Care Workers during routine house to house visits.

Active Surveys of all sorts have been banned by G O I

B. MDT

• Made available at all PHCs, Municipal Dispensaries & Health Posts, General Hospitals/Rural Hospitals/ Cottage Hospitals/ Cantonment Hospitals/ESIS & Railway Hospitals and selected Private Practitioners.
• After initiation of first dose at P H C, MDT is made available at subcentres.
• Accompanied MDT available at all these centres as per GOI guidelines.

C. I E C Activities: By G H C & NLEP staff, N G Os

• Emphasis on I P C (interpersonal communication) during home visits.
• Awareness generation in markets & haats through miking, use of hand–outs, posters & exhibitions etc.
• Bus & Office IPC, strengthening of school IPC.
• Erection of hoarding and wall paintings.
• Radio Jingles, Messages on Leprosy in Cinema Houses, Cable Network, Doordarshan.
• Involvement of Women Groups, Indian Red Cross, Scouts, Other NGOs, School Teachers & students, Scouts & Guides, NCC volunteers, AWWs, ANMs,Cured Leprosy patients, Community Leaders etc.

D. Prevention of impairment and disabilities (POID)
Deformities and disabilities contribute to the existence of Social Stigma against the disease. Intervention at the right time will prevent occurrence or worsening of deformity and disability. Hence “Care after cure” of deformed patient is a challenge of the decade.

POID at the start and during MDT call for proper recording of base– line information about nerve function, detection and high risk cases and management of reactions. Health education, training of paramedical staff and resources are essential for success of POID. Referral options for specialist POID care are imperative to make an integrated leprosy control system work. For POID, after chemotherapy , the patients must be empowered to understand when and where to request for care of the complications due to leprosy if they arise. High risk cases need periodic follow–up examinations. Patients with established disabilities should receive continued care.

To achieve the concept of “Deformity free patients” POD (Prevention of Deformity) training to selected GHCS staff through POD camps in each district has been initiated.

Key trainers’ training has been organised for faculties In each district 2 POD camps per block are scheduled, 638 completed out of 710 camps in the state. Necessary financial assistance for POD is assured by Govt. of India @ Rs.3150 per camp.

E. Rehabilitation: Medical, Social & Economic
Planning for Rehabilitation
The immediate need is reliable information on practically all aspects of the rehabilitation of leprosy– affected/cured persons for any given area. For this purpose it is probably best to take the district as a unit. Following information shall be needed for this purpose.

Deformity profile
Distribution of sites of loss of sensibility, nature of visible impairments, State of eyes and; presence of ulcer and scars in the feet of the subjects.

Demographic data on the leprosy
affected/cured persons including their family details & mode of subsistence and sources of income.

Information
about affected individuals and their families, their overall socio–economic status and dyshabilitation status” (or participation– limitation status); determining their rehabilitation potentials as per their perceived needs; the physical consequences of the disease, & their activities of daily life (mainly their occupation).

Identify and evaluate
availability and usefulness of the rehabilitation recourses in the immediate neighbourhood and in the district.

Corrective Surgery
Assessment of the fitness and willingness of corrective surgery of the visibly impaired individuals.

The rehabilitation project should be a well planned, time–bound and target–oriented programme and should also cover the “Unrehabilitable” to ensure a minimum level of economic security, including food security for this group.

Simultaneously extensive & initially intensive social awakening programme, using all available strategies and resources should be carried out to touch all levels of the society.

Rehabilitation activities will have to address three different issues, namely

1. Impoverishment of the affected individual and his/her family.
2. Activity limitations of affected persons and
3. Participation restriction involving the affected person and their families.

Urban areas
States health departments generally do not have comprehensive health infrastructure in urban areas. Various authorities and public/private sector agencies have jurisdiction in urban areas, but usually have a very limited health setup. Localized approaches will need to be developed for service delivery in urban areas. These could include

• Coordination with medical facilities of public and private agencies to enable them to establish regular diagnosis and treatment facilities.
• Involvement of the Indian Red Cross, Scouts and other Non–Government Organisations (NGOs) in urban areas.
• Sensitization of urban private practitioners.
• Holding of skin camps, supported by IEC for awareness generation.
• Service Delivery Points (SDPs) to be identified in urban slums, industrial township, collieries etc.
• Schools could initiate health programmes – with support from the health department.

Female patients
Identification of female patients has been a major problem, particularly since almost all leprosy workers are male. During the MLECs it has been the experience that involvement of female community level workers considerably helped to improve access to women, particularly in rural areas. It is envisaged that integration will make it easier to involve female providers and community based workers in helping to detect female patients. Also, for improving case finding in general and identifying female patients in particular, efforts will be made to involve women’s groups, school students suitable NGOs and other such agents.

Management of migratory patients
Migration of patients leads to disruption in the course of treatment. While a few of the patients may get registered elsewhere, the majority may be lost forever, resulting in deterioration of their condition. Such groups may include seasonal, agricultural or industrial labour, or other nomadic group and such groups should be

• Screened in the areas where they are available.
• Their permanent residential address should be recorded.
• All leprosy patients detected from among such groups should be given an identity card wherein the date of registration, diagnosis and number of doses of MDT given is recorded. This card would enable the patients to collect drugs from health institutions in the place they move to.
• They should be given accompanied MDT on priority

Role of State leprosy cell/health department

• Prepare the state’s annual implementation plan, and submitting it to GOI.
• Help districts to prepare and implement their annual plans.
• Develop special strategies for urban areas.
• Manage SAPEL project. Monitoring access & outcomes of attempts to reach special group.
• Channeling funds to the district societies.
• Close physical and financial monitoring of implementation.
• Monitoring of district societies expenditures.
• Giving regular feedback to districts on the basis of district reports.
• Planning and managing training activities.
• Planning and managing IEC activities.
• Drug inventory management – monitor district drug stocks and send supply requests to GOI.
• Facilitating mobility of staff.
• Facilitating logistics within the districts.
• Monitoring technical aspects.
• Facilitating coordination among the district collector, Chief Medical Officer & DLO.
• Procurement.
• Coordination with NGOs.
• Overall facilitation and problem solving.
• Developing a strategy on how the state would manage the programme after the project period.

Service Centers Available in each District
Leprosy Eradication Work was being performed by following institution under State Govt.

Sr. No.	Name of Center	Existing No.
1	Urban Leprosy Centres (being merged in dist. nucleus)	428
2	Supervisory Urban Leprosy Unit at urban towns with population > 5	23
3	Leprosy Training Centers (Pune ,Nagpur)	2
6	Govt. Leprosy Hospital (Ratnagiri, Osmanabad, Kolhapur, Pune)	4
7	Temporary Hospitalization Ward at selected civil hospitals ( merged in general wards)	3
8	Non Governmental Organization	46
	SET	10
	Rehabilitation	18
	Hospitals	18
9	RCS Units  Anandvan, Varora. Chandrapur, Richardson Leprosy, Miraj, dist. Sangli Dr. Bandorwala Leprosy Hospital Pune, Acworth Leprosy Hospital, Vadala, Mumbai J.J.Hospital, Mumbai Vimala Dermatological Center,Versova, Mumbai Leprosy Mission, Kothara, Amaravati All General Hospitals & Govt. Medical Colleges being equipped to provide RCS services in near future	7