National Leprosy Eradication Programme: Strategies and Achievements

Leprosy, an ancient disease that has affected humanity for millennia, was once considered incurable and carried immense social stigma. In India, where the disease had deeply entrenched itself across communities, the government launched one of the most ambitious public health initiatives to combat it. The National Leprosy Eradication Programme (NLEP) stands as a testament to what sustained political commitment, scientific advancement, and community engagement can achieve in disease elimination.

From control to eradication: the evolution of India’s leprosy programme 🔗

India’s formal fight against leprosy began in 1955 with the launch of the National Leprosy Control Programme (NLCP). This initial programme focused on controlling leprosy through early detection and treatment, primarily using Dapsone monotherapy. The Survey, Education, and Treatment (SET) approach became the standard method for leprosy control across the country.

The landscape changed dramatically in 1982 when the World Health Organization recommended Multi-Drug Therapy (MDT) as a revolutionary treatment approach. Recognizing this breakthrough, India restructured its programme and launched the National Leprosy Eradication Programme in 1983, shifting its focus from mere control to complete elimination. This transformation marked a pivotal moment in Indian public health history.

World Bank support and nationwide expansion 🔗

The programme received significant momentum when the first World Bank-supported project was introduced in 1993 and completed in 2000. This international assistance enabled NLEP to expand to all districts across the country by 1993-94. The second World Bank-supported project followed between 2001 and 2004, further strengthening infrastructure and service delivery.

In 1991, the World Health Assembly passed a resolution to eliminate leprosy globally by the year 2000. India committed to this target, and although the national goal was extended to 2005, the country made remarkable progress. By 2004, 17 states and 250 districts had already achieved elimination status.

Multi-Drug Therapy: the cornerstone of leprosy treatment 🔗

Multi-Drug Therapy consists of a combination of three medicines: rifampicin, dapsone, and clofazimine. This regimen effectively kills the pathogen and cures the patient while preventing drug resistance that was common with single-drug treatments.

Treatment protocols 🔗

WHO guidelines recommend a 6-month treatment duration for paucibacillary (PB) leprosy and 12 months for multibacillary (MB) leprosy. In 2023, India revised its classification and treatment protocols in alignment with WHO recommendations. The updated protocol, implemented nationwide from April 2025, uses a uniform 3-drug MDT regimen for both PB and MB cases.

A significant advantage of MDT is that patients stop transmitting the disease upon initiating treatment. The WHO has facilitated free MDT provision worldwide through donations-initially funded by The Nippon Foundation from 1995 to 1999, and by Novartis since 2000. This partnership has enabled the successful treatment of over 16 million leprosy patients globally.

Key strategies driving the programme 🔗

NLEP operates through several integrated strategies designed to detect cases early, provide quality treatment, and address the social dimensions of the disease.

Early case detection and active surveillance 🔗

The programme emphasizes proactive case finding through Active Case Detection Campaigns (ACDC), household contact surveys, and Focused Leprosy Campaigns in high-endemic areas. Accredited Social Health Activists (ASHAs) play a crucial role in detection and ensuring treatment completion at the community level.

Information, Education, and Communication (IEC) 🔗

Health education remains central to NLEP’s strategy. The programme promotes self-reporting to Primary Health Centres and works to reduce the stigma associated with leprosy. The “Sparsh Leprosy Awareness Campaign,” launched in 2017, exemplifies these efforts to change public perception and encourage affected individuals to seek care without fear.

Disability Prevention and Medical Rehabilitation (DPMR) 🔗

Beyond treating the infection, NLEP focuses on preventing disabilities through early intervention and providing rehabilitation services for those with existing deformities. The programme offers welfare allowances of Rs. 12,000 to patients undergoing reconstructive surgery, ensuring comprehensive support throughout their recovery.

Digital platforms for surveillance 🔗

The programme has embraced technology with platforms like Nikusth 2.0, launched in 2023, enabling real-time case tracking and data-driven planning. This digital infrastructure supports surveillance and reporting across all administrative levels, improving programme monitoring and patient follow-up.

Achievements and milestones 🔗

India achieved elimination status for leprosy at the national level in December 2005, meeting the WHO target of prevalence below 1 case per 10,000 population. This was a remarkable achievement considering that in 1981, the country had a prevalence rate of 57.2 per 10,000 population with nearly 4 million cases.

Dramatic decline in disease burden 🔗

The numbers tell a compelling story. From over 40 lakh (4 million) cases in 1982, India reduced the patient load to less than 2 lakh-representing approximately 97% reduction-by 2005. According to recent data from the Ministry of Health and Family Welfare, the prevalence rate has further declined from 0.69 per 10,000 in 2014-15 to 0.57 in 2024-25.

Progress at subnational levels 🔗

As of March 2025, 31 states and 638 districts have achieved prevalence rates below 1 per 10,000 population. Grade 2 disability among new cases has dropped significantly from 4.48 per million population in 2014-15 to 1.31 in 2024-25, indicating improved case finding and early intervention. The proportion of child cases has also declined from 9.04% to 4.68% during the same period, suggesting reduced community transmission.

Integration with the general healthcare system 🔗

Following the achievement of elimination status in 2005, leprosy services were integrated into the General Health Care System. This integration means that all public health facilities-including Primary Health Centres, Community Health Centres, District Hospitals, and Medical Colleges-now provide leprosy diagnosis and treatment services free of cost.

The programme operates under the National Health Mission (NHM), receiving technical and financial support from the central government. Four Research and Training Institutes established under the Directorate General of Health Services-Central Leprosy Teaching and Research Institute (CLTRI) at Chengalpattu and Regional Leprosy Training and Research Institutes at Raipur, Gauripur, and Aska-continue to support capacity building and research.

International collaboration and WHO partnership 🔗

India’s success in leprosy elimination has been supported by strong international partnerships. The WHO has provided technical support, free MDT drugs, independent programme evaluation, and assistance in capacity building. India has actively participated in developing Global Leprosy Strategies and has been part of The Global Appeal since 2006, sharing annual messages to raise awareness and call for an end to discrimination against affected persons.

The WHO India Country Co-operation Strategy includes leprosy as a priority area, focusing on strengthening surveillance, supporting post-exposure prophylaxis, reducing stigma, and enhancing access to treatment and rehabilitation.

National Strategic Plan 2023-2027: the road ahead 🔗

The National Strategic Plan and Roadmap for Leprosy 2023-2027, launched on January 30, 2023, sets an ambitious target of achieving zero transmission by 2027-three years ahead of the Sustainable Development Goal timeline of 2030. The plan’s vision encompasses zero infection, zero disability, and zero stigma and discrimination.

Five strategic pillars 🔗

The NSP is built on five pillars: leadership, coordination and partnerships; accelerated case detection; comprehensive quality leprosy services; prevention of disease, disabilities and discrimination; and robust surveillance and health information systems. Post-Exposure Prophylaxis (PEP) using single-dose rifampicin for contacts has been introduced as a preventive strategy.

Addressing antimicrobial resistance 🔗

Recognizing the emerging challenge of antimicrobial resistance in Mycobacterium leprae, the government has introduced dedicated AMR Guidelines under NLEP. A national surveillance network has been established across key institutions to monitor resistance trends to MDT drugs, ensuring treatment remains effective.

Challenges and the way forward 🔗

Despite remarkable achievements, challenges remain. Some districts continue to report prevalence rates above 1 per 10,000, requiring targeted interventions. The integration of leprosy services into the general health system, while improving accessibility, has also meant reduced specialized focus in some areas.

The programme continues to combat stigma and discrimination through community engagement and legal frameworks like the Rights of Persons with Disabilities Act, 2016. In 2025, leprosy was declared a notifiable disease, strengthening surveillance and ensuring all cases are reported for appropriate management.

NLEP’s journey from controlling a feared disease to approaching its elimination demonstrates the power of comprehensive public health programming. With sustained commitment, innovative strategies, and community participation, India moves closer to realizing Mahatma Gandhi’s vision of mainstreaming persons affected by leprosy into society with dignity.

What do you think? How can community health nurses contribute to the last-mile efforts in leprosy elimination? What role might digital health tools play in sustaining disease surveillance once elimination targets are achieved at all district levels?

References

1. https://dghs.gov.in/content/1349_3_NationalLeprosyEradicationProgramme.aspx
2. https://www.who.int/teams/control-of-neglected-tropical-diseases/leprosy/treatment
3. https://en.wikipedia.org/wiki/National_Leprosy_Eradication_Program
4. https://www.who.int/news-room/fact-sheets/detail/leprosy
5. https://www.who.int/activities/facilitating-the-provision-of-medicines-for-leprosy
6. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1894687
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5885632/
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC10954108/
9. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2174943
10. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1909081
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC2217676/