Health Policy Issues and Health Programmes in ... - Amazon S3

National Health Programmes: An OverviewIssues/Commentsl Planning is rather ad hoc instead of using a comprehensive approach to the problem.l Malaria control is truly a problem requiring inter-sectoral and inter-departmentalinvolvement, which has not been achieved.l The desire to eradicate the problem has subsided and, hence, there is less commitment inimplementation.l Only temporary efforts to ward off mosquito bites are adopted.l There is no reliable and true data on the occurrence of the disease due to a lack of concernfor diagnosis, non-reporting, efforts to under-report and so forth.l The treatment pattern adopted by government providers and private practitioners is notuniformly standardized and problems of drug resistance are likely.2. National Leprosy Eradication Programme (NLEP)The National Leprosy Control Programme was launched in 1955. A not very effectivemono therapy with dapsone, along with the high drop-out rates among the patients, resultedin the accumulation of an estimated 4 million cases with a prevalence of 57/10,000population in 1981.In 1983, the programme was redesigned as the National Leprosy Eradication Programme andthe whole country was covered with multi-drug treatment (MDT) in a phased-in manner. It wasgiven a high priority by making it a 100% centrally-sponsored scheme with the goal ofelimination of leprosy (the prevalence rate reduction to less than 1 per 10,000 population) by theyear 2000. Operationally the country was divided into the following areas.l High endemic areas (districts), prevalence > 50/10,000l Moderate endemic areas (districts), prevalence 20–50/10,000l Low endemic areas (districts), prevalence < 20/10,000.Funds were released through 490 District Leprosy Societies set up under the chairmanship of theDistrict Collectors. Leprosy Control Units for every 4–5 lakh people were established in the highendemic areas. Mobile Leprosy Treatment Units were established in the non-endemic districts—two each in moderate endemic districts and one each in low endemic districts. In endemic urbanpockets, Urban Leprosy Centres were attached to general hospitals.The classification of the disease was revised and patients registered on the basis of thepresence of bacilli (pausi or multi) in the skin lesions, skin smears, and the involvement ofnerves. Accordingly, regimens of MDT were prescribed. Single-dose therapy for a single skinlesion was also introduced. Immuno-therapeutic and prophylactic vaccines have not beenrecommended.The Modified Leprosy Elimination Campaign has been introduced in some high endemic statesto increase case detection. The leprosy services are being integrated with general health careservices. Prevalence of leprosy came down from 57/10,000 in 1981 to 5.2/10,000 in 2000.29