The district administration of Sambalpur in Odisha recently turned to women self help groups for an unlikely assignment — nursing care and assistance for leprosy patients.
The desperate intervention was necessitated as the State lacks requisite paramedical workers to nurse infected persons.
The intervention comes after Odisha declared itself as a leprosy-free State in 2006-07 following cases dropping below 10,000 and the prevalence rate dropping below 1%. The State had then dismantled infrastructure and done away with skilled manpower dealing with leprosy patients
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However, re-emergence of the disease with cases crossing the 10,000 mark annually in past few years has sent the health and civil administration into a tizzy.
The National Leprosy Eradication Prgramme (NLEP) began to be implemented in Odisha since 1981. In 1997-98, the State recorded highest ever detection of leprosy cases at 1,03,416. Due to NLEP intervention, the prevalence rate per 10,000 population came down from 123.2 in 1983-84 to below 1 in 2006-07. In the same year, only 5,088 persons were found to be suffering from the leprosy.
However, the annual number of cases breached the 10,000 mark in 2013-14. Since then there has been regular detection of over 10,000 cases or more every year. In 2020-21, cases could not be properly detected due to COVID-19 restrictions — 6,156 cases were recorded.
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Understaffed
Under NLEP, 2,137 persons were engaged of whom 1,251 were paramedical workers. Subsequently, however, the posts were abolished. Only 404 leprosy workers remained in their positions. Gradually, only 45 of them were left as government reportedly avoided fresh recruitments.
In 2018, the State government engaged multipurpose health workers as block level nodal workers by giving them three days of training. Activists however, pointed out that these workers were not skilled enough to handle leprosy cases.
Apart from a prevalence rate of over 1%, the high multibacillary (MB) rate has set alarm bells ringing. The increasing MB ratio is the result of early cases of leprosy not being detected.
When trained paramedical workers were deployed, the MB rate remained below 30%. After 2006-07, the MB rate has risen to between 40-50%. The probability of spread of infection becomes high due to increasing MB rate.
‘ASHAs ill-equipped’
“Odisha government has been detecting leprosy patients with help of Accredited Social Health Activist (ASHA). The ASHA workers have not received proper training to trace symptoms. In village areas, ASHA workers cannot even check men minutely. If a survey is done properly, the cases will be much higher than the present figure,” said Duryodhan Sahoo, President State Leprosy Welfare Federation.
As early as 2013-14, the Centre had warned Odisha of a relapse of leprosy cases. “In 2014, former Director General of Health Services wrote to the State government to recruit 22 district leprosy consultants and 184 paramedical workers for high endemic blocks and urban areas. The Centre also placed funds for the purpose. The positions were never created,” alleged Mr. Sahoo.
He alleged that though budgetary provisions for eradication of leprosy were made regularly, the posts of paramedical workers (leprosy) were not filled up.
In past five to six years, the rate of deformity caused by leprosy is also going up. During 1981 to 1983, the deformity rate was above 10%. For next two decades, however, the rate of deformity never crossed 10%. Now, after 2014, it is constantly exceeding 10%.
HC intervention
Hearing a public interest litigation that highlighted pathetic condition of leprosy patients in the State, a division bench led by Orissa High Court Chief Justice Dr. S. Muralidhar had appointed a three-member advocate committee to assess the living condition of leprosy patients in different colonies.
“After court intervention, the health administration of the State has become active. They have started taking steps to address issues concerning to leprosy patients due to constant monitoring by the Orissa HC,” said Bibhu Prasad Tripathy, senior counsel and member of advocates committee.
Stating that condition of the leprosy colonies in terms of sanitization and hygiene was pathetic, Mr. Tripathy said, “leprosy patients are in dire need of medical attention. Moreover, patients with hand and eye deformities are required to be enrolled in Aadhaar programme which will ensure their inclusion in welfare schemes.”
“In Odisha, there are 87 leprosy colonies and 8,032 inmates in those colonies. About 10,000 leprosy cases are reported in a year and about 10,000 patients are also discharged every year. However, the post of doctors and paramedical staffs deployed in leprosy colonies were abolished over the years. At present there are no dressers in these colonies,” admitted Basant Kumar Pradhan, Joint Director (Leprosy).