Table 3.
Description of National Leprosy Control/Elimination Programs in India, Nepal and Indonesia based on WHO framework
| WHO Framework | Themes | NLEP India | NLCP Nepal | NLCP Indonesia |
|---|---|---|---|---|
| Service Delivery | Coverage (Prevalence) 2014 | 88,833 cases registered and treated (Source: Global leprosy update 2014) | 2382 cases registered and treated (Source: Global leprosy update 2014) | 19,949 cases registered and treated (Source: Global leprosy update 2014) |
| Infrastructure | 153,655 Sub Center; 25,308 PHCs; 5396 CHCs (Source: Rural Health Statistics 2015, India) | 208 PHCs; 1559 HPs; 2643 SHP (Source: Annual Report 2013–14, Dept. of Health, Nepal) | 3395 HCs with IPD and 6345 HCs with only OPD (Source: Jumlah Puskesmas 2015, Indonesia) | |
| Activities | Case detection is mainly passive with few periodic active outreach | Case detection is mainly passive | Case detection is mainly passive with few periodic active outreach | |
| Routine household contact tracing | Routine household contact tracing | Routine household contact tracing; integrated SDR since 2012 in two districts | ||
| Suspect identification & their adherence is checked by volunteers (ASHA) at field level | Suspect identification & their adherence is checked by volunteers (FCHV) at field level | Suspect identification & their adherence is checked by paramedical staff (village midwife) | ||
| Contact screening by paramedical staff (PMW/ANM) at sub-center | Contact screening by paramedical staff (Leprosy Focal Person) at Health Post | Contact screening by paramedics staff (Leprosy officer) at HC | ||
| Confirmation diagnosis by doctor at PHC and higher | Confirmation diagnosis by Leprosy focal person / doctor at Health Post and higher | Confirmation diagnosis by Leprosy officer at HC and doctor at higher level | ||
| Process | Refer Fig. 3 | |||
| MDT supply (Source: Interviews) | No stock out situation reported at peripheral level | Seldom stock out situation reported for a very short period at peripheral level | A major stock out situation reported in 2016 at peripheral level | |
| Health Workforce | Staff | General health care staff. High epidemic PHCs have additional staff | General health care staff | General health care staff |
| Leprosy Training | 10,624 Doctors, 24,255 Paramedics and 104,011 volunteers trained on leprosy (Source: NLEP Progress Report 2014–15) | 150 health worker trained on leprosy. (Source: Annual Report 2013–14, Dept. of Health, Nepal) | 120 Doctors, 516 leprosy staff trained on leprosy in 2014 (Source: Subdit Kusta 2014, Indonesia) | |
| Information | Indicators | Standard set of indicators as per WHO | Standard set of indicators as per WHO | Standard set of indicators as per WHO |
| Data Management | Individual at sub-center level, then aggregated. | Individual at health-post level, then aggregated. General MIS electronic entry at district level but limited leprosy indicators. | Individual at sub-center level, then aggregated | |
| Supervision & Monitoring | CLD State Leprosy Office & District Leprosy Officer | CLD, Regional Health Directorate and District Health / Public Health officer | Department of Leprosy & Yaws (central), Provincial Leprosy Office and District Health Office | |
| Reporting | Monthly, quarterly and Annually. Bottom-up at all levels | Monthly, quarterly and Annually. Bottom-up at all levels | Monthly, quarterly and Annually. Bottom-up at all levels | |
| Innovation | New initiatives | Developed M.w vaccine | NA | NA |
| Financing | Budget | NLEP total budget decreased by 9.8% from 2014 to 15 to 2015–16 (Source: MoHFW, Outcome Budget 2014–15 & 2015–16) | NLCP recurrent budget (released) was increased by 58% from 2012 to 13 to 2013–14 (Source: Annual Report Dept. of Health, 2012–13 & 2013–14) | NA |
| Funding | CLD and State Leprosy Office | Ministry of Health and Population | Sub-directorate Leprosy & Yaws and District Health Office | |
| OOPs in leprosy | No evidence | |||
| Periodicity of funds (Source: Interviews) | Sometimes delay in salary disbursement at peripheral level or case reimbursements to ASHA | Sometimes delay in salary disbursement at peripheral level or case reimbursements to FCHV | Mostly on time | |
| Governance | National Strategy | Strategy focus on decentralization of leprosy services. For more information, refer Additional file 1 | Strategy focus on disability and rehabilitation. For more information, refer Additional file 1 | Strategy focus on early detection. For more information, refer Additional file 1 |
| Organization structure | Fig. 2 | |||
| Integration | Integrated into general health system | Integrated into general health system | Integrated into general health system | |
ANM Auxiliary Nurse Midwife, ASHA Accredited Social Health Activist, CHC Community Health Center, CLD Central Leprosy Division, FCHV Female Community Health Volunteer, HC Health Center, HP Health Post, LFP Leprosy Focal Person, MPW Multipurpose Worker, NA Not Available, PHC Primary Health Center, PMW Para Medical Worker, SHP Sub-Health Post