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 | |