| Limited care
The national leprosy elimination programme status report of the government for the last 5 years (1996-2001) disclosed that...while the overall state prevalence rate was stated to be 2.72 per 10,000 the PR in the four test-checked districts for the period 1996-2001 was found to be much higher... The PR as per the status report was not correct as revealed during scrutiny in the test-checked districts...
Estimated population in each year has been inflated which resulted in lower PR/10,000 population, whereas actual estimated population for each year was to be taken as per prescribed formula on the basis of 1991 and 2001 census for the period 1996-2001.
In text-checked districts, reports of all sub-centres/ sectors did not agree with the information recorded in relevant registers and records. The consolidated report of all sub-centres under a leprosy control unit did not also agree with the report submitted to district leprosy societies. Again consolidated reports of the LCUs did not agree with the report of the DLS submitted to the state leprosy officer for preparation of state report. Thus, the performance showing balance cases, PR, detection rate and PD ratio in the state report was not correct. This was also admitted by the secretary, health and family welfare department, who, as seen from the minutes of the workshop on leprosy held in June 2001...observed that the...department was very negligent of the scheme.
A total survey, such as school survey, contact survey and rapid survey, was to be conducted by each unit... under DLS covering at lest 90 per cent of the population of the endemic areas. Test-check of district records revealed that survey was conducted by LCU/modified LCU and so on, under concerned DLS during 1996-2001 only covering 10 to 25 per cent of the population for detecting new cases and proper records were not maintained. Had the survey been total, as envisaged under NLEP, new case detection would have been more than that reflected in the state report. In some units, not a single patient was registered during a period of more than one year.
The SLO issued an order in May 2000 that patients having no ration card or voter’s identity card should be treated separately and their cases should not be reflected in the reports on the grounds that the PR was not coming down even after repeated efforts. Action on such orders by the units under the DLS resulted in depicting incorrect number of PR.
The patients were to be released from treatment after completion of 6 doses of multi-drug therapy within 9 months in case of pauci-bacillary cases and 12 doses of MDT within 18 months in case of multi-bacillary cases. During test-check, some cases were noticed where patients (of both PB and MB cases) were discharged even before completion of required doses but shown under “released from treatment”. This irregular practice was done to depict lower PRs per 10,000.
About 25 per cent of the total patients discharged were shown as “other-wise discharged” on the grounds that the patient refused treatment or was absent. No follow-up action was taken to bring them under the treatment regime. Medical officer, LCU, Raigunj...stated that (May-June 2001) a number of patients were discharged as OD with a view to show a lower rate of PR as per oral instruction of higher authorities. The patients, thus, remained untreated...
From the above it is clear that the government not only failed to achieve the target of bringing down the PR to below 1 per 10,000 by end of 2000 but also reported a doubtfully low PR of 2.72 by showing less number of prevailing patients, discharging them before completion of treatment and by not registering new patients...