Lok Sabha Question No. 1166 (UNSTARRED), answered on 2017-12-22
Subject: Action Plan to Eliminate Diseases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: DODDAALAHALLI KEMPEGOWDA SURESH, NALIN KUMAR KATEEL

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 1166 TO BE ANSWERED ON   22ND  DECEMBER, 2017

## ACTION PLAN TO ELIMI NATE DISEASES

## 1166. SHRI D.K. SURESH:

## SHRI NALIN KUMAR KATEEL:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has set any deadline to eliminate diseases like Kala Azar, Le Measles and Tuberculosis in the country;
- (b) if so, the detail s and the targets achieved so far;
- (c) the number of such cases reported in the country during each of the last three year -wise/UT- wise; and
- (d) the details of measures taken in this regard, including filling up of vacant positions schemes/programmes launched thereunder?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

- (a) & (b): Yes. The target year set by the Government to eliminate following diseases are under: -

| Diseases         | Target Year of 2017   |
|------------------|-----------------------|
| 1. Kala- azar:   |                       |
| 2. Leprosy:      | 2018                  |
| 3. Measles:      | 2020                  |
| 4. Tuberculosis: | 2025                  |

Kala- azarKala- azar is targeted for elimination by 2017 i.e. 1 case per 10,000 populati block level.  As of 2016, 85% of the endemicblocks have achieved elimination target.

Leprosy: Elimination of Leprosy i.e., 1 case/ 10000 population at National level was already achieved in the year 2005.  T he short term target is reduc tion of Grade II disability cases to less than one million population, as per WHO document onGlobal Leprosy Strat egy, 2016 -2020.

Contd…….

Measles: Ministry of Health and Family Welfare has accepted the recommendation of Mission Steering Group for wide age group measles and rubella (MR) campaign covering children in age group of 9 months to less than 15 years followed by introduction of measles r ubella vaccine in routine immunization to further reduce morbidity and mortality due to measles and rube

As  on  18th  December  2017,  more  than  6.5  crore  children  have  been  vaccinated  with  MR vaccine in 13 States/UTs, namely, Andhra Pradesh, Chandigarh, Da ra & Nagar Haveli, Daman &  Diu,  Goa,  Himachal  Pradesh,  Karnataka,  Kerala,  Lakshadweep,  Puducherry,  Tamil  Nadu, Telangana and  Uttarakhand.

Tuberculosis As per the Global TB Report 2017, the incidence of TB has reduced from 217 pe lakh per year in 2015 to 211 per lakh per year in 2016 and mortality has reduced from 36 p lakh per year in 2015 to 32 per lakh per year in 2016.

(c ) Number of cases reported State/UT wise during the last three years in respect of Kala Leprosy, Measles and Tuberculosis are at Annexure I, II, III and IV respectively.

## (d) Kala- azar: -

- Intensification of surveillance activities for early identification of cases & prompt t
- Active case searches in all endemic villages.
- Intensified IEC/BCC activities
- IRS spray with Synthetic Pyrethroid  on regular basis and focal spray as per guideline.
- Hand  Compression  Pumps  for  quality  spray  introduced  in  2015  in  Kala - azar  districts  of endemic States.
- Treatment with single day single dose Ambisome Injection to Kala -azarpatient.
- Incentive to patients for loss of wages.
- Incentive to ASHAs.
- The States fill up the vacant positions.

## Leprosy : -

- (i) implementation of routine activities and all innovations introduced during 201 - 17 viz. three pronged strategy for early case detec tion i.e., i) Leprosy Case Detection Campaign  (LCDC)  (specific  for  high  endemic  districts),  ii)  Focussed  Lepros Campaign  (for  hot  spots  i.e.,  rural  and  urban  areas  where  Grade  II  disabili detected), iii) Special plan for hard to reach areas.
- (ii) Sparsh Leprosy  Awareness  Campaign  for  awareness,  Grade  II  disability  case investigation,
- (iii) Post Exposure chemoprophylaxis administration to the contacts of cases detected LCDC districts etc.
- (iv) ASHA  based  Surveillance  for  Leprosy  Suspects  (ABSULS)  has  been  introdu ced during 2017 - 18 to enhance early case reporting.

## Measels: -

The following measures have been taken  to achieve the target of measles elimination by 20

- Government of India introduced measles vaccine across the country in 1985 under Universal Immunization Programme (UIP). To further reduce the measles burden, a second dose of measles vaccine was introduced in the country in the year 2010.
- With an aim to increase the full immunization coverage to 90% by December 2018 including  improving  measles  vaccine  coverage  particularly  in  pockets  with  l immunization  coverage,  the  Ministry  of  Health  and  Family  Welfare  has  launched

Intensified  Mission  I ndradhanush  on  8th  October  2017.  The  Intensified  Mission Indradhanush is being carried out in 173 districts and 17 urban areas across 24 of the country and three rounds (Oct, Nov and Dec) have been completed since t launch.

- An  India  Expert  Adviso ry  Group  on  Measles  &  Rubella  (IEAG - MR)  has  been established,  comprising  national  and  international  experts,  to  provide  tech guidance on the disease elimination efforts from time to time. The group has twice since its formulation.

## Tuberculosis:

The  National  Strategic  Plan  (NSP)  for  elimination  of  Tuberculosis  (2017 - 25)  has  been formulated by the Ministry of Health and Family Welfare.

In  addition  to  the  existing  strategies  under  Revised  National  Tuberculosis  Co Programme (RNTCP), the NSP focus ses on:

- early diagnosis of all the TB patients, prompt treatment with quality assured and treatment regimens
- suitable patient support systems to promote adherence.
- engaging with the patients seeking care in the private sector.
- prevention strategies including active case finding and
- contact tracing in high risk / vulnerable population
- airborne infection control.

Under the National Health Mission (NHM), financial and technical support is provide the States/UTs to strengthen their health -care sy stem based on the requirements posed by the States/UTs  in  their  Program  Implementation  Plans.  Vacancies  in  the  State  are  fill respective State/District Health Societies under NHM. Regular follow up is done with States to ensure that the vacant pos itions are filled up.

…………………

## Annexure I

State/UT- wise Kala - Azar cases during the last three years

| Sl.No.   | State         |   2014 |   2015 |   2016 |
|----------|---------------|--------|--------|--------|
| 1.       | Bihar         |   7615 |   6517 |   4773 |
| 2.       | Jharkhand     |    937 |   1262 |   1185 |
| 3.       | West Bengal   |    668 |    576 |    179 |
| 4.       | Uttar Pradesh |     11 |    131 |    107 |
| Total *  | Total *       |   9241 |   8500 |   6249 |

## State/UT - wise new Leprosy cases detected during the last three years

## Annexure II

| S. No.   | State/ UT         | No. of new cases detected   | No. of new cases detected   | No. of new cases detected   |
|----------|-------------------|-----------------------------|-----------------------------|-----------------------------|
| S. No.   | State/ UT         | 2014-15                     | 2015-16                     | 2016-17                     |
| 1        | Andhra Pradesh    | 4687                        | 4355                        | 4228                        |
| 2        | Arunachal Pradesh | 32                          | 33                          | 28                          |
| 3        | Assam             | 856                         | 781                         | 1019                        |
| 4        | Bihar             | 16848                       | 16185                       | 21818                       |
| 5        | Chhattisgarh      | 8847                        | 10440                       | 12609                       |
| 6        | Goa               | 55                          | 136                         | 130                         |
| 7        | Gujarat           | 9024                        | 10138                       | 7266                        |
| 8        | Haryana           | 635                         | 672                         | 491                         |
| 9        | Himachal Pradesh  | 176                         | 162                         | 146                         |
| 10       | Jharkhand         | 4873                        | 4432                        | 6253                        |
| 11       | Jammu & Kashmir   | 159                         | 189                         | 143                         |
| 12       | Karnataka         | 3314                        | 3065                        | 2897                        |
| 13       | Kerala            | 663                         | 574                         | 496                         |
| 14       | Madhya Pradesh    | 6921                        | 6597                        | 7152                        |
| 15       | Maharashtra       | 16415                       | 15695                       | 15012                       |
| 16       | Manipur           | 17                          | 19                          | 20                          |
| 17       | Meghalaya         | 25                          | 33                          | 33                          |
| 18       | Mizoram           | 11                          | 9                           | 6                           |
| 19       | Nagaland          | 42                          | 67                          | 34                          |
| 20       | Odisha            | 8004                        | 10174                       | 10045                       |
| 21       | Punjab            | 620                         | 651                         | 626                         |
| 22       | Rajasthan         | 1060                        | 1106                        | 1042                        |
| 23       | Sikkim            | 13                          | 21                          | 23                          |
| 24       | Tamil Nadu        | 3604                        | 4925                        | 4937                        |
| 25       | Telangana         | 2905                        | 2800                        | 2658                        |
| 26       | Tripura           | 47                          | 42                          | 34                          |
| 27       | Uttar Pradesh     | 22223                       | 22777                       | 22301                       |
| 28       | Uttarakhand       | 532                         | 382                         | 375                         |
| 29       | West Bengal       | 10315                       | 8170                        | 11236                       |
| 30       | A & N Islands     | 25                          | 29                          | 18                          |
| 31       | Chandigarh        | 173                         | 136                         | 128                         |
| 32       | D & N Haveli      | 318                         | 425                         | 384                         |
| 33       | Daman & Diu       | 21                          | 4                           | 7                           |
| 34       | Delhi             | 2280                        | 2068                        | 1812                        |
| 35       | Lakshadweep       | 4                           | 0                           | 45                          |
| 36       | Puducherry        | 41                          | 42                          | 33                          |
| Total    | Total             | 125785                      | 127334                      | 135485                      |

## Annexure-III

State/UT- wise Measles cases during the last three years

| S. No   | States / UTs              | 2014   |   2015 |   2016 |
|---------|---------------------------|--------|--------|--------|
| 1       | Andaman & Nicobar Islands | 37     |     31 |     25 |
| 2       | Andhra Pradesh            | 281    |     44 |    115 |
| 3       | Arunachal Pradesh         | 35     |     17 |    365 |
| 4       | Assam                     | 507    |   1225 |   1382 |
| 5       | Bihar                     | 141    |    339 |    370 |
| 6       | Chandigarh                | 4      |    105 |     78 |
| 7       | Chhattisgarh              | 7      |     32 |     62 |
| 8       | Dadra & Nagar Haveli      | 78     |    142 |     51 |
| 9       | Daman & Diu               | 14     |      0 |      0 |
| 10      | Delhi                     | 1875   |   1083 |   1460 |
| 11      | Goa                       | 72     |     28 |     14 |
| 12      | Gujarat                   | 823    |    790 |    940 |
| 13      | Haryana                   | 155    |    262 |    348 |
| 14      | Himachal Pradesh          | 267    |    928 |    461 |
| 15      | Jammu & Kashmir           | 2840   |   2148 |   2071 |
| 16      | Jharkhand                 | 1019   |   1299 |    432 |
| 17      | Karnataka                 | 1116   |   1182 |    524 |
| 18      | Kerala                    | 1257   |   1782 |   1425 |
| 19      | Lakshadweep               | 0      |      0 |      0 |
| 20      | Madhya Pradesh            | 352    |    809 |    500 |
| 21      | Maharashtra               | 2030   |   1888 |   1988 |
| 22      | Manipur                   | 232    |    419 |    314 |
| 23      | Meghalaya                 | 228    |    266 |   1010 |
| 24      | Mizoram                   | 123    |    759 |    654 |
| 25      | Nagaland                  | 319    |     98 |     95 |
| 26      | Odisha                    | 583    |    808 |    581 |
| 27      | Puducherry                | 27     |     13 |      6 |
| 28      | Punjab                    | 1      |     32 |     16 |
| 29      | Rajasthan                 | 294    |   1407 |    592 |
| 30      | Sikkim                    | 102    |    802 |    278 |
| 31      | Tamil Nadu                | 499    |    405 |    251 |
| 32      | Telangana *               | -      |     83 |     91 |
| 33      | Tripura                   | 452    |    702 |    174 |
| 34      | Uttar Pradesh             | 298    |   1801 |   1525 |
| 35      | Uttarakhand               | 382    |    311 |    272 |
| 36      | West Bengal               | 3777   |   3521 |   3227 |
|         | Total                     | 20227  |  25561 |  21697 |

Source: Central Bureau of Health Intelligence, National Health Profile reports

ANNEXURE-IV Statewise Case Notification of TB for India

| S No   | State/UTs           |    2014 |    2015 |    2016 |
|--------|---------------------|---------|---------|---------|
| 1      | Andaman & Nicobar   |     756 |     584 |     509 |
| 2      | Andhra Pradesh      |   88638 |   61758 |   64420 |
| 3      | Arunachal Pradesh   |    2691 |    2748 |    2758 |
| 4      | Assam               |   38317 |   38014 |   36724 |
| 5      | Bihar               |   67991 |   64928 |   59020 |
| 6      | Chandigarh          |    2869 |    3143 |    2980 |
| 7      | Chhattisgarh        |   28864 |   29950 |   30821 |
| 8      | Dadar& Nagar Haveli |     450 |     487 |     510 |
| 9      | Daman & Diu         |     279 |     284 |     368 |
| 10     | Delhi               |   54037 |   55260 |   55657 |
| 11     | Goa                 |    1660 |    1599 |    1576 |
| 12     | Gujarat             |   77395 |   82585 |   89293 |
| 13     | Haryana             |   39498 |   40913 |   41389 |
| 14     | Himachal Pradesh    |   14441 |   14333 |   14070 |
| 15     | Jammu & Kashmir     |   10243 |    9873 |    9244 |
| 16     | Jharkhand           |   35907 |   34792 |   35130 |
| 17     | Karnataka           |   61328 |   59932 |   59732 |
| 18     | Kerala              |   23439 |   22785 |   20969 |
| 19     | Lakshadweep         |      27 |      40 |      23 |
| 20     | Madhya Pradesh      |  100034 |  103108 |  113172 |
| 21     | Maharashtra         |  135465 |  130874 |  122172 |
| 22     | Manipur             |    2198 |    1881 |    1768 |
| 23     | Meghalaya           |    4944 |    4674 |    3934 |
| 24     | Mizoram             |    1993 |    2088 |    2162 |
| 25     | Nagaland            |    3298 |    3316 |    2274 |
| 26     | Orissa              |   45777 |   45814 |   41807 |
| 27     | Pondicherry         |    1409 |    1288 |    1415 |
| 28     | Punjab              |   38152 |   38625 |   37093 |
| 29     | Rajasthan           |   94908 |   90296 |   90032 |
| 30     | Sikkim              |    1630 |    1400 |    1463 |
| 31     | Tamil Nadu          |   84570 |   80543 |   82107 |
| 32     | Telangana           |   18655 |   39498 |   38829 |
| 33     | Tripura             |    2507 |    7394 |    2344 |
| 34     | Uttar Pradesh       |  255364 |  246589 |  260572 |
| 35     | Uttarakhand         |   14429 |   14317 |   13255 |
| 36     | West Bengal         |   89819 |   87468 |   85179 |
|        | TOTAL               | 1443942 | 1423181 | 1424771 |