Lok Sabha Question No. 884 (UNSTARRED), answered on 2021-07-23
Subject: Disease Eradication Programme
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shrirang Appa Barne, Ravindra Kushawaha, Sudheer Gupta, Manoj Kumar Tiwari, Krishna Pal Singh Yadav, Ravi Kishan Shukla, Subrata Pathak, Prataprao  Jadhav, Chandra Sekhar Sahu, Sanjay Sadashivrao Mandlik, Bidyut Baran Mahato

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

## LOK SABHA U NSTARRED QUESTION NO. 884 TO BE ANSWERED ON 23 RD JULY, 2021

## DISEASE ERADICATION PROGRAMME

## 884. SHRI SHRIRANG APPA B ARNE:

SHRI RAVINDRA KUSHWA HA:

SHRI SUDHEER GUPTA:

SHRI MANOJ TIWARI:

DR. KRISHNA PAL SING H YADAV:

SHRI RAVI KISHAN:

SHRI SUBRAT PATHAK:

SHRI PRATAPRAO JADHA V:

SHRI CHANDRA SEKHAR SAHU:

SHRI SANJAY SADASHIV RAO MANDLIK:

SHRI BIDYUT BARAN MA HATO:

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

- (a) whether the Government is implementing various disea e eradication programmes
- nationwide, if so, the details thereof;
- (b) whether the Government has chalked out the outlines of these programmes, if so, the details thereof along with the targets fixed and funds allocated in this regard, State/UT - wise;
- (c) the steps taken/being taken by the Government to achieve said target in a time bound anner;
- and
- (d) the role of States/UTs, local administration and Non- Governmental Organ izations in these programmes?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR . BHARATI PRAVIN PAW AR )

(a):The  Government  is  implementing  3  (three)  disease  eradication  programmes  namely , National  Vector  Borne  Diseases  Control Programme  (NVBDCP) , National  Leprosy Eradication Programme (NLEP) andNational TB Elimination programme (NTEP).

Under National Vector Borne Diseases Control Programme (NVBDCP), 3 diseases namely  Malaria,  Filaria  &  Kala - Azar  are  under  elimination  programme .    These  diseases  are targeted  for  elimination,  and  not  for  eradication.    Eradication  of  the  disease  is  p reduction to zero of the worldwide incidences of infection caused by specific agent as a deliberate efforts; and when intervention m easures are no longer needed. However, Vector borne diseases (VBDs) are  caused  by  vector  and  vector  is  climate  sensitive  and  ecological  dri Vector  is  affected  by  temperature,  humidity,  rainfall  etc,  and,  therefore,  it  is  not eradicate the V BDs completely from the world.

The details of the diseases targeted for elimination are as follows: -

1. Malaria: The  goal  is  to  achieve  zero  indigenous  cases  of  Malaria  in  the  country 2030.
2. Lymphatic Filariasis: The definition of Elimination of Lymphatic Filariasis (LF) is to achieve  <1%  microfilaria  rate  (Mf  rate)  in  the  endemic  areas.  The  global  targe Lymphatic Filariasis is the elimination of the disease as a public health problem by
3. Kala- azar: The  definition  for  kala -azarelimination  as  a  public  health  problem  is  to achieve annual incidence of less than one case per 10,000 population at block leve efforts are being made to achieve the annual incidence of less than one case per population in all the 633 endemic blocks across 54 districts in 4 states by the end of 202 Once  achieved,  the  elimination  is  to  be  sustained  for  3  years  for  KA  elimina certification.
4. Leprosy can only be eliminated as a Public Health problem, and not eradicated beca of the extra human sources (reservoirs) of the Mycobacterium leprae ( M. leprae ), the agent  responsible  for  causing  leprosy.  However,  Government  of  India  is  committ towards achieving a leprosy free India through breaking the chain of transmission disease  at community  level.  The  definition  of  leprosy  elimination  as  a  Public  Heal Problem is to have less than 1 case per 10,000 populations. India has already ach this target at the national level in 2005.
5. Tuberculosis : The Government is implementing National TB Elimination programme (NTEP) with the goal of ending TB by 2025. Eradication of tuberculosis is not poss due to ongoing transmission of the disease. The programme is aiming at its elimina The National Strategic Plan (2017 - 25) is being impleme nt d for ending TB in the country by 2025.

(b)& (c) :The Government has chalked out disease elimination strategies . The details of plan and step being taken by the Government to achieve the target are as follows: -

## National Vector Borne Diseases Control Programme (NVBDCP)

## 1) Malaria:

The  Government  has  launched  the  National  Framework  for  Malaria  Elimination  (NFME), 2016- 2030  to  eliminate  malaria  in  India  in  a  phased  manner.  The  goal  is  to  achieve indigenous cases of Malaria in the country b y 2027 and to sustain elimination by 2030.

As per NFME, the States/UTs of the country are divided into three categories for ma elimination.

- I. 15 low burden states (category 1)
- II. 11 moderate burden states (category 2)
- III. 10 high burden states (category 3)

## Major Interventions are as follows:

- Early diagnosis and radical treatment: Use of Rapid Diagnostic Test Kits, ASHA incent for diagnosis & ensuring complete treatment.
- Case- based surveillance and rapid response
- Integrated vector management (IVM)
- Indoor residual spray (IRS) -2 rounds of IRS for vector control in areas with Annual Parasit Incidence >2.
- Long-lasting insecticidal nets (LLINs) / Insecticide treated bed nets (ITNs): LLINs ar used in the programme to cover sub centres with Annual Parasite Incidence >1.
- Larval source management (LSM)
- Epidemic preparedness and early response
- Behaviour Change Communication and community mobilization

## 2) Lymphatic Filariasis:

- Mass  Drug  administration  (MDA)  for  disease  transmission  control.  To  accelerate  dise elimination, an Accelerated Plan for Elimination of Lymphatic filariasis (APELF) 2018, Drug Therapy (Ivermectin + Diethylcarbamazine ( DEC) + Albendazole) has been implemented in 30 districts and is being further scaled up.
- Morbidity  Management  &  Disability  Prevention  (MMDP)  targets  100%  coverage  for hydrocele surgery and home - based morbidity management services for lymphoedema cases.
- The achievement of <1% Microfi laria rate is validated by Transmission Assessment Survey (TAS).

## 3) Kala- Azar:

- Single Dose Liposomal Amphotericin B (LAMB) for treatment.
- Use of synthetic pyrethroid in place of DDT for IRS.
- Introduction  of  hand  compression  pumps  in  place  of  stirrup  pumps for  convenience  and quality of IRS
- Revised  incentives  to  PKDL  patients  from  Rs.  2,000/ - to  4,000/ - and  to  ASHA  from Rs.300/ -to 500/ -in 2018 .
- Pucca houses in KA affected villages have been constructed under PMAY -G -Total 25,955 houses in 2017 - 18 (1371 houses in Bihar & 24584 in Jharkhand) .

## National Leprosy Eradication Programme (NLEP)

- A well laid out Operational strategy for Active Case Detection a nd Regular Surveillance has been put in place, both in rural and urban areas, through ASHAs and Frontline Worker order to ensure detection of leprosy cases on regular basis and at an early stage in prevent grade II disabilities.
- Leprosy scree ning has been integrated with Rashtriya Bal Swasthya Karyakram (RBSK) and Rashtriya Kishore Swasthya Karyakram (RKSK) for screening of children (0 - 18 years)
- Leprosy screening has been integrated with the activities of Comprehensive Primary He Care  und er  Ayushman  Bharat -Health  and  Wellness  Centre (AB - HWC)  for  screening  of people above 30 years of age.
- Contact tracing is done and Post Exposure Prophylaxis (PEP) is administered to the el contacts  of  Index  case  (Person  diagnosed  with  leprosy)  in  or der  to  interrupt  the  chain  of transmission at the community level.
- Various  services  are  being  provided  under  the  programme  for  Disability  Prevention Medical  Rehabilitation  (DPMR)  i.e.,  reaction  management,  provision  of  Microcellul Rubber (MCR) footwear, Aids & Appliances, self -care kits etc.
- Reconstructive  Surgeries  (RCS)  are  conducted  at  District  Hospitals/Medical  Colleg Central  Leprosy  Institutes,  and  welfare  allowance  @  Rs  8000  is  paid  to  each  pat undergoing RCS.

Progress made in the l ast five years is as under: -

| Financial Year   |   No. of districts with prevalence less than 1 |
|------------------|------------------------------------------------|
| 2016- 17         |                                            554 |
| 2017- 18         |                                            572 |
| 2018- 19         |                                            588 |
| 2019- 20         |                                            610 |
| 2020- 21         |                                            662 |

Other indicators showing consistent improvement in leprosy cases has been tabulated below -

| Year     |   Preval ence Rate |   Percentage of Child Cases |   Grade 2 Disability Per million |   Annual New Case Detection Rate/ 100,000 |
|----------|--------------------|-----------------------------|----------------------------------|-------------------------------------------|
| 2014- 15 |               0.69 |                        9.04 |                             4.48 |                                      9.73 |
| 2015- 16 |               0.66 |                        8.94 |                             4.46 |                                      9.71 |
| 2016- 17 |               0.66 |                        8.69 |                             3.89 |                                     10.17 |
| 2017- 18 |               0.67 |                        8.15 |                             3.34 |                                      9.27 |
| 2018- 19 |               0.62 |                        7.67 |                             2.65 |                                      8.69 |
| 2019- 20 |               0.57 |                        6.87 |                             1.96 |                                      8.13 |
| 2020- 21 |               0.41 |                        5.76 |                             1.14 |                                      4.58 |

## National TB Elimination programme (NTEP)

The key focus areas are:

- Early  diagnosis  of  all  the  TB  patients,  prompt  treatment  with  quality  assured  drug treatment regimens along with 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 vulnerable population
- Airborne infection control.
- Multi - sectoral response for addressing social determinants. The  Government  has  targeted  to  end  TB  by  2025,  5  years  ahead  of  the  global  targets Sustainable Development Goals (SDGs) of 2030. The SDG targets with regard to TB are:
-     80% reduction in incidence and
-     90% reduction in mortality (base line 2015).

Details of funds allocated to States and UTs during the last three Financial Years fro -19  to  2020 - 2021  in  respect  of  NLEP  is  at Annexure - I ,  NVBDCP  is  at Annexure - II and NTEP is at Annexure - III .

(d): Health  and  hospitals  being  a  State  subject,  all  the  programmes  are  implemented  by respective  States/UTs.  Government  of  India,  under  these  programmes,  provides  guidelin technical  guidance,  and  financial  support  to  the  State s/UTs  as  per  the  approved  annual Programme  Implementation  Plan  (PIP).  States/UTs  involve  local  administration  i.e.,  Dis Collectors, PRI members, block level officials etc. in these programmes as per the need programme.  A  few  States  also  involve NGOs  occasionally  in  these  programmes  if  there  are specific  requirements  or  special  challenges  under  the  programme  which  cannot  be  addres solely through Government intervention.

Annexure - I

## State/UT wise Allocation of funds under National Leprosy Eradication Programme ( NLEP

)

( Rs in lakhs)

| Sl. No.   | State/UT                  | 2018-2019   | 2019-2020   | 2020-2021   |
|-----------|---------------------------|-------------|-------------|-------------|
| 1         | Andhra Pradesh            | 167.00      | 189.00      | 160.00      |
| 2         | Telangana                 | 132.00      | 104.00      | 132.00      |
| 3         | Arunachal Pradesh         | 52.00       | 32.00       | 95.00       |
| 4         | Assam                     | 97.00       | 115.00      | 120.00      |
| 5         | Bihar                     | 263.00      | 285.00      | 263.00      |
| 6         | Chhattisgarh              | 153.00      | 232.00      | 153.00      |
| 7         | Goa                       | 5.00        | 3.00        | 5.00        |
| 8         | Gujarat                   | 132.00      | 104.00      | 132.00      |
| 9         | Haryana                   | 47.00       | 46.00       | 47.00       |
| 10        | Himachal Pradesh          | 26.00       | 22.00       | 26.00       |
| 11        | Jharkhand                 | 193.00      | 214.00      | 190.00      |
| 12        | Jammu & Kashmir           | 33.00       | 28.00       | 28.00       |
| 13        | Karnataka                 | 88.00       | 112.00      | 88.00       |
| 14        | Kerala                    | 25.00       | 20.00       | 25.00       |
| 15        | Madhya Pradesh            | 198.00      | 26.00       | 198.00      |
| 16        | Maharashtra               | 439.00      | 483.00      | 430.00      |
| 17        | Manipur                   | 18.00       | 13.00       | 20.00       |
| 18        | Meghalaya                 | 31.00       | 19.00       | 35.00       |
| 19        | Mizoram                   | 26.00       | 19.00       | 25.00       |
| 20        | Nagaland                  | 35.00       | 78.00       | 75.00       |
| 21        | Orissa                    | 219.00      | 196.00      | 219.00      |
| 22        | Punjab                    | 66.00       | 54.00       | 66.00       |
| 23        | Rajasthan                 | 63.00       | 74.00       | 62.00       |
| 24        | Sikkim                    | 26.00       | 11.00       | 35.00       |
| 25        | Tamil Nadu                | 176.00      | 185.00      | 165.00      |
| 26        | Tripura                   | 18.00       | 16.00       | 22.00       |
| 27        | Uttar Pradesh             | 421.00      | 483.00      | 420.00      |
| 28        | Uttarakhand               | 16.00       | 25.00       | 16.00       |
| 29        | West Bengal               | 194.00      | 161.00      | 195.00      |
| 30        | Andaman & Nicobar Islands | 18.00       | 14.00       | 9.00        |
| 31        | Chandigarh                | 14.00       | 10.00       | 9.00        |
| 32        | Dadra & Nagar Haveli      | 27.00       | 52.00       |             |
| 33        | Daman & Diu               | 13.00       | 20.00       | 10.00       |
| 34        | Delhi                     | 144.00      | 87.00       | 85.00       |
| 35        | Lakshadweep               | 14.00       | 1.00        | 9.00        |
| 36        | Puducherry                | 9.00        | 5.00        | 5.00        |
| 37        | Ladakh                    | NA          | NA          | 2.00        |
| Total     | Total                     | 3598.00     | 3538.00     | 3576.00     |

## Annexure - II

## State/UTs wise Allocation of funds under National Vector Borne Disease Control Programme ( NVBDCP )

(Rupees in Lakhs)

| Sl. No.   | State/UT          |   2018-19 |   2019-20 | 2020-21   |
|-----------|-------------------|-----------|-----------|-----------|
| 1         | Andhra Pradesh    |   1075.57 |     20    | 487.81    |
| 2         | Arunachal Pradesh |    405.89 |    210.65 | 1060.02   |
| 3         | Assam             |   1591.38 |    524.35 | 4012.53   |
| 4         | Bihar             |   1086    |      6    | 4023.13   |
| 5         | Chattisgarh       |   4295.9  |   1588.93 | 941.51    |
| 6         | Goa               |     65    |     27    | 0.00      |
| 7         | Gujarat           |   1102.38 |   1220    | 0.00      |
| 8         | Haryana           |    374    |      7    | 72.00     |
| 9         | Himachal Pradesh  |    155    |      2    | 0.00      |
| 10        | J & K             |    223.3  |      6.3  | 756.46    |
| 11        | Jharkhand         |   5775.19 |   2479.64 | 1762.67   |
| 12        | Karnataka         |    376.07 |    116.38 | 106.95    |
| 13        | Kerala            |    528    |     18    | 155.00    |
| 14        | Madhya Pradesh    |   5236.58 |  14998.8  | 375.56    |
| 15        | Maharashtra       |    571.86 |     20    | 536.00    |
| 16        | Manipur           |    124.3  |    147.07 | 941.35    |
| 17        | Meghalaya         |    171.46 |    116.53 | 1919.84   |
| 18        | Mizoram           |    235.04 |    145.4  | 773.98    |
| 19        | Nagaland          |    171.18 |    139.64 | 1557.57   |
| 20        | Odisha            |    191.44 |     15.28 | 21143.35  |
| 21        | Punjab            |    213    |      7    | 1184.37   |
| 22        | Rajasthan         |   1481.33 |    540.84 | 614.11    |
| 23        | Sikkim            |     20    |      0    | 0.00      |
| 24        | Tamil Nadu        |    694    |     90    | 368.00    |
| 25        | Telangana         |   1340.45 |     13    | 90.80     |
| 26        | Tripura           |    301.74 |    775.54 | 2862.31   |
| 27        | Uttar Pradesh     |   3823.04 |   2627.92 | 3913.98   |
| 28        | Uttarakhand       |    276.33 |     35    | 118.50    |
| 29        | West Bengal       |   1135.77 |    364.35 | 1371.17   |
| 30        | Delhi             |      0    |      0    | 53.74     |
| 31        | Puducherry        |     72    |    154    | 13.05     |
| 32        | A&N Islands       |     27.3  |    182    | 169.83    |
| 33        | Chandigarh        |     53    |     30    | 23.09     |
| 34        | D & N Haveli      |    253    |     41    |           |
| 35        | Daman & Diu       |     61    |     19    | 110.00    |
| 36        | Lakshadweep       |     37    |      0    | 25.00     |
| 37        | Ladakh            |      0    |      0    | 16.00     |
|           | Total             |  33544.5  |  26688.7  | 51559.68  |

Annexure III

## State/UTs wise Allocation of funds under National TB Elimination Programme (NTEP)

( Rs. in lakhs )

| Sl. No.   | State / UT           | 2018- 19   | 2019- 20   | 2020- 21   |
|-----------|----------------------|------------|------------|------------|
| 1         | Andhra Pradesh       | 4461.00    | 4914.00    | 5079.00    |
| 2         | Andaman & Nicobar    | 202.00     | 97.00      | 187.00     |
| 3         | Arunachal Pradesh    | 1944.00    | 1215.00    | 1621.00    |
| 4         | Assam                | 5622.00    | 4293.00    | 5435.00    |
| 5         | Bihar                | 6102.00    | 7029.00    | 5562.00    |
| 6         | Chandigarh           | 348.00     | 274.00     | 479.00     |
| 7         | Chhattisgarh         | 2851.00    | 4267.00    | 4393.00    |
| 8         | D adra& N agarHaveli | 160.00     | 95.00      |            |
| 9         | Daman & Diu          | 102.00     | 67.00      | 311.00     |
| 10        | Delhi                | 3951.00    | 1955.00    | 2043.00    |
| 11        | Goa                  | 263.00     | 289.00     | 293.00     |
| 12        | Gujarat              | 6567.00    | 5765.00    | 5976.00    |
| 13        | Haryana              | 2454.00    | 3976.00    | 4049.00    |
| 14        | Himachal Pradesh     | 1675.00    | 1496.00    | 1511.00    |
| 15        | Jammu & Kashmir      | 2125.00    | 2852.00    | 2182.00    |
| 16        | Jharkhand            | 3115.00    | 2934.00    | 3052.00    |
| 17        | Karnataka            | 6454.00    | 6148.00    | 6356.00    |
| 18        | Kerala               | 2850.00    | 3678.00    | 3785.00    |
| 19        | Ladakh               |            |            | 402.00     |
| 20        | Lakshadweep          | 84.00      | 17.00      | 20.00      |
| 21        | Madhya Pradesh       | 5920.00    | 7265.00    | 7515.00    |
| 22        | Maharashtra          | 16313.00   | 11427.00   | 11810.00   |
| 23        | Manipur              | 1583.00    | 1090.00    | 2508.00    |
| 24        | Meghalaya            | 1235.00    | 966.00     | 1025.00    |
| 25        | Mizoram              | 1427.00    | 1168.00    | 1286.00    |
| 26        | Nagaland             | 1409.00    | 937.00     | 1735.00    |
| 27        | Orissa               | 4042.00    | 4623.00    | 4761.00    |
| 28        | Puducherry           | 300.00     | 308.00     | 288.00     |
| 29        | Punjab               | 2584.00    | 3673.00    | 3758.00    |
| 30        | Rajasthan            | 5602.00    | 4904.00    | 4092.00    |
| 31        | Sikkim               | 759.00     | 685.00     | 855.00     |
| 32        | Tamilnadu            | 6737.00    | 8766.00    | 8997.00    |
| 33        | Tripura              | 962.00     | 900.00     | 1032.00    |
| 34        | Uttar Pradesh        | 15007.00   | 14207.00   | 12288.00   |
| 35        | Utt arakhand         | 1329.00    | 1999.00    | 2024.00    |
| 36        | West Bengal          | 6522.00    | 8211.00    | 8128.00    |
| 37        | Telangana            | 3372.00    | 4634.00    | 4741.00    |
|           | Total                | 126433.00  | 127124.00  | 129579.00  |