August 2016

National Leprosy Eradication Programme

Revised Operational Guidelines for

LEPROSY CASE
DETECTION
CAMPAIGN
August 2016

Central Leprosy Division

Directorate General of Health Services
Ministry of Health and Family
Welfare Government of India
TABLE OF CONTENTS

Foreword v
Message vii
Preface ix

Chapt
er Contents
No.
1 The epidemiology of leprosy 1-2
2 Background 3-7
3 Leprosy Case Detection Campaign (LCDC) –
Institutional framework 8-9
4 Leprosy Case Detection Campaign (LCDC) –
Planning & Implementation 10-12
5 Leprosy Case Detection Campaign (LCDC) –
Micro-planning 13-22
6 Other key components of planning and
implementation 23-28

Annexure I -Schedule for LCDCs activity at various level

Annexure II –
Instructions for supervisors’ and search teams’ training
Annexure III –
Instructions for Teams
Annexure IV –
Other important tips for Accredited Social Health Activists (ASHA)
and Field Level Workers (FLW)
Annexure V – Instructions for supervisors
Annexure VI – Frequently Asked Questions and answers
Annexure VII – Manpower planning form
Annexure VIII– Logistics & transport planning form
Annexure IX – Template for house-to-house case search planning form
Annexure X – Suggested checklist for preparing / reviewing microplans
Annexure XI – Supervisor’s checklist for supervising search team’s
activity Annexure XII – Tally sheet for house-to-house case search
activity Annexure XIII – Daily supervisor’s reporting format
Annexure XIV – Daily block reporting format
Annexure XV – Daily district reporting format
Annexure XVI – Consolidated district
reporting Annexure XVII – Consolidated state
reporting format
Annexure XVIII – Template for identifying supervisors & teams areas within
blocks requiring interventions
Annexure XIX – Day-wise IEC Activity Plan for LCDC
Annexure XX – Referral slip format
Annexure XXI – Instructions for using different formats during LCDC

Abbreviations

iii
 Dr. Jagdish Prasad Hkkjr ljdkj
M.S. M.Ch., LokLe; yoa ifjokj dY;k.k ea=kky;
FIACS LokLe; lsok egkfuns'kky;
Director General of Health fuekZ.k Hkou] ubZ fnYyh–110 108
Services
GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY
WELFARE
DIRECTORATE GENERAL OF HEALTH SERVICES
NIRMAN BHAWAN, NEW DELHI - 110 108
Tel.: 23061063, 23061438(O),
23061924 (F)
E-mail: [email protected]

fnukad@Dated 2 8 /1 /1 6
...... .. ... . ... . .. .......
....

FOREWORD

The National Leprosy Eradication Programme (NLEP) was started in the year 1983
with the objective of achieving eradication of the disease from the country. Though
the Elimination of Leprosy at National level has been achieved by India, in the
month of December 2005, it is still home to around 57% of the worlds' leprosy-
affected persons. The trend of two important indicators of program i.e. Annual
New Case Detection Rate (ANCDR) and Prevalence Rate (PR) and the percentage of
grade II disability amongst new cases detected indicate that the cases are being
detected Late in the community and there may be several cases which are lying
undetected or hidden. The decision of Government of India to launch the Leprosy
Case Detection Campaign is a unique initiative under NLEP to detect cases of
leprosy early in the community. It is a committed move to strengthen the services &
facilities to leprosy affected persons in India.

Early case detection and treatment is the key to achieve elimination as detection of
leprosy cases early in the community will lead to depletion of source of infection in
the community and so interrupt the transmission of the disease. The house-to-house
visits by the team of one ASHA and male volunteer will help in increasing our
capacity to detect most of the leprosy cases at the community level.

I am sure that the Revised Operational Guidelines prepared by various stakeholder

of the programme i.e., Central Leprosy Institutes, State Leprosy Officers of high
endemic States, WHO, ILEP representatives, will be useful in giving clear direction
to programme administrators and implementers in State and make practical use of
the same. I wish the programme for Leprosy Elimination a success.

(Dr. Jagdish Prasad)

v
 Dr. N.S. DHARMSHAKTU LokLe; lsok egkfuns'kky;
Special Director General of Health Services fuekZ.k Hkou] ubZ fnYyh–110 108
(PH)
MD (AIIMS), Cert. Sr. H. Plg. (JH), GEIS (CDC) DIRECTORATE GENERAL OF HEALTH SERVICES
Nirman Bhawan, New Delhi - 110
108 Tel.: 011-23062401, Fax: 011-
23062815
E-mail: [email protected]

fnukad@Dated 2 8 /1 /1 6
...... .. ... . ... . .. ...........

MESSAGE

As per the key facts publicized by WHO in April 2016, from 121 countries of 5
WHO regions the global registered prevalence of leprosy is 175554 cases at the end
of 2014. During the same year, 213899 new cases were reported. However, in India,
although the Elimination of Leprosy at National level has been achieved in
December, 2005, it is still home to around 57% of the worlds' leprosy-affected
persons. Under the National Leprosy Eradication Programme (NLEP), India is
giving emphasis on early detection of cases and treatment completion. However,
the percentage of grade II disability amongst new cases detected has been increased
from 3.10% (2010-2011) to 4.51% (2014-2015), which indicate that the cases are
being detected late in the community and there may be several cases which are
lying undetected or hidden. These hidden cases are the obstacles in achieving
elimination as untreated Leprosy affected person is an active reservoir in the
community which transmit the disease to susceptible.

The introduction of Leprosy Case Detection Campaign, as a paradigm shift to

detect hidden cases in high endemic districts ensuring coverage of labourers
population at construction sites, mining industries, migratory workers, slum
dwellers in the country by NLEP during 2015-2016 is highly commendable.

The Revised Operational Guidelines for Leprosy Case Detection Campign, which
is an outcome of Central Level workshop, held in CLTRI, Chengalpattu, 23rd-24th
June 2016, which was attended by State Leprosy Officers of high endemic districts,
Representatives from Leprosy Institutes, partners like ILEP, WHO etc. will
definitely guide all the Field Level Workers and Implementers to implement
quality LCDC. I would like to thank all participants of the Central level Workshop
for their technical input to the guidelines.

(Dr. N.S. Dharmshaktu)

vii
MkW. vfuy dqekj LokLe; lsok egkfuns'kky;
DR. ANIL KUMAR ¼LokLe; yoa ifjokj dY;k.k ea=kky;½
mi egkfuns'kd ¼dq"B½ Hkkjr ljdkj
Deputy Director General fuekZ.k Hkou] ubZ fnYyh–110 108
(Leprosy) DIRECTORATE GENERAL OF HEALTH SERVICES
(Ministry of Health & Family Welfare)
Government of India
Nirman Bhawan, New Delhi - 110
108 Tel.: 91-11-23062653 Fax: 91-11-
2306 1801
E-mail: [email protected]

fnukad@Dated 2 8 /1 /1 6
...... .. ... . ... . .. .......
....

PREFACE

Leprosy Case Detection Campaigns (LCDC) is the need of the programme to detect
the hidden cases in the community. It is a unique initiative of its kind under NLEP,
which will be implemented in high endemic districts of the country, in line with
Pulse polio Campaign. The "Revised Operational Guidelines for Leprosy Case
Detection Campaign" is the result of constructive feedback received by various
stakeholders of the programme, after successful implemention of first LCDC,
March 2016, during Central level workshop for LCDC, held in Central Leprosy
Training and Research Institute (CLTRI), Chengalpattu on 23rd - 24th June, 2016.

These guidelines will help all the programme officers at all levels, in understanding
their role to implement the LCDC. It wil give the directions for systematic
implementation of the activities pertaining to LCDC i.e. planning, coordination,
implementation, monitoring and review.

I hope this "Revised Operational Guidelines will be helpful in smooth

implementation of LCDC. I would like to acknowledge all the experts who helped
in bringing out these guidelines.

I would also like to acknowledge the support of Central Leprosy Training and
Research Institute (CLTRI), Chengalpattu for organizing the Central level workshop.

(Dr. Anil Kumar)

Let's Fight Leprosy & Make Leprosy a

History ffebsite: www.nlep.nic.in

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

1. THE EPIDEMIOLOGY OF LEPROSY

Agent: Leprosy is caused by Mycobacterium leprae intracellular, obligatory parasite. It is a
slow growing bacillus and one Leprosy bacillus takes 12–14 days to divide in to two. It is an
acid-fast bacillus and is stained red by a dye called carbol fuschin.

Source of infection: Untreated Leprosy affected person (Human beings) is the only known
source for M leprae.

Portal of exit: The major sites from which bacilli escape from the body of an infectious
patient is respiratory tract especially nose. Only small proportion of those suffering from Leprosy
can transmit infection.

Transmission of infection: Leprosy is transmitted from untreated Leprosy affected person to a

susceptible person through droplets, mainly via the respiratory tract.

Portal of entry: Respiratory route appears to be the most probable route of entry for the bacilli.

Incubation period: Incubation period (Duration from time of entry of the organism in
the body to appearance of first clinical sign and symptom) for Leprosy is variable from few
weeks to even 20 years. The average incubation period for the disease is said to be 5–7 years.

Host DRAFT

factors

Age: Leprosy can occur at any age but is usually seen in people between 20–30 years of age.
Increased proportion of affected children in the population indicates the presence of active
transmission of the disease in the community. As the disease burden declines, it is seen more
in older age groups.

Gender: Disease occurs in both the genders. However, males are affected more as compared to
females

Immunity: Occurrence of the disease depends on susceptibility/immunological status of

an individual.

Socio-Economic Factors: Leprosy is a disease generally associated with poverty and

related factors like overcrowding. However, it may affect persons of any socioeconomic
group.

Factors influencing susceptibility

 Age: Children are more susceptible than adults.

 Individual immunity: May be determined by certain genetic factors
which influence the susceptibility of an individual
 Climate: Leprosy is prevalent in tropical and subtropical climates.

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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Leprosy cases can be classified as under:

S.No. Characteristic PB(Pauci bacillary) MB(Multi bacillary)

1 Skin lesions 1-5 lesions with definite 6 and above with definite
loss of sensation loss of sensation
2 Peripheral nerve
No nerve/ only one nerve More than one nerve
involvement
3 Skin smear Negative at all sites Positive at any site

Table 1: Classification of Leprosy cases

Duration of treatment for leprosy cases and treatment regimen is as under:

Type of Leprosy Drugs used Criteria for RFT

MB Leprosy Rifampicin Completion of 12 monthly

pulses in 1 consecutive
Clofazimine months 8

Dapsone
PB Leprosy Rifampicin Completion of 6 monthly
Dapsone pulses in 9 consecutive
months
Table 2: Duration of treatment for leprosy cases and treatment regimen

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

2. BACKGROUND
National Leprosy Control Programme was started by Govt. of India in 1955, wherein
Dapsone domiciliary treatment was given through vertical units and survey education and
treatment activities were implemented. It was only in 1970s that a definite cure was identified
in the form of Multi Drug Therapy (MDT). MDT consisting of dapsone, clofazimine and
rifampicin was recommended as a standard treatment for leprosy by the World Health
Organization (WHO) in 1982. Following the recommendations of WHO Study Group, Geneva
(October, 1981) and Dr. M.S. Swaminathan committee (1981) the NLEP was launched in 1983
by GoI with the objective to arrest the disease activity in all the known cases of leprosy.
However coverage remained limited due to a range of organizational issues and fear of the
disease and the associated stigma. Further, in view of substantial progress achieved with MDT,
in 1991 the World Health Assembly resolved to eliminate leprosy at a global level by the year
2000. In order to strengthen the process of elimination in the country, the first World Bank
supported project was introduced in 1993.

The 1st Phase of the World Bank supported Project initiated from 1993-94 was
completed on 31.3.2000 with further 6 months extension to complete the preparation of
proposal for 2nd Phase Project. Wherein, 3.8 million leprosy cases were newly detected against
a target of 2 million cases and 4.4 million leprosy cases were cured with MDT. The prevalence
rate reduced from 24/10,000 population in 1992 before starting 1st Phase project to 3.7/10,000
by March 2001. The 2nd Phase of World Bank Project on NLEP started for a period of 3 years
from 2001-02 till 31st December 2004. This pha se was implemented with the objectives which
DRAFT

are as under:

1 Decentralization of NLEP responsibilities to States/ UTs through State/ District

Leprosy Societies.
2 Accomplish integration of leprosy services with General Health Care System (GHS) and
3 Achieve elimination of leprosy at National level by the end of the Project.

Herein, well planned activities were efficiently implemented in close association of

various NLEP partners viz. State & UTs Governments, World Bank, WHO, ILEP, DANLEP,
NGOs and Community, Pvt. Medical Practitioners and various concerned Govt.
Ministries/Departments such as Information & Broadcasting, Social Justice & Empowerment,
Education, Railways, Defence/ paramilitary, Labour and Industries etc. During the last two
years of the project a component of validation of case diagnosis was introduced.

In 2005, as the NRHM launched, the programme was subsumed under the aegis of
NRHM and being implemented as a centrally sponsored scheme, as per the defined rules. The
disease has come down to a level of elimination i.e. less than one case per 10,000 population
at the national level by December 2005.

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Map 1: Maps of India showing prevalence trend since 198 1 to 2011

D R A F T

Strategies for XII Five Year Plan (FYP)

Leprosy is a chronic disease with a long incubation period (average 5-7 years).
Although the disease has been eliminated at the National Level, there are Districts & Blocks
which are still having prevalence rate >1/10,000 population. Besides this the new cases would
continue to occur for few more years on account of long incubation period of the disease.
Therefore, creating awareness for self reporting, timely diagnosis and complete MDT
treatment of leprosy cases is crucial for ultimate eradication of the disease. Another aspect of
the programme is gender imbalance as seen in new cases detection. Since the programme aims
for eradication i.e. zero case of leprosy as the ultimate goal, sustained control measures need to
continue during the 12th plan period.

Results (Objectives) to be achieved during 12th plan period i.e. 2012-2017 are as follow:
 Improved early case detection
 Improved case management
 Stigma reduced
 Development of leprosy expertise sustained
 Research supported evidence based programme practices
 Monitoring supervision and evaluation system improved
 Increased participation of persons affected by leprosy in society
 Programme management ensured

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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

The programme components approved under XII FYP are as follows –

Flow chart 1: Programme components under XII FYP

Epidemiological Situation, as on March, 2016:

 Elimination at State level achieved in 34 States/UTs out of total 36 States/UTs.
 Chhattisgarh State and UT Dadra & Nagar Haveli yet to achieve elimination.
 Four states namely Delhi, Lakshadweep, Chandigarh and Orissa who have achieved
elimination earlier, shown PR >1/ 10000 population.
DRAFT

 Approx. 127326 new leprosy cases detected.

 86028 cases are on record as on 31st March 2016.

Further, the trend of Prevalence and Annual New Case Detection Rate per 10,000 population
since 2001-02 to 2015-16 is shown in the Graph below:

Graph 1: Trend of Prevalence and Annual New Case Detection Rate per 10,000 population,
2001-02 to 2015-16 (provisional)

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

It has been observed that trend of two important indicators of National Leprosy
Eradication Program, India i.e. Annual New Case Detection Rate (ANCDR) and Prevalence
Rate (PR) are almost static since 2006 – 2007.

In addition, the percentage of grade II disability amongst new cases detected has been
increased from 3.10% (2010 - 2011) to 4.61% (2014 - 2015), which indicates that the cases are
being detected late in the community and there may be several cases which are lying
undetected or hidden. The trend of Gr II disability cases amongst new leprosy cases from 2005-
06 to 2015-16 is depicted in the graph below.

DRAFT

Graph 2: The trend of number of Gr. II disabled cases and % of Gr. II disabled cases i.r.o new leprosy
from 2005-06 to 2015-16 (provisional)

Inter-alia, the report of Midterm Evaluation of the National Leprosy Eradication

Programme, India 10 – 21 November, DGHS, MoHFW and WHO joint initiative stated that “It
is clear that there are cases occurring in the community and detection capacity is not exactly
matching the level and intensity of disease occurrence.” (Para no.2, page no.41) It was also
mentioned that “There is presumptive and scientific evidence that the number of cases
detected is less than the number that occur. The exact magnitude of the gap cannot however
be known” and recommended that “Periodic active case detection campaigns should be
undertaken in priority areas with focus on detection of backlog cases as well as new cases.
(Para no.2, page no.70)

As per the epidemiology of Leprosy disease, the major source of infection in the
community is an untreated case i.e., a hidden case of leprosy lying undetected in the
community, who transmit the disease agent to other people of the community. Early
Detection

6
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

of same will lead to depletion of source of infection in the community, interrupt the active
transmission of disease, reduce the complication of case management and reduce the
disability. Hence, in order to detect the hidden leprosy cases, Leprosy Case Detection
Campaigns (LCDC), on line with Pulse polio Campaign has been introduced specifically for
high endemic districts, by Central Leprosy Division.

The LCDC as a flagship activity of NLEP is unique in its approach as various

committees are formed at each level i.e., National, State, District, Block to plan & implement
the LCDC. Intensive IEC activities, through various media are conducted during and before
the LCDC. Under this Focused training of all health functionaries from District to Village level
being given. The teams herein are being trained to suspect the leprosy patients through
physical examination of each and every person of house visited. House to house visits by team
encompassing one Accredited Social Health Activist (ASHA) and male volunteer i.e. Field
Level Worker (FLW), conducted during LCDC days as per micro-plans prepared for local
areas. Supervision of house to house search activities are done through identified field
supervisors. Central Monitors nominated by Central Leprosy Division are directly monitoring
the activities. Continuous, systematic collection and compilation of reports is being done
through the formats designed for this purpose which are filled by search teams and
supervisors. After the completion of the campaign the post LCDC evaluation also carried out
through independent evaluators.

DRAFT

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

3. LEPROSY CASE DETECTION CAMPAIGN (LCDC) –

INSTITUTIONAL FRAMEWOR
For better organization and management it is proposed to formulate special committees at
various levels. These committees will ensure inter-sectoral coordination between all partners
and other departments and review the progress in planning, implementation and monitoring
of LCDC. The constitution of various institutes for each level will be as under:

Central Operation Group

It comprises of officials from Government of India, ILEP, WHO and other partners at the
national level chaired by the DGHS, Government of India. The role of the Central Operations
Group is to:
 Support pre-planning and to fast track decisions on extent of LCDC.
 Coordinate activities with partner organizations like WHO, ILEP and State level
representatives Principle secretary HFW etc.
 Coordinate with other National and International organisations.
 Monitor implementation of LCDC activities at national, state and district level.

State Co-ordination Committee

State Co-ordination Committee under the chairmanship of Principal Secretary Health &
Family Welfare of the State with State Leprosy Officer as the Member Secretary, will be
formed. Other members of the committee would be Mission Director (MD), NHM, Director
DRA FT

Health Services (DHS), State level representa t ives of the key partners like Social Welfare,
Education, PRI, Partners i.e. ILEP, WHO, Association of Persons Affected with Leprosy
(APAL), Indian Medical Association (IMA), Senior Regional Director, State Program Manager,
NGOs working for Leprosy in the State. In addition two persons may be nominated by
Principal Secretary Health & Family Welfare of the State.
The role of the committee is:
 To ensure intersectoral coordination and full utilization of resources from partner
government and non government departments.
 Monitor preparedness in each district of the state.

State Leprosy Awareness Media Committee

State Leprosy Awareness Media Committee under the chairmanship of DHS/ MD (NHM)/
Director SIHFW of the State with the State Leprosy officer as the Member Secretary will be
formed. Partner organizations like ILEP, WHO, APAL, local NGOs and State Media Cell, local
Akashwani and Doordarshan Kendras will be represented in the committee through their state
level representatives. The role of the committee is to:
 Develop a media plan with timeline.
 Utilize all available resources and channels for delivering simple and clear messages to
the community, which will help to ensure success of LCDC & more acceptability and
cooperation to health teams during house to house visits.
 Monitor implementation of IEC/social mobilization activities in the states.

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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

District Coordination Committee

District Coordination Committee under the chairmanship of the District Collector/Magistrate/
Chief Executive Officer, Co-chaired by CMO/ CS/ DMO with the District Leprosy officer as
the Member Secretary will be formed. District level representatives from Zila Parishad, APAL,
Social Welfare deptt., District Publicity Department and District Health Education Officer,
District ASHA Coordinator, District Programme Manager, District Epidemiologist should be a
part of the committee. The role of the committee is to:
 Supervise, Support, Monitor and ensure Implementation of the highest quality LCDCs
in the district.
 DM and CMO should also use these meetings to clear obstacles for planning and
implementation of the LCDC.

Tehsil / Block Coordination Committee

Similar to the District Coordination Committee, Tehsil / Block Coordination Committee must be
set up under the chairmanship of Sub Divisional Magistrates (SDM) with Block Medical
Officer as co-chairman. Further, member of PRI, ICDS, Education, local NGOs, APAL, Social
Welfare deptt., ASHA facilitators/ Sahiya Saathi, Community mobilizers, Block development
officers and Block MOICs should be a part of the committee. The role of the committee is to:
 Supervise, Support, Monitor and ensure Implementation of the highest quality LCDCs
in the block.
 SDMs, BDOs and MOICs should also use these meetings to clear obstacles for planning
and implementation of the LCDC. DRAFT

 The Committee should meet at least once before the LCDC and at least once during the
activity.

LCDC control rooms shall be set up in the office of the State Leprosy Officer and
District Leprosy Officers. The role of the control rooms will be to monitor preparedness of
LCDC on a day to day basis especially mobilization of human and other resources like
transport, ensure intersectoral coordination and full utilization of resources from partner,
government and non- government departments. They should also monitor implementation of
the programme during the campaign. The control rooms should provide feedback to the
committees on progress being made and also on any obstacles being faced.

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

4. LEPROSY CASE DETECTION CAMPAIGN (LCDC) –

PLANNING & IMPLEMENTATION
In order to plan and implement in State, it is expected that meetings of all the committees must
be scheduled with clear objectives, agendas, and action points to be undertaken further. The
proceedings of meetings include progress, problems encountered, proposed solutions and new
action points with clearly defined responsibilities and deadlines. Minutes of the meetings and
action points should be shared with all the participants within 72 hours of meeting conducted.
It is the responsibility of the committees to ensure that activities are completed, adhering to
guidelines and timelines.

Meeting for LCDC planning at State level

 State Co-ordination Committee Meeting: Meeting of State Co-ordination
Committee must be held before each LCDC with the objective to channelize State
resources for successful implementation of LCDC.
 State Leprosy Awareness Media Committee Meeting: Meeting of State
Leprosy Awareness Media Committee must be held before LCDC to formulate the IEC
plan and select best suitable media approach for communication prior and during the
campaign.

Meeting for LCDC planning at District level

 District Coordination Committee Meeting: Meeting of District Co-
ordination Committee must be held before each LCDC with the objective to materialize
D RA FT

inter- sectoral coordination for LCDC implem entation and after LCDC to review the
LCDC implementation.
 District Micro planning Meeting/Urban Area Planning Meeting:
The Chief Medical Officers (CMO) / District Leprosy Officers (DLO)/ District
Leprosy Consultants and the NLEP consultants from ILEP, should facilitate these
meetings.
The meetings have to be attended by all Block/Municipal Medical Officers, urban
health planners, representatives from Social Welfare deptt., and other
organizations involved in social mobilization, along with personnel involved in
planning at the block level.
The objective of these meetings should be to sensitize the block medical officers
(BMOs) and the urban area planners on how to prepare micro plans for their areas
for the upcoming LCDCs. Special attention should be paid on developing area-
specific IEC strategies for problem pockets.

Meeting for LCDC planning at Block level

 Tehsil / Block Coordination Committee Meeting: Meeting of Block Co-
ordination Committee must be held regularly before, during and after LCDC with the
objective to materialize inter-sectoral coordination for LCDC implementation in block,
resolve issues if any regarding LCDC and plan corrective measures timely. It is the
responsibility of this committee to forward the important decision taken during the
meeting to higher level committee.

1
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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Trainings at Various level

State LCDC training workshop (More than one trainings may be conducted if
number of participants is higher. States may take decisions to conduct
training workshop at regional level.):
 Two days training workshop for District and Sub – district level officers to be
conducted, wherein SLOs, SLCs, Central Nominee and ILEP/WHO Representatives
would train DLOs, DLCs and Block/Municipal Medical Officers.
 The objective of the workshop is to sensitize the district & block level planners on the
strategy to be followed, need for preparing microplans for their areas, and sort out
issues of coordination between the implementing partners. Power point presentation
(PPT) on the need and guidelines of LCDC may be used to orient all participants in
respect of LCDC.
 The attendees may also be sensitized for the need of physical examination of each and
every person of the community to suspect the leprosy cases in the community.
Block/ Ward level training workshop:
 One day orientation training at blocks /ward level to be organized wherein, DLOs,
DLCs, Block/Municipal Medical Officers and ILEP/WHO Representative (wherever
available) would train ASHAs/ Field Level Workers (FLWs)/NGO staff/ Health
Worker Male & Female/ Health Supervisors and any other field supervisors.
 The objective of the trainings would be to build the capacity of search team members
and supervisors to conduct the house to house case search activity.
The orientation will cover the operational as w e ll as the interpersonal communication aspects
D R A F T

of the LCDC. The instruction sheet for search team, tally sheets, info kit on frequently asked
questions should be distributed and discussed during this orientation. The training session
has to be interactive and participatory with particular focus on newly inducted search team
members. Demonstration of filling up of tally sheet house marking followed by exercises for
imparting operational skills with help of Role Plays on IPC and FAQs should form an essential
component of the training sessions. Additionally, supervisors must be trained on their role
with the help of the training instruction given in the annexure and to fill the formats
pertaining to them.

State /District/ Block Review Meetings after completion of LCDC:

A review meeting should be organized at Block level after 2 days at District level after 5 days & at
State level after a week of completion of LCDC activities to review the performance of LCDC
activity based on the feedback from state, district and block level supervisors. Data analysis
from the LCDC round should also be presented at this meeting. The meeting should identify
actions to be undertaken for rectification of deficiencies in the next campaign. Timeline to
complete the confirmation process of suspects identified during LCDC has to be defined
herein.
Monitoring by State, District and Block Monitors (nominated by CLD, SLO,
DLO respectively):
The monitors for States will be nominated by Central Leprosy Division, from Central Leprosy
Institutes (CLTRI, RLTRIs), National JALMA Institute for Leprosy & Other Mycobacterial

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Diseases (NJILOMD), Regional Office for Health & Family Welfare (RoHFW), World Health
Organisation (WHO) and International Federation of Anti-Leprosy Associations (ILEP) etc.
District and Block Monitors must be nominated by State Leprosy Officers and District Leprosy
Officers respectively. The human resources working for the NLEP/ Health system of the
district where the LCDC is not planned in a particular year and representatives from ILEP,
WHO, NGOs may also be identified as district & block monitors.

These monitors should be allotted State/ Districts / Blocks/ Urban areas, which must be
meticulously visited before the LCDC for monitoring the preparedness and during the activity
to monitor the implementation of the activity. The monitors should identify any constraints
that are likely to affect the implementation of the programme and find solutions to remove
any bottlenecks. Qualitative and quantitative assessment of the LCDC activity from monitors
should be utilized for long term corrective actions like problems faced by ASHAs & FLWs
during campaign, review of microplans etc. or immediate corrective actions like repeating the
activity in an area where significant number of uncovered houses are found after completion
of activity.

The list of monitors along with the districts / blocks/ urban areas
allotted must be shared with Central Leprosy Division.

Role of monitors during preparatory

phase:
State Monitors:
DRAFT

 Attend State level workshops and meetings.

 Conduct visits to few of the districts selected for LCDC to assess preparedness.
 Report findings to DDG Leprosy.
District Monitors:
 Attend District Coordination Committee meetings.
 Conduct visits to few of the blocks for LCDC to assess preparedness and if microplanning is being
followed or not.
 Report findings to SLO.
Block Monitors:
 Attend Block Coordination Committee meetings.
 Review the micro plans to ensure
that: All components are present.
All geographical areas have been included.
Team composition is appropriate – all house-to-house teams have at least one ASHA and at least one
male Volunteer.
Sensitization trainings to detect the cases have been planned for all ASHAs and Volunteers.
Workload of teams in terms of houses to be covered/ day has been rationalized.
Areas requiring special attention have been identified and plans developed to cover them.
IEC/ Social Mobilization plans have been developed and documented.

Role of monitors during implementation phase:

 All officers should again visit their allotted States/ districts / blocks/ urban areas as applicable during
the implementation phase to assess the quality through the completeness of coverage of population/
area during house to house visit.
 Assess the quality through collection of information on missed areas, false (L) covered houses and
false X to L conversion conducting field visits. Facilitate immediate corrective action at all levels.

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5. LEPROSY CASE DETECTION CAMPAIGN (LCDC) – MICRO

PLANNING

Successful implementation of Leprosy Case Detection Campaign (LCDC) requires meticulous

microplanning. Important components of microplan are as under:
 Campaign specific IEC
 House-to-house case search activity

Information Education Communication (IEC) and Social Mobilization:

Effective communication is vital to ensure that all cases are detected during LCDC. This requires
a planned, intensive approach through interpersonal communication, community
mobilization, advocacy, and visibility of the programme through IEC activities. Each state and
district should aim to meet two broad objectives:
 Create community and family awareness & acceptance of the LCDC during house-to-
house activities so that no cases are missed.
 Coordination with GOI, State governments, district administrations, ILEP/ WHO,
NGOs, Panchayati Raj Institutions, Education department, Information and
Broadcasting department, ICDS, key religious institutions and others to expand the
reach and impact of the programme.

Activities to be undertaken for campaign specific IEC:

It is essential that adequate social mobilization measures and awareness at mass level are
undertaken prior to the LCDCs so that commu n ity is fully informed about the i) Dates of
D R A F T

field visits, to be undertaken by ASHAs and Volunteers in an area, ii) The need & benefits of
this campaign for Leprosy patients and community which should be reminded during the
campaign also. Considering before-mentioned necessities, following instructions to be
pursued:
 There must be publicity of LCDC for 5 days.
 2 days prior to starting the activity and for 3 days after starting the house to house case
search.
 Emphasis on need based planning may be given to address the local need for awareness
e.g. leaflets/pamphlets may be suitable for literate targets while folk play, miking,
drum beating will be effective for rural areas.
 The day wise IEC activity plan for LCDC is shared at annexure XIX.

Key Strategies:
 Focus on interpersonal communication (IPC) for raising awareness in urban slums and
rural areas supplemented by mass media & print material.
 Mobilization of the Panchayati Raj Institutions system to support leprosy elimination,
including calling of Gram Sabha to plan and ensure population screening for case
detection.
 High-risk area approach for programme planning, monitoring, training and social
mobilization in selected areas/ districts.

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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 Special messages & use of different channels of communication for hard to reach
groups and urban areas.
 Consistency in the message should be maintained.

Messages:
The following key messages must be delivered through pamphlets, big hoardings and
paintings and through interpersonal communication also in the language understood locally:
 If you have a light color patch, redness, loss of sensation, swelling or nodule over the
skin, it may be leprosy.
 Leprosy, like any other disease, can happen to anyone however it is completely curable.
 Disability caused by leprosy can be prevented if reported and treated early.
 Treatment of leprosy i.e. Multi Drug Therapy is available free of cost.

Message can be framed or edited as per the

circumstances and availability of resources.

Preparation and Distribution of IEC materials:

State-Level Activities: The State IEC Bureau must coordinate with partners to ensure timely
production and distribution of audio cassettes for miking in districts/blocks, Poster and banner,
Local Press-Advertisement and announcements/messages in local programs and cable
channels. Mobilize local cable-operators and cinema theatres in urban/peri-urban areas to
screen leprosy messages in the local cable-TV n e twork and cinema theatres.
D R A F T

IEC/Social Mobilization Microplans: At least 15 days in advance of the LCDCs, a block

level microplan will be finalized. The microplan will especially include the following:
 Listing of high-risk pockets and outreach areas requiring special efforts.
 Detailed route-charts/schedules for miking activities, prioritizing high-risk pockets.
 Listing of influencers such as community/religious leaders, gram pradhans, and
medical practitioners.
 Miking to be carried out by slow-moving vehicles such as cycle-rickshaws/cycles and
not from fast moving vehicles. Miking must be conducted in villages prior to the arrival
of a LCDC search team. Miking vehicles/drum-beaters must follow the route-charts.
Fixed-post miking in mosques/temples to be mobilized for making live
announcements at least thrice a day, on all 5 days. Conduct mobilization meetings with
local influencers such as community/ religious leaders, gram pradhans and panchayat
members (especially women panchayat members), and local medical practitioners.
School children should also be mobilized to encourage families and neighbours for
acceptability of LCDCs.

Mobilize local cable-operators and cinema theatres in

urban/peri-urban areas to screen leprosy messages in the local
cable-TV network and cinema theatres

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Essential steps for increasing community participation:

The LCDC, to be successful in detecting maximum number of cases, needs to be
supported by:
 Information, Education and Communication (IEC) over the mass media.
 Well planned local miking/drum beating on slow moving vehicles and from
fixed sites starting 2 days prior to the campaign and continued during
campaign.
 Interpersonal messages from the ASHAs/Health workers prior to the LCDC
round.
 Community participation in the selection of the dates to organize the house to
house search.
 Increased acceptance by the local level by involving all sectors (Health, ICDS,
Education, Panchayati raj institutions, local NGOs).
 Launching of LCDC by local influencers or community leaders.

General Principles to prepare Microplans for house to house case search:

 A micro plan would exist at many places. As far as possible review and make
improvements in the existing microplans rather than start to make new plans.
 The existing microplans used in the LCDCs should be reviewed along with the data
generated in the recent LCDCs and feedback from monitors, central and state
observers, medical officers, district an d block level supervisors, to make suitable
D R A F T

amendments in the microplans.

 Delegation of planning responsibility to the appropriate administrative level e.g., block
or PHC or urban area where the activities will take place. Each block/PHC/urban area
should be taken as the basic unit for microplanning. It should be further sub divided
into supervisor’s areas and these into LCDC team areas.
 Microplans should be developed and reviewed with the volunteers, ASHAs,
supervisors, block medical officer, community mobilizers, other field volunteers/ local
influencer (if available) and block medical officer (BMO) sitting together.
 Block medical officers and supervisors should be responsible for planning of LCDC
activities for their areas.
 All habitations and all houses in block/urban area jurisdictions should be included in
the microplans. Microplans must target whole population.
 The national guidelines regarding number of houses/ team/day, logistics and IEC etc
as per financial guidelines, should be considered and adapted to local needs. The
adapted plans should be communicated to the higher levels.
 Plans should be based on local conditions, accessibility, geography, population
movements, working hours (when are people available at home?) culture, etc. in the
catchment area.
 Meetings should be held with village pradhans (councilors in urban areas), sarpanches
and other local influencers to get their inputs on the local conditions while developing
or reviewing the microplans.

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 Micro plans should be prepared in local language so that volunteers, ASHAs,

supervisors, local influencers and other team members of LCDCs can follow them
easily.
 LCDCs activities can only be of high quality if microplans are based on local
capabilities and constraints

While planning for rural areas, ensure the following in the micro plan:
 All hamlets (tolas/ purwas) adjoining the village are documented and covered
during the activity.
 All residential schools are covered.
 Brick kilns are covered by h-t-h team or special mobile teams.
 Names of prominent local influencers like pradhans, panchayat members, local
doctors, teachers, religious leaders, anganwadi workers etc. are incorporated.
For urban areas ensure that:
 All peri-urban areas, slums, pavement dwellers, construction sites and new
settlements are covered in the micro plans.
 Households on upper floors are accounted for while estimating no. of houses to
be covered by teams.
 The names of local resident welfare organizations, community leaders etc. are
included in the microplans.

Use of Data for Planning DRAFT

Actions:
It is essential to use the existing data for identifying actions required to plan and implement
LCDC in the area. Existing micro plan of the area can provide data on: -
 Total houses along with population residing in the area.
 Name of villages and their hamlets/ Name of all urban mohallas/ localities. If these
lists are not available they should be developed with inputs from census data, revenue
records, local municipal bodies, elected representatives etc.
 List of high risk and underserved areas.
 List of areas missed in the previous LCDCs.
 Feedback from monitors and supervisors regarding past LCDC.
 Data derived from analysis of tally sheets and reporting formats.
 List of available volunteers/ ASHAs team members and supervisors with department
wise break up.
 Map of the block.

Micro Planning for High Risk Areas and Underserved Population:

It has been observed that the same population groups are often missed by the routine
programme activities. All these groups must be identified and such areas must be
enlisted in the micro plans. These areas should be considered as high risk and the
population as underserved.

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Indicators for High-risk areas i.e. area prone to extremely flooding for six months or
more per year, naxalite affected areas, hard to reach due to geographical location etc. and
underserved population include the following:
 A confirmed leprosy case has occurred in the recent past.
 Problems in terms of non-cooperation from community during case search/ campaign.
 Low routine case detection coverage.
 Urban slums or peri urban areas not recognized by district authorities.
 Remote, sparse and difficult to reach population groups like nomadic tribes, boat
people, and isolated families living along riverbanks for farming, river islands etc.
 Mobile population and tribes
 People with working hours that do not coincide with the visit of teams (for example
persons going to the fields during harvesting and sowing seasons are simply missed
because teams do not reach either before they leave or after they come back from the
fields).
 People living at construction sites, brick kilns
 Travelers, who may be on the road or in the train when the campaign takes place.
 People living in houses outside recognized settlements (the “no man’s land”).
 People that have lost their faith in the health programme, because of low quality of
services provided, lack of explanation, and/or rude behavior of health functionaries in
the past.
 People of specific socio economic status, which require ‘special’ efforts to reach.
Persons with high socio economic status may d i sagree with case detection campaign,
D R A F T

because they assume that leprosy cannot occur to them. Whereas, People of low socio
economic status may distrust anything offered for free and request other services.
 Misinformed groups, who may refuse examination because of wrong beliefs or stigma
attached to the Leprosy. They do not oppose examination because of religious reasons,
but because of lack of proper information through the proper channels.

Special efforts for high risk areas and underserved populations:

The States and districts will need to take special measures to ensure that all people are
examined in these high-risk pockets. The special measures for high-risk areas include the
following (these are in addition to what is already being done for other areas):
 Intensive efforts for social mobilization and IEC need to be undertaken in these areas,
such as:
Intensive miking, house-to-house visits by health workers to involve community
leaders, panchayat members particularly the women members, religious leaders and
other local influencers like medical practitioners, local moneylenders, grocery shop
owners, popular teachers, prominent youth etc. to provide proactive support.
 Local community members/influencers must accompany search teams during house-
to-house visits in such areas, especially during revisit to X houses.
 Deployment of reliable trained and motivated manpower in such areas – best workers
for worst areas.
 Workload of house-to-house search teams should be rationalized to give a feasible
workload to each team.

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 The search teams should undertake house-to-house visits when all persons are most
likely to be available at their homes. This may require changing hours of operational
activities to early mornings or late evenings.
 More intense supervision in the area with supervisors being allotted less number of
house-to-house search teams.
 Increased supervision in these areas by state and district officials who should make
frequent visits both during planning and implementation phase.
 Designate a person in each district to be responsible for these underserved population
groups/areas.
 Intensive monitoring of such areas by best supervisors to get accurate feedback.
 In some tribal areas residential schools are run same must be included in microplan.

LCDC in misinformed groups:

 Search teams working in these areas should be specifically selected and specially
trained to search for all hidden cases, in each household, convince them and then carry
out examination activities.
 Each house-to-house search team in such areas must have at least one male
member/volunteer and ASHA from the community where they are working.
 Teams in such areas should be assigned no more than 10-15 houses per day. This
would allow the teams to spend more time in each house.
 Local community members/influencers must accompany search teams in such areas to
convince reluctant community.
 Teams should also carry appeals community/religious leaders to convince
f r o m reluctant people/ community.
D R A F T

 During house-to-house campaign in these areas the male volunteer in the team should
take the lead in seeking permission from head of the family before entering the house.
 After introducing themselves and explaining the purpose of their visit members of
search team should determine the number of households in each house (as defined by
the number of kitchens in the house) and then determine the number of inhabitants in
each household by asking all relevant questions.
 Additionally members should also cross verify the number of people living in the
house from neighbours, local influencers accompanying the teams, people in the street
etc.
 If any family member raises queries regarding leprosy, team member must respond in
a respectful and courteous manner to clarify their doubts or misgivings. The portion
on FAQs may be referred by the search teams.

LCDC at Brick kilns, construction sites: Brick kilns, construction sites must be
covered by house-to-house search teams. Search teams must be specially trained to carry out
search in these specific situations.
 Owners of brick kilns/construction sites must be informed well in advance about the
date and purpose of visit by search team by the district/ block officials.
 The local clerk/contractor should be contacted in advance and a list of the families
working at the kiln/sites should be prepared.
 The search team must carry this list during their visits.

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 Search teams must visit the homes of the workers at these sites and also surrounding
brick fields (Pather/Pasar) where the families are making bricks. These may be situated
at a distance of about 1-2 kilometres from the brick kiln.
 The teams should examine all persons at these sites and should counter check from the
list to ensure that all families are covered and all persons are examined.
 Since families frequently migrate to these sites, brick kilns and construction sites should
be visited twice during each LCDC to ensure that all new arrivals have also been
examined.

Micro planning for urban areas (DLOs may identify areas where chances of
existence of leprosy cases are negligible and may exclude those areas for
LCDC):
Planning for urban areas is crucial for successful implementation of LCDCs. Some of the
commonly observed deficiencies in urban areas are:
 Lack of adequate health infrastructure and manpower
 Large slums (unauthorized)
 Periurban areas with new settlements and some areas/colonies not recognized by
municipal health authorities
 Multiple construction sites
For planning and implementation purposes, urban areas should be divided into smaller planning
units based on municipal wards or assemblies and if this is not possible then by roads or
prominent landmarks. Each such unit should be put under the charge of a medical officer or
nodal officer. The officer should be responsible for:
 Development of microplans for house to house LCDCs.
DRAFT

 Male and female volunteers selection from same community. USHAs will replace
ASHAs in urban areas.
 Manpower deployment in the area by arranging additional manpower from non health
departments like social welfare, education and NGOs or volunteers.
 Developing a plan for IEC activities like:
Miking from fixed sites and slow moving vehicles like cycle rickshaws
Delivery of messages on the programme through the cable TV, cinema slides and
telephone
Display of banners, posters, vertical boards, hoardings in the area. A list of
prominent sites for display of these should be developed.
Meeting with community and religious leaders of the area Training
of search team
Inter-sectoral coordination with other agencies
 Supervision of LCDC activities
 Daily feedback from supervisors and immediate corrective actions during the LCDC.
 Compilation of daily reports and onward transmission to identified officer/ official.
 Involvement of local municipal bodies and their staff is essential in urban areas.
Municipal staff is familiar with the layout of the urban areas and their inputs are vital
for planning and supervision of house-to-house activities.
 Coordination with education department, social welfare, civil defence, other local
NGOs, resident welfare associations and community leaders is vital for meeting

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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

shortage of community volunteers, social mobilization and also for community

acceptance.
 Maps must be used while planning for urban areas. If maps are not available with
municipal bodies search teams and supervisors should be sent to the area before LCDC
in order to become familiar with the area and develop maps.

Area allocation and workload of teams:

Each search team would be encompassing of one female and one male volunteer i.e. Accredited
Social Health Activist (ASHA) and Field Level Worker (FLW) for a population of 1000, on an
average 200 households. Each team should be allocated clear-cut, well-demarcated areas
clearly mentioning the starting and ending points, identifiable with landmarks; for each day
of h-t-h activity. The form P3, placed at Annexure IX may be filled in duplicates during
training session only, one copy has to be retained by teams and one to be submitted to
supervisor of respective teams.

The optimal number of houses to be covered should be decided in consultation with the
concerned teams working in the area taking into account the local geographical conditions
and the time taken in travel and to revisit X houses and not be fixed by the district officials.
However as a general guideline:
 In rural areas 15-20 houses per team per day may be planned. This number may be
changed in view of local situation to allow optimal time for travel and revisits to X
houses.
 In urban areas 20-25 houses per team per day may be planned.
DRAFT

 The number of houses per day may be less in sparse/scattered population. This number
may vary from day to day depending upon the geographical situation of area planned
to be covered by the team on a particular day.

The no. of houses to be covered each day should be mentioned in the microplan. Honorarium will
be paid to team members as per norms communicated by CLD.

Activities of teams:
(a) Search and detection/diagnosis of cases affected with Leprosy during house to house
visits :
 During h-t-h activity, the form P3 already submitted by teams, should be used to visit
all houses systematically. No house should be left unvisited.
 House to house visits and revisits to ‘X’ marked houses should be undertaken at the
time when inhabitants of the area are most likely to be available at their homes.
 During house-to-house visits, teams should knock at the door and then enter each
house.
 Team should then greet the respondent politely, introduce themselves, and explain the
purpose of their visit.
 Team members should discuss the need & benefits of this campaign for Leprosy
patients and community. They should try to address the queries and myths regarding
disease and programme.

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 The next task is to determine the correct number of inhabitants of the house. To
determine correct information, the team members have to go systematically and ask all
the following questions in each house:
How many families (households) are staying in the house? Number of families is to be
determined by the number of ‘chullahs’ (kitchens).
What is the number of persons residing in each house hold?
Are all persons in the house? Determine information household wise.
Are any person (who normally live with the family) away from home for reasons like:
Gone to fields or market place or school (in case of children), Visiting friends
/relatives within the village or in other villages / cities, Gone out to their place of
work. Outside the house for any other reason.

The case definition to be followed for suspect identification in the field is “Any
person with discoloration of skin and/or thickened and/or shiny and/or oily skin and/or
nodules and/or inability to close eyes and/or ulceration in hands and/or feet and/or clawing
of fingers and/or foot drop and/or informs tingling and/or numbness in hands and/or feet
and/or loss of sensation in palms and/or soles and/or inability to feel cold or hot objects
and/or weakness in hands and/or feet for holding/ grasping objects.”

All persons above 2 years of age should be should examined. All females should be examined by
female volunteer (ASHA or any other) and males should be examined by male volunteers. The
physical examination is to be carried out in well lighted room or in compound, maintaining
privacy.
DRAFT

The teams must fill the tally sheet for house to house case activity, Form T2, same may be retained
till the end of search activity and should be submitted to health system personnel after
signature.

Before moving to the next house, team should thank the mukhiya/ head of the family and family
members as well for their cooperation and be doubly sure that all inhabitants of house have been
examined in the house and if not the details of same has been captured in under X column.

(b) Marking of houses by search teams:

All visited houses should be marked with white/coloured chalks or geru as:
i) L/date:
 All persons staying in the house have been examined in this visit. This includes
persons visiting the house when the campaign is on.
ii) X/date:
 All or some eligible inhabitants of the house were not examined for reasons like:
Persons not at home for the following reasons away to farms/ fields, place of work,
school or market places
Visiting friends or relatives
Locked house

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

EXAMPLES OF HOUSE MARKING

T - 1 L-1 T – 1 L-2 T- 1 X - 3
Date Date Date

In above mentioned examples the T represents the Team No., L and X as per the status of
examination of inhabitants residing in house, done during the visit and arrow depict the
direction of movement.

However in tally sheets, X houses must be recorded in the table with reasons for the X in the
following categories:
i. XR = refusal by family for physical examination
ii. XH = any or all members not at home but will return during search period i.e., away to
farms/ fields, place of work, school or market places, visiting friends or relatives
iii. XV = any or all members of the family is not in home and is not expected to return
before the end of the search period
iv. XL = the house is locked and is expected to remain locked for the duration of the search
period

For revisit - make record of left out houses and revisit on the next day only. If not available
revisit on next day, 7th & 14th day of LCDCs. It is instructed to finish all the planned houses by
13th day of LCDC and revisit all the X houses, mark the houses as RV – 1, RV – 2 for revisit to
the houses.
DRAFT

The XV and XL houses wherein the inhabitants are not supposed to come back within the
stipulated time period of case search activity i.e., 14 days of LCDC or if house remained locked
till the end of activity, should not be considered as ‘X’.

In areas where people are reluctant to go for physical examination and leprosy
case search is an issue, revisits to X houses should be made along with the local
influencers/community leaders who would be able to motivate the family for
better cooperation.

Flexible timings and flexible days of activity will increase the acceptability and
cooperation by the community.

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Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

6. OTHER KEY COMPONENTS OF

PLANNING AND IMPLEMENTATION

Other key components which require planning and implementation are as under:
 Supervision
 Mapping of areas
 Recording and reporting
 Review of micro plans and data analysis for planning interventions
 Use of data for planning actions

Supervision: There must be three tiers supervision during LCDC. Field level supervisor for
ASHAs, Block level supervisors are Public Health Nurses and Block Medical officers and
District level supervisors are District Leprosy officers. Engagement of Para medical worker
(PMW) and Non-Medical Supervisors (NMS) is essential in supervising this activity.

High quality supervision is vital to the success of the programme. Supervision should not
merely be inspection for fault-finding. Supervisors should be supportive and should be able
to:
 Identify problems and help to solve them.
 Support, encourage and motivate search teams in carrying out high quality LCDC
activities completely.
Supervisors must assist the BMO in reviewin g and revising micro plans
DRAFT

before the LCDC and carry out the following activities: -

 Note the details of all teams to be supervised by him/her.
 Record the itinerary of all search teams i.e., clearly identified start and end points with
landmarks for each day.
 Develop the map for supervisors.
 The names of the local influencers should also be known to supervisors.
 Visit search teams working under him/her during house to house search activities to
identify issues like last minute absenteeism of team members.

Ensure that search teams are working as per their microplan and that:
 Ensure that all logistics, needed forms etc. are distributed to teams as per plan.
 All areas and houses are visited, including isolated communities, mountainous areas,
and apartment dwellers on top floors.
 Tally sheets are marked immediately after each home visit.
 Correct marking of houses being done.
 Revisit by search teams to X marked houses is being done.
 Randomly visit a sample of the ‘L’ marked houses to check if all persons are examined.
 Visit ‘X’ marked houses of reluctant persons to convince them about the need of the
LCDC.
 For teams not performing well, conduct on the spot orientation training of ASHAs and
FLWs to suspect the cases of leprosy.

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 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 Assist medical officer in Collection, compilation and analysis of data from search teams.
 Attend evening meeting and provide feedback to Medical Officer.
 All cases suspected during the LCDC must be confirmed.

The supervisors should be familiar with the area, prepare a supervisors’ maps with assignment
of teams on map, and develop a plan for supervising teams in a systematic and planned
manner. They should use the supervisors’ formats to supervise teams in the field. Each
supervisor should visit each team at least twice during the campaign days. Supervisors must
be trained on their role with the help of the training instruction given in the annexure.
If a supervisor, during random crosschecking of areas, already visited by search team, detects 3
or more than 3 false ‘Ls’, then the search team must revisit all houses in that area.

Supervisors must pay attention to high-risk areas and go where teams

do not like to go
Mapping: Maps are useful for planning and ensuring completeness of
activities.

Planning unit Maps: Maps should be developed at each block/ PHC/ Urban area and should
indicate:
 Supervisors’ areas with demarcation
 High risk and difficult to reach areas
 Areas from where more cases and grade II disabled cases have been detected
 Population likely to be missed
 Major landmarks and roads
DRAFT

Sample Map of planning unit-PHC/urban area

Map 1: Map of planning unit-PHC/urban area

2
4
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Supervisor Maps: Every supervisor should also have a map that indicates:
 Team areas with demarcation and day wise work plan
 Villages /urban wards / mohallas/ urban slums / hamlets
 High risk areas
 Areas from where more cases and grade II disabled cases have been detected
 Population likely to be missed
 Major landmarks and roads

DRAFT

Map 2: supervisor map

Recording and Reporting:

 Templates for tally sheets are given as forms T1 to T3. A tally sheet (Form T2) should be
used for recording number of persons examined and houses visited during each day.
No other system of recording should be used.
 During h-t-h case search days record the number of houses visited and the number of
persons examined in each house.
 At the end of each day, each supervisor should go through the tally sheets of all his/her
teams, compile the information and submit a consolidated report using the reporting
form for supervisors (Form MR1).
 At the end of each day, each block/urban area should send to the District Leprosy
Officer (DLO) a report of persons examined and houses visited using form MR2.
 The district should compile the report on form MR3 and send a consolidated district
summary report to the state on form MR4.

25
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 The SLO shall consolidate the state report on form MR5 and FAX and mail it to Deputy
Director General (Leprosy), Govt. of India within 7 days of completion of
activity on email id:- [email protected]

Major sources of LCDC data:

(a) Microplans
(b) Search team’s Tally sheets
(c) Supervisors and monitors feedback

(a) Microplans: The h-t-h activity microplans provide useful information on: Number of
h-t-hteams deployed
 Workload of each h-t-h teams for each day
 Whether all villages/hamlets/urban areas are planned to be covered
including theareas found missed in the previous LCDCs
 Teams deployed to cover areas at special risk

(b)Search teams’ tally sheets: The various basic data that can be derived from the search
team’s tally sheets are as follows:
 Number of houses visited by each team during the entire LCDC activity and also
during each day of activity.
 Number of persons examined by each search team during the entire LCDC
activity andalso during each day of activity. D R A FT

 Number and percentage of ‘X’ houses g e n erated by each team

 Number and percentage of ‘X’ houses revisited by teams to examine persons.
 Number and percentage of ‘X’ houses left at the end of activity. It may be
noted that any house marked ‘X’ at the beginning may not be
considered ‘X’ if the inhabitants are not supposed to come back
within the search period i.e., 14 days of LCDC.

All the above information should be collated for each supervisor area and for the block. The
information derived should be used to identify areas for interventions as follows:
 Very low generation of ‘X’ houses in a block or supervisory area or team area
denotes that the search activity is probably not been of good quality. If the teams
work correctlythere would be some generation of Xs. Very low generation of Xs
should, therefore, lead to actions like intensive monitoring in the area and
retraining of search teams.
 High X houses left at the end of activity could be due to absence of inhabitants at
home or a weak mechanism for revisits to X houses or failure to examine people
for various other reasons like refusal to examination. Appropriate actions in the
form of strengthening mechanism to revisit X houses or improving social
mobilization efforts need to be undertaken.

(c) Supervisors feedback: The information derived from supervisor’s feedback is:
 Percent false L houses detected by supervisors
 False L house is a L marked house where search teams have claimed to have
screenedall inhabitants (excluding children <2 years of age) of the house, but
unscreened
26
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

inhabitants are found by supervisors or monitors during their visit to the house. The
data on % false L houses detected is one of the most important indicator of performance
of search teams. High false L houses in an area could be due to one or all of the
following reasons:
Problems of microplanning such as irrational workload of teams or improper
composition of teams.
Problems of training resulting in lack of understanding of how to enumerate the
total number of inhabitants of house, before marking houses as ‘L’ or lack of
motivation to do a complete job of enumerating and examining all persons in the
area.
Lack of proper supervision of search teams.

Actions to be taken following detection of high false “Ls” should be based on the
underlying reason. It should call for:
 Analyzing the workload of each team for each day to rationalize the workload by
increasing teams or redistributing workload amongst existing teams considering the
geographical difficulties.
 Re-look at the composition of teams to have teams suited to the locale; which may
mean having at least one male volunteer (preferably from the area) in teams and/ or
having a team member of the same religion as the area in which team is working and
/or having a member of the local community working as a team member.
 High false Ls due to improper training and lack of motivation should be addressed by
retraining of search team by good quality trainers, ensuring attendance during
D R AF T

trainings of all search team members who did not perform well during the recent
LCDCs and also all volunteers/ search team members who are participating in the
programme for the first time.
 Address supervision issues by retraining and motivation of the supervisors to explain
the criticality of their role.
 Other actions like reducing the number of teams for supervision and having all teams
of a supervisor working in a close geographical area (sector approach) need to be
considered for improving supervision.

Areas with operational problems in terms of Missed areas

 % teams with search team members not as indicated in microplans.
 % teams with inappropriate composition of teams i.e. team of only female or male
members.
 % teams with inadequately trained members.
 % supervisors not cross checking the work done by the teams.
 % areas with clusters of houses missed by teams.
 % teams not conducting bi-phasic activity.

Percent houses with potentially missed cases (commonly called percent missed houses) :
This indicator is derived by adding the % X houses left at the end of the activity (data from
tally sheets) and % false L houses detected by monitor (data from monitors formats).

27
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

% missed houses = % X houses left at the end of activity + % false L houses detected by
supervisors

Data on percentage of missed houses should be looked at for recent LCDCs. High percentage
of missed houses indicates the probability of number of cases having been missed. This data,
therefore, helps to identify areas where there are problems of microplanning, training and
social mobilization. It is more important to look at the data on missed houses at the block and
supervisor level to pin point the geographical areas that require specific interventions to
reduce the missed cases during LCDCs.

Confirmation of suspects:
The suspects found must be provided with a referral slip printed in duplicates (Annexure XX).
One portion of referral slip is to be retained by the teams and one to be given to suspect.
Teams are responsible for the confirmation of suspects identified in their area and to claim
incentives later on. The MO PHC of the concerned area should confirm the diagnosis of
suspect before registration of the same to provide MDT and monitoring. The visits/ camps
may be planned for confirmation of suspects by MO of PHC. If any alternative arrangements
are made same may be intimated to CLD.

DRAFT

28
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

ANNEXURE - I

SCHEDULE FOR LCDCs ACTIVITY AT VARIOUS LEVEL

Days Activities to be planned for LCDC
40 days before the campaign State Coordination Committee & State Media Awareness
Committee meets
Communicate the days of LCDCs identified by CLD
Take all the necessary actions needed to conduct a
successful LCDC in State
30 days before the campaign District Coordination Committee meets to review
preparedness and set timeline for completion of planning
activities
Review microplans for house to house case search
Identify manpower for teams
Identify requirement of other resources like transport
Review plan for IEC
Assign blocks to district officers
15 days before the campaign Review and refinement of microplans at
blocks/PHCs/urban areas
Place orders for procurement of logistics and printing of
supervisory instructions, checklists and tally sheets etc.
Finalize an d release funds to blocks/urban areas
D R A F T

Start orientation of supervisors and search team members

at block level
2 days before the campaign Start intensive IEC activities and media announcements
Display IEC materials also for social mobilization
Continue supervisory visits to areas
Leprosy Case Detection Implement house to house case search activity
Campaign (LCDC) all days of District Coordination Committee meeting, daily to review
activity activity and take corrective actions
Daily evening meetings at block/PHC to get feedback
from supervisors and plan for corrective actions during
the campaign
3 days after completion of Consolidate reports for the district and report to SLO
campaign
5 days after campaign Organize District Coordination Committee meeting to
review implementation of last LCDC and plan corrective
actions for subsequent campaigns

29
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

INSTRUCTIONS FOR SEARCH TEAMs’ ANNEXURE -

TRAINING II
Before conducting the training, make sure:
 The training sessions have been scheduled in consultation with the Block Medical Officer.
 The date and time for the training and the venue has been clearly conveyed to the team
members.
Following materials will be required for the training sessions:
 Microplan of the block/urban area to be covered with the names of the search team
members, supervisors and local influencers.
 Chalk or geru to demonstrate house marking.
 Tally sheets to demonstrate how they should be filled in.

Following should be covered in Block level training session:

 Registration: Before starting the session registration must be done to ensure all FLWs/
ASHAs are present.
 Introduction: All participants must introduce themselves to trainer who should also give
his own introduction.
 Appreciation of the role of each member in attaining achievements under the NLEP.
 Review of the current status of NLEP situation.
 The preactivity preparations including identification and interaction with local influencers.
 Explanation of House to house activities including
o How to enter the home and initiate a dialogue with the family members ensuring
cordiality
DRAFT

o Key questions to be asked in each house

o Marking of the house
o Revisits to X houses
o IPC including responding to queries from people (with help of frequently asked
questions).
o Procedure for examining a person
o Tally sheet marking

Microplan and area allocation must be reviewed by the trainer:

 Check the names of search team members attending the programme to ensure that there are
no replacements.
 If the absent FLWs/ ASHAs are more than 5 (five), this should be explicitly recorded so
that special training sessions may be held for the left out search team members.
 Trainer should assess if the search teams are aware of the area to be covered by them in
the forthcoming LCDC.
 If search team members are not aware of the area assigned to them, trainer should note
the names of such team members/teams. The area assignment should then be discussed
with these search teams after the main training session is over along with the BMO and
supervisor.

Trainer should also discuss with the teams whether:

 They are comfortable with workload in the area to be covered by them.
 They have any constraints/problems/concerns in covering their areas.

30
 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

ANNEXURE - III

INSTRUCTIONS FOR TEAMS

Leprosy Case Detection Campaign (LCDC) aims to detect hidden cases of leprosy in community.
Detection of all leprosy cases during LCDCs are essential for elimination of leprosy. No person
is safe till leprosy is eradicated. All persons (excluding children up to 2 years of age) must be
examined during all LCDCs.

Pre Activity preparations:

 The preparations of the activity should start at least one to two weeks before the
scheduled dates of LCDC.
 Local influencers must be identified in advance to provide assistance during house-to-
house case search activity.
 Community leaders/local influencers must be identified to inaugurate the campaign in
the community/ area.

Before starting the LCDC activities:

 Check all other logistics like chalk/’geru’ to mark houses, pen/pencil along with tally
sheets
 You should prepare and carry a day wise itinerary with description of the area to be
covered before starting LCDC activities.

House to House LCDC activities: DRAFT

 During h-t-h activity, no house should be left unvisited.

 Do not sit at a convenient place but visit all houses in your designated area and actively
search cases by physical examination for signs of leprosy, of all people residing in an
area.
 Enter each house. Greet the respondent politely, introduce yourself, and explain the
purpose of your visit.
 Enquire about the number of families staying in the house and the members in each
family.
 Enquire about any person who may be away from home for reasons like:
Gone to farm/fields/workplace/ school/ market/ relative’s home etc.
Visiting friends, relatives or market places and Accompanying parents to their place
of work.
If any unexamined person/ persons is not at home during the time of your visit,
record this on the ‘X’ tally sheet and plan to revisit the house in the evening or on
the following days when the person would be most likely to be available in the
house.
 Before moving to next house ensure that every person in each household has been
examined physically during this round.
 Enquire about any person visiting the house. They should also be examined.

31
 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 Exercise utmost care in exhibiting polite and courteous behaviour while interacting
with family members. Answer all queries correctly and confidently. Do not lose
patience or be impolite under any circumstances.
 Before moving to the next house thank the head of the family and family members for
their cooperation and ask them if they are sure that all persons have been examined.
 A new tally sheet should be used every day. Record information on the tally sheet for
every visited house.
 All visited houses should be marked L/date or X/date.
 All houses marked X/date should be revisited during the LCDC till all persons in the
house have been examined.
 House to house activity should stop only when you are sure that all houses have been
visited and all persons have been examined.

House marking:
Team No. - L/date: -
 All persons have been examined.
 This also includes persons visiting the house when the LCDC activity is on.

Team No. - X/date*: -

 All or some persons, are not examined for reasons like:
 Persons not at home for the following rea sons D R AF T

Away to farm, fields, workplace, school, market places etc.

Visiting friends or relatives
Refusal Locked
house

What to do if…?
Tally sheets are finished Use plain paper to record.
Chalks/ Geru not supplied Procure chalks/ geru locally.
Family members refused for their
Find out reasons for their refusal, try to convince
examination them or seek help of local community
influencers. If not successful inform supervisor.

* X marked houses should not be considered as ‘X’, if the inhabitants are not coming within LCDC
search period i.e., 14 days.

The case definition to be followed for suspect identification in the field is

“Any person with discoloration of skin and/or thickened and/or shiny
and/or oily skin and/or nodules and/or inability to close eyes and/or
ulceration in hands and/or feet and/or clawing of fingers and/or foot
drop and/or informs tingling and/or numbness in hands and/or feet
and/or loss of sensation in palms and/or soles and/or inability to feel
cold or hot objects and/or weakness in hands and/or feet for holding/
grasping objects.”

32
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

ANNEXURE - IV

OTHER IMPORTANT TIPS FOR ASHAs AND FLWs

1. Be sure and clear about the programme and its activities to be undertaken.
2. This activity is going to benefit your own people.
3. If there are in doubts and confusion – please get them clarified before start of work.
4. Conduct a group meeting with important people in your village – to explain about the
programme and seek their participation.
5. If there are questions difficult to answer – please note them and inform people that it
will be answered after consulting your Medical Officer. Document information in your
own language.
6. Do not ridicule any opinion, be polite to your villagers and respect their opinion.
7. If possible – rehearse, practice your approaches before starting the programme.
8. Make sure that people trust you and please ensure confidentiality.
9. Make sure that members in the families are examined in privacy.
10. Do not postpone the information to be provided to the Medical Officer/ MPW at the
end of the each day’s activity.
11. Remember you are a health activist and not a medical professional to make diagnosis of
leprosy, you are supposed to suspect the skin disease which includes leprosy.
12. Please keep your higher authorities info r med on any difficulty encountered during
D R A F T

the programme.
13. Do not give the verdict or any negative comment while screening/ physical
examination as this could lead to a lot of unpleasant situations – make sure the Medical
Officer confirms the suspects and give their impression.
14. Validity and reliability of your data is important – make sure the data collected is
correct – while filling the forms.
15. Be well prepared for the programme and do not hurry-up in haste.

33
 Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

ANNEXURE - V
INSTRUCTIONS FOR SUPERVISORS

Your role is critical to the success of the programme and effective supervision carried out by you
will help reaching the goal of leprosy elimination. You have to identify problems and solve
them on the spot.

General Instructions:
 You should be familiar with your area of supervision before the day of LCDC.
 You should have a plan for supervising all team areas working in your area.
 You should have maps of the area with team areas assigned on the maps.
 You must meet all teams in the morning before they start work.
 You must meet the medical officer of your area every evening to give a feedback of the
work done in your area along with the checklist and map.
 You should be constantly moving in your area on the LCDC days.

Before the LCDC:

Visit the areas to be covered by teams in the areas allotted to you and familiarize yourself with (At
least 3 days prior to activity)
 Houses in the areas.
 Search teams.
 Boundaries of your area and boundaries o f your teams.
D R A F T

Check:
Area allocation with day wise activity plan for the teams.
Team maps and prepare supervisor’s maps.
Areas where problems were encountered in last LCDC.
Analyse tally sheets and feedback of supervisors from previous LCDCs to
determine problems and problem areas.
Plan for supply of logistics to all your teams.
Mee
t:
Community leaders (formal as well as informal) from the area and arrange
volunteers to assist teams during house to house visits.
Team members to discuss the area allocation and special plans to cover problem
areas.
Supervision of house-to-house case search activity:
In the morning:
 Check that all h-t-h teams:
Have reported to their area
Have received logistics. If not, report to Block MO to arrange for same
Are clear about the area/houses that they have to visit each day
Have begun work on time

34
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

 Check at least 5 houses along with each h-t-h team to see whether they are:
Making an attempt to enter all houses.
Determining the correct number of residents of the
house. Examining all persons in each house.
Marking the house L/Date or X/date and filling the tally sheet as per the
guidelines before moving to next household.
 Check the areas already covered by each team.
Also cross check few X to L converted houses for correctness. Border
areas between the teams are covered.
Border areas with the neighbouring supervisors are covered
Fill supervisors’ tally sheet and submit to Block MO

In the afternoon and evening:

 Visit X houses/X clusters with the teams to examine the community people.
 Meet all your teams.
 Collect the tally sheets and review them for X houses/X clusters.
 Discuss any problems faced by the teams in the field and suggest solutions.
 Give feedback to teams based on random checks of ‘L’ houses.
 Plan activity for the next day with all the teams.

Reaching all hidden cases of leprosy in your area is your responsibility

DRAFT

35
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

ANNEXURE - VI

FREQUENTLY ASKED QUESTIONS AND ANSWERS

Can everyone get leprosy?

No. Have you ever seen everyone, around you, suffering from all the diseases? Are all
sneezing & having running nose? Are all suffering from diarrhea and dehydration? Similar is
the case of leprosy that everyone doesn’t suffer from leprosy. It indicates that our body
responds to different infections differently. This is individuals’ capacity to resist a disease or
infection, which is also known as immunity or resistance of the body.

What is body resistance/immunity?

Body resistance/immunity is the ability of the body to fight back the germ and prevent
causation of disease. There are cells in our blood specially created for the purpose of fighting
the infection. These cells have the capacity and power to recognize, engulf, digest and destroy
harmful germs. Because of these cells and the capacities they have, our body is resistant to
most of the harmful germs and bacteria, including the germs of leprosy.

What leads to development of disease?

When a germ enters our body, it tries to locate itself in a preferred location to nourish, enjoy
and multiply itself. If the multiplication and nourishment is not controlled it causes disease.
On the other hand, our body resists the spread of germ and aborts the further growth,
multiplication and development of disease. If the body is not able to fight the infection the
DRAFT

disease develops.

Why all of us don’t develop all the diseases?

This is the capacity of individual body and their cells to identify and recognize a particular
type of harmful bacteria. Different cells of different human beings have high or low capacity
to fight a particular disease. E.g. if a capacity to fight common cold is high in a particular
person, he’ll not suffer from common cold. On the other hand there are certain individuals,
who have low capacity to fight common cold and suffer from common cold easily.

Why everyone is not suffering from leprosy?

This depends on the individual capacity of a person to fight leprosy organisms. Through
research it has been found that 95 – 99% of our population is resistant or can fight the leprosy
micro-organisms if they enter in their body meaning thereby that 1 – 5% of the whole
population is prone to develop the disease.

Facts about leprosy

Leprosy is like any other disease caused by a germ known as Mycobacterium leprae. It affects
mainly peripheral nerves, skin and other organs of the body and if not treated adequately,
leads to disabilities & deformities.

36
Revised Operational Guidelines for Leprosy Case Detection Campaign, August 2016

Can I live with a person infected/suffering with leprosy?

Yes, because the disease is mildly infectious. However, it is mandatory that the person
affected should take the MDT regularly.

What, if I marry a person affected by leprosy /patient?

Why not? Your married life will be as normal as of any other couple. If the person is treated
with required doses of Multi Drug Therapy, (s)he is taken as cured.

Does the children of persons affected by leprosy have the risk of developing
the disease?
Leprosy is not hereditary, susceptibility depends on Body resistance/immunity.

Can a leprosy patient be treated at home?

Yes, it is better to treat him/her at home.

Whether the treatment is life long?

No, only 6 or 12 months, depends upon type of disease.

Can leprosy deformity be corrected?

Yes, the deformities can be corrected, after completion of treatment, by reconstructive surgery.

Should a leprosy patient be accepted by the society?

Why not. The disease is least infectious, curable with effective Multi Drug Therapy (MDT). An
infectious patient becomes non-infectious after three regular doses of MDT. If detected early
D RAFT

and treated completely, will not lead to development of disability or deformity.

Can persons affected by leprosy be employed?

Yes, a person affected by leprosy is not a threat to the fellow citizens/colleagues if (s)he is
taking or has completed the treatment.

Which are the centres for rehabilitation of persons affected by leprosy?

There are many centres in India, where besides vocational trainings, economic rehabilitation is
also provided

Can the leprosy treated patient with disabilities get the facilities of disabled
persons?
Yes, there are provisions, wherein the facilities are provided through Ministry of Social Justice
and Empowerment.

What are the rights of persons affected by leprosy, treated or untreated?

All should be considered as a normal citizen having the same rights.

37
 ANNEXURE - VII

LCDC MANPOWER
Manpower PLANNING
Planning form FORM Form P1

Campaign
Revised Operational Guidelines for Leprosy Case Detection
Name of District/ Block/Urban area: Round:
Name of Urba House to house case search Underserved population case search
the Area n/
Rura Estimated Team Team Supervisors Number of Team Team Supervisors
l houses in the s members required sites with s members required
area requir required floating requir required
ed population ed
and sparse
population to
be covered
by
search team
38

DRAFT

Total
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - VIII

LOGISTICS AND TRANSPORT PLANNING FORM

LCDC Logistics and Transport Planning form Form P2

Name of District/ Block/Urban area: Round:
Name Urba Logistics for Supervisors Other logistics Transport for supervision
of the n/
Area Rura Checklists L Reporting Team Chal Pen/ Armband No. of No. of Addition Specif
l sweep formats s' k/ Pencil s/ Identity Superviso Superviso al y
tally tally geru cards rs rs using vehicles type
sheet shee own required
ts transpor for
t superviso
rs
39

Total
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE – IX
TEMPLATE FOR HOUSE TO HOUSE CASE SEARCH PLANNING FORM (It must be filled by teams during training
session only in duplicates one copy retained by teams and one to be submitted to supervisors)

LCDC Template for House to House case search Planning form Form P3
Name of District/ Block/Urban area: Round:
Name of Supervisor:
Team Name of Day Day Day Day 4 Da Day Day Day 8 Da Day Da Da Day Day 14
numbe team 1 2 3 y5 6 7 y9 10 y y 13
r member 11 12
s
Description of area to
be covered
Name & Address of
first
house owner
with landmark
40

Name & Address of last

DRAFT

house owner with

landmark
No. of houses in the
area
Name of local
influencer/s
Special area planning
Timing of visit
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - X
SUGGESTED CHECKLIST FOR PREPARING / REVIEWING MICROPLANS

Checklist for Preparing / Reviewing Microplans Form P4

District / Block / Urban Area: Date: / / Round :
MICRO PLANNING CHECKLIST YES NO
Has data and feedback from past rounds been analyzed for corrective actions this round?
Brick kilns, construction sites, periurban areas, slums, recently developed townships included in microplans
High risk and hard to reach areas identified and special plans developed to cover these
Have reliable and motivated volunteers been identified and assigned areas/ search teams?
Well defined day-wise area allocation to house to house search teams with boundaries
At least one male volunteer from the local community part of each house to house team
Are ASHA workers part of search teams in their areas?
Is the daily workload distribution of house to house teams reasonable (in terms of houses and geography)
Are young and energetic volunteers deployed as a part of these search teams?
Supervisors identified and assigned for house to house search teams?
Is there an orientation plan for volunteers/ search team members and supervisors? DRAFT

MAPS
41

Map of Planning unit /block/urban area with essential information marked prepared
Supervisor’s map with day-wise demarcation of area to be covered by each team
TRANSPORT
Inventory of available and required vehicles
Firm arrangements made for the procurement/hiring of vehicles
Independent mobility / transport arranged for each supervisor
Daily vehicle movement / route chart prepared for each vehicle for supervision
SOCIAL MOBILIZATION
IEC plan through mike announcements, inter-personal communication etc.
Plans for briefing media (District and State level)
SCHEDULE
Plan for DTF / TTF / BLTF meetings
Schedule for District level officials to visit blocks to oversee preparations and monitor implementation
Work plan with time-line, activities/task, time to be completed and person responsible
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - XI

SUPERVISOR’S CHECKLIST FOR SUPERVISING SEARCH TEAM’S ACTIVITY

LCDC Supervisor’s Checklist for Supervising search team’s Activity Form T1

Name of Supervisor :
Name of District /Block / Urban Area : Round :
Note: Write Y (Yes) or N (No) in answer each question Y/N Corrective action taken(Remark)
Does the area have an IEC material (like banner) displayed prominently?
Have all team members reported to work? If no, arrange for replacement
Does the team clear on the work they are supposed to do today?
Does the team have sufficient tally sheets? If no, arrange to supply
Is the team examining all the family members (even children more than 2 years) for
the cardinal DRAFT

signs of leprosy?
Is the team marking the tally sheet correctly after each person examined?
42

Is the team marking each house correctly after each household's examination?
 ANNEXURE - XII
TALLY SHEET FOR HOUSE TO HOUSE CASE SEARCH ACTIVITY (To be filled by teams every day in order to record the
activities done during each day, all forms to be submitted to Supervisors at the end of activity with the signature)
Form T2
Name of the State: …………………………………………….. Date of visit: ……………….

Campaign
Revised Operational Guidelines for Leprosy Case Detection
Team No………………..
Name of the Supervisor: ………………………………………………………
Name of the District: ………………………………. Name of the Block: ……………………………
Name of the Village: ………………………………. Urban Area Ward No. : ………………………..
Name & Address with Land Mark of First Household:-
House Name of Total No. of House Marking Date House No. of persons Name of the Date of
43

hold the Head of no. of persons X/L (specify Converted from examined in X Person Confirmation
No. Family & persons Examined reason of X X to L (if house houses Suspected
Address in marking as per is marked X
Family codes given earlier)
below)

A. The X houses must be recorded in the table above with reasons for the X in the following categories:
i. XR = refusal by family for physical examination
ii. XH = any or all members not at home but will return during search period i.e., away to farms/ fields, place of work, school or
market places, visiting friends or relatives
iii. XV = any or all members of the family is not in home and is not expected to return before the end of the search period
iv. XL = the house is locked and is expected to remain locked for the duration of the search period

Name and signature of Team Members: 1. ………………………………………………………

2. ………………………………………………………

TALLY SHEET FOR HOUSE TO HOUSE CASE SEARCH ACTIVITY (To be filled by teams every day in order
to record
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - XIII
DAILY SUPERVISOR’S REPORTING FORMAT (TO BE FILLED BY THE SUPERVISOR AT THE END OF EACH DAY)

LC Daily Supervisor’s reporting format (to be filled by the Supervisor at the end of each day) Form
D MR1
C Name of Supervisor : Date: / / LCD
C:
S. Te Total No. of L No. of X no. of no. of 'X' no. of no. of 'X' no. of 'L' no. of Total persons Suspects
No a houses houses houses persons houses persons houses left houses unexamined examined identified
. m visited by examined in converted to examined in at the end of checked by persons (1+2+3)
no teams 'L' houses 'L' by teams 'X' houses the day supervisor examined in
. by teams by teams 'L' houses
by
supervisor
To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu Today Cumu To Cumu
da lative da lative da lative da lative da lative da lative da lative da lative da lative lative da lative
y till y till y till y till y till y till y till y till y till till y till
date date date date date date date date date date date
1A 1B 2A 2B 3A 3B 1A+2 1B+2
A+3 B+3B
A
44

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 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - XIV

DAILY BLOCK REPORTING FORMAT (TO BE FILLED BY THE BLOCK MEDICAL OFFICER AT THE END OF EACH DAY)
LC Daily Block reporting format (to be filled by the Block Medical Officer at the end of each day) Form
DC MR2
Name of Block: Date: / / LCDC
:
S. Nam Total Total houses No. of L No. of X no. of no. of 'X' no. of no. of 'X' no. of 'L' no. of Total persons Suspects
No. e of teams visited by houses houses persons houses persons houses left houses unexamined examined (1+2+3) identified
super super teams examined in converted to examined in at the end of checked by persons
visor vised 'L' houses by 'L' by teams 'X' houses by the day supervisor examined in
and teams teams 'L' houses by
no. of supervisor
each
team To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu To Cumu Today Cumul To Cumu
da lative day lative day lative day lative day lative day lative day lative day lative day lative ative da lative
y till till till till till till till till till till y till
date date date date date date date date date date date

1A 1B 2A 2B 3A 3B 1A+2 1B+2
A+3A B+3B
45

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DRAFT
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE –
XV DAILY DISTRICT REPORTING FORMAT (TO BE FILLED BY THE DISTRICT LEPROSY OFFICER AT THE END OF
EACH DAY)

LC Daily District reporting format (to be filled by the District Leprosy Officer at the end of each day) Form
D MR3
C
Name of District: Date: / / LCD
C:
S. Na To Total No. of L No. of X no. of no. of 'X' no. of no. of 'X' no. of 'L' no. of Total persons Suspects
No m tal houses houses houses persons houses persons houses left houses unexamine examined identified
. e no. visited by examined converted examined at the end checked by d persons (1+2+3)
of of teams in 'L' to 'L' by in 'X' of the day supervisor examined
Bl se houses by teams houses by in 'L'
oc arc teams teams houses by
k h supervisor
tea To Cum To Cum To Cum To Cum To Cum To Cum To Cum To Cum To Cum Toda Cum To Cum
ms da ulativ da ulativ da ulativ da ulativ da ulativ da ulativ da ulativ da ulativ da ulativ y ulativ da ulativ
y e till y e till y e till y e till y e till y e till y e till y e till y e till e till y e till
date date date date date date date date date date date
1A 1B 2A 2B 3A 3B 1A+2 1B+
A+3 2B+3
46

A B

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 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE -
XVI CONSOLIDATED STATE REPORTING FORMAT (TO BE FILLED BY THE SLO AND TO BE SEND TO CENTRAL
LEPROSY DIVISION

L Daily State reporting format (to be filled by the State Leprosy Officer and sent to Central Leprosy Division at the end of each day and share through fax Form
C 011 - 23061801 and email id [email protected] & [email protected]) MR4
D Name of State: LCD
C Date: / / C:
S. Na To Total No. of L No. of X no. of no. of 'X' no. of no. of 'X' no. of 'L' no. of Total Suspects
N me tal houses houses houses persons houses persons houses left houses unexamin persons identified
o. of no visited by examined converted examined at the end checked ed persons examined
Di . teams in 'L' to 'L' by in 'X' of the day by examined (1+2+3)
stri of houses by teams houses by supervisor in 'L'
ct se teams teams houses by
ar supervisor
ch To Cum T Cum T Cum T Cum T Cum T Cum T Cum T Cum T Cum Tod Cum To Cum
te da ulati od ulati od ulati od ulati od ulati od ulati od ulati od ulati od ulati ay ulati da ulati
a y ve ay ve ay ve ay ve ay ve ay ve ay ve ay ve ay ve ve y ve
m till till till till till till till till till till till
s date date date date date date date date date date date
1A 1B 2A 2B 3A 3B 1A+ 1B+
47

2A+ 2B+3
3A B

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Name of SLO:
Signature:
 ANNEXURE - XVII
TEMPLATE FOR IDENTIFYING SUPERVISORS & TEAMS AREAS WITHIN BLOCKS REQUIRING INTERVENTIONS

Campaign
Revised Operational Guidelines for Leprosy Case Detection
LCDC Form MR 5
Template for Identifying Supervisors & Teams areas within blocks requiring interventions

Name of Block/Urban area: LCDC:

Name of Supervisor Number of Number of % X houses % % False Any operational
houses visited person generated Remaining L houses problems
by teams examined by by teams X houses at
teams end of
activity
48
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - XVIII

TEMPLATE FOR IDENTIFYING SUPERVISORS & TEAMS AREAS WITHIN BLOCKS REQUIRING INTERVENTIONS

LCDC Form MR 6
Template for Identifying Supervisors & Teams areas within blocks requiring interventions

Name of Block/Urban area: LCDC:

Name of Supervisor Number of Number of % X % % False Any

houses visited person houses Remaining L
by teams examined by generated X houses houses operational
teams by teams at end of problems
activity

DRAFT
49
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - XIX

DAYWISE IEC ACTIVITY PLAN FOR LCDC

S.No. Mode of Communication Activities Days Remarks

1 Traditional Media Drum beating -1st,-2nd, 6th, 9th Publicity should create noise in
Wall painting -1st,-2nd the districts through drum beating
& loudspeakers before beginning
Loudspeaker announcement -1st,-2nd, 3rd ,9th
of the LCDC.

Street Play 6th

Magic shows 3rd
Puppet shows 6th
2 Electronic Media Local Cable TV -1st, -2nd, 3rd, 6th , 9th Message will run for all five days.
DRAFT

3 Other Media IPC/Advocacy meeting with -2nd, 9th Before activity, it is important to
village leaders/Panchayats know mindset of the locals and at
50

the end of the campaign; an IPC

will help us to know how far they
are influenced.

In the aforementioned table, (-) indicates days before LCDC. Hence traditional media & electronic media will run two days prior LCDC and on 3 rd, 6th and
9th day during the LCDC days. Similarly, other media will run 2 days prior to LCDC and 9th day during the LCDC days.
 Campaign
Revised Operational Guidelines for Leprosy Case Detection
ANNEXURE - XX
Referral slip format

National Leprosy Eradication National Leprosy Eradication

Programme Referral slip Programme Referral slip
Leprosy Case Detection Campaign Leprosy Case Detection Campaign

S. No. Date: S. No. Date:

Name of suspect: Name of suspect:

Age: Sex (F/M) Age: Sex (F/M)

Father’s/ Husband’s name:_ Father’s/ Husband’s name:

Address: Address:
DRAFT
51

Mobile No.: Mobile No.:

Primary Health Centre: Primary Health Centre:

Team No.: Team No.:

Name and signature of team members: Name and signature of team members:

1. 1.

2. 2.
Revised Operational Guidelines for Leprosy Case Detection
Campaign

Annexure XXI
Instructions for using different formats during LCDC
For Name of the Who is Whom to When to Remarks
m format to give give
No. prepare
P1 Manpower DLO SLO At State Block/ Urban
Planning Form level wise information
workshop to be prepared
P2 Logistic Planning DLO SLO Immediately Block/ Urban
Form after State wise information
level to be prepared
workshop
P3 Template for Search Block MO During the The formats
house to house teams has I/C, training needs to be filled
case search to Supervisor/ session in duplicates one
planning form prepare Trainers copy should be
retained by
teams and other
by supervisors.
P4 Suggested check- DLO - Before and Take corrective
list for preparing/ MO I/C during actions if
reviewing Micro- LCDC required
plan
T1 Supervisor’s Each MO I/C Every day Take corrective
Checklist for Superviso during actions if
supervising search r every LCDC required
team’s activity day supervision
T2 Tally sheet for Each MO I/C
D R A F T At the end This should be
house to house team through of each compiled
search activity every day day’s everyday by
Supervisor
activity Supervisors
MR1 Daily Supervisor’s Each MO I/C Every day Compiled at
reporting format superviso Block-level
r every
day
MR2 Daily Block MO I/C DLO Every day
reporting format
MR3 Daily District DLO SLO Every day
Reporting Format
MR4 Consolidated DLO SLO On the 5th
District Reporting day after
format completion
of LCDC
MR5 Consolidated State SLO DDG (L) On the 7th
Reporting format day after
completion
of LCDC
MR6 Template for MO I/C DLO At the end
identifying of LCDC
supervisors &
teams areas within
blocks requiring
interventions

52
Revised Operational Guidelines for Leprosy Case Detection Campaign

ABBREVIATIONS
ANCDR: Annual New Case Detection Rate
APAL: Association of Persons Affected with Leprosy
ASHA: Accredited Social Health Activist
BCC: Behavior Change Communication
BDO: Block Development Officer
BMO: Block Medical Officer
CBO: Community Based Organization
CMO: Chief Medical Officer
CLD: Central Leprosy Division
DANLEP: DANIDA assisted National Leprosy Eradication Programme
DGHS: Directorate General of Health Services
DHS: Director Health Services
DLC: District Leprosy Consultant
DLO: District Leprosy Officer
DPM: District Programme Manager
DPMR: Disability Prevention and Medical Rehabilitation
DRC: Designated Referral Centre
FLW: Field Level Worker
IEC: Information Education Communication
ILEP: International Federation of Anti-Leprosy Association
LCDC: Leprosy Case Detection Campaign
MD: Mission Director
MDT: Multi Drug Therapy
NGO: Non Government Organization DRAFT

NLEP: National Leprosy Eradication Program

NRHM: National Rural Health Mission
PHC: Primary Health Centre
PMW: Para Medical Worker
PR: Prevalence Rate
PRI: Panchayat Raj Institution
SDM: Sub Divisional Magistrate
SHS: State Health Society
SIHFW: State Institute of Health & Family Welfare
SHSRC: State Health System Resource Centre
SLO: State Leprosy Officer
SPM: State Programme Manager
SOE: Statement of Expenditure
TOT: Training of Trainers
UT: Union Territory
VHNSC: Village Health, Nutrition and Sanitation Committee
WHO: World Health Organization

53
Revised Operational Guidelines for Leprosy Case Detection
Campaign
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