Integration of vertical disease programmes into general health systems can be a double-edged sword. Discuss with reference to leprosy control in India.

A vertical programme targets one disease and has its own staff, funds and surveillance. India's leprosy control shows both sides of merging such a programme into general health services. India reached "elimination as a public health problem" in 2005, meaning fewer than 1 case per 10,000 people [1]. Yet it still reports over half of the world's new cases [1].

Integration as a strength

• Wider reach: Free MDT and disability rehabilitation are delivered through routine health facilities under NLEP [1].
• Prevention at scale: Single-dose rifampicin post-exposure prophylaxis (SDR-PEP) for contacts runs through the general system [1]. The NSP & Roadmap 2023–27 also adds Nikusth 2.0, a common web portal for reporting cases [2].
• Sustained gains: Prevalence fell from 57.2 to 0.57 per 10,000 between 1981 and 2025. 638 districts are below the elimination threshold [1].
• Efficiency: Shared staff and infrastructure avoid duplication, which fits the NSP's push for multi-disease service integration [2].

Integration as a weakness

• Diluted focus: Once "elimination" was declared, leprosy became one priority among many. Without dedicated workers, active case search can weaken.
• Low prevalence can mislead: Shorter MDT keeps patients on the register for less time, so recorded prevalence can fall while transmission continues. New child cases, which signal recent spread, made up 4.68% of new cases in 2024–25 [1].
• Loss of expertise: General staff may miss early skin and nerve signs. Diagnosis then comes late, and late diagnosis causes grade-2 disability.
• Stigma left unaddressed: Integration does not remove social barriers. 108 discriminatory laws (3 Union, 105 State) were flagged for amendment [4]. Law Commission Report No. 256 proposed the EDPAL Bill, 2015 [3]. Patients who fear exclusion delay seeking care, so their contacts are never traced.

Integration therefore widens coverage but can wear away the specialist alertness that leprosy needs. The way forward is "integration with protection": keep leprosy expertise within multi-disease services [2], continue active case detection even in districts reporting zero cases, trace every contact for SDR-PEP, and enact the EDPAL framework. These steps would help India reach zero transmission by 2027, three years ahead of SDG 3.3 [2].