New child cases are the most sensitive indicator of ongoing leprosy transmission. Explain, and evaluate the NSP 2023–27's district-level approach.

India reached leprosy "elimination" (prevalence below 1 per 10,000) in 2005 [1], but the disease is still spreading. The National Strategic Plan (NSP) & Roadmap 2023–27 therefore measures progress by transmission instead of prevalence, and it uses new child cases as the key signal. This is a sound indicator, but using it at the district level needs safeguards.

Why child cases signal ongoing transmission

• Recent infection: a child has had only a short time to be exposed. A child case therefore points to an infectious adult nearby now, not an old infection showing up late.
• Not affected by treatment length: shorter treatment courses take patients off the register sooner, so recorded prevalence falls even while spread continues. New child cases track new spread directly.
• Used by the programme: the share of child cases among new cases fell from 9.04% (2014-15) to 4.68% (2024-25), which the government reads as reduced active transmission [1].

NSP's district-level approach: strengths

• Clear milestones: a district has interrupted transmission after zero new child cases for at least 5 consecutive years. It has eliminated the disease after a further 3 years with zero new cases of any age [1].
• Targeted effort: intensive case-finding in high-burden districts, surveillance in low-burden ones, and special monitoring of 121 districts where prevalence is above 1 per 10,000 [1].
• Tools that break the chain: a single preventive dose of rifampicin reached 92% of eligible contacts in 2024-25. Children are also screened under the school and adolescent health programmes RBSK and RKSK [1].

Limitations

• Zero found is not zero infected: the indicator counts children detected, so a district that searches less qualifies sooner. The door-to-door detection campaign (LCDC) alone confirmed 27,428 new cases in 2024-25 [1].
• Wrong incentive: every child case found restarts the five-year count, which penalises districts that search hard.
• Weak verification: districts are followed up for verification at the same time as they progress [1]. Nothing requires an independent check before certification.
• Stigma hides cases: Law Commission Report No. 256 recommended repealing the Lepers Act, 1898 and drafted a model anti-discrimination law, the EDPAL Bill, 2015 [2]. While discrimination continues, families may hide early symptoms.

New child cases are the right indicator, but only when read alongside how hard each district is searching. Districts should report screening coverage next to their zero-child-case figures. Independent verification and anti-discrimination law reform would help the NSP turn statistical elimination into real zero transmission, advancing SDG 3.3 and the right to health under Article 21.