Challenges in Implementation of National Leprosy Eradication Program: Cross-Sectional, Qualitative Study in Three High Endemic Districts of West Bengal, India.

Background: Leprosy, although eliminated at the national level in 2005, remained a public health problem in a few districts of India. This study aims to explore the perception and experience of healthcare providers and programme managers in delivering the services to the community members under National Leprosy Eradication Program in West Bengal. Methods: In this descriptive, cross-sectional study with a qualitative survey approach, data were collected during the period of January-May, 2022 from the service providers and programme managers through In-depth Interviews (IDIs) and Focused Group Discussions (FGDs) in three high endemic districts of West Bengal, namely, Purulia, Birbhum, and Uttar Dinajpur. Data were analysed through inductive coding, and emergent themes were identified. Pile sorting exercise was done for improving neutrality in theme identification in R with Anthrotools. Results: Twelve IDIs and Six FGDs were conducted before reaching data saturation. Triangulation of findings led to four themes encompassing various challenges - delay in recognising the problem by infected individuals, perceived stigma, delay in accessing healthcare by the affected individuals, and delay in treatment after approaching the health care system. Mass media campaigns through new age social media (e.g., Facebook, Instagram, etc.) with emphasis on audio-visual mode and financial incentives for improving compliance were suggested by study participants as solution. Conclusions: Improving health communication, frequent case detection camps, and capacity building with the help of various professional organisations is the need of the hour. Concerted effort of the policymakers involving various stakeholders in this will help in eliminating the disease from these high-endemic districts.