SUSTAINING LEPROSY CONTROL MEASURES

IN THE PUBLIC HEALTH SYSTEM

TO ENSURE QUALITY CARE

Supported by
ANESVAD Foundation, Spain
implemented by
ALERT INDIA, Mumbai, India

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 INDEX

1. ANESVAD MISSION AND ITS PRIORITIES

2. ANESVAD INTERVENTIONS IN THE FIELD OF LEPROSY

3. LEPROSY - BASIC CONCEPTS

4. LEPROSY - WORLDWIDE

5. WHY A LEPROSY ELIMINATION ACTION PROGRAMME (LEAP)?

6. LEAP AND ITS COMPONENTS

7. INNOVATIVE APPROACH

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 ANESVAD’s MISSION

ANESVAD Foundation established in 1968 is an independent, non

religious and non-governmental organisation for development
(NGOD) with the following objective:

To contribute to the PROMOTION AND PROTECTION OF

HEALTH understood as a fundamental human right:

- Defending health as complete physical, mental and social

well-being.

- Intervening politically, socially, economically and culturally.

- Developing alliances with the different actors involved.

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 ANESVAD’s PRIORITIES

• NEGLECTED TROPICAL DISEASES (NTDs)

Leprosy, Buruli Ulcer, Chagas Disease, Dengue Fever
and Leishmaniasis

• COMMUNITY HEALTH

• MOTHER - CHILD HEALTH AND SEXUAL &

REPRODUCTIVE HEALTH

• HUMAN TRAFFICKING

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 ANESVAD AND ITS INTERVENTION IN THE FIELD OF LEPROSY

• 40 years of experience.
• 1st experience in Culion Island
(Philippines) with 36 years of
intervention. In 1997 leprosy was
eliminated.
• More than 500 projects to combat
leprosy in Asia, America and Africa
have been developed.
• Special focus in Asia, particularly in
India supporting leprosy control
Culion Island, Philippines
programmes. was a former leprosy colony.
Now leprosy free island and
a famous tourist destination.
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 LEPROSY BASIC CONCEPTS

• Is caused by bacillus called Mycobacterium

leprae (Hansen, 1874) that causes nerve
damage leading to disabilities and deformities.

• Least infectious of all communicable diseases.

• Completely curable and treatment provided in the

early stages averts permanent disability.
M.Leprae, a germ causing
leprosy
• Since early 80’s there is a treatment for leprosy
MDT (3 drugs) free of charge since 1995.

• With minimal training, leprosy can be easily

diagnosed based on clinical signs.

• Between 1985 and 2008, close to 15 million Multidrug therapy (MDT) cures
people were diagnosed and cured with MDT leprosy

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 LEPROSY WORLDWIDE
Country No. of new %
cases
• 17 countries represent 94% of detected
2007
the new leprosy cases detected Angola 1.269 0,5%

(NCD) worldwide. Bangladesh 5.357 2,1%

Brazil 39.125 15,4%

China 1.526 0,6%

• The total of NCD in 2002 was Democratic

Republic of Congo
8.820 3,5%

620.638 while in 2007 were Côte d’Ivoire 1.204 0,5%

254.525 cases detected. India 137.685 54,1%
Ethiopia 4.187 1,6%

Indonesia 17.723 7,0%

• Although global leprosy Madagascar 1.644 0,6%
prevalence is declining between Mozambique 2.510 1,0%

2006-2007, in 10 countries NCD Myanmar 3.637 1,4%

has increased. Nepal 4.436 1,7%

Nigeria 4.665 1,8%

Philippines 2.514 1,0%

• The NCD in India represented Sri Lanka 2.024 0,8%

54% of the global total leprosy Sudan

Total
1.706

240.032
0,7%

94%
burden in 2007. Global total 254.525 100%
Table 1. 17 countries reporting >1000 new cases during
2007
Source: Weekly Epidemiological Record, WHO 2008, 83 7
 WHY A LEPROSY ELIMINATION ACTION PROGRAMME (LEAP)?

• WHO global strategy for leprosy states that

the efforts must focus on integrating leprosy
in the general health care system and
ensure providing quality care and services.

• Inadequate leprosy care services in the

general health care due to absence of an
effective referral system.

• New leprosy cases continue to emerge and

a significant number are detected with early
disabilities and deformities results in social
ostracisms.

• Leprosy is a chronic disease that requires

long-term planning and control measures.

• The challenge is to deliver a sustainable

care and services for leprosy affected
persons (new & old cases).
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 LEPROSY ELIMINATION ACTION PROGRAMME (LEAP)

WHAT’S LEAP:
LEAP is a strategic programme with defined
intervention to ensure the rights of people affected by
leprosy through sustained leprosy control measures
and enhanced quality care within public health care
system.

WHERE IS LEAP IMPLEMENTED:

States of Maharashtra and Chhattisgarh

HOW:
ALERT INDIA + 35 partners with the involvement of
the national health care system and the local
communities

SUPPORT:
8 years (2005 -2013)
2.262.150 euros (2005-2009)
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 LEAP COMPONENTS

Component 1: SPECIAL SELECTIVE DRIVES

Component 2: LEPROSY REFERAL CENTERS

Component 3: CONTINUING MEDICAL EDUCATION

Component 4: EPIDEMIOLOGICAL MONITORING AND

EVALUATION (EME)

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 LEAP COMPONENT 1

SELECTIVE SPECIAL DRIVES (SSD)

Train local community members for creating

mass awareness.

Objective

Enable local community to promote voluntary

reporting of new cases and to refer them to
the adequate services

Main Achievements

• 5.309.391 people reached through

awareness programmes - 3.829 villages /
slum pockets
• 4.847 new leprosy cases detected

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 LEAP COMPONENTS

Component 1: SPECIAL SELECTIVE DRIVES

Component 2: LEPROSY REFERAL CENTERS

Component 3: CONTINUING MEDICAL EDUCATION

Component 4: EPIDEMIOLOGICAL MONITORING AND

EVALUATION (EME)

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 LEAP COMPONENT 2

LEPROSY REFERAL CENTRES (LRC)

Train and equip the health care providers at the

primary and intermediate level with the
necessary skills and tools.

Objective

Improve access to quality services in the public

health system increasing the self-reliance of the
health care providers.

Main Achievements

• 62 LRCs supported - 3385 patients receive

disability care and prevention services
• State government of Maharashtra has
recommended the LRC’s as a “best practice”
under health system reforms.

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 LEAP COMPONENTS

Component 1: SPECIAL SELECTIVE DRIVES

Component 2: LEPROSY REFERAL CENTERS

Component 3: CONTINUING MEDICAL EDUCATION

Component 4: EPIDEMIOLOGICAL MONITORING AND

EVALUATION (EME)

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 LEAP COMPONENT 3

CONTINUING MEDICAL EDUCATION (CME)

Updating the technical knowledge and
transferring practical skills to the public and
private health care providers using information
and communication technology (ICT) tools.

Objective
Add clinical acumen to identify, treat and
manage leprosy by health providers and
develop links with other health programmes.

Main Achievements

• 8403 medical and paramedical personnel /

students given orientation on leprosy
• 1.135 private medicine / general practitioners
trained in diagnosis and treatment
• Diagnostic, treatment and deformity control
guides for public health doctors recognised by
the Leprosy Division (G.I) and used nationally
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 LEAP COMPONENTS

Component 1: SPECIAL SELECTIVE DRIVES

Component 2: LEPROSY REFERAL CENTERS

Component 3: CONTINUING MEDICAL EDUCATION

Component 4: EPIDEMIOLOGICAL MONITORING
AND EVALUATION (EME)

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 LEAP COMPONENT 4

EPIDEMIOLOGICAL MONITORING AND

EVALUATION (EME)
Disease surveillance and monitoring through
operational research programmes and validating
trend and magnitude of leprosy burden In
Mumbai

Objective

Obtain update leprosy related data and trends

Main Achievements
• Mumbai leprosy statistics system established
• Provide inputs for publications and advocacy for
policy change
• Involvement of different actors in data collection

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 INNOVATIVE APPROACH

LEAP has an integral approach

to sustain leprosy control and ensure rights of leprosy affected persons
by . . .

• facilitating the process of

integration of basic leprosy
services and specialized referral
services within the public health
system

• promoting an IEC strategy that

involves and trains volunteers as
spokesperson for leprosy in local
communities who suspect and
refer new cases of leprosy at an
early stage
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 INNOVATIVE APPROACH

• advocating a decentralized, guaranteed

access to quality care for the leprosy affected
persons at the primary and intermediary levels
in the public health delivery system and thus
aims to secure a right place in health resource
planning

• developing trainers and faculty at different

levels of Health System for Continuing Medical
Education

• involving health and development NGOs as

partners in leprosy control by imparting the
skill and expertise required for under a
common strategy for leprosy detection and
referral services
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THANK YOU VERY MUCH FOR YOUR ATTENTION

ENSURING RIGHTS OF THE LEPROSY AFFECTED TODAY

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