SUSTAINING LEPROSY CONTROL MEASURES

IN THE PUBLIC HEALTH SYSTEM

TO ENSURE QUALITY CARE

Supported by

ANESVAD Foundation, Spain

implemented by

ALERT INDIA, Mumbai, India

1

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

2

ANESVAD’s MISSION

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.

3

ANESVAD Foundation established in 1968 is an independent, non religious and non-governmental organisation for development (NGOD) with the following objective:

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

4

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 programmes.

5

Culion Island, Philippines was a former leprosy colony. Now leprosy free island and a famous tourist destination.

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.

• 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 people were diagnosed and cured with MDT

6

M.Leprae, a germ causing leprosy

Multidrug therapy (MDT) cures leprosy

LEPROSY WORLDWIDE

• 17 countries represent 94% of the new leprosy cases detected (NCD) worldwide.

• The total of NCD in 2002 was 620.638 while in 2007 were 254.525 cases detected.

• Although global leprosy prevalence is declining between 2006-2007, in 10 countries NCD has increased.

• The NCD in India represented 54% of the global total leprosy burden in 2007.

Country No. of new cases

detected2007

%

Angola 1.269 0,5%

Bangladesh 5.357 2,1%

Brazil 39.125 15,4%

China 1.526 0,6%

Democratic Republic of Congo

8.820 3,5%

Côte d’Ivoire 1.204 0,5%

India 137.685 54,1%

Ethiopia 4.187 1,6%

Indonesia 17.723 7,0%

Madagascar 1.644 0,6%

Mozambique 2.510 1,0%

Myanmar 3.637 1,4%

Nepal 4.436 1,7%

Nigeria 4.665 1,8%

Philippines 2.514 1,0%

Sri Lanka 2.024 0,8%

Sudan 1.706 0,7%

Total 240.032 94%

Global total 254.525 100%

7

Table 1. 17 countries reporting >1000 new cases during 2007 Source: Weekly Epidemiological Record, WHO 2008, 83

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).

8

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)

9

LEAP COMPONENTS

Component 1: SPECIAL SELECTIVE DRIVES

10

Component 2: LEPROSY REFERAL CENTERS

Component 3: CONTINUING MEDICAL EDUCATION

Component 4: EPIDEMIOLOGICAL MONITORING AND EVALUATION (EME)

LEAP COMPONENT 1

SELECTIVE SPECIAL DRIVES (SSD)

Train local community members for creating mass awareness.

Objective

Enable local community to promote voluntaryreporting 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

11

LEAP COMPONENTS

12

Component 3: CONTINUING MEDICAL EDUCATION

Component 4: EPIDEMIOLOGICAL MONITORING AND EVALUATION (EME)

Component 2: LEPROSY REFERAL CENTERS

Component 1: SPECIAL SELECTIVE DRIVES

13

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.

LEAP COMPONENTS

14

Component 1: SPECIAL SELECTIVE DRIVES

Component 2: LEPROSY REFERAL CENTERS

Component 4: EPIDEMIOLOGICAL MONITORING AND EVALUATION (EME)

Component 3: CONTINUING MEDICAL EDUCATION

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

15

LEAP COMPONENT 3

LEAP COMPONENTS

Component 4: EPIDEMIOLOGICAL MONITORING AND EVALUATION (EME)

16

Component 1: SPECIAL SELECTIVE DRIVES

Component 2: LEPROSY REFERAL CENTERS

Component 3: CONTINUING MEDICAL EDUCATION

LEAP COMPONENT 4

EPIDEMIOLOGICAL MONITORING AND

EVALUATION (EME)

Disease surveillance and monitoring throughoperational research programmes and validatingtrend 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

17

INNOVATIVE APPROACH

• 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

18

LEAP has an integral approach to sustain leprosy control and ensure rights of leprosy affected persons by . . .

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

19

THANK YOU VERY MUCH FOR YOUR ATTENTION

20

ENSURING RIGHTS OF THE LEPROSY AFFECTED TODAY