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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

REPORT: Enhancing the Global Strategy

Informal consultation recommends innovative approaches for post-2010

Exploring ways of making the global strategy for dealing with leprosy more strategic and innovative in addressing the remaining and emerging challenges was the subject of an informal consultation organized by the WHO's Global Leprosy Program among a small group of experts on September 17-18 in New Delhi.

Chaired by Dr. S.K. Noordeen, president of the Leprosy Elimination Alliance, the meeting resulted in a number of recommendations on key technical, operational and strategic areas that will be taken into account as the WHO develops its "Enhanced Strategy for Reducing the Leprosy Burden in Endemic Countries: 2011-2015."

As a next step, a working group is being established to draw up the first draft of the "Enhanced Strategy," which will be shared with all partners and experts to get their comments and suggestions. There will also be a meeting of selected national program managers from all WHO regions, members of the International Federation of Anti-Leprosy Associations (ILEP) and other partners on April 20-22, 2009, in New Delhi.

RECOMMENDATIONS

TARGETS. After in-depth discussion on the merits and demerits of setting numerical targets and time frames, the group recommended that the enhanced strategy for reducing the leprosy burden should include the setting of realistic numerical targets based on grade 2 disabilities among new cases, since this is likely to have an impact on reducing the occurrence of new cases in the population. The benefits of using this indicator include promoting early case detection, reducing delays in diagnosis leading to transmission, reducing stigma and discrimination, reducing costs on disability care and promoting collaboration with other partners.

HOUSEHOLD CONTACTS. In most countries where leprosy was once highly endemic, the current leprosy profile shows a relatively low endemicity, while in others it is reaching the profile of a rare disease. Under these circumstances, the risk of leprosy among household contacts becomes significant. In areas where a high proportion of new cases are being detected among contacts, examining household contacts at the time a new case is diagnosed and providing a single dose of rifampicin to household members as a prophylaxis would be a useful measure to reduce the occurrence of leprosy in the community.

ALTERNATIVE TREATMENT REGIMENS. The current treatment of leprosy based on WHO recommended multidrug therapy for MB and PB leprosy is unlikely to see any major changes over the next 10 years. However, the situation may be threatened by two very likely scenarios: question marks over the continuing availability of clofazimine due to pressure on the manufacturing industry, and the emergence of rifampicin resistance, which may reverse the hard-fought achievements of leprosy control. Recognizing the long duration and relatively complex studies needed for testing the efficacy and safety of newer drug regimens for anti-leprosy chemotherapy, it will be important to start testing alternative treatment regimens.

RESEARCH. It is important to continue research, particularly in key areas of disease prevention, drug development and operational research for improving tools and methods for disease control and improving quality of clinical services, including referral services.

CAPACITY BUILDING. Capacity building of general health services personnel is important for providing adequate services for leprosy. However, capacity-building programs should carefully assess needs and direct efforts only to areas where leprosy occurs in order that programs are efficient and cost-effective.

ENHANCED SUPERVISION. Supervision over many programs remains weak-something seen even during the era of specialized national leprosy control programs. In the current integrated leprosy control era, there is a need for enhanced supervisory support, particularly at the field level. Appropriate resources should be made available to strengthen effective supervision at all levels.

SPECIALIZED SERVICES. With the decreasing occurrence of leprosy, the issue of integration should be carefully reassessed so that specialized services are available where necessary and at the appropriate level.

UNDERSERVED POPULATIONS. There is a need to focus on underserved populations so that the magnitude of leprosy among them can be assessed and locally-specific sustainable anti-leprosy activities developed with inter-sectoral collaboration. Although the current global strategy says that leprosy services should be based on the principles of equity and social justice, and accessible to all who need them, leprosy services are still not adequately available.