Leprosy workers need to adapt, says new head of WHO’s Global Leprosy Program.
I am a medical doctor. I graduated from the University of Ghent in Belgium and obtained a postgraduate degree in tropical medicine from the University of Liverpool and an MSc in Global Health Policy from the University of London. I have worked in public health my entire career.
I worked for the Damien Foundation in a leprosy and TB control project in the western part of Bangladesh from 1995 to 2000. We reported almost 1,000 leprosy patients a year. During that period, I mostly learned the clinical aspects of leprosy as well as program management, becoming acquainted with the most diverse presentations of leprosy and its complications. Next, I joined WHO as an adviser for leprosy, TB and Buruli ulcer in Papua New Guinea (2000-2004). In my posting to WHO’s Southeast Asia Regional Office (2004-2007), I was responsible for TB before moving to the WHO Country Office for Bangladesh to support the national leprosy and TB programs (2007-2011). Prior to joining the Global Leprosy Program (GLP), I was medical officer for TB in Myanmar.
There were several reasons. Leprosy remained close to my heart. In primary school, we had to learn about the works of Father Damien, who a few years ago was selected as the greatest Belgian in history. Dr. Frans Hemerijckx, another great name in leprosy, lived in a town close to mine and we even went to the same school.
Although the GLP is a small WHO program, I felt that any contribution would be more visible. The global leprosy community is rather like a big family. Everyone seems to know everyone.
Leprosy control has come to the stage where it should be possible to significantly reduce the burden in countries with a large burden. I am therefore happy that I have the chance to contribute to ending the leprosy epidemic.
Reaching elimination of leprosy as a public health problem is not the end of the work. The number of new cases is going down much more slowly. The main challenge will be how to keep leprosy on the agenda in a changing context from vertical programs to those increasingly combined with neglected tropical diseases (NTDs) or fully integrated with general health services. The pool of leprosy experts is ageing, too, and it is a challenge to motivate young doctors to take up leprosy. The more leprosy becomes a rare disease, the more the unit cost for control activities goes up while financial support becomes harder to get due to competing priorities.
Having a clear, succinct strategy is a very helpful start. Leprosy, as do other disease control programs, needs direction. There should be a vision — in this case, “a leprosy-free world” — and an ambitious yet realistic goal in the medium term so that we all can work in the same direction.
Partnerships are also very important. Each partner has a distinct advantage, insufficient to make a total change alone, but collectively complementing each other so that all requirements for a successful program can be provided. Such partnerships must be inclusive, with all partners truly involved from the design stage through implementation to evaluation.
It is also important that WHO identifies which role it can and should play, and which it should not. The organization remains in the first place a technical agency. Based on this role, the technical unit should be properly composed and include both medical and technical officers. The GLP does not work in a vacuum but is well connected to the staff in charge of leprosy at regional and country-office levels. This network of actors within WHO is also very important for efficient delivery at a global level.
It is important to realize that while there may be agreement on the common goal to pursue, there may be different ways to get there. It is important to accommodate these different perspectives, without diluting the message.
Most important for successful implementation is to take care that all three pillars of the strategy are implemented (see sidebar). As all three are mutually reinforcing, the result of their combined application will be more than the sum of their individual applications. The strategy must be considered in its entirety, although some partners may focus on specific areas they are best placed to support.
Leprosy work is not yet finished. But business-as-usual will also not continue. People working in leprosy will need to reinvent themselves and adapt to the changing realities. In the future, more than in the past, flexibility will be expected.
Dr. Erwin Cooreman is Team Leader of the WHO’s Global Leprosy Program, based in New Delhi. He took up his post in November 2015.