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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

BRIEFING: Small Islands, Big Challenges

Certain countries face special issues in tackling leprosy.

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One of Kiribati’s 33 atolls and islands: the country’s population of 100,000 is scattered across a vast area of the Pacific.

Dr. Nobuyuki Nishikiori recently accompanied the Goodwill Ambassador on his mission to Kiribati in the South Pacific. We asked him about the challenges small island states such as Kiribati face in controlling leprosy.

1. Weak health system capacity

Many small island countries face significant challenges in organizing healthcare systems due to a lack of financial and human resources. A population size might be too small to afford an appropriate education system to produce health care professionals, resulting in the necessity to hire doctors, nurses and other health professionals from abroad.

2. Scattered population over a wide geographical area

Some island countries consist of many small islands scattered across the ocean. For example, the 33 islands and atolls of Kiribati form a total land area of some 800 square kilometers but extend across 3,900 kilometers of the Pacific. Some outer islands may be accessible via scheduled shipping service only once every six months because of the high cost involved. Ensuring access of island populations to essential health care is extremely challenging under such conditions. Early diagnosis and prompt treatment of leprosy, which is usually a cornerstone of an infectious disease control strategy, is almost impossible to achieve even with a substantial financial investment.

3. High cost for all aspects of program operations

Due to seriously limited domestic production capacity, many countries heavily rely on imports for a wide range of commodities. Almost all kinds of goods are hugely expensive, including water, food, gasoline and stationery. In particular, transportation costs can be prohibitive due to the highly scattered population.

4. Non-availability of specialist services

Beside essential primary health care services, it is also extremely challenging to secure specialist services. For example, people affected by leprosy with complications may require diagnosis and treatment by a dermatologist experienced in such cases. Rehabilitation and prosthetic services for people with disabilities may also call for specialized care. Normally such services are difficult to secure in small island countries, leaving many people affected by leprosy without optimal quality care.

5. Epidemiological transition

Many small island countries are experiencing significant epidemiological transitions. The burden of non-communicable diseases such as hypertension, diabetes, heart disease and strokes is sharply increasing due to lifestyle factors. Scarce health resources need to be diverted, with those for infectious disease control, including leprosy, witnessing significant decline in many countries.

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AUTHOR: Dr. Nobuyuki Nishikiori

Dr. Nobuyuki Nishikiori is Coordinator of the Stop TB and Leprosy Elimination Unit, Division of Communicable Diseases, World Health Organization. He is based at the WHO’s Regional Office for the Western Pacific.