Increasing scarcity of qualified leprosy personnel needs to be addressed.
The annual meeting of national program managers and partners involved in leprosy control in Africa was held June 22-24 at the WHO Regional Office for Africa in Brazzaville, Republic of Congo. The 62 participants, including 37 national program managers and 14 representatives of partners, reviewed epidemiological trends over the past five years, identified major problems for leprosy control programs and drew up targets and priorities for Africa for the next five years when the WHO's enhanced global strategy comes into effect.1
National control programs in Africa have registered good results during the last two decades. These have seen every country in the WHO AFRO region attain the threshold for eliminating leprosy as public health problem of less than one case per 10,000 inhabitants.
However, within the last three years, some countries have been witnessing a progressive upward trend in the prevalence and detection. rates of leprosy. Having achieved the elimination target, many countries no longer consider leprosy as a national priority, even when entire districts remain hyper endemic and persons affected by the disease continue to be stigmatized.
Another concern is the increasing scarcity of qualified personnel working in leprosy, and the impact this is having on case detection, the monitoring and evaluation of leprosy control programs. Many program managers feel that leprosy goes undetected in certain health districts because of the lack of competence in this area. Qualified and skilled personnel are retiring, or joining other programs as leprosy is given less priority in health services; also, there is no organized initiative to train new personnel joining the programs.
The scarcity of qualified staff means that use of established reporting tools for data collection is declining, leading to a lack of documentation on the achievements registered by leprosy control programs.
As regards stigma and discrimination, these remain a fact of life for persons affected by leprosy in many health districts, despite the progress made in reducing the prevalence of the disease in the community. The public image of leprosy does not seem to have changed at the same rate as disease prevalence. Some patients are still reluctant to disclose their illness and tend to hide themselves, making it unlikely that such patients will be picked up through passive case detection methods.
To address these issues, a number of action points and recommendations emerged from the Brazzaville meeting. These include:
- Reorganize and improve information systems in order to generate the information needed for advocacy, since the mobilization of resources is a key determinant of the success of the new enhanced global strategy.
- Develop national strategic plans based on the enhanced global strategy and the revised operational guidelines, taking into consideration the specific context of the country concerned and its national health system.
- Promote involvement of people affected by leprosy in detection, treatment and follow-up of new cases, as well as community sensitization and education.
- Integrate services for the management of leprosy and the referral of complications into the general health system in order to improve the quality of care.
- Reinforce collaboration and information sharing between countries for better management of leprosy cases from special populations such as pygmies, nomads, displaced persons and refugees.
- Give priority to measures to avoid stock outs and/or expiry of stocks in the treatment centers, as the availability of free, high quality anti-leprosy drugs constitutes the key to the successes registered by the national leprosy control programs.
- Place emphasis on the description of lesions and the proper categorization of disabilities at the time of diagnosis, given that the objective of the enhanced global strategy is the reduction by 35% of the grade-2 disability2 disability per 100,000 inhabitants by 2015, taking the rate of 2010 as baseline. The collection of data related to the development of disability during and after treatment is also necessary in order to appreciate the impact of sensitization of patients and their education on self-care and other activities for the prevention of disabilities.
1 Enhanced Global Strategy for Further Reducing the Disease Burden Due to Leprosy 2011-2015
2 Classified as visible damage or disability.