WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: Checking on Progress

Meetings in India and Switzerland keep the Goodwill Ambassador busy as he updates himself on the leprosy situation in different parts of the world.

With Dr. Henk Bekedam

INDIA (MAY 11-15)

During a visit to India in May, I called on the WHO country representative, the deputy director general (leprosy) of the Ministry of Health & Family Welfare, met with leaders of the Association of People Affected by Leprosy (APAL), visited with members of the Forum of Parliamentarians for a Leprosy-Free India and attended a board meeting of the Sasakawa-India Leprosy Foundation (S-ILF).

It was my first meeting with Dr. Henk Bekedam, the WHO representative to India, who told me that the India country office was the biggest in the WHO system, with 1,000 staff in the field. Many of them had been working to eradicate polio, which India succeeded in doing two years ago. Dr. Bekedam hoped that the lessons learned from this success story could be applied to eradicating leprosy, and that some of the WHO’s field staff could now be utilized for this effort.

I was also meeting DDG(L) Dr. Anil Kumar for the first time. He too spoke of using India’s success in eradicating polio in the fight against leprosy. He said the budget for his program translated into and he wanted to send teams of men and women working in pairs to visit households and examine families in a bid to promote early detection, even in remote and low-endemic areas. The ministry would be conducting a major case detection campaign in September and he invited me to witness it.

Posing for a commemorative photo with APAL leaders — and some of their children and grandchildren — in New Delhi

APAL was founded in 2005, when it was known as the National Forum. It is a nationwide network of people affected by leprosy, primarily those living in the country’s 800 or so self-settled leprosy colonies. In the years since, it has worked to promote socio-economic empowerment, improve living conditions, foster dignity and respect, and educate people affected by leprosy about government schemes and benefits that can assist them.

Of current concern at the time of my visit was a shortage of operating funds. This is due to the delay in APAL being granted permission to receive funds from The Nippon Foundation under India’s Foreign Contribution Regulation Act. We are all hoping that this can be resolved at the earliest opportunity.

The Forum of Parliamentarians for a Leprosy-Free India is headed by Mr. Dinesh Trivedi, MP. He invited me to his residence where I met with several other members of the forum and thanked them for the work they are doing. Next year, the Global Appeal to end stigma and discrimination against people affected by leprosy will be endorsed by the Inter-Parliamentary Union. It is to be launched in India and I believe the forum will have a valuable role to play.

S-ILF was established in 2006 to support efforts at reintegrating people affected by leprosy through economic and social empowerment; it marks its 10th anniversary this year. S-ILF is active in three main areas — self-reliance, education and awareness training — and I received updates on its recent projects. It is planning a special anniversary event for 2016 that will be announced in due course.


Greeting Ethiopia’s minister of health (top) and attending a meeting with a delegation from Mozambique (above) in Geneva; at a gathering of the Forum of Parliamentarians for a Leprosy-Free India in New Delhi (above right)

Each year I travel to Geneva to attend the World Health Assembly, where I present the Sasakawa Health Prize, which was won this year by Medicus Mundi Spain (FAMME) for a project on transforming public health systems based on the principles of primary health care. As always, I took the opportunity to meet with health ministers or their representatives on the sidelines of the assembly to hear about the leprosy situation in their country. I have summarized the main points from some of the meetings I had below.

Brazil is taking its school-based de-worming and leprosy case-finding initiative nationwide.

Ethiopia still sees around 4,000 new cases a year and the government wants to move ahead with the mapping of hot spots. There are around 300 high-endemic areas in the country. About 20% of new cases in these areas already have Grade 2 (visible) disability, compared with the national average of 12.5%.

Indonesia has increased its budget for leprosy control. It is making concerted efforts to find new cases and is introducing chemoprophylaxis for contacts of confirmed cases. Not all areas of the country are easy to access, and there is a lack of expertise in some places, making it essential to develop the capacity of medical personnel. To eliminate stigma and discrimination, the government is using public broadcasting to disseminate messages about leprosy in an effort to change mindsets.

Brazil is redoubling efforts at case detection in high burden states such as Mato Grosso, Pará and Maranhão. It is also taking its school-based de-worming and leprosy case-finding initiative nationwide. The country is currently in the process of validating data which, if confirmed, would mean Brazil has eliminated leprosy as a public health problem at the national level. This would represent a remarkable achievement, but Brazil will not be resting on its laurels.

In the Philippines, local governments earlier this year made a commitment to strengthening anti-leprosy activities. The country aims to have no new cases of leprosy in coming years. In the meantime, there remains a need to promote the reintegration of people affected by leprosy into society.

Democratic Republic of Congo is concentrating its efforts on early detection of the disease in order to prevent disability and reduce stigma. It is focusing its activities on high-endemic areas and says that incidence of leprosy is declining in many provinces.

Mozambique is tackling leprosy within the context of neglected tropical diseases. The country has achieved elimination of leprosy as a public health problem, but in recent years interest in the disease has waned. In some areas, case numbers are creeping up again and there is a need to reactivate efforts against leprosy.

Tanzania sees around 2,000 new cases of leprosy a year. It has a number of disease hot spots where transmission is occurring and children are especially at risk. Since 2007, the country has been conducting awareness-raising campaigns with WHO support and is actively promoting the social reintegration of people affected by the disease. It has begun testing the use of chemoprophylaxis. It has also carried out early case detection in three areas, together with the tuberculosis program, with the support of Novartis.

Several countries are currently undertaking special anti-leprosy initiatives with monies from a fund set up for this purpose after the International Leprosy Summit in Thailand in 2013. I look forward to hearing more about the progress they are making in due course.