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Leprosy & health: Improving access to diagnosis and treatment

Since the mid 1980s, anti-leprosy programs, using MDT, have led to dramatic falls in the prevalence of leprosy in countries across the world. These programs were, for the most part, the responsibility of specialized or vertically-structured departments within national health services. In recent years however, health ministries throughout the world have seen the advantages of integrating these separate leprosy units into general health services.

A major priority in the fight against leprosy is improving access to diagnosis and treatment. Training local healthcare staff in the straightforward procedure of identifying the symptoms has immediate benefits, permitting early treatment or referral. Treating the disease as early as possible is crucial, as it enables a cure before the onset of disability or deformity, while also cutting the risk of infection. Clearly, the use of the extended network of general health clinics for this purpose is immensely useful, greatly reducing travel times for those seeking care and in many cases, assisting in continuity of care and patient compliance.

Integration has a number of other advantages. The training that general healthcare staff receive helps to break down any residual anxiety or prejudice about the disease they might have. In a similar way, the existence of leprosy services in general health clinics serves to demystify the disease, reinforcing the idea among local people that leprosy is just another disease, and that the cure is at hand. In this latter respect, the presence of leprosy treatment in widely distributed local clinics is itself a vital component in the social marketing campaigns designed to change the perception of the disease.

Several countries where the disease is still a public health problem, now face a situation where leprosy cases are concentrated in only a few regions. As well as assisting anti-leprosy efforts in these higher prevalence areas by offering greater availability of services, the integrated approach is also useful in the other low prevalence regions. In these, there was a danger that infrequent contact with leprosy on the part of the health services would result in unfamiliarity and a resultant inability to offer care. Making leprosy an integral part of general healthcare training addresses this risk.

Due to the relatively low numbers of leprosy cases, the ease of treatment in a large majority of them and freely available supplies of MDT, the incorporation of leprosy treatment into general services does not make substantial demands on resources. Indeed, with the prospect of rapid progress towards leprosy elimination, the integrated structure is best equipped to offer cost effectiveness as well as sustainability.

Implementing the structural changes of integration has inevitably offered numerous challenges to national health services, as established relationships and responsibilities, both personal and institutional have been altered. The Novartis Foundation is collaborating with WHO, national health authorities and other organizations in undertaking integration and decentralization programs. In a number of areas, most particularly that of training, the initiatives have meshed closely with the Foundation's work in communicating information about leprosy and giving the disease a "positive image".
Source: www.foundation.novartis.com/leprosy/access_diagnosis_treatment_concept.htm

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