Defeating leprosy

Due to failure of timely treatment, many leprosy patients became disabled, creating a burden on respective families and the state

Though leprosy can be defeated easily, it remains our health problem. The disease can be eradicated if it gets attention by the authorities concerned. The government has scope to carry out the anti-leprosy programme. Test and treatment of the disease are available for free in the country. The disease is curable with early detection and treatment.          

Although the government and NGOs are maintaining model partnership to implement leprosy control activities, the stagnancy in case detection rate since 2006, variability in multibacillary (MB) and child cases, disability rates among new cases indicates the need for strengthening National Leprosy Elimination Programme (NLEP) strategies and services. In spite of integrated service delivery, infrastructure support at all level and provision of free multi-drug-therapy (MDT), the NLEP is gradually facing loss of focus as a public health agenda. As a result, delivery of services deteriorates day by day, losing skilled persons and the NLEP is facing inadequacy of fund in both the government and NGO sectors. 
MDT is available, but other medicines and logistics for the management of complications of leprosy and treatment and prevention of disability services are not adequate. 
Experiences and skill of service providers are difficult to retain due to inadequate actions of training and capacity building as well as gradual retirement of senior staff. Supervision and monitoring of leprosy services are not uniform throughout the country.
Operational researches and surveillance are presently inadequate in priority areas.

Major challenges 
NLEP is facing several critical challenges even when national elimination was achieved in 1998. The most urgent issue faced by NLEP is created with the elimination itself. Since 1998, there was a gradual less allocation of fund for the programme, the activities became lesser, less training, losing experienced persons and ultimately leprosy lost its face as an important infectious disease in the country.
When the call for leprosy elimination by the year 2000 was made the word “Elimination” was defined as reduction of leprosy prevalence to below 1 case per 10,000 population. When Bangladesh achieved elimination at national level this specific definition of ‘elimination’ has been misunderstood. It was assumed that the disease is under control and after year 2000, there is hardly any need of continuing fight against leprosy. So, reaffirmation of commitment of the government and other stakeholders towards leprosy control programme is very much needed.
The next major challenge is to sustain knowledge, skills and experience in leprosy management especially in low prevalence situation that relates to a significant decrease in work-load for leprosy control activities in field.
Thirdly, leprosy continues to be stigmatized condition deeply embedded in our society. Socially, marginalized groups such as women and urban poor are less likely to attend for care. Proper steps need to be taken for better understanding the causes of stigma and assess the effect of intervention to decrease it.
Finally, additional challenges remained for prevention of secondary disability and deformity those who already have primary disability after MDT and community-based rehabilitation of those affected people.

Strategy 
The enhanced global strategy requires endorsement and commitment of everyone working towards elimination of leprosy. The basic principles of leprosy control are timely detection of new cases and their effective treatment. Based on this principles and strategies laid down in the Global Strategy the national post elimination leprosy control strategy was formulated.
The goal of the national strategy is to further reduce the disease burden due to leprosy, to sustain the provision of quality leprosy services for all the affected people, to ensure the principles of equity, social justice and human rights.
Guiding principles in the strategy called for supporting and guiding all implementing partners for mobilization and effective management of resources to further reduce the disease burden. It called for promoting integrated approaches using Upazila Health Complexes as the peripheral centre or even below level such as Community Clinic to provide quality leprosy services, including suspect referral for management, and introducing cost effective community awareness and health education programme involving local stakeholders to reduce stigma and discrimination against persons and families affected by leprosy.
Ensuring that NLEP as well as its partners invest adequately in long term human resource development through appropriate international and national training strategies that will sustain national expertise in leprosy. In this regard, the government and partner NGOs should take strategy to retain expertise/experienced senior staff till disease burden is significantly reduced. Promoting and strengthening sustainable innovative approaches to extend leprosy control services in underserved communities and difficult to access areas. Sustaining early case detection and provision of MDT of free of cost with improving treatment adherence and timely completion of treatment, it added.
“Strengthening all measures aimed at preventing the occurrence and worsening of disabilities by timely detection and effective management of acute complications and promoting problem oriented self-care practices. Promoting the use of community-based rehabilitation to improve the quality of life of persons and families affected by leprosy. In this regard, active support is very much needed from WHO, international and national humanitarian agencies. Striving for effective collaboration with international, national and local community-based organizations related to health and other sectors”, said the principles.
As the disease is the most stigmatized in our country, many patients faced inhuman bahaviour, which is violation of their human rights.
The strategy also mentioned about guidelines, which said, states should protect and ensure the full realization of all human rights and fundamental freedoms for all persons affected by leprosy and their family members without discrimination on the grounds of leprosy.
A number of documents and strategy papers have been made in the world for protecting the human rights, especially that of people with disabilities. Some of these are: UN Principles and Guidelines for the elimination of discrimination against persons affected by leprosy and their family members, UN Charter of Universal Human Rights, Human Rights Council of UNO, UN Convention on the Rights of people with disabilities, Global Partnership on disabilities and development, New/WHO Guidelines on Community Based Rehabilitation and New Interest in disability within ILEP----New Technical Guideline on CBR.
The documents stressed on establishing the rights of disabled people, caused by leprosy, so that they can live with full dignity.      
According to The Leprosy Mission International-Bangladesh (TLMI-B), due to failure of timely treatment, many leprosy patients became disabled, creating a burden on respective families and the state. According to NLEP sources, there were 26,479 people from 1985 to 2015 in the country with deformity caused by the disease. Some 203423 people were diagnosed as leprosy cases in the country during the period. 
The data indicated that over 10% affected people were disabled due to the disease a year.  
Urgent steps need to be taken for proper implementation of the national strategy. Bangladesh cannot go ahead without addressing the leprosy issue. It is hoped that all concerned would come forward to build a better country by defeating the disease. 

The writer is a journalist working with a private TV channel. His e-mail is: [email protected]     

 

Defeating leprosy

Due to failure of timely treatment, many leprosy patients became disabled, creating a burden on respective families and the state

Though leprosy can be defeated easily, it remains our health problem. The disease can be eradicated if it gets attention by the authorities concerned. The government has scope to carry out the anti-leprosy programme. Test and treatment of the disease are available for free in the country. The disease is curable with early detection and treatment. Although the government and NGOs are maintaining model partnership to implement leprosy control activities, the stagnancy in case detection rate since 2006, variability in multibacillary (MB) and child cases, disability rates among new cases indicates the need for strengthening National Leprosy Elimination Programme (NLEP) strategies and services. In spite of integrated service delivery, infrastructure support at all level and provision of free multi-drug-therapy (MDT), the NLEP is gradually facing loss of focus as a public health agenda. As a result, delivery of services deteriorates day by day, losing skilled persons and the NLEP is facing inadequacy of fund in both the government and NGO sectors. MDT is available, but other medicines and logistics for the management of complications of leprosy and treatment and prevention of disability services are not adequate. Experiences and skill of service providers are difficult to retain due to inadequate actions of training and capacity building as well as gradual retirement of senior staff. Supervision and monitoring of leprosy services are not uniform throughout the country. Operational researches and surveillance are presently inadequate in priority areas. Major challenges NLEP is facing several critical challenges even when national elimination was achieved in 1998. The most urgent issue faced by NLEP is created with the elimination itself. Since 1998, there was a gradual less allocation of fund for the programme, the activities became lesser, less training, losing experienced persons and ultimately leprosy lost its face as an important infectious disease in the country. When the call for leprosy elimination by the year 2000 was made the word Elimination was defined as reduction of leprosy prevalence to below 1 case per 10,000 population. When Bangladesh achieved elimination at national level this specific definition of elimination has been misunderstood. It was assumed that the disease is under control and after year 2000, there is hardly any need of continuing fight against leprosy. So, reaffirmation of commitment of the government and other stakeholders towards leprosy control programme is very much needed. The next major challenge is to sustain knowledge, skills and experience in leprosy management especially in low prevalence situation that relates to a significant decrease in work-load for leprosy control activities in field. Thirdly, leprosy continues to be stigmatized condition deeply embedded in our society. Socially, marginalized groups such as women and urban poor are less likely to attend for care. Proper steps need to be taken for better understanding the causes of stigma and assess the effect of intervention to decrease it. Finally, additional challenges remained for prevention of secondary disability and deformity those who already have primary disability after MDT and community-based rehabilitation of those affected people. Strategy The enhanced global strategy requires endorsement and commitment of everyone working towards elimination of leprosy. The basic principles of leprosy control are timely detection of new cases and their effective treatment. Based on this principles and strategies laid down in the Global Strategy the national post elimination leprosy control strategy was formulated. The goal of the national strategy is to further reduce the disease burden due to leprosy, to sustain the provision of quality leprosy services for all the affected people, to ensure the principles of equity, social justice and human rights. Guiding principles in the strategy called for supporting and guiding all implementing partners for mobilization and effective management of resources to further reduce the disease burden. It called for promoting integrated approaches using Upazila Health Complexes as the peripheral centre or even below level such as Community Clinic to provide quality leprosy services, including suspect referral for management, and introducing cost effective community awareness and health education programme involving local stakeholders to reduce stigma and discrimination against persons and families affected by leprosy. Ensuring that NLEP as well as its partners invest adequately in long term human resource development through appropriate international and national training strategies that will sustain national expertise in leprosy. In this regard, the government and partner NGOs should take strategy to retain expertise/experienced senior staff till disease burden is significantly reduced. Promoting and strengthening sustainable innovative approaches to extend leprosy control services in underserved communities and difficult to access areas. Sustaining early case detection and provision of MDT of free of cost with improving treatment adherence and timely completion of treatment, it added. Strengthening all measures aimed at preventing the occurrence and worsening of disabilities by timely detection and effective management of acute complications and promoting problem oriented self-care practices. Promoting the use of community-based rehabilitation to improve the quality of life of persons and families affected by leprosy. In this regard, active support is very much needed from WHO, international and national humanitarian agencies. Striving for effective collaboration with international, national and local community-based organizations related to health and other sectors, said the principles. As the disease is the most stigmatized in our country, many patients faced inhuman bahaviour, which is violation of their human rights. The strategy also mentioned about guidelines, which said, states should protect and ensure the full realization of all human rights and fundamental freedoms for all persons affected by leprosy and their family members without discrimination on the grounds of leprosy. A number of documents and strategy papers have been made in the world for protecting the human rights, especially that of people with disabilities. Some of these are: UN Principles and Guidelines for the elimination of discrimination against persons affected by leprosy and their family members, UN Charter of Universal Human Rights, Human Rights Council of UNO, UN Convention on the Rights of people with disabilities, Global Partnership on disabilities and development, New/WHO Guidelines on Community Based Rehabilitation and New Interest in disability within ILEP----New Technical Guideline on CBR. The documents stressed on establishing the rights of disabled people, caused by leprosy, so that they can live with full dignity. According to The Leprosy Mission International-Bangladesh (TLMI-B), due to failure of timely treatment, many leprosy patients became disabled, creating a burden on respective families and the state. According to NLEP sources, there were 26,479 people from 1985 to 2015 in the country with deformity caused by the disease. Some 203423 people were diagnosed as leprosy cases in the country during the period. The data indicated that over 10% affected people were disabled due to the disease a year. Urgent steps need to be taken for proper implementation of the national strategy. Bangladesh cannot go ahead without addressing the leprosy issue. It is hoped that all concerned would come forward to build a better country by defeating the disease. The writer is a journalist working with a private TV channel. His e-mail is: [email protected]