The past three decades have witnessed some impressive advances in leprosy control. Elimination as a public health problem (i.e. registered prevalence below 1 per 10 000 population) was achieved in all countries1.
The agenda of eliminating leprosy at the subnational level is still unfinished in many countries and will therefore continue to be pursued in the coming years.
Other challenges remain: continued delay in detecting new patients, persisting discrimination against people affected by leprosy and limited impact on transmission of leprosy.
The Global Leprosy Strategy 2016–2020 aims at accelerating action towards a leprosy-free world. It is based on the principles of initiating action, ensuring accountability and promoting inclusivity.
Initiating action involves developing country-specific plans of action.
Ensuring accountability will be achieved by strengthening monitoring and evaluation in all endemic countries in order to objectively measure progress towards achieving targets.
Promoting inclusion can be supported through estab lishing and strengthening partnerships with all stakeholders, including persons or communities affected by the disease.
The global strategy fits within the WHO aim to provide universal health coverage with its focus on children, women and vulnerable populations. It will also contribute to reaching Sustainable Development Goal 3—reaching health and wellbeing for all by 2030.
Its goal is to further reduce the burden of leprosy at the global and the local level. The strategy is structured around three pillars:
(1) Strengthen government ownership, coordination and partnership
(2) Stop leprosy and its complications
(3) Stop discrimination and promote inclusion.
Under each pillar broad core areas of interventions are included, among which five are the key strategic operational changes:
(1) Focus on early case detection before visible disabilities occur. A special focus will be on children as a way to reduce disabilities and reduce transmission. The target is zero disabilities among new paediatric patients2 by 2020.
(2) Target detection among higher risk groups through conducting campaigns in highly endemic areas or communities; and improving coverage and access for marginalized populations. This will result in earlier detection and reduction of patients with grade-2 disabilities (G2D) at the time of diagnosis. The target of G2D rate is less than one per million population.
(3) Develop national plans to ensure screening of all close contacts, especially household contacts. The target is to have all household contacts screened.
(4) Promote steps to move towards the use of a shorter, uniform treatment regimen for all types of leprosy based on a thorough review of available evidence on uniform MDT and designing a global plan of action for its roll-out.
(5) Incorporate specific interventions against stigma and discrimination due to leprosy by establishing effective collaboration and networks to address relevant technical, operational and social issues which will benefit persons affected by leprosy.
A significant (measurable) reduction of stigma and discrimination against persons affected by leprosy by 2020 is aimed for through actions to reduce stigma and discrimination and promote social inclusion).
National leprosy programmes in endemic countries are encouraged to adapt the concepts and principles as proposed in the Global Leprosy Strategy 2016–2020 for developing country- specific plans of actions. Countries that report few or no cases will still need to adapt the strategy to their context, focusing especially on surveillance and on sustaining of a referral system either at the national level or through linking up to regional centres.
The Global Leprosy Strategy 2016–2020 is aligned with the Roadmap for Neglected Tropical Diseases whose target for leprosy is consistent with the G2D target of this strategy.
It aims to promote further integration at the country level between leprosy services and other services at the primary and referral levels aimed at tackling other infectious diseases and also disabilities.