3) Organisation of Leprosy Services Under Low Endemic Conditions
Dr. H. Eggens
In this presentation I would like to discuss the following issues：
Why are new policies on leprosy control needed when a country or area has become low endemic?
How could Ministries of Health adapt their policies to this situation?
1. Why are new policies needed?
1.1 The epidemiological situation is different
Leprosy is a slowly evolving disease. A country or state may find itself slowly developing towards low endemicity.
In some countries, leprosy field staff now deal with a few patients only. Training institutions may find themselves training professionals in a rare disease.
A real possibility is that a Ministry of Health continues to pursue the same strategies as years ago, that donor agencies still follow the same approaches towards cure and care, while the circumstances have changed. Slowly, but surely.
1.2 Priority for leprosy control is reduced
Secondly, as the leprosy problem becomes less and less, the political interest is likely to drop, especially after the year 2000. Other pressing priorities take over political attention, budget and human resources. Partly this is understandable, but reduced priority and having no priority at all are different matters.
1.3 Health sector reforms
Another reason to take active steps in redesigning leprosy control policies is the changing context in which leprosy services are operating. More often than not, ministries of health are engaged in reforms, either slowly and incremental or swift and radical. If a control programme takes a passive and defensive attitude towards these changes, it might well end up losing an opportunity to influence new health sector policies.
It seems to me that a well-defined set of strategies aimed at efficient and effective leprosy control, presented at the right time would keep leprosy on the agenda. Not in capital letters, perhaps, but on the agenda nevertheless.
1.4 Active steps or evaporation?
What I would like to appeal for in this presentation is the following：
It would serve the leprosy patients, and the handicapped ex-leprosy patients, to take active steps to design new leprosy control policies and strategies for the health care delivery system of tomorrow. These policies should be based on an analysis of the situation of today, its likely trend, the expected needs and the resources that are and will be available in future. Active steps are needed to optimize the organisation of leprosy services. It seems important to avoid at all costs what is already happening in a few countries： sit back, wait and watch the leprosy control programme evaporate into nothing.
