Strategies need to be defined to respond to a single new case. This could be considered an 'outbreak' of leprosy. In those situations, Ministries of Health could have made provisions to do outbreak management such as：
･ Maintain the capacity for surveillance, by ensuring the awareness of health staff.
･ Verification of diagnosis and treatment of the index case, possibly by staff from a more centralised level.
･ Examination of intensive contacts of an identified index case： household contacts, neighbours, and other significant contacts.
･ Central notification and follow-up of individual patients.
･ Public education; updating of health staff.
3.1.4 The process of changing policies
The process of changing policies is not an overnight affair, at least I would hope so： some steps have to be taken one at a time：
･ It is essential that the approach to change involves all concerned from the start.
･ Analysis (needs, resources, stakeholders)
･ Priority setting
･ Designing new strategies and implementing them.
This needs time and dedicated efforts; not in the least because there may be frank opposition to change at all, or to change towards sustainability and improved cost-effectiveness. This expected resistance justifies：
･ A thorough stakeholder analysis.
･ Getting all the political support you can get.
3.2 Co-operation
Ministries of Health may seek assistance to this process for redefining policies. Various organisations should be able and willing to give technical and financial support： I am thinking of WHO Leprosy Unit, of course, ILEP-Medico-Social Commission, of course and ILEP-members, of course, ILA possibly. A first start has been made with a sustainability workshop with similar aims, held in Vietnam recently. It was organised jointly by the National Institute for Dermatology and Venereology, Damien Foundation and the Nether-lands Leprosy Relief Organisation.
4. Summary： wrapping up
The purpose of this presentation was to plead for an active position by decision-makers： new situations in leprosy control make reviews of existing policies and strategies essential. To close your eyes and try to go on as usual is doomed to lead to the vanishing of leprosy control in a country.
New strategies should have sustainability as its goal. Practical solutions may lead to an increased integration of management tasks, and the change towards outbreak management strategies.
H. Eggens, Royal Tropical Institute (KIT), Amsterdam, THE NETHERLANDS
