A first small step towards achieving this could be to make sure that at least the persons registered for MDT do not develop new disabilities and their existing disabilities do not worsen during the treatment Studies have already shown that delay in the diagnosis and starting of treatment is closely linked to development of disabilities among the new patients. Thus, strengthening of leprosy control services for early diagnosis and starting of treatment remains the most efficient way of preventing disabilities.
Rehabilitation needs related to physical disabilities：
A lot of knowledge exists about the provision of rehabilitation services for answering the needs of persons with physical disabilities caused by leprosy. Still, some aspects need special attention.
Prevention of disabilities (POD)： Affected persons and their family members need to make life-long changes in their attitudes, behaviours and life-styles. However, many leprosy field workers do not have sufficient knowledge and skills to promote these changes. Further, what are the long-term effects of patient education provided in leprosy control programmes? Studies on this subject are limited to relatively short follow-up periods. However these studies have shown effectiveness of self-care in prevention of new complications especially those related to occurrence of plantar ulcers.
Perhaps, more can be learned from community-based rehabilitation (CBR) programmes that utilize the involvement of target beneficiary groups, family members and community members in acquisition of knowledge for self-care. Training and involvement of leprosy-affected persons in reaching other leprosy-affected persons and their families for transfer of knowledge and skills, needs to be undertaken and studied in a systematic way.
The non-governmental organisations (NGOs) involved in community development and rehabilitation programmes have been advocating the need for involvement of potential project beneficiaries in all aspects of planning, management and implementation of project activities for a long time. This strategic change in way services are organised has not reached many leprosy-related rehabilitation services, which often continue to be dominated by the traditional care giver - care receiver relationships in which the beneficiaries of a service have little or no say.
Footwear and Orthopaedic appliances： Leprosy projects continue to promote the production of special footwear for persons with plantar ulcers and often there is not enough attention towards the acceptance and use of this footwear by the beneficiaries. Apart from other problems, such production services may not be able to cover the needs of all the persons who need them.
Persons with plantar anaesthesia, without other visible foot deformity and before the occurrence of plantar ulcers, often do not receive footwear. There is increased scope for promoting the use of commercially available footwear, at least for those persons who have no visible foot deformity.
