Leprosy programmes may also learn from community-based rehabilitation (CBR) programmes in terms of involvement of local craftsmen and family members for the production of simple appliances through the use of simple technology and locally available raw materials. This requires a shift in the attitudes among the care-givers, who need to share more information with leprosy affected persons and their family members.
Specialised services： With decrease in the prevalence of leprosy, integration of leprosy control services into the general health services has become a priority issue.
Even in such conditions, it is imperative to ensure that national and regional level referral centres continue to function for more specialised rehabilitation services likere-constructive surgery, orthopaedic surgery, ophthalmology services, research, etc.
Specific issues related to socio-economic rehabilitation：
Reaching those who are most in need： While the resources for socio-economic rehabilitation activities of leprosy affected persons are very limited, more attention is needed in defining clear criteria to ensure that the most needful persons benefit from such services. In addition, it is possible that because of stigma and marginalisation, still common in many parts of the world, the target group of socio-economic rehabilitation services may be much larger than the persons who have a visible deformity. The criteria for defining the most-in-need must be sensitive to the social and cultural situations of each area and thus may be difficult to generalise. However, an exploration of ways and means to bridge this gap needs to be a priority among all who are involved in leprosy-related work.
Adopting a development approach： The development approach means working with the strategy of providing opportunities for becoming self-sufficient and promoting independence among the target groups. Traditionally, socio-economic rehabilitation activities for leprosy affected persons, have been often based on "charity" approach rather than a development approach. The last decade has seen a gradual strengthening of the development approach in leprosy rehabilitation programmes, but still much more needs to done in this direction. Clearly there is strong need for proactive stance by all involved in leprosy work to foster this process of self-direction,
self-determination and self-sufficiency at all levels.
It is possible that the most-in-need persons may be excluded from activities aiming at self-reliance and independence, because they may lack the prerequisites (education
level, psychological characteristics, entrepreneur abilities, etc.) . Therefore, special effort is needed to define appropriate strategies which promote gradual development and strengthening of this group of persons.
