Mozambique, Angola and Madagascar - the Political Will to Eliminate Leprosy
There are six countries in the world that have not achieved the elimination of leprosy. Three of these
countries are in Africa: Angola, Mozambique and Madagascar. All three have had to deal with food
shortages, poverty, natural disasters and political unrest. However, leaders at the highest levels of
government impressed me with the seriousness with which they are treating the push to eliminate leprosy by 2005.
Priority is being given to educational and health services, because these two areas have the greatest impact on elimination―
both of the disease and of the stigma surrounding it. Reflecting on the efforts that I saw when I was there, I feel strongly that all three of these countries stand a very good chance of achieving elimination by the year 2005.
Mozambique (September 14-21, 2002)
My visit to Mozambique last year was very enlightening. It showed me that while political commitment is an absolutely vital base, efforts at much broader levels need to be just as strong if elimination is to be achieved. Mozambique has a prevalence rate of 3.63/10,000. However, as in India, there is a large imbalance between provinces, with a few areas in the north reaching numbers as high as 10 per 10,000. It is my belief that country-level elimination can be achieved if efforts are focused on these northern areas.
I began my journey in the capital city, Maputo, where I met Prime Minister Pascal Mocumbi. Being
a medical doctor himself and former Health Minister, Prime Minister Mocumbi has a full
understanding of the state of leprosy elimination in the country. He expressed to me his firm political
commitment to the fight against the disease. In Maputo, I was able to observe the way in
which former patients are being rehabilitated. There were several self-help projects, under which people
managed a well and sold water, manufactured blocks for construction, and made shoes for the physically
disabled. Health Minister Songane explained, “It is in the Mozambique spirit to offer a constructive role
in society to physically disabled people.”
Then I proceeded to the northern provinces to meet with local political leaders and visit hospitals and
health centers. In Pemba City in Cabodelgado Province, I was taken to another self-help facility,
managed by an alliance known as ALEMO. This group is made up of physically handicapped people and
those who have been affected by leprosy. There, I witnessed people being rehabilitated and producing
rope as a way of generating income. In Namaita Village, Nampula Province, about 1,300km from the capital, I took part in the launching
ceremony of COMBI (Communication for Behavioral Impact). COMBI is an effort to educate people about
leprosy and promote self-check activities among children and their family members, with assistance
from volunteer village health workers. Several hundred people gathered for the ceremony. Among them were
many school children wearing yellow T-shirts bearing the message, “Check your skin.”
In Mozambique, it was gratifying to find such strong commitment, to both elimination and
education, among the government leaders. However, I felt that the more basic components of the country’s
effort still need to be improved. It is hoped that political will can be translated into more effective
activities at grass roots levels.
Children at Foulpointe Basic Health Center in Toamasina Province, Madagascar
Angola (July 29 - August 2, 2003)
In Angola, I visited Bie Province, about an hour and a half by air from Luanda, the capital. For years, the long Angolan civil war nearly stopped progress there in many ways. Not
only did Bie see some of the fiercest fighting in the civil war, but it now also has one of the highest prevalence rates in the country―5.83
as of 2002. We drove 80 kilometers from the city of Kuito to a hospital in a town called Camakupa. The hospital is understaffed and lacking
in equipment, and I can only imagine how difficult it must be to work there. Nevertheless, in spite of these conditions, it was encouraging
to see a young volunteer doctor from overseas working diligently alongside the local staff.
Meeting with Outpatients at a Hospital in Camakupa, Bie Province, Angola
During my visit, I also had a chance to attend a Partners’ Meeting on Leprosy Elimination. It was
apparent that there is a strong political will to achieve the elimination of leprosy by the end of 2005. I felt
assured that progress, having been delayed for so long by the civil war, will now begin in earnest. When I
attended the meeting, all partners were treated as equals, from the health minister, representatives of
WHO and NGOs, to the people affected by leprosy. This is a good indication of the government’s efforts to
deal with the issue, both medically and socially. Progress must be made, not only in improving
detection and treatment, but on the issue of discrimination as well.
Madagascar (September 14-21, 2003)
In Madagascar, I accompanied Dr. E.M. Samba (regional director of WHO-AFRO), and Michel
Recipon (president of the Association Francaise Raoul Follereau), as we looked at the state of elimination
activities there. While in the country, the three of us exchanged views with representatives of the
government and local medical personnel, encouraging them to make further progress.
We took a close look at the high prevalence rate in the northeast part of the country, visiting several
villages in our efforts to promulgate accurate information about leprosy. We were welcomed in a
village in Toamasina Province by around 300 villagers who performed educational songs and dances about the
elimination of leprosy. When a group of more than 100 children was asked who knew that leprosy is curable,
nearly all of them raised their hands. During this trip, top leaders were able to meet and
discuss issues. Both a thorough knowledge of leprosy and a high level of political commitment toward the
problem were expressed. It was emphasized that the fight to eliminate the disease is connected with the
fight to eliminate poverty.
Certainly, there are barriers to overcome in these three countries, from access problems in difficult areas
to the need for better training for local health workers. However, having felt firsthand the political will to
reach the elimination goals, I am convinced that the road to the elimination of leprosy is not such a long one.
Children Performing Leprosy Educational Play at Antetezambaro Basic Health Center in Toamasina Province, Madagascar
