WHO draws up a global strategy for 2006 and beyond.

　

The question of how to sustain the progress of the past two decades has been addressed in the recently published WHO Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities 2006-2010.
　The document, which was drawn up in consultation with ILEP and other global partners, calls for shifting away from “a campaign-like elimination approach” in the direction of “a long-term process of sustaining integrated, high-quality leprosy services.” These services, in addition to case detection and treatment with multi-drug therapy, also include prevention of disability and rehabilitation.
　The basic principles of leprosy control ― early detection and treatment ― remain unchanged.
　The main elements of the new strategy are:
●sustain leprosy control activities in all endemic countries;
●use case detection as the main indicator to monitor progress;
●ensure high-quality diagnosis, case management, recording and reporting in all endemic communities;
●strengthen routine and referral services;
●discontinue the campaign approach;
●develop tools and procedures that are home/community based, integrated and locally appropriate for the prevention of disabilities/impairments and for the provision of rehabilitation services;
●promote operational research in order to improve implementation of a sustainable strategy; and
●encourage supportive working arrangements with partners at all levels.

　

WHO's Southeast Asian Region, which accounts for 12 million of the 14.2 million cases cured globally with MDT, outlined its own strategy.
　Setting a goal of reducing annual case detection to less than 10/100,000 population for the region and each country by 2010, its key objectives are: sustaining elimination at the national level and achieving it at the sub-national level and below; progressively reducing annual new case detections through timely case detection, prompt treatment and achievement of high cure rates; and ensuring and sustaining quality leprosy services.

Five months remain to achieve the shared goal of eliminating leprosy as a public health problem. Of the nine countries still to reach the elimination target, India and Brazil are almost there; the remaining seven are making determined efforts.
　While we want to see every country reach the target, a concern arises that some might announce they have succeeded without having any scientific basis for doing so. In the past, over-reporting has been a problem; more recently, underreporting has been emerging as a problem as well.
　WHO's director general, Dr. Lee Jong-wook, commented in May that it would be counterproductive to announce that elimination has been successfully achieved by every country unless the evidence backs this up. If we are impatient at this final stage, he said, it will call into question what has been achieved to date.
　One of the fruits of the elimination strategy has been the political commitment that has been generated. Leprosy services have reached out to more people, millions have been cured, drugs are freely available, and diagnosis and treatment are being integrated within general health services.
　But the 110-plus countries that have already achieved elimination must guard against complacency. Their work is not yet done. The WHO strategy has always been a milestone, not the final destination.
　It is very important that these countries keep moving forward. They owe it to themselves but also to the countries that have yet to achieve the elimination goal. They must show by example how passing the elimination milestone represents a positive achievement that leads to further progress.
　Achieving elimination at the sub-national level is a route already being taken by many countries that had a large number of cases. Maintaining the quality of leprosy services is another scenario, one that requires close cooperation with NGOs.
　As the final push for elimination continues, it must be accompanied by serious consideration of what comes next.

　

　

　

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