1 / HEALTH SERVICES DELIVERY
1.4 / DISEASE CONTROL PROGRAMME
1.4.2.i. / Communicable Diseases Control:
Leprosy Control (as of March 2008)
A / Focal Point / DDG PHS
B / Implementing Agencies / Anti Leprosy Campaign
PD/DPD/RE
D/THH, Dermatologists
C / Target Areas & Beneficiaries / Through entire general health system to patients and the community
Project Summary:
Leprosy Control/Elimination activities in Sri Lanka have been implemented through the vertical programme, Anti Leprosy Campaign (ALC) for many decades. Due to successful implementation of MDT programme since 1983 and Social Marketing Campaign since 1990, Sri Lanka was able to achieve the elimination target set by WHO at national level in 1995, five years ahead of the targeted year. Since then ALC involved in strengthening the infrastructure for the integration of leprosy services into General Health Service.
In 2001, Integration was launched. Experience two years after integration has shown that regional authorities have taken the ownership of the programme which is functioning smoothly. With the total integration of leprosy services, ALC aims to reach the elimination target in remaining few districts and sustain the achievement made so far by constantly monitoring the programme with regional epidemiologists.
Actions have already been taken to repeal the Leper’s ordinance 1901 which made admission to these hospitals compulsory and to delete obsolete clauses with regard to leave for leprosy patients in the establishment code. To sustain the achievement made so far and to maintain the continued surveillance, ALC may need additional funds from the Ministry of Health in the event of two current funding agencies leaving the programme

1. Justification:

Leprosy is eliminated at national level as a public health problem with the achievement of elimination target of prevalence less than 1 patient for 10,000 population. However, leprosy is not evenly distributed throughout the country. There still remain 2 districts in the Western and 3 in Eastern provinces with prevalence more than the elimination target.

In low endemic situation, it is essential that remaining few cases should have easy access to the diagnosis and treatment facilities. Moreover, the limited staff of vertical campaign will not be able to detect these cases which emerge sporadically from various part of the country. It is not cost effective and cost benefit to run a vertical programme when the number of patients are declining.

Leprosy is a disease which had a high social stigma in the past. With the launching of Social Marketing Campaign, stigma has been reduced to a greater extent. However, existence of special programme with ‘specialised staff’’ will enhance the stigma among the community. By integrating, ‘specialness’ of the disease will be removed and as a result, stigma will come down. It also signals the health workers and the community that leprosy is now a normal disease which can be treated at any health institutions.

Existence of legislation and leprosy hospitals which are out dated is a stumbling block to the further reduction of stigma.

2. Important Assumptions/Risks/Conditions:

Provisional health authorities will allocate funds and other resources to keep strict surveillance on low-priority, low endemic disease.

Frequent turnover of trained Regional Epidemiologists who are the chief implementers of the leprosy elimination programme at regional level.

Unavailability of funds for training, monitoring and IEC activities in the event of foreign funding agencies leaving the programme

Inadequate supervision of the district programme by regional health administrators

Need for on-going training programme for new MOs, Pharmacists, dispensers and other health workers

Close monitoring of the drug distribution by regional health authorities

3. Project Objective:

Objective / Indicators / Means of Verification
to fully integrate all the leprosy elimination activities into general health service with simultaneously achieving the elimination target in remaining 5 districts. / Prevalence
New case detection rate
Child rate
Multi-bacillary rate
Deformity rate
Timeliness and completeness of returns
Number of sentinel sites Availability of drugs
Number of health institutions with adequate supply of MDT / Monthly/quarterly/Annual reports on epidemiological indicators
Software programme on leprosy management information system
Annual drug estimate books
Periodical survey
Reports Reports of field visits of field visits

4. Project Output/Product:

Outputs / Indicators / Means of Verification
Health care providers made competent in patient management procedures / Number trained and number to be trained / Records at DPD Office
Patients with visible deformities are provided with essential deformity care and rehabilitation / Number of physiotherapists trained
Availability of shoes, splints, and ulcer care kits / Reports and returns
Facilities made available at all health institutions to treat leprosy / Number with MDT / Software programme
MDT return
Drug estimate books
Programme is periodically evaluated by internal and external experts / Availability of the programmes evaluation report
Evaluation by external experts / Programme evaluation reports

5. Related Projects:

Project No. / Project Title
Capacity building
Leprosy management information system
MDT monitoring
Health education
Deformity care programme

6. Relevant Agencies to be Coordinated:

Ministry of health, Provincial government, Department of Social Services, Department of education

7. Monitoring & Evaluation:

1.Who? Anti Leprosy Campaign, Provincial Health Administrators, dermatologists

2.When? Review meetings, annual reports, periodical and Ad-hoc surveys

sentinel reports

3. What actions to be taken based on results of monitoring & evaluation?

  • Revision of training curriculum
  • Revision of regulations and guidelines
  • Improve Provision of service

8. Activities:

Activities / Expected Results / Process Indicators
1 / Conduct training programmes for new /untrained MOs and AMPs in all districts / Health Care Providers in the health institutions with skills to diagnose and manage Leprosy / Number of trained Mos/AMPs in the district
2 / Distribute MDT drugs through the normal channel of GHS ( MSD- Regional Drug stores-Districts) / Uninterrupted supply of leprosy drugs to health institutions / Number of institution with MDT
3 / Establish a close monitoring of leprosy situation in all districts / Ability to asses the leprosy situation with a view of planning further activities / Availability of periodical reports
4 / Conduct awareness programmes for community – low endemic areas,
Northern province and high endemic areas / Voluntary reporting increased
Stigma reduced / Area specific Plans of action
5 / Develop and implement standards for comprehensive care for patients with deformity ensured / Trained physiotherapists / PHIs
Patients on self care / Deformity register