Leprosy Mailing List – August 3rd, 2007
Ref.:
Leprosy Programme in Sri Lanka
From:
Settinayake S., Colombo, Sri Lanka
Dear Dr. Noto,
I am the Manager of the
National Leprosy Elimination Programme (Anti Leprosy Campaign - ALC),
in Sri Lanka for last 7 years. I
joined the programme in 1986. I
believe, I am the most senior leprosy programme manager at SEARO-WHO
at the moment. Since 1989, I have attended all inter-country
meetings of WHO-SEARO without any break.
I was eagerly following the
comments made by experts on the WHO leprosy statistics on WER of 22nd
June 2007. However the
latest appeared in the leprosy dialogue that of Dr. Pannikar’s
prompted me to do a comparison between Thailand and Sri Lanka. All the programme managers of
Thailand since 1988 are good friends of mine. I have visited Thailand on
more than 3 occasions and I learnt lot from Thailand. I fully agree with Dr.
Pannikar (LML July 31st, 2007) that it is one of the most
successful programmes.
Sri Lanka is very much
smaller in extent when compared to Thailand and also population is
very much lower.
Sri Lanka introduced MDT in
1983 and the same year we achieved 100% coverage thanks to the
provision of MDT drugs free of charge by Swiss Emmaus (presently
Lepra.ch). Thailand
reached 100% coverage in 1989, six years after us. Thailand being a large
country, introduced MDT in phase manner.
Thailand is the first country
in SEARO to reach the elimination target in 1994. Sri Lanka reached the
elimination target in the following year (1995).
Since reaching the
elimination target, new case detection rate (NCDR) has the declined
steadily in Thailand and the child rate also has dropped to a very low
value of 5.3% indicating the interruption of the transmission.
But in Sri Lanka, since
reaching the elimination target, during last decade, NCDR fluctuates
around 9/100,000 with annual new cases over 1000. Child rate fluctuates and is
now at 10.3%.
This difference can simply be explained as to
delay in integrating leprosy activities into general health service in
Sri Lanka. Leprosy
control /elimination activities were implemented exclusively by the
vertical programme of the Ministry- Anti Leprosy Campaign- till 2001. Thailand, I believe is the
first country to integrate leprosy control activities 3 decades ago.
The first peak of NCDR (17
/100,000) was observed at the end of the first year (1990) of the
Social Marketing Campaign supported by Novartis foundation for
Sustainable Development before reaching elimination. The second peak of NCDR
(12/100,000) in Sri Lanka was observed at the end of first year (2001)
of integration.
With the integration,
ownership is gradually being shifted to peripheral health workers of
General Health Service and ALC is providing technical guidance,
training trainers and monitoring the programme regularly. There is a constant dialogue
with new stakeholders by way of review meeting and sending of
quarterly epidemiological reports.
If Sri Lanka would have
integrated leprosy few years before, we would have observed steady
decline of NCDR.
With regards,
Dr. Sunil Settinayake,
Director, Anti Leprosy
Campaign
E-mail slelp1@sltnet.lk
