Leprosy Elimination Monitoring (LEM)
Monitoring MDT services
Having MDT available at the national level is no guarantee that the drugs will reach patients in the more peripheral areas: there is little evidence to suggest that patient demand is effective in ensuring a regular and uninterrupted flow. There is a need to actively plan, control, quantify and monitor the supply of MDT at all levels.
Assessment of interventions becomes particularly important when considering the leprosy elimination goal. Taking into account the epidemiological characteristics of leprosy, and the large number of grey areas in our understanding of the disease, it is important to select carefully the outcome indicators that we would like monitored - incidence is the most relevant indicator, but may be the most difficult one. Prevalence, as a composite indicator varies considerably, depending on the operational components of interventions. Incidences of disability and of MB cases in the community could be very useful to evaluate the leprosy situation. The uneven distribution of leprosy, as well as the role of various local factors, calls for caution when extrapolating the results from one place to another. There is a clear need to collect a set of indicators to enable programme managers in endemic countries to analyse the results of their work, increase their motivation and convince the decision-makers.
The main purpose of LEM is to collect a limited number of indicators that can describe the performance of MDT services at the national, sub-national and peripheral levels of most endemic countries. The term ‘MDT services’ refers to comprehensive health activities, including: diagnosis, classification, prescription of treatment, delivery of MDT, case-holding and cure of leprosy patients. It is expected that such indicators will assist decision-makers and programme managers in assessing progress towards the elimination of leprosy at the most peripheral level. This will also assist in planning and implementing appropriate action and to measure its impact. In some situations, these indicators could help in identifying areas where special campaigns or projects could be implemented.