Leprosy Elimination Monitoring (LEM)
Monitoring MDT services
Objectives of LEM
LEM intends to measure specific aspects of leprosy elimination programmes. It is meant to complement existing information systems and methods for reviewing elimination programmes. The principal objective of LEM is to assess the extent and quality of MDT services at the national, regional, district and sub-district levels and to identify potential problems. If major structural problems are uncovered, WHO will assist in making an in-depth evaluation of the system. Details of all findings will be provided to national programme managers and indicators published at least once a year in WHO’s internal reports.
The design of the monitoring will depend on many factors and may vary from one country to another. However, the monitors collect key indicators on the following issues:
- Availability of MDT blister-packs and geographic coverage of MDT services: this will be based on a cross-sectional survey of randomly selected health facilities;
- Quality of patient care: diagnosis and case-holding. This will be based on a review of individuals’ records and leprosy registers. The quality of MDT services will be reviewed on the basis of cohort analysis;
- Analysis of elimination indicators: internal validity of information on prevalence and detection (crude and specific) and analysis of trends. This will be based on the analysis of existing information and review/updating of leprosy registers.
Indicators have been developed in such a way that all required data can be analysed manually. However, programmes or monitors having access to a computer can easily use spreadsheet and database softwares. WHO/LEP is developing and updating a set of spreadsheets and databases for recording and analysing key indicators. A programme is being developed for data entry, standard reporting, analysis and mapping of MDT services.
Design of LEM exercises
Only a limited number of indicators are collected. These are well standardised and have been in use for several years in many countries and are well known to programme managers. They should be seen as a simple tool for quick and reliable assessment for some of the critical aspects of a national leprosy elimination plan. All the required data are collected from existing patient records, leprosy registers, reporting forms and stock bin cards Information is collected at a limited number of health facilities. This sample should reflect the situation prevailing in a specific geographical or administrative area at a given point in time. Selection of the sample and sample size is essential for extrapolating the findings.