WHO Seventh Expert Committee (June 1997)
Reaching special populations, human rights, post-elimination strategy
Reaching special population groups
To reach patients living in difficult-to-access areas, or those belonging to underserved population groups, special action projects for the elimination of leprosy (SAPEL) constitute an important initiative to ensure the fullest MDT coverage. The essential elements of SAPEL are, firstly, to find cases living in difficult areas or situations who are in need of treatment and, secondly, to cure them. Innovative and practical strategies involving mainly operational solutions will be used in order to provide MDT to these patients. Since the project operates in situations where the health infrastructure is weak or does not exist, the strategies used should promote self-reliance and self-help, and must involve the community so that the activities begun under SAPEL can be sustained.
Leprosy and human rights
Patients on MDT, and those cured of disease, should not suffer from restrictions in areas such as employment, education and travel. Any special legal measures that might increase prejudice against leprosy or prevent early cases from presenting themselves for diagnosis and treatment should be abolished. In some countries, the human rights problem is particularly serious among female patients, firstly, because of their gender, and secondly, because of the stigmatization associated with leprosy.
Strategy beyond elimination
After the year 2000, simplifying MDT services and strengthening the process of integration into the general health services are the keys to sustaining anti-leprosy activities, especially in low prevalence situations. The uneven distribution of leprosy makes it possible to have significant endemicity in some parts of a country, particularly for larger countries, even though the national elimination target has been attained. It is important to focus elimination activities at the most peripheral levels and to plan to reach the elimination goal at sub-national levels.