Abstract
BackgroundLeprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system’s situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future.MethodsThe study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007).ResultsIn all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year.ConclusionsThe findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.
Highlights
Leprosy has a wide range of clinical and socio-economic consequences
National Leprosy Control Programs The general health care system is based on a three-tier structure in all reviewed Leprosy Post Exposure Prophylaxis (LPEP) countries, i.e. national, provincial and district level (Fig. 2)
Our study showed that the national leprosy programs as part of the health systems are diversified in the three countries, based on organizational hierarchy, human resource quantity and capacity
Summary
Leprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. The health systems are pivotal in leprosy service delivery. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. Leprosy is an infectious disease, predominantly affecting peripheral nerves and the skin. It leads to a wide range of clinical symptoms, eventually resulting in disfigurement and disability if left untreated [1]. Tiwari et al BMC Health Services Research (2017) 17:684 elimination of leprosy (zero incidence) needs alternative control strategies. The general health systems are pivotal for leprosy service delivery. Case detection and subsequent treatment with multi-drug therapy (MDT) are the key strategies to reduce the disease burden [8, 9]. It has been argued that leprosy programs are not implemented properly [6, 14], and needs to be improved [15, 16]
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