1. Leprosy – cross-cutting issues with NTDs Doug Soutar ILEP General Secretary WORKING TOGETHER FOR A WORLD WITHOUT LEPROSY

2. Background to Leprosy Control Pre-1990s – high prevalence disease (estimated 5 million registered for treatment) Vertical Approach –Specific leprosy control programmes –Dedicated staff –Training centres –Separate leprosy hospitals –Long duration dapsone monotherapy WORKING TOGETHER FOR A WORLD WITHOUT LEPROSY

3. Advent of short course MDT Introduced to combat drug resistance (1982) Shorter duration led to reduced prevalence Elimination as a public health problem by 2000 (less than 1 in 10,000) - 1991 90+% reduction in registered prevalence New case detection currently static at around 250,000 per year WORKING TOGETHER FOR A WORLD WITHOUT LEPROSY

4. Vertical Approach Unsustainable Unsustainable and not cost-effective Options: –Integration in primary health care –Integration in general health services –Combined with Tuberculosis programmes –Adopted by dermatology services –Linked to disability services in CBR Neglected Tropical Diseases - synergy? WORKING TOGETHER FOR A WORLD WITHOUT LEPROSY

5. Leprosy and NTDs Poverty and disadvantage Marginalised populations Lack visibility and political voice Discrimination and stigma –esp. women Morbidity burden – 15 million completed MDT, 3 million with residual disability Strategy – intensive case management WORKING TOGETHER FOR A WORLD WITHOUT LEPROSY

6. Cross-Cutting Opportunities Community awareness Detection Treatment Training Supervision Patient education Drug distribution Monitoring Information systems Community participation Morbidity management Disability prevention Rehabilitation Stigma Discrimination Research Surveillance etc WORKING TOGETHER FOR A WORLD WITHOUT LEPROSY

7. OPPORTUNITIES Potential for collaborative approaches to: Control Morbidity management and POD CBR Stigma reduction Advocacy with persons affected Accessing funding

8. NEED FOR INNOVATION M.Leprae continues to require us to adopt innovative approaches if we are to ever get rid of it. Political contradictions too require us to think together outside the box

9. IDM beyond 2020 IDM cannot be time limited by a 2020 target Unless we can scale up resources for R&D of new tools to break transmission, leprosy and its disabling consequences will require IDM well beyond 2020 Intensive, innovative and collaborative disease management will be needed if we are to avoid some ‘neglected’ diseases becoming ‘re- emerging’ diseases.