Fw: Ref.: (LML) The agenda of the upcoming ILC and problems encountered in the field do not overlap

Leprosy Mailing List – July 13,  2022

 

Ref.: (LML) The agenda of the upcoming ILC and problems encountered in the field do not overlap

 

From:  Henk Eggens, Santa Comba Dão, Portugal

 

Dear Pieter and all,

Greetings from Portugal.

I am following the conversation after Wim Theuvenet's observations.

I am working on a response on Wim's point on his findings in Indonesia concerning the lack of access and insufficient utilisation of secondary health services for leprosy patients. But I am not getting there.

Most endemic areas, I suspect, suffer from incomplete access and suboptimal utilisation of leprosy services. It seems logical that the performance in leprosy services would correspond more or less with the performance in general health services. Unless leprosy is an extremely neglected disease in an endemic country.

How can one demonstrate a more objective view of the state of affairs?

I am thinking of relating leprosy service performance to the UN  Sustainable Development Goal (SDG) 3, specifically Indicator 3.8.1: Universal Health Coverage (UHC) service coverage index. Access to leprosy services and its effective utilisation should be at least at par with the performance of general health services. Actually it should do better than general health services, leprosy being a neglected disease.

Since I retired as a half-baked epidemiologist I am struggling with the right indicators for access to leprosy services and effective utilisation.

Real, population-based, incidence or prevalence rates are not available for leprosy, I think.

So far I came up with the usual suspects:
1. Disability grade 2 (DG2) at diagnosis as an indicator for early case detection.
2. MDT completion rates by cohort.
3. Proportion of patients without deterioration of DG at the end of MDT  as an indicator for effective utilisation of services (a very rough indicator).

These indicators should follow the trend in line with Indicator 3.8.1. of the SDG.

For instance, the Indonesian UHC service coverage index rose from  22 in 2000 to 59 in 2019. (The index unit is not given, as it is a result of 14 indicator values).
https://data.worldbank.org/indicator/SH.UHC.SRVS.CV.XD?end=2019&locations=ID&start=2000&view=chart

So, in simple reasoning, performance in leprosy service access and utilisation should at least have risen with the same trend.

And then there is the point of limited access due to governments' financial policies for health services, as Wim mentioned for Indonesia and probably apply in more countries.

I am not even mentioning the necessary non-medical interventions to improve quality of life for (ex-) leprosy patients.

How to compare these general health service performance indicators with leprosy service performance indicators?

I am still at a loss.

It looks like a good operational research topic.

Just sharing my struggle with you. Any ideas?

Best wishes,

Henk Eggens

 

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

 

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