Fw: Ref.: (LML) New Publications On Cross-Cutting Issues In NTDs. September, 2026.

 

Leprosy Mailing List –  October 9,  2026

 

Ref.:  (LML) New Publications On Cross-Cutting Issues In NTDs. September, 2026.

From: Elizabeth Talatu Williams, Amsterdam, the Netherlands

____________________________________________________________________________

 

Dear Colleagues,

We are pleased to share the September 2026 edition of the InfoNTD newsletter, featuring new research, practical resources, and important updates from the 2026 NNN Conference.

InfoNTD was glad to attend the 2026 NNN Conference in Kigali, where we officially launched the InfoNTD Chatbot, an AI-powered tool designed to help users easily find reliable NTD resources. We invite you to use the chatbot and share it with health workers and program managers in your network. 

We also announced our new partnership with NNN to establish the NNN Resource Hub, creating a dedicated space to bring together resources for the NTD community. Stay tuned for more updates!

This edition highlights the latest WHO global leprosy update, which emphasises the importance of a person-centered approach to leprosy elimination.

Across the latest publications, we explore a range of cross-cutting NTD issues, covering schistosomiasis, soil-transmitted helminthiases, onchocerciasis, leishmaniasis, and trachoma. These issues include the use of AI and digital approaches for diagnosis, access to care, community engagement, health equity, diagnostics, and the integration of NTD services.

We also highlight an important global milestone, with WHO validating Timor-Leste’s elimination of trachoma as a public health problem, as well as new opportunities and events for the NTD community.

We hope this edition provides valuable insights and resources to support your work and strengthen collaboration across the NTD community.

Please feel free to contact us if you would like access to full-text articles not directly available through InfoNTD, or if you would like support with literature searches.

Warm regards,
Elizabeth Talatu Williams

www.InfoNTD.org
info@InfoNTD.org

 

 

 

Literature Reviews

 

Automating Diagnosis of Skin Neglected Tropical Diseases via Patient Metadata through Machine Learning Model with Adaptive Balancing and Dual Cross-Validation: Retrospective Diagnostic Accuracy Study
Minyilu Y, Yimer MA, Meshesha M. Online Journal of Public Health Informatics. JMIR Publications Inc. 2026.

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Stigma and discrimination among children affected by leprosy: a systematic review of a skin-related neglected tropical disease
Daehnhardt M, Cecil C, Bhorkar S, et al. Transactions of The Royal Society of Tropical Medicine and Hygiene. Oxford University Press (OUP). 2026.

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Gendered experiences of people living with tuberculosis or leprosy: A global systematic review
Unterkircher SCW, Lenz J, Mwasuka G, et al. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2026; 20 (9): 1 - 25. 

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Therapeutic Management of Schistosomiasis in Pregnancy: A Comprehensive Review of Praziquantel Safety and Clinical Outcomes
Mustafa HM, Elfaki T, Adam I. Biomedicines. MDPI AG. 2026; 14 (9): 1 - 20. 

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Contemporary challenges of Schistosomiasis mansoni in Brazil: a review of epidemiological indicators, SUS protocols, and control strategies (2010–2026)
Soares I, Gomes KNF, Faria RX. Frontiers in Tropical Diseases. Frontiers Media SA. 2026; 7 (1918824): 1 - 12. 

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Epidemiological transitions of Visceral Leishmaniasis in G20 countries: A 33-year retrospective joinpoint and demographic decomposition analysis with 20-year ARIMA projections
Wang Y, Zhang R, Liu Z, et al. PLoS neglected tropical diseases. 2026; 20 (9): 1 - 21. 
 

 

 

Practical materials

 

International Snakebite Awareness Day Webinar: Connecting Climate, Communities and Care Through a One Health Approach
the Royal Society of Tropical Medicine and Hygiene (RSTMH). 2026.

 

Epidemiological Record

 

Global leprosy (Hansen Disease) update, 2025: Strengthening a person-centered approach is integral to elimination of leprosy
World Health Organization. 2026.

 

 

New publications

 

Soil-transmitted helminth prevalence in a Sri Lankan sentinel community 22 years after the initiation of mass drug administration: a cross-sectional survey
Liyanapathiranage DA, Fernando BNT, Yahathugoda TC. BMC Infectious Diseases. Springer Science and Business Media LLC. 2026.

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The community drug distributor passport: a case study of training and recognition in Chad
Diane S, Oumar AM, Kali B, et al. Frontiers in Public Health. Frontiers Media SA. 2026; 14 (1879806.): 1 - 7. 

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Soil-transmitted helminthiasis prevalence and infection intensity among school-going children in Timor-Leste after the prolonged interruption of deworming: a cross-sectional survey (2025)
Jin H, Magno Neves MA, Pinto F, et al. The Lancet Regional Health - Southeast Asia. Elsevier BV. 2026.

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Co-designing the 'LEAD' strategy: A theory-informed stakeholder-led behavioural intervention to improve mass drug administration compliance for lymphatic filariasis elimination in an urban block of Odisha, India
Rehman T, Pattanaik A, Bal M, et al. PLoS neglected tropical diseases. 2026; 20 (9): 1 - 18. 

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Endemicity and environmental reservoirs of schistosomiasis and soil-transmitted helminth infections in Ghanaian rural communities
Akologo RN, Williams I, Adu-Gyasi D, et al. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2026; 20 (9): 1 - 18. 

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Feasibility of paediatric schistosomiasis prevention with praziquantel, Madagascar
Marchese V, Andrianarimanana D, Ratefiarisoa S, et al. Bulletin of the World Health Organization. 2026; 104 (9): 601 - 612. 

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Towards point-of-care diagnostics of neglected tropical diseases using nucleic acid amplification tests
Priem N, Rodriguez-Mateos P, Waweru H, et al. Analytical and Bioanalytical Chemistry. Springer Science and Business Media LLC. 2026.

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Declining Onchocerca volvulus transmission despite limited ivermectin delivery in the Kakoi–Koda focus, Ituri, Democratic Republic of the Congo: An epidemiological, entomological and landscape evidence synthesis
Amaral L, Ukety T, Upenjirwoth J, et al. PLOS Neglected Tropical Diseases. Public Library of Science (PLoS). 2026; 20 (8):1 - 26. 

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Epidemiological and entomological assessment of persistent onchocerciasis transmission after long-term ivermectin treatment in communities along the Kéllé river, Cameroon
Tanguep Siakam JL, Nwane PB, Nana Djeunga HC, et al. Scientific Reports. Springer Science and Business Media LLC. 2026.

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Soil-Transmitted Helminths and Their Impact on Nutritional and Anaemia Status Among School-Aged Children in Some Schools in Dutsin-Ma, Katsina State Nigeria
Yusuf M, Isa A, Danjuma ES, et al. Journal of Science Research and Reviews. Erdel Concept. 2026; 3 (5): 117 - 126.

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A Comparative Assessment of Onchocerciasis Knowledge and Ivermectin Uptake in Two Communities of Kano State, Nigeria
Mustapha, M.B., Surakat, O.A., Dogara, M.M., et al. Dutse Journal of Pure and Applied Sciences (DUJOPAS). African Journals Online. 2026; 12 (3c): 270 – 279.

 

Insecurity as a driver of migration, and its impact on the uptake of neglected tropical diseases preventive chemotherapy interventions in Kaduna State, Nigeria
Olanrewaju TO, Enwezor FNC, Lar L, et al. BMC Public Health. Springer Science and Business Media LLC. 2026.

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A national geostatistical survey for schistosomiasis and soil-transmitted helminths in Zimbabwe following interruption of preventive chemotherapy
Midzi N, Mutsaka-Makuvaza M, Phiri I, et al. BMC global and public health. 2026; 4 (1): 1 - 13. 

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Shared and targeted barriers to care for skin-related neglected tropical diseases in two endemic communes of Benin: Toward a framework for resource allocation
Houngnihin R, Biao M, Gbèbioho B, et al. Dialogues in Health. Elsevier BV. 2026.

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Forecasting the incidence of leishmaniasis in Ethiopia using global burden of disease 2021 data
Kelkay JM, Alemu EA, Alemayehu MA, et al. Discover Artificial Intelligence. Springer Science and Business Media LLC. 2026; 6 (1): 1 - 18. 

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Ripple Effects Mapping of a gender equity and social inclusion behaviour change activity in Uganda’s trachoma effort
Ssegawa E, Chhan D, Karlsson C, et al. International Health. Oxford University Press (OUP). 2026.

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Antigen Positivity Without Infection: Confirmatory Mapping in Children Rules out Lymphatic Filariasis in Loiasis Co-Endemic Settings in Gabon
Bakajika D, Atsame J, Pambou JR, et al. Tropical Medicine and Infectious Disease. MDPI AG. 2026; 11 (10): 1 - 13. 

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Awareness perception and attitude towards neglected tropical diseases among health professionals in South-West Nigeria
Olaniyan KO, Akande FA, Adedeji OA, et al. Discover Public Health. Springer Science and Business Media LLC. 2026; 23 (1): 1 - 23. 

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Absence of human yaws and detection of Haemophilus ducreyi in skin ulcers of school children near wildlife protected areas in Tanzania
Lubinza C, Anton A, Lueert S, et al. PLoS neglected tropical diseases. 2026; 20 (9): 1 - 14. 

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Impact of two rounds of azithromycin mass drug administration on active trachoma and ocular Chlamydia trachomatis infection in Naoero
Cowling C, Apadinuwe S, Cama A, et al. PLoS neglected tropical diseases. 2026; 20 (9): 1 - 13. 

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Diagnosis of localized cutaneous leishmaniasis and treatment outcomes following carbon dioxide cryotherapy performed by health centre staff: A pilot implementation study in Ethiopia
Zewdu FT, Alemu K, Lambert S, et al. PLOS Global Public Health. Public Library of Science (PLoS). 2026; 6 (9):1 - 14.

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Assessment of Knowledge, Attitudes and Practices of Indigenous Population about Onchocerciasis in Endemic Communities of Kogi West, Kogi State, Nigeria
Zakari H, Audu PA, Lucas A, et al. Life Science Review. Research Floor. 2026; 10 (2): 56 - 66. 

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Feasibility of paediatric schistosomiasis prevention with praziquantel, Madagascar
Marchese V, Andrianarimanana D, Ratefiarisoa S, et al. Bulletin of the World Health Organization. 2026; 104 (9): 601 - 612. 

 

 

News & Events

 

AEIP Scholars Programme 2026-2027 [Africa Europe Innovation Platform]

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WHO validates Timor-Leste’s elimination of trachoma as a public health problem [World Health Organization]

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World NTD Day 2027 Photo Competition [FESTMIH]

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Senegal launches pilot study on schistosomiasis treatment for preschool-aged children in Kédougou region [ADP Health]

 

World Health Summit 2026
Date and Location: October 11 – 13, 2026, Berlin, Germany and Online
 
The World Health Summit 2026, held under the theme "From Crisis to Resilience: Innovating for Health", will take place from October 11–13, 2026, in Berlin, Germany, and online. As the leading platform for global health, the World Health Summit convenes leaders from politics, science, civil society, and the private sector from around the world to catalyze collaborative and innovative solutions for key global health priorities.

 

GDPR & the InfoNTD newsletter

 
New EU data protection regulations came into force on 25 May 2018. We have been reviewing our practices with regards to the GDPR, including our privacy statement and mailing list.

InfoNTD sends out monthly e-mails with an overview of recent publications on NTDs and cross-cutting issues. The purpose of this activity is to keep subscribers up to date.

InfoNTD will only process the data we have (names, email addresses) for the purpose of sending you the newsletter. We take your security seriously and will never share your contact details with anyone else.

You can update your preferences or unsubscribe from this list at any time.

 

Send us an email

 

Visit our website

 

__________________________________________________________________

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

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

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

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Fw: Ref.: (LML) Last mile outcomes in Leprosy care, pushing the value chain to the edge. Part 2.

 

Leprosy Mailing List –  September 28,  2026

 

Ref.:  (LML) Last mile outcomes in Leprosy care, pushing the value chain to the edge. Part 2.

From: Arie de Kruijff, Kijabe, Kenya

____________________________________________________________________________

 

Note editors:

Last week, September 23, 2026,  we published the first part of Arie de Kruijff’s essay  “Last mile outcomes in Leprosy care, pushing the value chain to the edge”. We thought this excellent and thoughtful but lengthy contribution better be divided in two parts to improve readability.

 

Last mile outcomes in Leprosy care, pushing the value chain to the edge. PART TWO OF TWO · CONCLUSION

Paying for activity, hoping for outcomes

The money sits underneath all of this, and it is where the model is most visibly misaligned. Leprosy control is almost everywhere funded as activity: a training delivered, a campaign mounted, a supervision visit completed. Government budgets cover the staff establishment and little else. The operational money that does flow comes largely from NGOs, often from non-designated funds rather than institutional line items, and it is billed against outputs — people trained, people screened — while the outcome everyone actually wants — a case found before disability, a contact examined, a treatment course completed — goes unmeasured and unpaid.

Several structural consequences follow. Output is paid for while outcome is merely hoped for. Short funding cycles produce short horizons, in a disease that demands multi-year follow-up and surveillance measured in decades. Activity funds, when they stop, leave no budget line and no institutional memory behind them. And the sector is caught in a loop of its own making: outcomes are not funded because they are not verifiable, and they are not verifiable because the information system is paper-based and geographically dispersed.

That information system is the clearest illustration of the whole problem. Leprosy is notifiable, yet in many countries the primary record remains a paper clinic card held at a facility, with only aggregate numbers travelling upward. Four consequences follow. Verification is expensive, because confirming a register entry means a physical visit — a 400-kilometre drive to flip through a card box — and therefore happens rarely. The data is not case-based at higher levels, so no one can follow an individual through treatment. It is hard to map, which makes hotspot identification guesswork. And confidence in the numbers is limited, including among the health officials who must use them.

The more instructive reading is that the information system is not merely a reporting problem. It is the mechanism by which leprosy service quality is made visible — or not — to the people who allocate money. That is a business-model question as much as a technical one.

What the new technology could change

This is where artificial intelligence becomes relevant, though the field is over-supplied with speculative language and under-supplied with field evidence. The genuinely practical capabilities are unglamorous: reading a paper form accurately from a phone  photograph, extracting and geocoding a location, checking a record for internal inconsistency, and co-ordinating a small set of follow-up actions between named people.

Applied to leprosy, the concrete possibilities are these. Case-based notification can become a by-product of the clinical encounter rather than a separate administrative task performed months later: a health worker photographs the card, the software extracts the data, the worker verifies and corrects it, the address is pinned to a map and the record is confirmed into the national structure. If notifications carry location, hotspot identification becomes a standing capability rather than a special study. The system can flag what a busy clinic cannot — a missing disability grade, an ulcer with no follow-up, a reaction recorded without a treatment plan, gaps in a monthly treatment record. And if the trail of service delivery is captured digitally, verification stops being an expedition and becomes a trace of the work itself.

The concerns here are very real: Connectivity remains a real constraint in the places leprosy concentrates, and offline-capable workflows is a requirement, not a feature. The accuracy of card-reading software is not yet proven across countries’ differing forms, and should be measured before any operational claim is made. Leprosy is a stigmatised disease, so data protection is not a compliance detail but a condition of doing the work at all. Digital verification has to earn the trust it claims; a visible digital layer over a weak data foundation can manufacture false confidence rather than real assurance. And none of this removes the need for human judgement — the realistic design keeps a clinician at the helm, with software supplying the memory and the co-ordination.

The honest characterisation is that technology plays the platform role, not the doctor role. It can make peripheral work visible and therefore financeable. It cannot perform the work, and it should not be asked to pretend otherwise.

The lessons are already on the record

None of this ”pay for verified results at the edge” thinking is new in public services. Results-based financing has a two-decade history, and its examples are worth recalling mainly to establish that the idea is not exotic. Argentina’s Plan Nacer programme, launched in 2004, tied part of its funding for maternal and child health to a set of verified clinical indicators, with payments flowing onward to the facilities that produced the results. Performance-based financing has run in health systems across dozens of countries. A development impact bond for maternal and newborn care in India tested the structure that lets private investors pre-finance delivery and be repaid only on verified outcomes. And outcome-linked funding of community health worker networks has proved, at least in principle, that a peripheral network can be the contracted party.

The accumulated lessons from that literature are hard-won and bear repeating, because each one maps onto leprosy with unusual precision. Government ownership decides whether a scheme survives; those embedded in national financial management persist, while those living in donor project units collapse when the project ends. Metrics distort behaviour — pay narrowly and providers tunnel-vision onto the paid indicator and cherry-pick the easy cases. Outcomes must sit within the provider’s control and be measurable in a reasonable window, which for a slow disease argues for rewarding verified service events rather than distant epidemiological shifts. Verification cost decides feasibility. And pre-financing decides participation: small facilities and volunteer networks cannot bankroll months of work awaiting payment, so the poorest actors are exactly the ones who need capital provided up front.

That literature neither proves such an approach would work in leprosy nor proves it cannot. What it establishes is that the mechanisms exist, that their failure modes are well understood, and that nobody has yet made the serious attempt to adapt them to a neglected disease whose defining problem is the last mile.

Where the argument will meet resistance

A candid account must name the tensions, because pretending they do not exist is how good ideas die quietly.

Shifting value and decision-making toward the last mile touches established roles, reporting lines and budget control, and the reasonable question from a national programme is not whether the idea is good but who is accountable when it goes wrong. A decentralised model that leaves the centre without the information it needs will not survive its first supervision visit; the objective is not to route around central structures but to make their job easier while the work is done closer to the patient. Incentives, if they reach frontline actors, have to be transparent and able to survive a change of government. The question of what happens when external funding stops is the one that determines whether any of this is real — a design that only works while the grant lasts is a project, not a service model. Data that makes health workers and patients more visible also makes them more exposed, and consent, ownership and the limits of automated judgement must be settled before, not after, deployment. And technology cannot substitute for capability: no application delivers disability care where no one has been trained and no supplies exist.

Questions for reflection

What remains is less a proposal than a set of questions the sector has not yet answered, and which may usefully be argued over rather than resolved.

Which outcomes are sufficiently meaningful, measurable and within a provider’s control to be worth paying for — and which should explicitly not be reduced to a metric? What concrete mechanisms would keep value at the edge, where the work happens, rather than letting it be captured by the centre? Which functions genuinely improve when pushed outwards, and which must stay central for safety and equity? What independent evidence would be needed before trusting automated verification in a national programme? And what would a health department need to see — in cost, evidence and exit routes — to pilot a different model in a single district, and to keep it standing if every external funder left?

The ambition behind the questions is deliberately modest in means and demanding in aim: to give the people who already do the work the tools, the information and the recognition that actually reach them, and to let the value they create finally reach the people affected by the disease.

 

Sources

 World Health Organization, Leprosy (Hansen&#39;s disease) fact sheet; and Global leprosy (Hansen disease) update, Weekly Epidemiological Record.

 World Health Organization, Towards zero leprosy: global leprosy (Hansen&#39;s disease) strategy 2021–2030 (2021); and WHO technical guidance on contact tracing and post-exposure prophylaxis.

 World Bank evaluations of Argentina&#39;s Plan Nacer / Sumar programme (Gertler et al., 2014, and subsequent literature).

 Documentation of results-based financing and development impact bond programmes, including the Utkrisht maternal and newborn care bond (India) and outcome-linked community health worker funding (Living Goods).

 Grover, D., et al., “Using supervised learning to select audit targets in performance-based financing in health”, PLOS One (2019), on machine-learning targeting of verification audits.

____________________________________________________________________________

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

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

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

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Fw: Ref.: (LML) Last mile outcomes in Leprosy care, pushing the value chain to the edge. Part 1.

 

 

Leprosy Mailing List –  September 23,  2026

 

Ref.:  (LML) Last mile outcomes in Leprosy care, pushing the value chain to the edge. Part 1.

From: Arie de Kruijff, Kijabe, Kenya

____________________________________________________________________________

 

Last mile outcomes in Leprosy care, pushing the value chain to the edge.

A cure has been free for three decades — yet roughly 200,000 new cases are still diagnosed every year, many only after permanent nerve damage has set in. The obstruction is no longer medical. It is the way leprosy services are organised, funded and verified, a model largely unchanged since the 1980s.

In 1991 the World Health Assembly resolved to eliminate leprosy as a public health problem by the turn of the century, and by that measure the target was reached. Multi-drug therapy — recommended by the WHO in 1982, funded by the Nippon Foundation and donated by Novartis since 2000 — had turned an ancient, disabling infection into one cured by six to twelve months of pills, and the disease duly drifted from the global agenda.

The disease quietly declined to co-operate with the ending. More than 120 countries still report cases, and roughly 200,000 new infections are diagnosed worldwide each year. A stubborn proportion of those diagnoses arrive late — after nerve damage has already occurred, leaving the visible, permanent impairment that specialists read as a measure of how long the disease travelled undetected. The presence of children among the newly diagnosed confirms that transmission is still happening in the present, not merely resurfacing from the past.

None of this points to a failure of medicine. It points to a failure of architecture: the leprosy programmes responsible for finding, treating and following these patients are still organised around a design conceived in the early 1980s for a very different disease burden — and the burden has moved to precisely the places that the design can no longer reach.

 

A structure built for a different war

The classical leprosy programme was, for its task, an effective machine. A national office fed a chain of provincial and district supervisors, who in turn reached peripheral clinics and community workers. That vertical chain held the drug supply, kept the registers, ran the trainings and mounted the case-finding campaigns. Its purpose was singular: find cases and push a twelve-month course of pills through a pipeline to them. At that it succeeded, and prevalence fell by orders of magnitude.

Then the ground shifted. Leprosy services were folded into general primary healthcare — a sensible move for sustainability and for reducing stigma, but one that dispersed the disease among clinicians who might now see a handful of cases across an entire career. Skills that are rarely exercised fade; supervisors once dedicated to leprosy were given tuberculosis, better- funded and more politically visible, as their first priority. After the elimination declaration, dedicated budgets and political attention largely followed the headline. What remained was a patchwork: NGOs financing a training here and a campaign there, usually from non-designated funds, because institutional funding channels were never built to pay for granular, last-mile work.

The quiet consequence was that the parts of leprosy care beyond the initial cure were left behind. Multi-drug therapy clears the infection; it does not prevent or resolve the reactions, the nerve damage, the ulcers, the disability and the social exclusion that follow. Those require sustained, often specialised attention — and they were never the core business of the vertical pipeline, nor of a general primary care system that had never been equipped for them.

The uncomfortable summary is not that the programme failed. It is that the organisation chart outlived the resourcing that once animated it. The structure still describes how information is supposed to flow, more than how care is actually delivered.

 

How technology changes a business model — a lesson from the taxi rank

The relevant question now is not clinical. It is commercial in the broadest sense: how does technology change the way a service is organised and paid for?

The clearest recent example has nothing to do with medicine, and is useful precisely for that reason. For most of a century the taxi industry ran on a single design: a company owned the vehicles, employed the drivers, operated a central dispatch desk and collected the fare. Value was created at the kerbside, but it was priced, captured and distributed at the centre.

The arrival of three everyday technologies — smartphones with mobile coverage, satellite positioning, and digital payments that settle small transactions instantly — made a different model possible. Ride-hailing platforms own no vehicles and employ no drivers. Individual car owners supply and maintain the asset and choose when to work. The platform centralises only what genuinely benefits from centralisation: matching, pricing, payment rails and the two-way ratings that make quality visible. The value itself is produced, recognised and substantially retained at the edge.

Four principles carried the shift, and they are the transferable payload of the story. Centralise the infrastructure, decentralise the delivery. Give the person producing the value agency — and a direct reward attached to it. Make quality visible and verifiable cheaply, through the digital trace of every transaction rather than a fleet of inspectors. And expect adjacent services to grow on the same rails, as food delivery and parcel logistics did.

The analogy must however be handled with care. A public health service is not a market with willing buyers; a leprosy patient does not choose between providers on price, and the services that matter most — contact tracing, stigma reduction, disability prevention — produce benefits for third parties, not a paying customer at the point of use. The state has obligations a platform does not: notification, drug quality, safety and equity of access cannot be delegated. Outcomes are slow and only partly attributable to any single actor; a prevented disability is not a completed trip. And nothing here is a transaction between consenting equals, because the disease itself carries stigma and power imbalance.

What survives those caveats is narrower and more durable: a structural question. If the coordination layer were held centrally while the value were produced, recognised and partly retained at the periphery, what would leprosy service delivery look like?

 

Where the value is actually created

The answer begins with geography. In leprosy care, value is created in the space between the health post and the household: the nurse who notices a suspicious patch, the community volunteer who knows which family to visit, the traditional healer patients consult before anyone else. This is the last mile — and it is simultaneously where the outcomes are produced, where the information is generated, and where the least value, agency and recognition currently flow.

Those facts pointing at the same place explain, more than any funding shortfall, why the disease persists.

The work this last mile must deliver is wider than the old pipeline allowed for. It includes timely  diagnosis — before nerve damage becomes permanent — and uninterrupted treatment. It includes recognising and managing leprosy reactions, which remain substantially under- diagnosed and poorly treated at the periphery. It includes disability care: ulcers, nerve function,  footwear, self-care. It includes contact examination and preventive treatment for household contacts, which is logistics before it is medicine — listing contacts, reaching them, screening them, recording what happened. And it includes attention to stigma and social participation, which are outcomes in their own right.

The last mile is not empty. It is staffed by people with more capability than the system credits them with: clinic nurses with medical training and community trust, volunteers with local knowledge no campaign can purchase. The realistic opportunity is not to recruit a new workforce. It is to give the existing one the leprosy knowledge it lacks, the tools it needs, and a reason to stay engaged.

 

What each actor should receive

If the last mile is where outcomes are made, then value has to land there — or the model will quietly depend on goodwill until the goodwill runs out, which is substantially what has happened to the existing structure. A digital system that adds reporting burden to an overworked nurse in exchange for better national dashboards is not a sustainable model; it is a subsidy extracted from the periphery.

The design question is therefore concrete: what does each actor receive?

The peripheral nurse or clinic focal point gets a shorter path from a suspected case to a correct decision, decision support when the presentation is atypical, and less duplicated paperwork rather than more. She gets evidence of the quality of her own work, which today is almost invisible beyond her facility. She gets knowledge and support for the parts of leprosy she finds hardest — reactions and disability care.

Community actors get a defined, recognised role and a channel to escalate a concern rather than managing it alone. District and provincial supervisors get a map-based picture they can act on, and the ability to direct scarce supervision toward the places that need it. National programmes get case-based data that meets their reporting obligations, and stock visibility so drug allocation is planned rather than guessed. Implementing organisations and funders get the thing they most lack: a credible, verifiable account of results, which is the precondition for access to institutional, longer-term funding rather than project-cycle grants.

And patients get care that continues after the pills are finished, and less time spent travelling to reach what little care exists. It is a telling omission in most such inventories that value for patients is the least well understood — what would make the system meaningfully better from the patient’s side is a question that, by most accounts, has never been properly asked of those affected.

 

— End of part one. The conclusion follows next week. —

____________________________________________________________________________

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

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

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

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Fw: Ref.: (LML) AI in Leprosy - a view from the Philippines

 

Leprosy Mailing List –  September 22,  2026

 

Ref.:  (LML) AI in Leprosy - a view from the Philippines

From: Francesca Cajete, Manilla, the Philippines

____________________________________________________________________________

 

Dear Henk, Pieter, and colleagues,

 

Thank you, Henk, for this very timely and balanced warning — and thank you to Pieter for sharing the Hinton excerpt and the INFOLEP collection.

 

As we in the Philippines finalize our NLCP Manual of Procedures,the Philippine Leprosy Corpus,  — with WHO WR, DOH NLCP,Philippine Dermatological Society and The Culion Foundation Inc.— we find AI helpful for organizing literature and drafting, but we fully agree with the cautions raised.

 

From field experience in Culion,Palawan and other regions in the country the risk of false negatives and of AI-generated images that reinforce stigma is real. Our community health workers remain irreplaceable for early detection and for trust.

 

We are therefore adopting the practice now recommended by The Leprosy Review: use AI as assistant only, with all clinical and historical interpretation verified by human experts.

 

Thank you for continuing to mentor us in thinking critically, even after retirement. You shaped many of us in this field.

 

Warm regards from the Philippines,

 

Dr Francesca Cando Gajete,MHA,FPLS

Former National Leprosy Control 

     Program Manager

Member, International Leprosy 

           Association (ILA)

Former Vice President,ILA 

Trustee, Culion Foundation Inc 

____________________________________________________________________________

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

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

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

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Fw: Ref.: (LML) Leprosy and AI

 

Leprosy Mailing List –  September 22,  2026

 

Ref.:  (LML) Leprosy and AI

From: Henk Eggens, Santa Comba Dão, Portugal

____________________________________________________________________________

 

Dear Pieter and LML readers,

 

Geoffrey Hinton, co-winner of the 2024 Nobel Prize in Physics and widely known as the “godfather of AI,” has repeatedly warned about the dangers of advanced AI. CEOs of major American AI companies—Dario Amodei (Anthropic), Sam Altman (OpenAI), and Elon Musk (xAI)—have joined his call. These four key figures (the four horsemen) are advocating for constraints on AI development to prevent a potential existential threat to humanity.

In the meantime, we continue to harness AI for our benefit, and specifically for this LML forum, to advance the fight to diagnose, cure, and rehabilitate leprosy patients.

Numerous publications have addressed this topic. INFOLEP provides a great overview featuring 31 publications on the subject:

https://www.leprosy-information.org/search?elasticsearch_index_infolep_prod_resources%5Bquery%5D=AI

I recently came across a publication by The Leprosy Mission that I would like to bring to the attention of the LML readership, titled "Leprosy and AI: Do the pros outweigh the cons?":

https://www.leprosy-information.org/search?elasticsearch_index_infolep_prod_resources%5Bquery%5D=AI

The article summarises the positive contributions AI has made to the leprosy community, such as improving diagnostic accuracy and facilitating data processing for epidemiological purposes. However, it is fairly light on the negative consequences. At the same time, it mentions AI-generated images that could reinforce prejudices; I was able to correct those within five minutes using an AI image tool. Furthermore, the author fails to address the risk that AI applications may produce false negatives when diagnosing skin conditions—for example, missing a leprosy diagnosis altogether. 

Overall, it serves as a helpful, light overview of progress in this field, though INFOLEP's list offers deeper insight into practical field experiences with AI.

 

Best,

 

Henk Eggens

 

PS: AI improved my English 

------
Henk Eggens

(henk.eggens@gmail.com)

____________________________________________________________________________

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

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

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

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