Fw: Ref.: (LML) Integrated Framework for Skin NTDs

Leprosy Mailing List – July 14, 2022

Ref.: (LML) Integrated Framework for Skin NTDs

From: Sunil Deepak, Schio, Italy



Dear Pieter,


In June 2022, WHO has launched the integrated framework for the management of skin-related non-tropical diseases (Skin NTDs), which include leprosy along with Buruli ulcer, cutaneous leishmaniasis, lymphatic filariasis, onchocerciasis, etc. It can be downloaded from the link: https://apps.who.int/iris/rest/bitstreams/1430467/retrieve

I would like to hear from LML members their opinions regarding this new framework. I have a few quick remarks/questions regarding this framework:

 

(1) This framework wants to bring together the control of the identified skin conditions and its aim is to get this framework adopted in a certain number of countries by 2030. Compared to the combined leprosy-TB programmes in the past, this sounds like a more logical approach towards the control of these conditions. I remember prof. Ryan's advocacy for such an approach for so many years. However, in terms of the present organisation of leprosy services in the health ministries, what kind of challenges this approach is going to pose?

 

(2) Among the strategies, it includes combined active case detection for all the identified conditions through district teams, who will need to be trained through adequate combined training materials. WHO has produced a manual for front-line workers in this regards (link below). This would raise the issue of funding and I am not sure if in the present scenario, that would be feasible. Download Link: https://apps.who.int/iris/rest/bitstreams/1138601/retrieve

 

(3) Annex 4 of the Framework, also deals with lab diagnosis of the different skin NTDs. For leprosy it mentions slit skin smear and skin biopsies. Hopefully with combined lab diagnosis services for the different skin NTDs, this would become more feasible compared to the past.

 

(4) Annex 9 of the Framework is about disease-specific targets. It has targets for maximum number of new cases for leprosy - 148,000 in 2023, 123,500 in 2025 and 62,500 by 2030. I imagine that the countries with major leprosy burden will also be asked to have their own targets. There is the issue of diagnosed cases versus actual cases in the communities.

Secondly, as had happened (and continues to happen), when countries are asked to meet specific targets, health workers risk being seen as "bad workers" if they find more than the target number of new cases, so I would also like to know what safeguards can be put in place so that artificial changes in data or hiding of new cases does not happen or is minimised.

 

With best wishes,

 

 

Sunil

 

Dr Sunil Deepak

Schio (VI), Italy

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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