9 August 2022 · Global Partnership for Zero Leprosy

Meet Dr. Baskota, Nepal’s National Leprosy Programme Manager

Dr. Rabindra Baskota is the National Leprosy Programme Manager of Nepal and a member of the GPZL Leadership Team. Dr. Baskota shares his experience in the leprosy field and reflects on opportunities to advance closer to leprosy elimination.

Rabindra BaskotaHow did you begin working in leprosy?

Nepal declared the elimination of leprosy as a public health problem in 2010. Still, the country is facing post-elimination challenges. There is a high burden of leprosy in terms of prevalence rate, Multi-Bacillary cases, child cases, and cases with grade-2 disabilities. I was well aware of this while I was working as a medical officer in 2008. At that time, I was posted in a highly endemic district of Nepal. This motivated me to study dermatology so that I could pursue further training in leprosy and skin conditions.

In 2019, in partnership with the Global Partnership for Zero Leprosy, a team of national and international experts conducted an in-depth review of Nepal’s National Leprosy Programme. The review recommended extra efforts to reach zero leprosy. While earning my Master of Public Health (MPH) in 2021, I learned that the global elimination of leprosy is only possible with innovative strategies. Now, I bring my education, experience, and enthusiasm to my leadership role in Nepal’s National Leprosy Programme.

Can you describe your role as leprosy program manager?

As a leprosy program manager, my primary role includes the timely and effective planning, monitoring, and evaluation of National Leprosy Programme activities in Nepal.

My role includes:

  • Helping the Ministry of Health and Population (MoHP) to form national policies and strategies necessary for leprosy elimination
  • Determining the leprosy control criteria, protocols, and guidelines and ensuring quality services for leprosy
  • Monitoring and providing technical support to national and sub-national levels for strengthening and effective implementation of leprosy activities
  • Ensuring capacity strengthening of various categories of health workers
  • Encouraging and supporting persons affected by leprosy through social rehabilitation and management
  • Supporting monitoring and evaluation, surveillance, and research work related to leprosy at the national level

What challenges and opportunities do you encounter in your work to end leprosy in Nepal?

Because of the number of cases reported each year, Nepal is one of the WHO’s global priority countries for leprosy. Although leprosy has been eliminated at the national level, the prevalence rate is high in certain districts.

The new case detection rate (NCDR) has remained constant for 10 years (10.7-12.2 per 100000 population). Likewise, the proportion of Multi Bacillary cases (MB) has increased from 52% in 2010 to 74% in 2021. The proportion of child cases among new cases is still high (approximately 5%), indicating high local transmission. Similarly, the proportion of grade-2 disabilities among new cases shows a slightly increasing trend from 3.47% in 2010 to 4.37% in 2020, indicating late diagnosis.

Other challenges include limited human resources at all administrative levels, inadequate expertise among available staff, lack of clarity in roles of different health segments, a sharp reduction of the national budget for leprosy, and inadequate financial resources. Prevailing stigma in the community and a lack of awareness compound the situation. Reaction management and disability care services for persons affected by leprosy are still lacking in governmental health facilities, and the services depend mainly on NGO-run hospitals.

Despite these challenges, the National Leprosy Programme has several opportunities that could sustain elimination. A national Zero Leprosy Roadmap and a strategic plan are in place to guide the National Leprosy Programme. Similarly, leprosy-dedicated hospitals in strategic locations support improved case detection, treatment, and complication management. The MoHP has a dedicated section for planning and regulating leprosy activities in the country. There is strong collaboration and coordination between supporting partners. Additionally, the recording and reporting system has been incorporated into the national HMIS system. Nepal has been receiving MDT and clofazimine free of cost from the WHO and Novartis Foundation. Lastly, leprosy services have been integrated as part of the basic health service package.

What are some of the National Leprosy Programme’s current priorities?

  • Strengthening the surveillance system through case base reporting system
  • Strengthening passive detection and expanding active case detection of leprosy through mixed approaches for early diagnosis, treatment, and management of complications
  • Improving self-care practices
  • Capacity strengthening of health workers at all levels of service delivery
  • Incorporating leprosy services into national health insurance

Nepal was one of the first countries to partner with the Global Partnership for Zero Leprosy. What steps has Nepal’s National Leprosy Programme taken since it began working with GPZL?

At the request of the MoHP of Nepal, the Global Partnership for Zero Leprosy (GPZL) and the World Health Organization’s (WHO) Global Leprosy Programme conducted a two-week-long country review in July 2019. This review was conducted in close collaboration with the National Leprosy Programme staff, local NGOs (including ILEP partners and organizations of persons affected), and WHO Nepal.

Based on findings from the field visits and a stakeholder meeting, a Zero Leprosy Roadmap for Nepal was developed. The development involved a broad range of stakeholders that set 2030 targets and interim milestones for 2022 and 2025. Nepal’s Zero Leprosy Roadmap then informed the national Zero Leprosy Action Plan. The MoH endorsed the National Leprosy Strategy and Action Plan 2021-2025 with the goal of eliminating leprosy at the national and sub-national levels. 

What do you hope to see the Global Partnership for zero Leprosy accomplish in the near and long term?

First of all, I would like to thank GPZL for its continuous support of the National Leprosy Programme of Nepal as we embark on the implementation of the National Leprosy Strategy and Action Plan 2021-2025. I would like to see GPZL support countries in improving a wide range of leprosy activities, including active case detection, surveillance, capacity building of health workers, and treatment and complication management services. Where implementation research is a priority, GPZL can help to strengthen the capacities needed to conduct research.

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