16 January 2019 · Global Partnership for Zero Leprosy
Program Profile: Bangladesh
Over the past several decades, great efforts have been made in ending leprosy worldwide. However, leprosy control in the South-East Asia Region remains a challenge. These countries are determined to overcome leprosy and its resulting complications. Every month we will be highlighting a new South East Asian country to show the steps they are taking to actively progress towards a leprosy-free world. This month we are looking at the country of Bangladesh.
Tackling Leprosy in Bangladesh
Bangladesh’s Ministry of Health and Family Welfare, Directorate General of Health Services has put in great efforts tackling the country’s leprosy situation. In 2017, a total number of 3,431 cases have been under treatment; however, in the same year, a total number of 3,754 new cases were detected. To address leprosy, the National Leprosy Programme is implementing its National Leprosy Strategy which is largely based on the WHO’s Global Leprosy Strategy for 2016-2020, composing of three implementation parts: Pillar I, II, and III. You can read more about WHO’s Global Leprosy Strategy here: http://www.who.int/iris/handle/10665/208824
Implementing the Global Leprosy Strategy
The implementation of the strategy for Pillar I focuses on the inclusion of disability patients in universal health care (UHC). In Bangladesh, the general health system provides treatment for disability due to leprosy. Some patients require additional reconstructive surgery services, provided by both government and NGO hospitals. Actions taken to ensure the inclusion of all persons affected by leprosy into UHC consist of: the inclusion in Essential Health Service Packages, involvement of nongovernmental organizations through Memorandum of Understanding, involvement of persons affected by leprosy in campaign and advocacy, and lastly, awareness and orientation of health care service providers, village doctors, and traditional healers.
The implementation of Pillar II brings attention to drug resistance in leprosy. Facilities for identification of drug resistance cases is currently not available in Bangladesh. Furthermore, Bangladesh currently has no policy on chemoprophylaxis, the administration of medication to prevent the development of disease. For wound care, institutional and community-based treatment is available. About 6% of leprosy patients need ulcer care, where various health centers across the country provide this service. NGO hospitals especially play a key role in providing this service. To further address wound care for leprosy, every patient who has an ulcer is also trained for self-care at home.
The Pillar III implementation concentrates on legislation and tools to facilitate social inclusion of persons affected by leprosy. The impact of this Pillar has initiated the social welfare department to give priority to grade-2 disability due to leprosy in their list of disability for ensuring allowances by the government. Moreover, the Government of Bangladesh assists disabled people including leprosy through different mechanisms. On the legislation level, there are no more laws that discriminate on the basis of leprosy. UN Principles and Guidelines also is focusing on the elimination of discrimination against persons affected by leprosy and their family members. As a result, there has been no reported instances of discrimination during the year of 2017.
Challenges
Although Bangladesh has had great successes in addressing leprosy, the country still faces challenges. These challenges include high burden pockets, shortage of expertise at all levels, inadequate human resources and financial support, delay in case detection, and no policy and availability of quality assured MDT at the local level. Regardless of these challenges, we are confident Bangladesh will overcome them with their consistent efforts.