7 July 2019 · Global Partnership for Zero Leprosy
Q&A: Meet Dr. Quao, Ghana’s National Leprosy Programme Manager
Dr. Benedict Quao leads the National Leprosy Programme in Ghana, and is the newest member of the Global Partnership for Zero Leprosy’s Leadership Team. We sat down with Dr. Quao to talk about his work in Ghana and the role of the partnership in supporting National Leprosy Programme Managers.
How did you begin working in leprosy?
When I completed my internship (house-job) after medical school, I accepted a posting to serve as a medical officer at the Ankaful Leprosy General Hospital in Ankaful, away from the capital city of Ghana, and where I’m based now. The hospital is a former leprosarium that’s been transformed into a general hospital. When I accepted this post I initially didn’t know it was also the headquarters of the national leprosy programme; I just knew they cared for people affected by leprosy. When I arrived, I began working with the former national leprosy programme Manager who started coaching me and introducing me to the work. When he retired last year, I took over for him, but the transition hasn’t been abrupt. In the last few years leading up to his retirement he let me take the lead in many of the programmatic activities, especially regarding the move toward integration, bringing leprosy under the skin-NTD umbrella.
I specialized in family medicine in addition to receiving training in leprosy, but interestingly, when I first finished medical school I wanted to do neurology (a specialty in medicine dealing with nerves). I’m not doing neurology now, but look at what’s happened– I find myself now taking care of patients affected by a disease with nerve damage being its major complication.
How are you working to integrate leprosy with other neglected tropical diseases in the national leprosy programme?
In Ghana we are working more and more to integrate leprosy with other skin-related neglected tropical diseases (NTDs) endemic in the country, such as Buruli ulcer and Yaws. Skin-related NTDs have historically been managed through programmes that functioned vertically in Ghana. I bring a different perspective to this field because, as a family medicine specialist, I am essentially a primary care person, and I am looking at how we can put leprosy (and other skin-NTD) treatment within the normal pathways that patients use to access healthcare. We’re trying to find the best way to practice real integration, not just in name only, using our normal healthcare structures. We are increasingly integrating and working together with other NTD programmes in a new way.
Describe your role as programme manager, and characterize the fight against leprosy in Ghana– what challenges and opportunities do you encounter in your work to end this disease?
I serve as the head of the hospital that functions as the national referral center for leprosy for Ghana. We coordinate care of complicated cases of leprosy across the country. The programme is comprised of myself and the support staff in the hospital that help with the programme work. I also have regional coordinators that I work with for country-wide monitoring and surveillance, and training coordination.
Now that we are increasingly integrating with other skin NTD programmes, we’re beginning to involve them more in our planning and programmes. I’m working to change things in the way leprosy is addressed in the country. Ghana has gone from a place where we had high numbers of cases of leprosy to very low numbers. The general feeling within the national leprosy programme, and the public health division as a whole, is that we’re at the end of the disease. This has a potential danger of slowing down elimination efforts, but as a young person coming in, I’m interested in sustaining the gains made before me and work to accelerate our drive toward true elimination.
At one point we had dedicated leprosy trained disease control officers, but now they’ve mostly retired or left and we have a new generation of disease control officers that don’t really “know” the disease. This lack of expertise may lead to late diagnosis– and in the last few years we have had very high grade 2 disability rates. This begs the question, is there poor capacity for diagnosing skin lesions in Ghana? A lot of people think it’s a dead disease, and when you tell them you’re recording 250-300 cases a year on average they are shocked that we even detect this number of cases. It almost feels like our good work has worked against us– sometimes you have to fight to make your voice heard.
You’ve recently joined the Global Partnership’s leadership team. What do you hope to see the partnership accomplish in the near and long term?
I see myself in a privileged position by being chosen to be a part of the Global Partnership for Zero Leprosy’s Leadership Team. It is good to see aligned action toward achieving a new agenda in leprosy. It’s been something I’ve felt we’ve needed since the moment I entered the world of leprosy, because cases have plateaued and we’ve stagnated for a while. Now we all seem to be on the same page. It’s good to see there’s new global momentum toward actually ending the disease.
I like that we’re streamlining a research agenda. We’ll be answering the questions that we need to answer to move toward zero leprosy. The toolkit is also an excellent idea. We are putting together tools that will help, and country programmes need that support. There are some programme managers who have limited capacity and they need someone out there helping them. The toolkit will be a major resource for national leprosy programme managers.
The Global Partnership has adopted a country approach to ending leprosy globally. What are the strengths of a county-led approach?
Leprosy tends to be focal within countries, and all countries have different problems addressing the disease. You can’t have a one-size-fits-all approach. A country-based approach with countries playing a leading role will be most effective.
Countries need to feel like they’re being listened to, like they own whatever strategy is being put forward, and will own whatever is being achieved. It’s the way we can get to the end of leprosy.
What do you think are the most important issues for national programme managers in leprosy? As the Global Partnership for Zero Leprosy works toward zero leprosy, what can we do to make sure we’re meeting the needs of programme managers?
In some countries, the national leprosy programme manager’s voice is the lone voice saying, “We still need to pay attention to this.” In some cases, you’ll see that the leprosy programme has been added to the tuberculosis programme, and in many countries attention to leprosy is dwarfed. The momentum of the Global Partnership will help the world realize this disease is still there and we need to get to the end of it. The partnership can help amplify that voice.
Additionally, the partnership can support the capacity of new programme managers. We need to ensure the capacity to fight leprosy is there. A lot of the programme managers from Africa are new and have strongly voiced that they desire capacity building. Capacity of frontline people is critical in diagnosis and the work that leads to elimination, and resources are linked to capacity. Many programme managers need help getting more resources.
Lastly, leprosy has long-term effects that require support from organizations in other sectors, and it can be difficult for national programme managers to bring those partners together to support people impacted by leprosy. The partnership can help to align in-country partners to bring together the support services needed.
Interviewed by Andie Tucker, Global Partnership for Zero Leprosy communications