The MOH/WHO Joint Workshop and field visit on Implementing the Strategy to Sustain Leprosy Services Following Elimination in China was conducted in Guizhou Province

Under the commitment of Ministry of Health (MOH) and World Health Organization (WHO) and support from Institute of Dermatology, Guizhou Provincial Central for Disease Prevention and Control (CDC), National Center for Leprosy Control, China CDC (NCLC) organized the MOH/WHO Joint Workshop in Xinlian Hotel, Guiyang City, Guizhou Province from November 11 to 23, 2006.

Dr. Liu Haitao, Division of Communicable Disease Prevention and Management Department of Disease Control, MOH, Dr. Barua, Medical Officer, Stop TB and Leprosy Elimination, WHO, Western Pacific Regional Office (WPRO), Prof. Zhang Guocheng, Deputy Director General, NCLC, Dr. Zhang Yuqiong, Deputy Director, Department of Disease Control, Guizhou Provincial Health Bureau, Dr. Yang Zhao, Deputy Director, Guizhou Provincial CDC participated the opening ceremony of the workshop and made speeches. Dr. Yan Liangbin, Director, Department of Leprosy Control, NCLC declared the workshop to be opening and introduced each government leader and resource person participatory the workshop. The workshop was focusing on further reducing the burden of leprosy and sustaining leprosy services under the current Chinese leprosy situation. The general objective of the workshop was to draft a national plan of action for implementing WHO “Strategy to Sustain Leprosy Services following elimination in Asia and the Pacific”. During the workshop, Dr. S Barua and Dr. Yan Liangbin presented the Updates on Global Regional Leprosy Situation and Chinese Leprosy Control Programme (2006-2010) respectively. At the same time, the Provincial Leprosy Control Programme and situation of Guizhou, Yunnan and Sichuan were also presented during the workshop by provincial program managers.

Facilitated by Dr. Tin Shwe, WHO WPRO short term consultant and referred to Strategy to sustain leprosy services following Elimination in Asia and Pacific, the four elements of the strategy, i.e. Integration of Leprosy Services with General Health Services, Sub-National Approaches, Monitoring Supervision, Surveillance and Evaluation, & Political Commitment and Partnership were analyzed and discussed. A total number of 28 problems in the first element were identified. Among which eight were prioritized: 1) Poor leprosy awareness in the community; 2) Lacking proper Job description for the general health workers; 3) Inadequate IEC material; 4) Inadequate training for the general health workers; 5) Lacking financial resources; 6) Presence of social stigma related to leprosy; 7) Lacking motivation; and 8) Weak policy for integration. A Plan of Action (POA) was worked out for these prioritized problems by group works, presented at the plenary, discussed and approved.

Due to time limitation, the POA of other three elements did not discuss during the workshop. But the objectives were reached: 1) The WHO “Strategy to Sustain Leprosy Services following elimination in Asia and the Pacific” was oriented to provincial coordinators; 2) The capacity of the provincial coordinators in programme management were built through group-works; 3) The Chinese National Leprosy Control Programme 2006-2010 was reviewed and adopted; and 4) The recommendations for the implementation of the developed POA was developed.

In order to implement the strategy to sustain the leprosy service successfully, a supervision team consisting of Dr. Tin Shwe, WHO WPRO short term consultant, leprosy experts from NCLC and Institute of Dermatology, Guizhou Provincial CDC was sent to several counties, Qianxinan Prefecture to visit field for supervision. During the field visit, one prefecture Center of Skin Diseases, one prefecture leprosy hospital, one county CDC, two county Stations of Skin Diseases, three county leprosy villages and one township health center were visited from November 25 to December 1, 2006. At the same time a total number of 47 leprosy (cured) cases were interviewed and examined. Among whom 30 were from leprosy villages/hospital. Meanwhile, the POD and rehabilitation activities implemented by Institute of Dermatology, Guizhou Provincial CDC cooperated with American Leprosy Mission (ALM) were also observed.

During the field visit, the team did not find any over diagnosis among the 47 reviewed leprosy (cured) patients but one MB patient was classified as PB patient and the disability grade 2 among newly detected patients was found to be under reported. At the same time, a total number of 3 relapse patients were reviewed and the relapses were not definite. The main cause for over diagnosis of relapse was without quality skin smear test. This problem was reported by leprosy expert from NCLC during the Annual Workshop on Leprosy Surveillance in 2005. The training on knowledge and skill for diagnosis of leprosy relapse with skin smear technique should be strengthened. The inadequate surveillance for neuritis was also found during the field visit although all the fields were covered by the project. It is obvious that the quality of neuritis surveillance was not satisfactory and the motivation of leprosy workers was also declined after completion of the project. The self care to be performed by the PALs has reduced which was mainly led by inadequate monitoring and supervision of POD. Less than fifty percent PALs can insist on practicing POD activities. Surgeries (especially on eye) were correct with good effects in the visited areas which were support by ALM through Institute of Dermatology, Guizhou Provincial CDC and NLR through NCLC. Some social stigma still remains in the community.

Review of the epidemiological data showed a low MDT registered prevalence, low new case detections and high proportion of GII disability( 21.3%) among new cases and high MB proportion (about 85%), but the children proportion among new cases was reported very low. The cases reported as relapse were also not real relapse ones, which needed to be verified before reporting. But there are still 54 counties with a leprosy prevalence rate above 1 per 10,000 population, most of which were in Yunnan, Guizhou, Sichuan, Tibet and Hunan Provinces, which are the pocket areas of leprosy in China.