SOCIOECONOMICS OF A GLOBAL LEPROSY ERADICATION PROGRAM

In the absence of evidence in the literature on cost factors in the ma nagement of leprosy, a reference is made to the sporadic attempts to s tudy costs of case detection and treatment. Such studies indicate that in the currently declining phase of leprosy endemicity, employing a c onventionally trained, salaried class of paramedical staff for field s urveys is prohibitively expensive if cost per case detected is compute d. Involving primary healthcare and community derived workers is cost effective. Likewise, short course chemotherapy with newer drugs under trial, administered under supervision by community volunteers, reduces the expenses considerably. Community-based disability services using inexpensive tools may cut cost by 90%. Operational research on cost ef fectiveness of rehabilitation comparing 'integrated' with 'vertical' a pproaches is, unfortunately, still in a primitive stage. It is urged t hat in view of the changing logistics, manpower costs and financial im plications should be given serious consideration by health planners. P ost-elimination problems such as: (i) unearthing hidden cases; (ii) co mmunity-based supervised treatment with highly promising newer drugs; (iii) identification of reactions and relapses; and (iv) field managem ent of disabilities resulting from acute and silent neuritis etc could be solved in a much cheaper manner. Integration of leprosy into gener al healthcare services and community-based rehabilitation of leprosy p atients along with those disabled by other diseases will be the major task in future as these procedures are expected to reduce management c osts and eliminate stigma.