SUSTAINING LEPROSY SERVICES IN THE CHANGING CONTEXT OF HEALTH SECTOR REFORM

National leprosy control programmes currently face a number of changes to the environment within which they operate. This paper examines the issues arising from these. It focuses, in particular, on those arisin g from changes in the structure of the health sector as a result of po licies of health sector reform which are being considered or adopted i n many developing countries. These include decentralization, financing strategies, greater role for the private and NCO sectors and the inte gration of vertical programmes. The paper is structured around a numbe r of key steps in the development of a strategy for sustainability of appropriate leprosy services. These are the assessment of the epidemio logical, social and health services context, development of programme objectives, planning of human and financial resources, development of the strategy, mapping the roles of potential actors, development of re gulatory and incentive mechanism, action planning and managing change and, finally, re-evaluation of the programme objectives and service de livery organization. The paper stresses the importance of process in d eveloping ownership of a strategy, it concludes with a set of key ques tions which it suggests need to be addressed bg leprosy programme mana gers in the development of a proactive response to the changes.