Integration of leprosy services into the General Health Service in Sri Lanka: overcoming challenges to implementation in a remote district

Abstract

Sri Lanka took a policy decision to integrate leprosy services into the generalhealth services (‎GHS)‎ in 1999. This paper aims to summarize the emergence ofnew, specific challenges and how they were overcome during the integration ofleprosy services to the GHS in a remote, leprosy endemic district in Sri Lanka.In this article, the regional epidemiologist as the team leader describes theprinciples used for transition to an effective integrated model of leprosy servicesfrom a centralized leprosy control model in the district. In addition, rationale forintegration is viewed from the epidemiological and operational perspectives.National and district leprosy epidemiological data from secondary sources arealso reviewed for corroborating the effectiveness of integration. Challengessurfaced were mainly related to the transfer of ownership of the programme,selection of appropriate service providing institutions easily accessible toclients, sustainability of leprosy services at the GHS, ensuring participation of allstakeholders in capacity building programmes and co‑ordination of patient care inthe absence of a dermatologist in the district. An empowered district team leaderwith specified roles and responsibilities, his sound technical and managerialknow how and ability to translate ‘team work’ concept to practice were foundto be essential for successful implementation of integration. Decision‑makingpowers at the district level and flexibility to introduce new, area‑specific changesto the centrally prepared core activities of integration were also vital to overcomelocally surfaced challenges.