24 March 2019
Tackling and eliminating the scourge of leprosy in the Solomon Islands.
One aspiring candidate for a seat in Parliament after the forthcoming General Election to be held on 3 April told the Solomon Star that there would be $188 million in cash reserves for working capital for the new government providing an adequate safety net for the importation of capital goods, food and medicines.
The importation of medicines and drugs to tackle the ongoing scourge of leprosy is the focus of my concern in this letter.
In January this year, the supervising director in the health promotion department of the Ministry of Health and Medical Services (MoHMS), Ben Riki, announced that three provinces reported cases of leprosy, namely, Guadalcanal, Malaita and Honiara City.
Mr Riki said Honiara had the most cases of leprosy, arising it was implied, from the crowded informal settlements.
Other reported cases of leprosy occurred in the mountainous areas of Central and North- East Guadalcanal.
We have often thought leprosy an age-old disease, described in the literature of ancient civilizations. Throughout history, people afflicted have often been ostracized by their communities and families.
Although leprosy was managed differently in the past, the first breakthrough occurred in the 1940s with the development of the medicine dapsone. The duration of treatment lasted many years, often a lifetime, making compliance difficult.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early stages can prevent disability.
In 1981, the World Health Organization (WHO) recommended MDT. The currently recommended MDT regimen consists of medicines: dapsone, rifampicin and clofazimine. This treatment lasts for six months for pauci-bacillary and 12 months for multi-bacillary cases. MDT kills the pathogen and cures the patient.
Since 1995 the WHO has provided MDT free of cost. Free MDT was initially funded by The Nippon Foundation, and since 2000 it is donated through an agreement with Novartis until at least 2020.
It immediately comes to mind, therefore, whether the Solomon Islands MoHMs is getting free MDT medication through the agreement with Novartis and with sourcing assistance from the WHO?
More than 16 million leprosy patients have been treated with MDT over the past 20 years.
Mr. Rix said in January that the country’s total number of recorded cases from 2014 to 2018 was 231 and he stressed that the increasing rate of leprosy had further reinforced the TB leprosy unit in the MoHMS to strategically come up with a five-year plan, 2018 to 2025, to help eliminate the disease.
He mentioned the plan was to advocate discrimination, stigma and prejudice associated with leprosy and to review the leprosy guidelines for an eradication strategy.
Mr. Rix also promised to conduct an annual “endless leprosy campaign” and give special action to eradicate leprosy in hotspot areas across the provinces with continuous training for medical officers and CBR staff to help them conduct annual disability assessments among those with disability.
I venture to ask how the MoHMs campaign to tackle leprosy has progressed and whether the MDT medicine is being sourced free of charge to administer to leprosy sufferers?
The WHO in 2016 launched its own “Global Leprosy Strategy 2016-2020 – “Accelerating towards a leprosy-free world” to reinvigorate efforts for leprosy control.
The three key pillars of that strategy were identified as:
Strengthen government ownership, coordination and partnership.
Stopping leprosy and its complications, and
Stopping discrimination and promoting inclusion.
Under each of the three key pillars the interventions outlined in the WHO Global Leprosy Strategy the following:
Ensuring political commitment and adequate resources for leprosy programmes.
Contributing to universal health coverage with a special focus on children, women and underserved populations including migrants and displaced people.
Promoting partnerships with state and non-state actors and promoting intersectoral collaboration and partnerships at the international and national levels.
Facilitating and conducting basic and operational research in all aspects of leprosy and maximize the evidence base to inform policies, strategies and activities.
Strengthening surveillance and health information systems for programme monitoring and evaluation (including geographical information systems).
Strengthening patient and community awareness of leprosy.
Promoting early case detection through active case-finding (e.g. campaigns) in areas of higher endemicity and contact management.
Ensuring prompt start of, and adherence to treatment, including working towards improved treatment regimens.
Improving prevention and management of disabilities.
Strengthening surveillance for antimicrobial resistance including laboratory network.
Promoting innovative approaches for training, referrals, and sustaining expertise in leprosy, such as e-health.
Promoting interventions for the prevention of infection and disease.
Promoting societal inclusion by addressing all forms of discrimination and stigma.
Empowering persons affected by leprosy and strengthening their capacity to participate actively in leprosy services.
Involving communities in actions for improvement of leprosy services.
Promoting coalition-building among persons affected by leprosy and encourage the integration of these coalitions and/or their members with other community-based organizations.
Promoting access to social and financial support services, for example to facilitate income generation, for persons affected by leprosy and their families.
Supporting community-based rehabilitation for people with leprosy-related disabilities.
Leprosy is curable with multidrug therapy (MDT) and I very much hope the MoHMS will continue to give special attention to the eradication of leprosy and discrimination in the Solomon Islands and work closely with the WHO to ensure the free availability of MDT medicine while the sourcing agreement with Novartis pertains.