Care for people affected by leprosy has, in the past, usually been made available in institutions that were not part of the general health services, because of stigma and the rejection of sufferers by normal society. When effective treatment became available with dapsone in 1950, its distribution continued to be organized outside routine health programs, for the same reasons - these were known as 'vertical' programs, as the whole set-up from the Ministry of Health down to the peripheral clinics was independent of, and unconnected to, any other services.

In recent years, however, there has been a shift in attitudes, whereby leprosy is seen as a disease like any other, which should be treated through the general medical services, just as other diseases are; this is termed integration'. As with other diseases, difficult cases could still be referred to specialists, but these would be within, rather than outside the general health services. The process of changing from a vertical program to an integrated program is not simple, but there is general agreement that the advantages of integration (greater sustainability, better coverage, reduced stigma) outweigh the disadvantages (difficulty in maintaining the quality of services at the level of the peripheral clinic). See the ILEP Technical Guide: Facilitating the Integration Process.

Much discussion at present relates to methods of guaranteeing the quality of services in the field, especially in areas where leprosy is not common.

The Novartis Foundation advocates improved access to diagnosis and treatment: The Hansen's Disease Programs oversee leprosy services in the USA.