Nepal

Nepal is one of the poorest countries in the world and access to quality basic health care is lacking especially for the poor and those living in isolated areas. The stigma and fear associated with leprosy means that those impaired or disabled by leprosy are among the poorest of the poor. They face economic, social and emotional marginalisation, as well as physical difficulties. Women affected by leprosy are also further discriminated against in terms of access to health service.

Leprosy has been recognised for a very long time in Nepal as a public health problem. Khokana Leprosorium near Kathmandu is 140 years old (opening in 1857), while Malangua Leprosarium opened in 1939. 

Leprosy control activities began in 1960 with leprosy surveys. About 100,000 cases were estimated in the country in 1966, with higher endemicity in the Western and Far Western Regions. A pilot project to control leprosy with dapsone monotherapy started in 1966, and was replaced with multi-drug therapy (MDT) in a few areas and hospitals in 1982/83. MDT covered all 75 districts of the country by 1996. After the introduction of MDT, the prevalence rate in the country has declined significantly.

In 2008 it is reported by the WHO that all 4190 peripheral health facilities can provide MDT services and that the majority of nearly 20,000 health personnel manning these facilities have undergone comprehensive leprosy training. A majority of Nepal’s 47,000 Female Community Health Volunteers have also undergone leprosy orientation and should therefore be capable of suspecting leprosy and referring suspect cases to local health facilities. There is a system for referral of problematic cases to secondary and tertiary levels, but functionality of the system has not yet been established.  



(Sources include: http://www.moh.gov.np/programmes/Leprosy.asp - Ministry of Health Nepal; Dr Hugh Cross - ALM)