Lepr Rev. 2006 Sep;77(3):IX, X, 1-50.
The Global Strategy for further reducing the leprosy burden and sustaining leprosy control activities (2006 - 2010) has been widely welcomed and endorsed. The overall goal is to provide access to quality leprosy services for all affected communities following the principles of equity and social justice. The purpose of these Operational Guidelines is to help managers of national health services to implement the new Global Strategy in their own countries. This will be done as they develop detailed policies applicable to their own situation, and revise their National Manual for Leprosy Control. Leprosy services are being integrated into the general health services throughout the world; a new emphasis is given here to the need for an effective referral system, as part of an integrated programme. Good communication between all involved in the management of a person with leprosy or leprosy- related complications is essential. These Guidelines should help managers to choose which activities can be carried out at the primary health care level and for which aspects of care patients will have to be referred. This will depend on the nature of the complication and the capacity of the health workers to provide appropriate care at different levels of the health system. The promotion of self-reporting is now crucial to case detection, as case- finding campaigns become less and less cost-effective. It is important to identify and remove barriers that may prevent new cases from coming forward. The procedures for establishing the diagnosis of leprosy remain firmly linked to the cardinal signs of the disease, but the accuracy of diagnosis must be monitored. The Guidelines suggest a greater emphasis on the assessment of disability at diagnosis, so that those at particular risk can be recognized and managed appropriately. The treatment of leprosy with MDT has been a continuing success; neither relapse nor drug-resistance are significant problems and the regimens are well- tolerated. Clear procedures are given for managing irregular treatment with MDT. Leprosy reactions are a serious complication affecting some patients. The Guidelines contains this aspect, with additional references under Further Reading. A key decision for programme managers is to determine how and at which level of the health system leprosy reactions are to be managed in their country. Different countries must develop their own detailed guidelines on this issue. Prevention of disability (POD) is also described in some detail as there is a need for much greater coverage with basic POD activities. This is an important component of 'quality leprosy services' emphasized in the Global Strategy. Items mentioned under Further Reading will be essential for programmes planning to build capacity and increase their service provision in this area. Rehabilitation may include a medical component (such as reconstructive surgery) but its scope is much broader. It is likely that some people affected by leprosy would benefit from socio-economic rehabilitation (for example, vocational training or a small loan). Staff in the health services need to be familiar with what is being done in the locality, and know how and where to refer people who need these services. Recording and reporting are essential to maintain quality in any programme. The indicators selected in the Global Strategy are useful for monitoring and evaluation, and they determine which data must be recorded. The data needed to monitor POD activities have not been collected routinely in the past, so this represents a significant change - national managers must therefore decide for themselves which indicators will be used to ensure quality as these will vary from country to country. Programme management is a broad subject; the topics covered in this Section are those that are central to the running of integrated leprosy control services, including supervision, supply of MDT, partnerships, training and programme evaluation.
《进一步降低麻风病负担及持续开展麻风病防治活动全球战略（2006 - 2010年）》受到广泛欢迎并得到认可。总体目标是按照公平和社会正义原则，为所有受影响社区提供优质麻风病服务。本《操作指南》的目的是帮助各国卫生服务管理人员在本国实施新的全球战略。这将通过制定适用于本国情况的详细政策以及修订本国麻风病防治手册来实现。麻风病服务正在融入全球各地的一般卫生服务中；这里新强调了建立有效转诊系统的必要性，作为综合规划的一部分。所有参与麻风病患者或麻风病相关并发症管理的人员之间保持良好沟通至关重要。这些指南应帮助管理人员选择哪些活动可在初级卫生保健层面开展，以及哪些护理方面的患者需要转诊。这将取决于并发症的性质以及卫生工作者在卫生系统不同层面提供适当护理的能力。随着病例发现活动的成本效益越来越低，促进自我报告对于病例检测至关重要。识别并消除可能阻碍新病例前来就诊的障碍很重要。麻风病诊断程序仍与该疾病的主要体征紧密相关，但必须监测诊断的准确性。指南建议在诊断时更加强调对残疾情况的评估，以便识别出特别危险的人群并进行适当管理。用多药联合化疗（MDT）治疗麻风病一直持续取得成功；复发和耐药都不是重大问题，且治疗方案耐受性良好。给出了管理MDT不规则治疗的明确程序。麻风病反应是影响部分患者的严重并发症。指南涵盖了这一方面，并在“进一步阅读”部分提供了更多参考文献。对于项目管理人员来说，一个关键决策是确定在本国卫生系统的哪个层面以及如何管理麻风病反应。不同国家必须就这一问题制定各自详细的指南。预防残疾（POD）也有较为详细的描述，因为基本POD活动需要更大范围的覆盖。这是全球战略中强调的“优质麻风病服务”的一个重要组成部分。“进一步阅读”部分提到的内容对于计划在该领域建设能力并增加服务提供的项目至关重要。康复可能包括医疗部分（如整形手术），但其范围要广泛得多。一些麻风病患者可能会从社会经济康复中受益（例如职业培训或小额贷款）。卫生服务人员需要熟悉当地正在开展的工作，并知道如何以及将需要这些服务的人转诊到何处。记录和报告对于任何项目维持质量都至关重要。全球战略中选定的指标对于监测和评估很有用，它们确定了必须记录哪些数据。过去，监测POD活动所需的数据没有常规收集，所以这是一个重大变化——因此各国管理人员必须自行决定使用哪些指标来确保质量，因为这些指标因国家而异。项目管理是一个广泛的主题；本节涵盖的主题是综合麻风病防治服务运作的核心内容，包括监督、MDT供应、伙伴关系、培训和项目评估。
