Jaeggi T, Manickam P, Weiss M G, Gupte M D
Swiss Tropical and Public Health Institute & University of Basel, Basel, CH-4002, Switzerland.
Indian J Lepr. 2012 Jul-Sep;84(3):177-84.
Although leprosy has been declared as eliminated in India, treated patients with persisting disabilities still require care. With the shift from vertical to integrated services, questions remain about case detection and maintaining the quality of patient care. We conducted a qualitative study to clarify the perceived status of elimination, patient care and other aspects of leprosy control from the perspective of various stakeholders. We interviewed leprosy programme managers, Non-governmental organization directors, healthcare providers, patients and community leaders from Kanchipuram district, Tamil Nadu. Consensus endorsed the current approach to integration of leprosy in primary healthcare, but healthcare personnel acknowledged problems from shortage of medicines and failure to fill key positions. Patients were concerned about limited clinic hours, long waits and delayed treatment. Disabled patients indicated how they were troubled by stigmatization of their condition. Programme managers mentioned limited support for needed research and some emphasized the potential threat of emerging drug resistance. Although consensus supports an integrated approach for leprosy services in primary care, the relative priority of different aspects of leprosy control vary among stakeholders. Perspectivist approaches to methodologically sound operational research could guide planning for effective case detection and patient care during the post-elimination era.
尽管印度已宣布消除麻风病，但仍有持续残疾的接受治疗患者需要护理。随着从垂直服务向综合服务的转变，关于病例发现和维持患者护理质量的问题依然存在。我们开展了一项定性研究，从各利益相关方的角度阐明对消除麻风病、患者护理及麻风病控制其他方面的认知状况。我们采访了来自泰米尔纳德邦坎奇普尔姆区的麻风病项目管理人员、非政府组织负责人、医疗服务提供者、患者和社区领袖。各方一致认可目前将麻风病纳入初级卫生保健的做法，但医护人员承认存在药品短缺和关键岗位空缺的问题。患者担心门诊时间有限、等待时间长以及治疗延误。残疾患者表示他们因自身状况遭受污名化而困扰。项目管理人员提到对所需研究的支持有限，一些人强调了新出现的耐药性的潜在威胁。尽管各方一致支持在初级保健中采用综合麻风病服务方法，但麻风病控制不同方面的相对优先次序在利益相关方之间存在差异。采用视角主义方法开展方法合理的运筹学研究可指导后消除时代有效病例发现和患者护理的规划工作。
