When I first joined my country’s national leprosy program in 2018, I did not have enough knowledge of the disease. In medical school, our textbooks had only one page of clinical description of leprosy. Working in the leprosy program has been life changing for me. I have gained insight, knowledge, and experience from hours of long discussion with leprosy patients and health workers. I have learned about the poor, below-standard lives of leprosy patients, and I know now that there is so much to do for them.

In Bangladesh, a small, tropical low-lying southeast Asian country, more than 21% of people are living below the national poverty line and many people suffer from malnutrition. Traditional ways of life contribute to illiteracy, teenage marriage, and increased maternal and neonatal mortality. Bangladesh achieved the target of elimination of leprosy as a public health problem (less than 1 case per 10,000 population) in 1998, but there are still endemic hotspots (11 High Burden Districts) where the leprosy new case detection rate is more than 5 per 100,000 population. For various reasons, some people delay seeking treatment, which results in increased disability.

National Leprosy Conference co-hosted by the Ministry of Health and Welfare of Bangladesh, The Nippon Foundation, and Sasakawa Health Foundation in Dhaka, Bangladesh (2019). Nearly 600 health officials from around the country attended.

Living with leprosy, especially with disability, has a huge impact on an individual’s personal, familial, and social life. In the past, people treated leprosy as a “curse of God” and exiled those with the disease or sent them to a sanatorium. In Bangladesh, the influence of religious beliefs makes people susceptible to misleading and false information. Persons affected by leprosy may feel embarrassed about seeking treatment, and they often face discrimination. Many of them must quit their jobs, which causes additional social and economic burdens.

Bangladesh’s National Leprosy Program, established in 1985, acts as an umbrella body for leprosy activities throughout the country. With the help of our excellent partners, the program managed to achieve elimination of leprosy as a public health problem before 2000. Since achieving the target, however, the leprosy program has not been receiving adequate attention at the policy level. Complacency and lack of leprosy-specific knowledge contribute to underfunding: In 2019, the government allocated only US$11,000, and support from international donors has been decreasing. Government leprosy hospitals are facing tremendous issues as the government withdraws staff and reassigns them to other health facilities. 

Prime Minister Hasina announced her commitment to achieve zero leprosy by 2030.

Despite this situation, the current government, and especially the prime minister, has taken an initiative to achieve zero leprosy status. On Dec. 11, 2019, Prime Minister Hasina announced the “Zero Leprosy Initiative by 2030.” A special campaign was launched to reduce discrimination to zero and to detect and treat the disease early in order to achieve zero disability. This campaign has renewed the motivation and commitment of health workers and sent a clear message at the health policy level about the importance of leprosy elimination. With the prime minister as the torchbearer, there is a bright ray of hope for elimination of leprosy in Bangladesh. 

Dr. Rahat Chowdhury
Deputy Program Manager
National Leprosy Program, Bangladesh
http://www.nlp.gov.bd (accessible from April 2021)

NO. 102 MARCH 2021