Health systems research training as a tool for more effective Hansen's disease control programmes in Brazil.

In Brazil, Hansen's disease (HD) is still a public health problem. Although much progress has been made in Hansen's disease control (HDC) at all levels of government over the past 20 years, efforts have been hampered by information gaps related to specific areas of the disease, exacerbated by an absence of appropriate evaluation instruments and routine systematic analysis. Health Systems Research (HSR) aims to collect the necessary data to provide the most relevant information to policy makers and health managers to take more informed decisions. In Brazil, four HSR courses on HDC were organized by two non-governmental organizations (NGOs), Netherlands Leprosy Relief (NLR) and the British Leprosy Relief Association (LEPRA) between 2001 and 2005. Key personnel working in HDC from various states were invited to participate in the courses. The research proposals were developed during an HSR workshop and carried out in the field. The research topics of the projects included the following: the integration of HDC programmes into the primary health care system; the high percentage of the new patients diagnosed and treated at state referral centres; the psychological and social impact of surgical rehabilitation; the efficacy of neurolysis; the quality of the national health information system and the effectiveness of new case detection and health education campaigns. Following the completion of the field work, the data were analysed and a research report written. The results and recommendations were later presented to key stakeholders and policy makers in the states. Practical outcomes of the HSR courses include the drafting of new HDC guidelines; improvement of health information system databases and the revision of epidemiological data. These results have been presented at national and international congresses and published in peer-reviewed jornals. HSR has had a positive impact on the working routines of trainees through the process of learning the research methodology, collecting relevant data and implementing the recommendatons that originate from the findings. We conclude that HSR is an important vehicle for human resource development and a practical tool to improve the effectiveness of HDC programmes, primarily at the state and municipal levels. HSR also is an example of a successful cooperation between NGOs and governmental organizations working in HDC.

Ramos AN Jr ，Heukelbach J ，Gomide M ，Hinders DC ，Schreuder PA ... -  《LEPROSY REVIEW》

An evaluation of the Sinan health information system as used by the Hansen's disease control programme, Pernambuco State, Brazil.

Galvão PR ，Ferreira AT ，Maciel MD ，De Almeida RP ，Hinders D ，Schreuder PA ，Kerr-Pontes LR ... -  《LEPROSY REVIEW》

Global strategy for further reducing the leprosy burden and sustaining leprosy control activities 2006-2010. Operational guidelines.

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.

World Health Organization Regional Office for South-East Asia New Delhi 《LEPROSY REVIEW》

[Research in tropical medicine and primary health care in Peru].

Guerra H ，Falconí E ，Llanos-Cuentas A ，Chang J ... -  《SALUD PUBLICA DE MEXICO》

The production of social discourse on Hansen' disease and health education materials in Brazil: a skin patch as something harmless or a serious disease?

Santos AK ，Ribeiro AP ，Monteiro S 《LEPROSY REVIEW》