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Partners In Leprosy Action (PILA): a community skin health strategy as a combined approach to detecting skin-related neglected tropical diseases

Lead Dermatologist: Dr. Belen Lardizabal Dofitas
Project team members: Ana Marisa CAMBEL, Raquel REYES, Dr. Sherjan KALIM
Affiliation: Philippines Leprosy Mission, Inc., Philippines

 

Partners in Leprosy

 

Partners in Leprosy Action (PILA) brings together various stakeholders in an innovative integrated approach to the control and eradication of five skin-related Neglected Tropical Diseases (NTDs) in the Philippines.

 

Video

Executive summary

Five of the seven skin–related NTDs prioritized by the World Health Organization exist in the Philippines. This project aims to determine the effectiveness of the Partners In Leprosy Action (PILA) strategy as a combined approach to skin–related NTDs in the Geographically Isolated and Disadvantaged Area (GIDA) of Maguindanao. Innovative and integrated approaches to NTD control are needed in areas of armed conflict and remote communities.

The PILA strategy brings together various stakeholders to develop sustainable community skin health programs. This study will explore the potential for the strategy to be implemented in other parts of the country.

The challenge

  • Five of the seven skin­related NTDs exist in the Philippines: leprosy, yaws, lymphatic filariasis, mycetoma, and cutaneous leishmaniasis, but an integrated approach has not yet been tested.
  • The Philippines has the highest number of new leprosy cases detected (~1000­2,000/year) in the Western Pacific Region. Despite the curability of leprosy and availability of free medication, delays in consultation, diagnosis, and treatment have contributed to disability and deformity caused by the disease. One of the biggest barriers to receiving care is the stigma attached to the disease and the discrimination against current or former patients and their family members. There is limited public awareness about leprosy such as early signs and symptoms, its curability, and the availability of free medication, which contributes to poor health­seeking behaviour.
  • Yaws, last reported here in 1961, is actually endemic in Liguasan Marsh area, Mindanao. The ongoing Yaws Study has detected yaws and leprosy cases in the Liguasan Marsh area of Maguindanao, Cotabato, and Sultan Kudarat. In these areas of armed conflict and geographically inaccessible communities, there are likely to be more cases of skin­related NTDs.
    Innovative and integrated approaches to NTD control and eradication are needed. The ongoing Yaws Study used a modified PILA strategy to detect yaws and appears to be promising for skin-related NTDs.

Project overview

Main objective:

To assess the effectiveness of Partners In Leprosy Action strategy (Community Skin Health Program approach) in the detection of skin­related NTDs (i.e. leprosy, yaws, mycetoma, lymphatic filariasis) in the province of Maguindanao, Mindanao Region, the Philippines.

Main Deliverables:

  • The target is to cover 85% of households per municipality in Maguindanao province within 12 months
  • Full report on the case detection rates of each skin­related NTD found in Maguindanao and recommendations
  • PILA Manual to guide health managers in adopting the strategy in other parts of the Philippines or in another country

Target communities: Three municipalities of Maguindanao (alternative: North Cotabato) where the ongoing Yaws Study (headed by dermatologist Dr. Belen Dofitas) has detected yaws and leprosy cases. Some towns in these provinces are classified as GIDA or are areas of armed conflict.

Description of the project:

Social Preparation

PLM, with Department of Health permission, will present the PILA project to local chief executives (i.e. Governors, Mayors) and request their leadership in implementing the project through the municipal health office or rural health unit and in partnership with the Department of Education. Formal agreements with the following partners:

  • Department of Health
  • Department of Education
  • Local Government Unit (local chief executives i.e. Mayors)
  • Private sector: Members of the Philippine Dermatological Society, local NGOs

Operations Phase

  • Orientation and training: PLM will conduct orientations, provide information materials and organize the training activities of government doctors, nurses, health workers and schoolteachers. A local PILA Team for each province will be formed to coordinate and implement activities.
  • Pre­screening of schoolchildren and households for any skin diseases:
    • Once a year, elementary and high school students will be instructed and required by their teachers to inspect their family members and themselves closely with the aid of flyers showing photographs of leprosy and other skin diseases. Students will undergo yearly skin check­ups by school nurses and physicians.
    • Students will record family members with skin problems and submit this homework to their teacher.
    • School authorities collect, consolidate the data and periodically submit the consolidated reports to their counterpart health authorities.
    • Once a year, elementary and high school students will be instructed and required by their teachers to inspect their family members and themselves closely with the aid of flyers showing photographs of leprosy and other skin diseases. Students will undergo yearly skin check­ups by school nurses and physicians.
    • The Village Health Workers will screen households that are not included in the schools’ screening.
  • Free skin health services and treatment of leprosy cases and NTDs: Those with skin problems will then be encouraged to visit the health center for proper diagnosis and treatment or consult during scheduled free skin clinics per village. Teledermatologists will be available for difficult to diagnose or manage skin patients.

Sustainability:

  • Leaders of local government units will have a sense of ownership of the PILA project. Local ordinances should be passed so that there will be a budget and continuity for PILA. This is the desired output in order to ensure political and logistical support beyond the project’s term.
  • The Department of Health will continue to support the PILA strategy using government funds for NTDs. Department of Education will institutionalize the PILA strategy under its health and nutrition program.

Success criteria and evaluation

In the middle and at the end of the project term, the following output will be measured:

  • No. and % coverage of households = target 85%
  • No. and % population screened for any skin disease
  • No. of skin­related NTDs detected (per diseases, total)
  • No. and % skin diseases detected
  • No. of public health workers oriented and trained in skin­related NTDs and PILA

At the end of the project term, a feedback meeting will be held with the various stakeholders to present the project’s findings and recommendations, and to involve the local government and health authorities in the finalization of the report and future plans.

Expected Outcomes and Benefits:

Patients and community members – Improved skin health literacy and community participation:

  • Individuals with any skin disease will be provided accessible and free treatment, thus reducing the burden of skin diseases.
  • Hidden cases of leprosy, yaws, and other NTDs will be detected and immediately referred to the local health units for further tests and treatment.
  • Families and the community at large will be involved in the detection process and acquire more knowledge and awareness on NTDs and skin health, thus reducing the stigma of skin-related NTDs.

Health sector – Strengthening of existing health system:

  • The training seminars and IEC materials further equip health workers to provide primary level care for common skin diseases, especially skin­related NTDs.
  • Rural Health Units equipped with health workers and simple ointments will increase voluntary consultations for skin problems in RHUs.