Dr. Hernani: March 2002 – April 2008
Following government policy, the Sub-Directorate Yaws was combined with the Sub-Directorate Leprosy to become the Sub-Directorate for Leprosy and Yaws.
The elimination of leprosy had been achieved at national level in July 2000, but some provinces and districts still had high prevalence. Elimination of leprosy should now expand to province and district levels.
Based on the existing conditions, the strategy of elimination also needed revision. There was a need to make guidelines for leprosy elimination in low and high endemic areas.
In 2003, more than 60% of the provinces and districts had attained elimination (17 provinces with 315 districts)12. Since the country had reported that elimination had been attained in 2000, the government’s perception was that leprosy is not a public health problem anymore. Therefore the budget allocation from the government for leprosy control became less and less. In reality the burden of leprosy was still high, therefore advocacy to the authorities needed to be done. One of the results of advocacy was that the government established the National Alliance for the Elimination of Leprosy (Aliansi Nasional Eleminasi Kusta – ANEK) for the National level andAliansi Daerah Elininasi Kusta – ADEK for provincial level. The members of ANEK consisted of the Governors of those provinces that had not achieved elimination yet.
Indonesia participated in the International Leprosy Congress Salvador Brazil (2002) and Hyderabad India (2008). The issues of leprosy rehabilitation and human right is an essential program to be developed along with leprosy control.
Dr Hernani retired since May 2008, then Dr Christina Widaningrum replaced her as acting head of Sub-directorate Leprosy and Yaws Control.
Data compiled form 1990 to 2007, found that 349,013 people had been released from treatment (RFT) and 26,237 with disability grade 2 in total.
The PR had gone down and elimination of leprosy at national wide had been achieved in July 2000, but the leprosy burden in Indonesia was still high.
· People after RFT still needed medical care because of their impairments
· Most of the people affected by leprosy were poor
· The governmental budget was limited
· After the crises in Indonesia the Inter-Sector Leprosy Control Committee (formed in 1979) was not in function anymore.
Care and Rehabilitation
Care after RFT and rehabilitation should go along with the elimination program. At this time NLR extend the support to the Ministry of Health with a Care and Rehabilitation program.
The Care and Rehabilitation program consisted of capacity building through trainings for health staff working in the field of leprosy, support for reconstructive surgery, provision of impairment aids, training in self care and the formation of self care groups, and social economic rehabilitation.
NLR sent 7 orthopaedic technicians from 4 leprosy hospitals (Daya, Sumberglagah, Sungai Kundur and Pulau Sicanang) for training in shoemaking and prosthetics to Vietnam. These 4 hospitals then started producing prostheses from polypropylene and other impairment aids. All types of impairment aids were given free of charge to the people affected by leprosy in need of it.
Self Care Groups
In a self-care group (SCG) people affected by leprosy come together with the aim of supporting each other primarily in prevention and reduction of impairments, and in finding solutions for problems they face as a result of leprosy.o
The concept of SCG has been taken over from countries like Ethiopia and Nigeria. The first groups in Indonesia were formed in West and East Java in 1999. Since 2003, SCG have been systematically developed and promoted throughout all Indonesia. Every year more groups are formed, some of them run only for a short time until all members are confident in practicing self care daily at home; other groups continue for years, sometimes adding other activities like saving circles (arisan) or income generating projects. The overall results of SCG in reducing impairments have been very good, and many people were also successful in reducing their social problems thanks to an increased self confidence. Most SCG are based in local HCs because this seems to be preferred by both members and facilitators. Other groups formed in leprosy settlements, and some few groups meet in their own villages in the midst of not-leprosy affected communities. This later option is often preferred by the LCP because it promotes integration, but it is still difficult to achieve due to general stigma.
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