Referral system: a vital link in the sustainability of leprosy services.

Sustaining adequate and effective leprosy services in the light of low endemic situations and changing policies of health sector reforms is a challenging task. – 3 Disease Control Systems must be sustained as long as the need exists, until the disease and its complications are totally eliminated. – 5 Such sustainability depends not only on political wills but the administrative aspects of training and capacity building of service staff to provide quality care, as well as on the availability of necessary resources, especially drugs and other therapies. Beyond these grass root requirements, under the integrated health settings, successful sustainability requires a feasible, acceptable and efficient referral system that provides the necessary support to grass root staff in managing complex issues in patients as well as to provide education to the staff and the community. For developing countries, strategies that give greater focus on strengthening referral systems will assist better use of scarce resources. Establishing such a referral system seems acceptable and a good concept, but in many developing countries the health services have failed in its implementation. – 13 An effective referral system seems to be the weakest link in successful health delivery under the integrated setup, especially in rural areas. – 15 In India, referral systems planned for most urgent health problems such as maternal and child care, communicable diseases and many life-style diseases are dysfunctional, and leprosy services are no exception. – 17 In this paper observations and discussions focus on the need for a strong, efficient referral system if leprosy services are to be sustained in countries such as India, adopting contemporary and technological innovations and full community involvement. Components of a good referral system using public-private-people partnerships and methods of monitoring the functioning are given. Some background details of India’s National Leprosy Control Programmes and the involvement of international anti-leprosy organisations are provided.