Clara Volpi, TLM Head of Operations Support
The Leprosy Mission started a new Global Strategy in 2019 that was due to run to 2023. When the strategy was written, we had little idea of the challenges that the world would face over the five-year course of the strategy.
Following the impact of Covid-19, war, and the growing influence of the climate crisis, we have made the decision to extend our strategy by a year (to 2024) and are in the process of completing a mid-term review.
In this article, we want to share what we have learnt following our review and some of the ways we plan to fine-tune our strategic direction. We are not at the stage of developing detailed plans yet, but we do have a very solid idea of what the last four years have meant and what the next two years – and beyond – should look like.
© Tom Bradley
The consequences of the pandemic, conflict, and the worsening climate crisis mean that we have good reason to fear rising global inequalities and significant obstacles to a world without leprosy.
Covid-19 and war in Ukraine have triggered economic crises in a number of countries. These crises make it harder to secure funding for leprosy control and ongoing care. These crises may also force more people into contexts with worsening nutrition, sanitation, hygiene, and accommodation. All of this will harm our efforts to achieve zero leprosy.
The climate crisis is also likely to have an influence on national economics and may encourage political turmoil. We are likely to see increasing pressure on limited planetary resources (such as minerals and water) fuelling conflicts. Ongoing crises may become the norm.
According to the 2022 Global Risks Report, by 2024, GDP growth in developing countries is likely to be 5.5 percent below expected, while advanced economies will be 1 percent above. This equates to an extra 51m people in extreme poverty.
Within this global context, we look to the funding horizon and see reduced commitment to development spending from the Global North and greater challenges accessing the resources we need to defeat leprosy.
The last four years, along with the escalating climate crisis, have thrown up serious roadblocks on our journey to a world without leprosy. However, as we wrote at the start of this year, we still believe it will be possible to end the transmission of this ancient, persistent disease by 2035. Here’s a look at how.
Our Global Strategy 2019-2023 highlighted a number of priorities that remain central to our plans moving forward. Some, perhaps, have an increased importance for the years to come.
The 2019-23 Strategy highlighted the importance of active case finding, contact tracing, and implementing PEP (a preventative antibiotic); a trident of tools that are essential to ending transmission.
As we have monitored these strategic approaches, we have seen the impact they can have when implemented effectively. Whatever the future may hold, these three elements will be central if we wish to end leprosy transmission. We plan to increase our investment in these areas.
The 2019-23 Strategy sparked a renewed focus on the power of research to enable us to achieve zero leprosy. Since then, TLM has directed more funding towards leprosy and worked to raise awareness of the impact of research.
In the years to come we hope to see future-defining new tools become readily available. From improved and instant diagnostics to perfected PEP and a leprosy vaccine, the capacity of research to develop tools to end leprosy will be made evident in the coming years.
We are pleased that investment in research has grown since 2019, but we recognise that more resources have to be concentrated in this area of our work.
The same is true of advocacy. TLM’s presence at the United Nations has grown from nothing in 2018 to an established part of our annual cycle each year. Our challenge now is to build on this promising start.
We aim to create stronger national and local advocacy networks, particularly through empowered organisations of persons affected by leprosy. By combining this local effort with our international advocacy at the United Nations and within the wider disability movement, we will encounter more opportunities to channel resources and political commitment towards defeating leprosy.
TLM will increasingly focus on strengthening national health systems to better support persons affected by leprosy. We have made a start on this through ongoing training for healthcare professionals and strong relationships with Ministries of Health and National Leprosy Control Programmes. In the years to come we will make this a bigger focus of our work – something that will require increased advocacy support.
Within this, we have to acknowledge that our own systems would benefit from strengthening. At the moment, we are not doing enough to monitor patients for signs of disability or monitor existing impairments. We strive towards zero disability and we recognise this will not be possible if we do not improve our monitoring.
The same is true of self-care. The self-care in which we train patients does not have high adherence levels. In recent years there has been much research in this area and we hope that the fruit from this research will mean new and future self-care guidelines will be much easier for patients to maintain.
Through our monitoring of the 2019-23 Strategy, we have begun to recognise that our solutions are not local enough. This manifests itself in a number of ways.
Firstly, we do not have enough reliable local data. We receive data at the national-level, which allows us to plan our work at a national level, but does not help us understand the reality on a sub-national level. If we receive data at this level, we will be able to provide more effective technical support to governments and eliminate leprosy in the countries we work in.
© Ricardo Franco
Secondly, we recognise that we have to do more to bring innovative disability care to communities. Many of our patients do not live near our hospitals or clinics and travel is not always quick or straightforward.
In India, Myanmar, and Nigeria we have seen success with travelling clinics that go to communities, either in a bus or a truck. In Bangladesh and India, we have seen that tele-health provides patients with more immediate answers to their problems. In Myanmar, we have seen the impact of empowering churches to provide basic self-care and physiotherapy support.
Ongoing disability care will be more impactful if it is more local. This will be our direction of travel in the future.
Lastly, investing in local solutions means investing in local partners, which brings us to our next point.
At the local level, our partnerships start with organisations of persons affected by leprosy, but extend to our leprosy and NTD partners, churches, and local governments.
Organisations of persons affected by leprosy are demonstrating their potential by becoming key implementing partners and our most powerful advocates. The direction of travel for the future will undoubtedly see greater investment in these groups.
We also recognise the growing connectedness and power of the wider NTD sector. Recent years have seen this network go from strength to strength and the potential of the future lies in integrating NTD programmes, accessing funding in partnership, and greater collaboration at all levels. You can expect to see more of TLM within the NTD sector.
Lastly, TLM is going to move towards better activating our partnerships with churches and local government. In many of the endemic countries we work in, much local power lies within these organisations. Our goal is to better understand how we can access this potential and engage new partners who have something to contribute to the fight to defeat leprosy in their community.
Above are some – not all – of the ways in which we plan to fine-tune our strategy to meet the challenges ahead of us. Surrounding all of this is a key recommendation from our mid-term review: be more agile to cope with an uncertain world.
Organisational agility is not an easy thing to achieve, but we are aware that, in order to better respond to the uncertainties ahead, we will have to consider a few key steps:
We will continue to invest in training and preparing our leaders, we will grow our access to income, we will increase the breadth and depth of digital skills in the organisation, and we will integrate our approaches, rather than having disciplines that work in silos.
The challenges ahead of us are not small, but nor are the ones behind us, the ones we have already come through. We feel equipped and inspired by fresh perspectives and a focus on the areas of work that will have the most impact. Zero leprosy by 2035 remains our goal.
