The reduced incidence of leprosy cases since the 90’s and the uprising of other health priorities have triggered a reduced attention to this disease by Health Authorities. Shrinking resources both in terms of medical professionals and financial means have had serious adverse effects on the service delivery of leprosy programs and as a result remaining patients have been left undiagnosed and got neglected in treatment. Raised ignorance on the disease by patients and their communities, the medical staff and the hiding of affected patients due to stigma, makes it more and more difficult to trace them.
Even the relative low number of current cases will however still spread the disease affecting wellbeing among the population and as long as this takes, patients need to be identified and treated and ‘Leprosy’ should be kept on the agenda.
A pilot project in Cambodia supported by the NOVARTIS Foundation demonstrated that a focused survey and specialized examination of family members and neighbours of former leprosy patients led to the disclosure and diagnosis of several new cases. Many of whom however had no clear signs and were not aware of being a carrier and ‘spreader’ of leprosy. With an estimated incubation period of 5 – 30 years together with the current disregard of the disease, it is expected and a realistic thread that leprosy is even on its return … while simple medication of those infected will cure and stop them from spreading.
The formulation process consisted of the following phases:
– a preparation phase designing the steps and procedures of the process,
– an implementation phase with: the coaching of the Core Formulation Team; the organisation of Launching Events; field visits by the coach facilitator to better understand the dynamics of the disease and implications of the treatment; and a facilitated participative 5 day LFA workshop with (35) representatives of different stakeholders with an official closing ceremony covered by the press,
– a formulation phase in which the program plan will be drafted in both Khmer and English,
– a funding phase during which the plan will be presented to and followed up with various funding agencies.
The LFA workshop was attended by 35 persons mainly from the national, provincial and district Health Services as well as from Village Health Centres and Village Health Committees. Even quite some former leprosy patients joined the 5 days.
Indeed the workshop was facilitated with excellent interpretations in Khmer! And it worked! What worked? Yes the communication between the facilitator and the participants went smooth! According to the expatriate project manager the participants were more active than ever before!
The 5 days of the workshop were mainly covering the following steps of the LFA procedure:
- WHO (for who and by who)
- WHY (problems – negative existing situations)
- WHAT (intervention logic) and WHAT NOT (assumptions)
- HOW will it happen matrix (capacity building)
- SUPPORT matrix (Project Management
Following the above steps of the LFA procedure participants analysed and agreed on the specific type of patients they should aim at, did a brainstorming or session to identify the problems as perceived by leprosy patients and health and other institutions involved, which, after having discussed and clarified these, the moderator could even facilitate the construction of the problem tree! The interpreters wrote the English translation with pencil underneath the Khmer text on the cards enabling the moderator to follow the issues discussed.
We generated the Logical Framework Matrix, defining and agreeing on the purpose of the programme (“patients and their family feel equal in society”), after which the potential impacts (Overall Objectives) were identified ‘selling’ the project better.
The Results or Outcomes were partly deducted from the problem analysis and from the assumptions. This led to the following 7 Results each providing a service to the ‘end-users’ (patients):
Result 1: Community and patients perceive leprosy as easy to handle and cure
Result 2: Suspects detected as early as possible
Result 3: Effective diagnoses carried out
Result 4: Effective treatment assured
Result 5: Medical rehabilitation effective
Result 6: Psycho, Social, Economic rehabilitation effective
Result 7: Worsening of disabilities prevented
Then for each Result sub-groups were formed that proposed possible activities which were discussed in plenary. All participants were invited to ‘shoot’ at the proposals by writing their questions, doubts and suggestions on cards that were each discussed anonymously. In that way we got a list of agreed activities (or working procedures) for each of the Results.
Once we had the ‘WHAT should happen Matrix’ prepared we could analyse HOW this could happen and we prepared a HOW Matrix, or Capacity Building Matrix. The respective internal Organisational Results that got identified were:
A. Policy of Leprosy back on political agenda
B. Sufficient budget allocated / available
C. Improved communication National–Provincial–OD–Health Centres
D. Professional Capacities of OD is assured (see separate plan)
E. Participation of Local Authorities assured
F. Effective examination of women suspects assured
G. Learning from others and from ourselves assured !
H. INTEGRATION & INSTITUTIONALISATION of new approach (RPLEP) is successful !!
Again, sub-groups prepared proposals to address each Organisational Result which were extensively discussed and modified in plenary.
At the end of the workshop we focused on the management of the project and identified the following areas of concern, which each were discussed and approaches agreed:
- The Manager
- Monitoring performance Results at End-users
- Reporting procedures
- Standard Operating Procedures (SOP)
- Quality of staff
- Planning, Review and Re-planning
- Fund raising / Budget management / allocation, Sponsorship
- Stakeholder Management (commitment)
An official closing ceremony was launched with the Director of the Leprosy Department, Ministry of Health where the results of the workshop were presented. Seven journalists from TV stations and Newspapers were present.
Reflections and Lessons learnt on the ‘5-day participatory multi-stakeholder LFA workshop’ as a tool to prepare the elements and components for a Revised Provincial Leprosy Elimination Program (RPLEP)
It is to my humble experience of quite some 30 years as a moderator that I am very proud that the Logical Framework Analysis procedures helped again in smoothly streamlining this participatory analysis and planning workshop in such a great way.
In the debriefing we learnt that the workshop did a great job in mobilizing, activating and motivating the Cambodian counterparts – key stakeholders of the National Leprosy program, to participate wholeheartedly to the discussions and contributions of ideas on cards in this workshop.
Quite a number of issues on Leprosy itself and operating procedures on the identification and treatment of the disease were clarified and agreed upon!
The participants showed a great account of responsibility by all being always on time, even at early starts, weekends and the public holiday during the 5 days. I had been warned for the mobile phone behaviour of Cambodian counterparts, but I must say that such disturbance NEVER occurred during the 5 days. Was it the fear for the ‘bucket’? 😀
I trust that the ownership and concern demonstrated by the Cambodian counterparts and particularly by the members of the Core Formulation Team keep up the great spirit and keep on pushing this train! It is for the good of a Leprosy Free Cambodia ultimately!
Now it is up to the Core Formulation Team to demonstrate this ownership and commitment and execute the next step …. being, the actual writing of the plan (proposal), which will first be written in Khmer and then translated into English for commenting by the expatriate advisers from CIOMAL, NOVARTIS Foundation and possibly other experts. We left the CFT team with a time schedule which we prepared together…..
Novartis for Sustainable Development: http://www.novartisfoundation.org/page/content/index.asp?MenuID=217&ID=493&Menu=3&Item=43.2