In the past, because of the stigma and rejection that people affected by leprosy suffered, healthcare was only available in institutions that were outside the general health services.
When effective treatment for leprosy became available with dapsone in 1950, its distribution continued to be organised outside routine health programmes for the same reasons and were known as ‘vertical’ programmes, as its organisation from the Ministry of Health down to the peripheral clinics was independent of, and unconnected to, any other services.
In recent years, there has been a shift in attitude whereby leprosy is seen as a disease that should be treated through the general medical services, just as other diseases are; this is termed ‘integration’. As with other diseases, difficult cases should still be referred to specialists, but these should be within, rather than outside the general health services.
The process of changing from a vertical programme to an integrated programme is not simple, but there is general agreement that the advantages of integration (greater sustainability, better coverage, reduced stigma) outweigh the disadvantages (difficulty in maintaining the quality of services at the level of the peripheral clinic).
Much discussion at present relates to methods of guaranteeing the quality of services in the field, especially in areas where leprosy is not common.