November 27, 2017
Each month we are showcasing the work of one of our members.
Ten months into his new role as CEO of Lepra, Geoff Prescott discusses how he has made a career working on behalf of marginalised people, why he believes the WHO global prevalence targets have been ‘shocking’ and why the leprosy community is special.
Professional, serious but also humorous – three words the easy-going but passionate Geoff Prescott uses to describe himself.
A trained nurse in infectious diseases, and with degrees in international relations and health planning and finances, Geoff has worked throughout the world in the health, humanitarian and children’s sectors.
Now living in the UK with his wife and four children, his first job in nursing was on an AIDS ward in the 1980s and he has since worked in various hotspots including Afghanistan, Somalia, and Sudan—always working on behalf of marginalised people and to advance causes that are hard to get attention for. Moving to the leprosy community was therefore a “coherent next step” in a successful career built on “believing in what you do”.
Given his medical and humanitarian background, it is perhaps not surprising that Geoff takes aim at the WHO’s global targets, which he argues are without epidemiological basis and which led to leprosy being incorrectly considered eliminated as a public health problem at a global level in 2005:
“The WHO prevalence figures [where elimination was defined by less than one case out every 10,000 people] allowed for the reduction of services and attention to leprosy. It’s a shocking situation to be hamstrung by targets with no scientific basis.” But, he says “now we have an opportunity to get it back on the agenda.”
The mandate to put the needs of people affected by leprosy first (rather than secondary to political agendas) coupled with the good internal coherence and cohesion of the leprosy NGOs means that ILEP members are well positioned to drive for much-needed reinvestment in leprosy services and programmes.
One low-tech solution, but the main method of “leprosy control” Lepra is championing, is active case finding. In some parts of India, this approach is identifying and treating people newly diagnosed with leprosy at a rate three times that of the official government programmes in the same areas.
These figures further underscore the importance of investment in strengthening national health programmes and bringing diseases such as leprosy into mainstream health care provision. “The fault of the NTD system is that there are many vertical programmes, and this is something to avoid in the long-term. A plethora of vertical programmes are inefficient, duplicative and expensive. They should only really be used for a limited time and always with a view to horizontally integrating with existing services when conditions are right. Thus close and cooperative relations should be maintained with Ministries of Health.”
Geoff stresses that this philosophical approach also needs to be pragmatic. Lepra works to “hold governments and the WHO responsible for the health of the people. Secondly, we need to be realistic and provide assistance where Government services are weak or non-existent. Thirdly, as a last resort, NGOs should provide independent autonomous services where there is no better alternative to meet the needs of beneficiaries.”
Lepra directs considerable resources into programmes that advance social inclusion and the related rights of disabled people with leprosy and Lymphatic Filarisis. Alongside lobbying and advocacy they provide practical support for people affected by leprosy, such as diagnosis, treatment, economic assistance, WASH and specialist shoes.
Deeper engagement with the NTD community is also important, and Geoff has recently returned from the Cor NTD summit in Baltimore. Impressed by the large turnout, he identifies discussions on the operational research (where there are direct benefits to patients), the LPEP programme, new human vaccine trials and working more closely with mental health providers as issues of key relevance for the leprosy community.
But the bigger picture issue that he seems most passionate about is the need to reframe leprosy as a global health problem. He argues that by looking at the disease’s impact on disability, social inclusion, mental health and poverty—rather than simply in terms of its prevalence —we will make a more compelling case for action. “We need to speak the language of the Ministry of Health and funders to make the stronger case for leprosy.”
And how well positioned is ILEP and partners to lead such a big ask? Geoff is optimistic: “I am very new to the leprosy community but what I’ve found very impressive is the degree to which people want to work together. ILEP is not competitive, we are collaborative – and that’s special!”
Find out more about Lepra.