Healthcare Performance of Leprosy Management in Peripheral Health Facilities of Dhanusa and Mahottari, Nepal

Background The global elimination of leprosy transmission by 2030 is a World Health Organization (WHO) target. Nepals leprosy elimination program depends on early case diagnosis and the performance of health workers and facilities. The knowledge and skills of paramedical staff (Leprosy Focal Person, LFP) and case documentation and management of health facilities is therefore key to the performance of health care services. Methods The performance of health workers and facilities was evaluated through a combined cross-sectional and retrospective study approach of 31 health facilities and their LFPs in Dhanusa and Mahottari Districts in Madhesh Province. An average of 6 patients (paucibacillary, PB, or multibacillary, MB) per health facility registered within the 2018/2019 fiscal year were also enrolled in the study. LFP knowledge (e.g., of the three cardinal signs) and skills (e.g., nerve palpation) and facility processes (e.g., record keeping) were scored (e.g., 0, 1) and then rescaled to a proportion, where 1 is perfect. Internal benchmarking was used to guide performance management. Results The overall performance of health care services was 0.43 (95% confidence interval (CI), 0.40-0.46), ranging from 0.33 (95% CI, 0.25-0.40) for LFP knowledge and skills, 0.37 (95% CI, 0.32-0.43) for documentation and 0.60 (95% CI, 0.58-0.61) for case management scores of health facilities. Leprosy-related training was significantly related to the knowledge and skill of the health workers. All identified cases (n =187) adhered to the complete treatment and release after treatment (RFT) scheme, out of which 84.5% were satisfied with the service they were provided. Leprosy disability and Ear Hand and Feet (EHF) scores were not significantly reduced in treated patients, but counseling by LFPs significantly improved cases positive belief and practices regarding self-care. Conclusion Overall leprosy care performance was low (43%) and can be improved by evidenced-based training, onsite coaching, monitoring, and supervision to facilitate leprosy transmission elimination. The results highlight many of the challenges facing leprosy elimination programs.